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Journal of Nuclear Cardiology

, Volume 14, Issue 3, pp 298–307 | Cite as

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

  • Mark A. Trimble
  • Salvador Borges-NetoEmail author
  • Stuart Smallhelser
  • Ji Chen
  • Emily F. Honeycutt
  • Linda K. Shaw
  • Jaekyeong Heo
  • Robert A. Pagnanelli
  • E. Lindsey Tauxe
  • Ernest V. Garcia
  • Fabio Esteves
  • Frank Seghatol-Eslami
  • G. Neal Kay
  • Ami E. Iskandrian
Original Articles

Abstract

Background

Cardiac resynchronization therapy (CRT) is approved for the treatment of patients with advanced systolic heart failure and evidence of dyssynchrony on electrocardiograms. However, a significant percentage of patients do not demonstrate improvement with CRT. Echocardiographic techniques have been used for more accurate determination of dyssynchrony. Single photon emission computed tomography (SPECT) myocardial perfusion imaging has not previously been used to evaluate cardiac dyssynchrony. The objective of this study is to evaluate mechanical dyssynchrony as described by phase analysis of gated SPECT images in patients with left ventricular dysfunction, conduction delays, and ventricular paced rhythms.

Methods and Results

A novel count-based method is used to extract regional systolic wall thickening amplitude and phase from gated SPECT images. Five indices describing the phase dispersion of the onset of mechanical contraction are determined: peak phase, phase SD, bandwidth, skewness, and kurtosis. These indices were determined in consecutive patients with left ventricular dysfunction (n=120), left bundle branch block (n=33), right bundle branch block (n=19), and ventricular paced rhythms (n=23) and were compared with normal control subjects (n=157). Phase SD, bandwidth, skewness, and kurtosis were significantly different between patients with left ventricular dysfunction, left bundle branch block, right bundle branch block, and ventricular paced rhythms and normal control subjects (all P<.001) Peak phase was significantly different between patients with right ventricular paced rhythms and normal control subjects (P=.001).

Conclusions

A novel SPECT technique for describing left ventricular mechanical dyssyn-chrony has been developed and may prove useful in the evaluation of patients for CRT.

Key Words

Myocardial perfusion imaging heart failure gated single photon emission computed tomography 

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Copyright information

© American Society of Nuclear Cardiology 2007

Authors and Affiliations

  • Mark A. Trimble
    • 1
    • 3
  • Salvador Borges-Neto
    • 1
    • 2
    • 3
    Email author
  • Stuart Smallhelser
    • 5
  • Ji Chen
    • 6
  • Emily F. Honeycutt
    • 3
  • Linda K. Shaw
    • 3
  • Jaekyeong Heo
    • 4
  • Robert A. Pagnanelli
    • 2
  • E. Lindsey Tauxe
    • 4
  • Ernest V. Garcia
    • 6
  • Fabio Esteves
    • 6
  • Frank Seghatol-Eslami
    • 4
  • G. Neal Kay
    • 5
  • Ami E. Iskandrian
    • 5
  1. 1.Division of Cardiovascular Disease, Department of MedicineDuke University Medical CenterDurham
  2. 2.Department of RadiologyDuke University Medical CenterDurham
  3. 3.Duke Clinical Research InstituteDuke University Medical CenterDurham
  4. 4.Department of RadiologyUniversity of Alabama at BirminghamBirmingham
  5. 5.Division of CardiologyUniversity of Alabama at BirminghamBirmingham
  6. 6.Department of RadiologyEmory UniversityAtlanta

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