Skip to main content
SpringerLink
Log in

Association between left ventricular mechanical dyssynchrony with myocardial perfusion and functional parameters in patients with left bundle branch block

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

Abstract

Objective

To identify predictors of left ventricular mechanical dyssynchrony (LVMD) in patients with known left bundle branch block (LBBB) using gated single-photon emission computed tomography (SPECT) phase analysis.

Methods

81 patients (74% male, 70 ± 10 years) with LBBB and suspected or known coronary artery disease underwent ECG-gated myocardial perfusion SPECT. LV perfusion and functional parameters were measured, and phase analysis was performed to quantify LV-dyssynchrony.

Results

35/81 patients (42%) had prior myocardial infarction (MI), and the mean left ventricular ejection fraction (LVEF) was 49% ± 16%. LVMD was present in 58/81 (72%) patients. The summed thickening score (STS) (P < .001; odds ratio 1.22) emerged as independent predictor for the presence of LVMD in a multivariate regression model. In addition, prior MI, low LVEF, summed stress score, summed rest score, summed motion score, and LAD rest extent were identified as predictors of LVMD in a univariate model. Clinical baseline characteristics, cardiac risk factors, and QRS duration (P = .051) had no influence on the presence of LVMD.

Conclusion

In patients with LBBB, the occurrence of LVMD as assessed by gated SPECT phase analysis is mainly influenced by reduced myocardial contractility as expressed by the STS. Proper discrimination between LVMD arising from known electrical conduction delay as opposed to areas of MI causing reduced regional contractility seems to be mandatory for therapy planning in patients with LVMD.

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.

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Henneman MM, Chen J, Dibbets-Schneider P, Stokkel MP, Bleeker GB, Ypenburg C, et al. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med 2007;48:1104-11.

    Article  PubMed  Google Scholar 

  2. Uebleis C, Hellweger S, Laubender RP, Becker A, Sohn HY, Lehner S, et al. Left ventricular dyssynchrony assessed by gated SPECT phase analysis is an independent predictor of death in patients with advanced coronary artery disease and reduced left ventricular function not undergoing cardiac resynchronization therapy. Eur J Nucl Med Mol Imaging 2012;39:1561-9.

    Article  PubMed  Google Scholar 

  3. Chen J, Boogers MJ, Bax JJ, Soman P, Garcia EV. The use of nuclear imaging for cardiac resynchronization therapy. Curr Cardiol Rep 2010;12:185-91.

    Article  PubMed  Google Scholar 

  4. Trimble MA, Velazquez EJ, Adams GL, Honeycutt EF, Pagnanelli RA, Barnhart HX, et al. Repeatability and reproducibility of phase analysis of gated single-photon emission computed tomography myocardial perfusion imaging used to quantify cardiac dyssynchrony. Nucl Med Commun 2008;29:374-81.

    Article  PubMed  Google Scholar 

  5. Samad Z, Atchley AE, Trimble MA, Sun JL, Shaw LK, Pagnanelli R, et al. Prevalence and predictors of mechanical dyssynchrony as defined by phase analysis in patients with left ventricular dysfunction undergoing gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2011;18:24-30.

    Article  PubMed  Google Scholar 

  6. Rao HB, Krishnaswami R, Kalavakolanu S, Calambur N. Ventricular dyssynchrony patterns in left bundle branch block, with and without heart failure. Indian Pacing Electrophysiol J 2010;10:115-21.

    PubMed  Google Scholar 

  7. Dickstein K. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: Application of natriuretic peptides. Reply. Eur Heart J 2008;30:383.

    Article  Google Scholar 

  8. Hacker M, Jakobs T, Matthiesen F, Vollmar C, Nikolaou K, Becker C, et al. Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions: First clinical experiences. J Nucl Med 2005;46:1294-300.

    PubMed  Google Scholar 

  9. Sharir T, Berman DS, Waechter PB, Areeda J, Kavanagh PB, Gerlach J, et al. Quantitative analysis of regional motion and thickening by gated myocardial perfusion SPECT: Normal heterogeneity and criteria for abnormality. J Nucl Med 2001;42:1630-8.

    PubMed  CAS  Google Scholar 

  10. 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 

  11. 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 A Coll Cardiol 2007;49:1708-14.

    Article  Google Scholar 

  12. Boogers MJ, Chen J, Veltman CE, van Bommel RJ, Mooyaart EA, Al Younis I, et al. Left ventricular diastolic dyssynchrony assessed with phase analysis of gated myocardial perfusion SPECT: A comparison with tissue doppler imaging. Eur J Nucl Med Mol Imaging 2011;38:2031-9.

    Article  PubMed  Google Scholar 

  13. Boogers MM, Van Kriekinge SD, Henneman MM, Ypenburg C, Van Bommel RJ, Boersma E, et al. Quantitative gated SPECT-derived phase analysis on gated myocardial perfusion SPECT detects left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy. J Nucl Med 2009;50:718-25.

    Article  PubMed  Google Scholar 

  14. Van Kriekinge SD, Nishina H, Ohba M, Berman DS, Germano G. Automatic global and regional phase analysis from gated myocardial perfusion SPECT imaging: Application to the characterization of ventricular contraction in patients with left bundle branch block. J Nucl Med 2008;49:1790-7.

    Article  PubMed  Google Scholar 

  15. Uebleis C, Ulbrich M, Tegtmeyer R, Schuessler F, Haserueck N, Siebermair J, et al. Electrocardiogram-gated 18F-FDG PET/CT hybrid imaging in patients with unsatisfactory response to cardiac resynchronization therapy: Initial clinical results. J Nucl Med 2011;52:67-71.

    Article  PubMed  Google Scholar 

  16. Birnie DH, Tang AS. The problem of non-response to cardiac resynchronization therapy. Curr Opin Cardiol 2006;21:20-6.

    Article  PubMed  Google Scholar 

  17. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845-53.

    Article  PubMed  Google Scholar 

  18. Aljaroudi W, Koneru J, Heo J, Iskandrian AE. Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2011;18:36-42.

    Article  PubMed  Google Scholar 

  19. AlJaroudi W, Alraies MC, DiFilippo F, Brunken RC, Cerqueira MD, Jaber WA. Effect of stress testing on left ventricular mechanical synchrony by phase analysis of gated positron emission tomography in patients with normal myocardial perfusion. Eur J Nucl Med Mol Imaging 2012;39:665-72.

    Article  PubMed  Google Scholar 

  20. Chung ES, Leon AR, Tavazzi L, Sun JP, 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 

  21. Van de Veire NR, Delgado V, Schuijf JD, van der Wall EE, Schalij MJ, Bax JJ. The role of non-invasive imaging in patient selection. Europace 2009;11(Suppl 5):v32-9.

    Article  PubMed  Google Scholar 

  22. 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 

Download references

Acknowledgment

None.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Ludwig-Maximilian’s University, Munich, Germany

    Christopher Uebleis MD, Xaver Hoyer MD, Sebastian Lehner MD, Andrei Todica, Alexander Haug MD, Peter Bartenstein MD & Marcus Hacker MD

  2. Cedars-Sinai Medical Center, Los Angeles and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Serge D. Van Kriekinge PhD & Guido Germano PhD

  3. Medical Department I, Ludwig-Maximilian’s University, Munich, Germany

    Franziska Schuessler & Alexander Becker MD

  4. Institute of Medical Informatics, Biometry, and Epidemiology (IBE), Ludwig-Maximilian’s University, Munich, Germany

    Rüdiger Paul Laubender MA, MPH

  5. ABX Advanced Biochemical Compounds, Radeberg, Germany

    Paul Cumming PhD

  6. Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Marcus Hacker MD

Authors
  1. Christopher Uebleis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xaver Hoyer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Serge D. Van Kriekinge PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franziska Schuessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rüdiger Paul Laubender MA, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexander Becker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sebastian Lehner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrei Todica
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexander Haug MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Peter Bartenstein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Paul Cumming PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Guido Germano PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Marcus Hacker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcus Hacker MD.

Additional information

Disclosures/Funding

Cedars-Sinai Medical Center receives royalties for the licensure of software used in the quantitative assessment of function, perfusion, and viability, a portion of which is distributed to some of the authors of this article.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uebleis, C., Hoyer, X., Van Kriekinge, S.D. et al. Association between left ventricular mechanical dyssynchrony with myocardial perfusion and functional parameters in patients with left bundle branch block. J. Nucl. Cardiol. 20, 253–261 (2013). https://doi.org/10.1007/s12350-013-9673-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-013-9673-7

Keywords

Search

Navigation