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Phase analysis of gated blood pool SPECT for multiple stress testing assessments of ventricular mechanical dyssynchrony in a tachycardia-induced dilated cardiomyopathy canine model

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Stress-induced dyssynchrony has been shown to be independently correlated with clinical outcomes in patients with dilated cardiomyopathy (DCM) and narrow QRS complexes. However, the extent to which stress levels affect inter- and intraventricular dyssynchrony parameters remains unknown.

Methods

Ten large dogs were submitted to tachycardia-induced DCM by pacing the right ventricular apex for 3–4 weeks to reach a target ejection fraction (EF) of 35% or less. Stress was then induced in DCM dogs by administering intravenous dobutamine up to a maximum of 20 μg·kg−1·min−1. Hemodynamic and ventricular dyssynchrony data were analyzed by left ventricular (LV) pressure measurements and gated blood pool SPECT (GBPS) imaging. In order to assess mechanical dyssynchrony in DCM subjects and compare it with that of 8 normal counterparts, we extracted the following data: count-based indices of LV contraction homogeneity index (CHI), entropy and phase standard deviation, and interventricular dyssynchrony index.

Results

A significant LV intraventricular dyssynchrony (CHI: 96.4 ± 1.3% in control vs 78.6% ± 10.9% in DCM subjects) resulted in an intense LV dysfunction in DCM subjects (EF: 49.5% ± 8.4% in control vs 22.6% ± 6.0% in DCM), compared to control subjects. However, interventricular dyssynchrony did not vary significantly between the two groups. Under stress, DCM subjects showed a significant improvement in ventricular functional parameters at each level (EF: 22.6% ± 6.0% at rest vs 48.1% ± 5.8% at maximum stress). All intraventricular dyssynchrony indices showed a significant increase in magnitude of synchrony from baseline to stress levels of greater than or equal to 5 μg·kg−1·min−1 dobutamine. There were individual differences in the magnitude and pattern of change in interventricular dyssynchrony during the various levels of stress.

Conclusions

Based on GBPS analyses, different levels of functional stress, even in close intervals, can have a significant impact on hemodynamic and intraventricular dyssynchrony parameters in a DCM model with narrow QRS complex.

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Abbreviations

DCM:

Dilated cardiomyopathy

GBPS:

Gated blood pool SPECT

TAC:

Time–activity curve

ROI:

Region of interest

CHI:

Contraction homogeneity index

SV:

Stroke volume

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Acknowledgments

This study was conducted with the collaboration of the Electrophysiology Service of the Montreal Heart Institute. We wish to thank Marc-Antoine Gillis, Evelyn Landry, Marie-Pierre Mathieu, and Sophie Marcil for their expert technical assistance.

Disclosure

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Montreal Heart Institute and University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada

    Samaneh Salimian MSc, Vincent Finnerty MSc, Jean Grégoire MD & François Harel MD, PhD

  2. Department of Medicine, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada

    Bernard Thibault MD

Authors
  1. Samaneh Salimian MSc
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  2. Bernard Thibault MD
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  3. Vincent Finnerty MSc
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  4. Jean Grégoire MD
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  5. François Harel MD, PhD
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Corresponding author

Correspondence to François Harel MD, PhD.

Additional information

See related editorial, doi:10.1007/s12350-015-0379-x.

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Salimian, S., Thibault, B., Finnerty, V. et al. Phase analysis of gated blood pool SPECT for multiple stress testing assessments of ventricular mechanical dyssynchrony in a tachycardia-induced dilated cardiomyopathy canine model. J. Nucl. Cardiol. 24, 145–157 (2017). https://doi.org/10.1007/s12350-015-0338-6

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  • DOI: https://doi.org/10.1007/s12350-015-0338-6

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