Skip to main content
SpringerLink
Log in

Paradoxical septal motion from prior coronary artery bypass graft surgery does not impact left ventricular mechanical dyssynchrony by gated myocardial perfusion imaging

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Phase analysis of gated myocardial perfusion imaging (MPI) provides automated and reproducible assessment of left ventricular (LV) mechanical dyssynchrony (LVMD) (phase standard deviation [SD]). Many patients undergoing gated MPI have history of prior coronary artery bypass graft surgery (CABG). The latter is often associated with paradoxical septal wall motion (PSM). The effect of prior CABG and PSM on LVMD has not been evaluated.

Methods and Results

From the single-photon emission computed tomography (SPECT) and positron emission tomography (PET) MPI clinical database maintained at the Cleveland Clinic, we identified 200 consecutive patients with SPECT (100 control with normal LV ejection fraction [EF], MPI, and QRS < 120 ms; and 100 with LVEF < 35%), and 631 patients with LVEF < 35% with gated PET. Patients with QRS ≥ 120 ms, bundle branch block, ventricular pacing or isolated non-CABG surgery were excluded. There were 162 patients with gated SPECT (46 with prior CABG), and 568 with gated PET (220 with prior CABG) that were left for analysis. Phase SD was derived using Emory Cardiac Toolbox (ECTb) (for gated SPECT) and Corridor 4DM (4DM) (for gated SPECT and PET images). Multivariate linear regression analysis was performed to assess whether prior CABG was an independent predictor of worse LV mechanical dyssynchrony. After adjusting for patients’ demographics, co-morbidities, medications, and MPI data, history of prior CABG was not and independent predictor of LV mechanical dyssynchrony (P = .67 with 4DM, P = .97 with ECTb) in patients undergoing gated SPECT or among patients undergoing gated PET imaging (P = .18).

Conclusions

Although paradoxical septal wall motion is commonly seen after cardiac surgery, prior CABG does not affect or impact LV mechanical dyssynchrony indices measured from gated SPECT or PET images. Whether dyssynchrony measurements with echocardiography that has higher temporal resolution might uncover intraventricular delays, remains to be determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: Development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol 2005;12:687-95.

    Article  PubMed  Google Scholar 

  2. Chen J, Bax JJ, Henneman MM, Boogers MJ, Garcia EV. Is nuclear imaging a viable alternative technique to assess dyssynchrony? Europace 2008;10:iii101-5.

    Article  PubMed  Google Scholar 

  3. AlJaroudi W, Chen J, Jaber WA, Lloyd SG, Cerqueira MD, Marwick T. Nonechocardiographic imaging in evaluation for cardiac resynchronization therapy. Circ Cardiovasc Imaging 2011;4:334-43.

    Article  PubMed  Google Scholar 

  4. AlJaroudi W, Jaber WA, Grimm R, Marwick T, Cerqueira M. Alternative methods for the assessment of mechanical dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. Int J Cardiovasc Imaging 2011 (Epub ahead of print).

  5. Aljaroudi W, Alraies MC, Hachamovitch R, Jaber WA, Brunken R, Cerqueira MD, et al. Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: A study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS. Eur J Nucl Med Mol Imaging 2012 (Epub ahead of print).

  6. AlJaroudi W, Alraies M, DiFillipo F, Brunken R, Cerqueira M, Jaber W. Left ventricular mechanical dyssynchrony should be assessed from stress gated positron emission tomography in patients with normal myocardial perfusion. Eur J Nucl Med Mol Imaging 2012;39:665-72.

    Article  Google Scholar 

  7. Pazhenkottil AP, Buechel RR, Nkoulou R, Ghadri JR, Herzog BA, Husmann L, et al. Left ventricular dyssynchrony assessment by phase analysis from gated PET-FDG scans. J Nucl Cardiol 2011;18:920-5.

    Article  PubMed  Google Scholar 

  8. Chen J, Garcia EV, Bax JJ, Iskandrian AE, Borges-Neto S, Soman P. SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony. J Nucl Cardiol 2011;18:685-94.

    Article  PubMed  Google Scholar 

  9. Lin X, Xu H, Zhao X, Folks RD, Garcia EV, Soman P, et al. Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies. J Nucl Cardiol 2010;17:811-6.

    Article  PubMed  Google Scholar 

  10. Chen J, Faber TL, Cooke CD, Garcia EV. Temporal resolution of multiharmonic phase analysis of ECG-gated myocardial perfusion SPECT studies. J Nucl Cardiol 2008;15:383-91.

    Article  PubMed  Google Scholar 

  11. Feneley M, Kearney L, Farnsworth A, Shanahan M, Chang V. Mechanisms of the development and resolution of paradoxical interventricular septal motion after uncomplicated cardiac surgery. Am Heart J 1987;114:106-14.

    Article  PubMed  CAS  Google Scholar 

  12. Joshi SB, Salah AK, Mendoza DD, Goldstein SA, Fuisz AR, Lindsay J. Mechanism of paradoxical ventricular septal motion after coronary artery bypass grafting. Am J Cardiol 2009;103:212-5.

    Article  PubMed  Google Scholar 

  13. AlJaroudi W, Jaber WA, Cerqueira M. Effect of tracer dose on left ventricular mechanical dyssynchrony indices by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2012;19:63-72.

    Article  PubMed  Google Scholar 

  14. Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138-47.

    PubMed  CAS  Google Scholar 

  15. Ficaro EP, Lee BC, Kritzman JN, Corbett JR. Corridor 4DM: The Michigan method for quantitative nuclear cardiology. J Nucl Cardiol 2007;14:455-65.

    Article  PubMed  Google Scholar 

  16. Aljaroudi W, Aggarwal H, Venkataraman R, Heo J, Iskandrian AE, Hage FG. Impact of left ventricular dyssynchrony by phase analysis on cardiovascular outcomes in patients with end-stage renal disease. J Nucl Cardiol 2010;17:1058-64.

    Article  PubMed  Google Scholar 

  17. Al-Jaroudi W, Iqbal F, Heo J, Iskandrian AE. Relation between heart rate and left ventricular mechanical dyssynchrony in patients with end-stage renal disease. Am J Cardiol 2011;107:1235-40.

    Article  PubMed  Google Scholar 

  18. Chung E, Leon A, Tavazzi L, Sun J, Nihoyannopoulos P, Merlino J, et al. Results of the predictors of response to CRT (PROSPECT) trial. Circulation 2008;117:2608-16.

    Article  PubMed  Google Scholar 

  19. Nesser HJ, Winter S. Speckle tracking in the evaluation of left ventricular dyssynchrony. Echocardiography 2009;26:324-36.

    Article  PubMed  Google Scholar 

  20. Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J III. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960-8.

    Article  PubMed  Google Scholar 

  21. Lim P, Buakhamsri A, Popovic ZB, Greenberg NL, Patel D, Thomas JD, et al. Longitudinal strain delay index by speckle tracking imaging: A new marker of response to cardiac resynchronization therapy. Circulation 2008;118:1130-7.

    Article  PubMed  Google Scholar 

  22. Gorcsan J 3rd, Abraham T, Agler DA, Bax JJ, Derumeaux G, Grimm RA, et al. Echocardiography for cardiac resynchronization therapy: Recommendations for performance and reporting—a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society. J Am Soc Echocardiogr 2008;21:191-213.

    Article  PubMed  Google Scholar 

  23. Bai R, Biase LD, Mohanty P, Hesselson AB, Ruvo ED, Gallagher PL, et al. Positioning of left ventricular pacing lead guided by intracardiac echocardiography with vector velocity imaging during cardiac resynchronization therapy procedure. J Cardiovasc Electrophysiol 2011;22:1034-41.

    Article  PubMed  Google Scholar 

  24. Marsan NA, Henneman MM, Chen J, Ypenburg C, Dibbets P, Ghio S, et al. Real-time three-dimensional echocardiography as a novel approach to quantify left ventricular dyssynchrony: A comparison study with phase analysis of gated myocardial perfusion single photon emission computed tomography. J Am Soc Echocardiogr 2008;21:801-7.

    Article  PubMed  Google Scholar 

  25. Henneman MM, Chen J, Ypenburg C, Dibbets P, Bleeker GB, Boersma E, et al. Phase analysis of gated myocardial perfusion single-photon emission computed tomography compared with tissue Doppler imaging for the assessment of left ventricular dyssynchrony. J Am Coll Cardiol 2007;49:1708-14.

    Article  PubMed  Google Scholar 

  26. Trimble MA, Borges-Neto S, Smallheiser S, Chen J, Honeycutt EF, Shaw LK, et al. Evaluation of left ventricular mechanical dyssynchrony as determined by phase analysis of ECG-gated SPECT myocardial perfusion imaging in patients with left ventricular dysfunction and conduction disturbances. J Nucl Cardiol 2007;14:298-307.

    Article  PubMed  Google Scholar 

  27. Pazhenkottil AP, Buechel RR, Husmann L, Nkoulou RN, Wolfrum M, Ghadri JR, et al. Long-term prognostic value of left ventricular dyssynchrony assessment by phase analysis from myocardial perfusion imaging. Heart 2010;97:33-7.

    Article  PubMed  Google Scholar 

  28. Aljaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkataraman R, Heo J, et al. Relation of left-ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2010;17:398-404.

    Article  PubMed  Google Scholar 

  29. Friehling M, Chen J, Saba S, Bazaz R, Schwartzman D, Adelstein EC, et al. A prospective pilot study to evaluate the relationship between acute change in LV synchrony after cardiac resynchronization therapy and patient outcome using a single-injection gated-SPECT protocol. Circ Cardiovasc Imaging 2011;4:532-9.

    Article  PubMed  Google Scholar 

  30. Reynolds HR, Tunick PA, Grossi EA, Dilmanian H, Colvin SB, Kronzon I. Paradoxical septal motion after cardiac surgery: A review of 3,292 cases. Clin Cardiol 2007;30:621-3.

    Article  PubMed  Google Scholar 

  31. Walker CM, Chung JH, Reddy GP. Septal bounce. J Thorac Imaging 2012;27:W1.

    Article  PubMed  Google Scholar 

  32. Dohi K, Onishi K, Gorcsan J III, Lopez-Candales A, Takamura T, Ota S, et al. Role of radial strain and displacement imaging to quantify wall motion dyssynchrony in patients with left ventricular mechanical dyssynchrony and chronic right ventricular pressure overload. Am J Cardiol 2008;101:1206-12.

    Article  PubMed  Google Scholar 

  33. Spottiswoode B, Russell JB, Moosa S, Meintjes EM, Epstein FH, Mayosi BM. Abnormal diastolic and systolic septal motion following pericardiectomy demonstrated by cine DENSE MRI. Cardiovasc J Afr 2008;19:208-9.

    PubMed  CAS  Google Scholar 

  34. Chen C, Li D, Miao C, Feng J, Zhou Y, Cao K, et al. LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome. Eur J Nucl Med Mol Imaging 2012;39:1191-8.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have indicated that they have no financial conflicts of interest.

Author information

Authors and Affiliations

  1. Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/J1-5, Cleveland, OH, 44195, USA

    Wael AlJaroudi MD, M. Chadi Alraies MD, Richard Brunken MD, Manuel Cerquiera MD & Wael A. Jaber MD

Authors
  1. Wael AlJaroudi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Chadi Alraies MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Brunken MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Manuel Cerquiera MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wael A. Jaber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wael AlJaroudi MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

AlJaroudi, W., Alraies, M.C., Brunken, R. et al. Paradoxical septal motion from prior coronary artery bypass graft surgery does not impact left ventricular mechanical dyssynchrony by gated myocardial perfusion imaging. J. Nucl. Cardiol. 19, 1190–1197 (2012). https://doi.org/10.1007/s12350-012-9627-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-012-9627-5

Keywords

Search

Navigation