First Harmonic Fourier (Phase) Analysis of Blood Pool Scintigrams for the Analysis of Cardiac Conduction Abnormalities

  • Elias H. Botvinick
  • Melvin M. Scheinman
  • Michael W. Dae
  • J. William O’Connell
  • Donald B. Faulkner


In recent years there has been a burgeoning of noninvasive imaging techniques for the evaluation of cardiac structure, perfusion, and function. Prominent among these methods and widely used owing to their important clinical impact are cardiac scintigraphic methods [1–3]. Here, a minute intravenous dose of a radiopharmaceutical permits image characterization and often, quantification of some quality of the cardiac whole. The radiation dose is small (generally less than that related to a flat and upright X-ray of the abdomen) and requires only a single peripheral injection of the radionuclide. In addition to its noninvasive nature, primary advantages of the scintigraphic method include its ability to analyze pathophysiologic markers, its quantitative nature, and its extreme amenability to computer analysis.


Phase Angle Phase Image Atrial Pace Right Bundle Branch Block Right Bundle Branch Block 
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  1. 1.
    Patterson RE, Eng C, Horowitz SF: Practical diagnosis of coronary artery disease: A Bayes’ theorem nomogram to correlate clinical data with noninvasive exercise tests. Am. J. Cardiol. 53: 253, 1984.CrossRefGoogle Scholar
  2. 2.
    Werner JA, Botvinick E, Shames D, Parmley W: Acute myocardial infarction imaging: The clinical application of technetium-99 m stannous pyrophosphate infarct scintigraphy. West. J. Med. 127: 464, 1977.PubMedGoogle Scholar
  3. 3.
    Botvinick EH, Schiller NB: The complementary roles of m-mode echocardiography and scintigraphy in the evaluation of adults with suspected left-to-right shunts. Circulation 62: 1070, 1980.PubMedGoogle Scholar
  4. 4.
    Ashburn WL, Schelbert HR, Verba JW: Left ventricular ejection fraction — a review of several radionuclide angiographic approaches using the scintilation camera. Prog. Cardiorasc. Dis. 20: 267, 1978.CrossRefGoogle Scholar
  5. 5.
    Botvinick EH, Glazer HB, Shosa DW: What is the reliability and the utility of scintigraphic methods for the assessment of ventricular function? In Rahimtoola SH (ed.): Controversies in Coronary Artery Disease, Philadelphia, FA Davis Co., 1982.Google Scholar
  6. 6.
    Schiller NB, Botvinick EH: Noninvasive quantitation of the left heart by echocardiography and scintigraphy. Cardiovasc. Clin. 1985 (in press).Google Scholar
  7. 7.
    Okada RD, Kirschenbaum HD, Kushner FG, Strauss HW, Dinsmore R, Newall J, Boucher C, Block P, Pohost G: Observer variance in the qualitative evaluation of left ventricular wall motion and quantitation of left ventricular ejection fraction using rest and exercise multigated blood pool imaging. Circulation 61: 128, 1980.PubMedGoogle Scholar
  8. 8.
    Pavel DG, Zimmer M, Patterson VN: In vivo labeling of red blood cells with 99 m-technetium: A new approach to blood pool visualization. J. Nucl. Med. 18: 305, 1977.PubMedGoogle Scholar
  9. 9.
    Freeman M, Berman D, Staniloff H, Waxman AD, Maddahi J, Buchbinder NA, Forrester JS, Swan HJC: Improved assessment of inferior segmental wall motion by the addition of the 70° left anterior oblique view in multiple gated scintigraphy. Am. Heart J. 101: 169, 1981.PubMedCrossRefGoogle Scholar
  10. 10.
    Bacharach SL, Green MV, Bonow RO, Findley SL, Ostrow H, Johnston GS: Measurements of ventricular function by ECG gated blood pool scintigraphy during atrial fibrilation. J. Nucl. Med. 22: 226, 1981.PubMedGoogle Scholar
  11. 11.
    Green MV, Ostrow HG, Scott RN, Douglas MA, Bailey JT, Johnston GS: A comparison of simultaneous measurements of systolic function in the baboon by electromagnetic flow meter and high frame rate ECG gated blood pool scintigraphy. Circulation 60: 312, 1979.Google Scholar
  12. 12.
    Links JM, Becker LS, Shindledecker JG, Guzman P, Burow RD, Nickeloff EL, Alderson PO, Wagner HN: Measurement of absolute left ventricular volume from gated blood pool studies. Circulation 65: 82, 1982.PubMedCrossRefGoogle Scholar
  13. 13.
    Rigo P, Alderson PO, Robertson RM, Becker LC, Wagner HN: Measurement of aortic and mitral regurgitation by gated cardiac blood pool scans. Circulation 60: 306, 1979.PubMedGoogle Scholar
  14. 14.
    Champeney DC: Fourier transforms and their physical applications. New York, Academic Press, 1973, p. 8.Google Scholar
  15. 15.
    Goris ML: Functional or parametric images. J. Nucl. Med. 23: 360, 1982.PubMedGoogle Scholar
  16. 16.
    Gandsman EJ, North DL, Shulman RS, Bough EW: Measurement of the ventricular stroke volume ratio by gated radionuclide angiography. Radiology 138: 161, 1980.Google Scholar
  17. 17.
    Maddox DE, Holman BL, Wynne J, Idoine J, Parker AJ, Uren R, Neill JM, Cohn PF: Ejection fraction image: A noninvasive index of regional left ventricular wall motion. Am. J. Cardiol. 41: 1230, 1978.PubMedCrossRefGoogle Scholar
  18. 18.
    Holman BL, Wynne J, Idoine J, Zielonka J, Neill J: The paradox image: Noninvasive index of regional left ventricular dyskinesis (abstract). J. Nucl. Med. 20: P661, 1979.Google Scholar
  19. 19.
    Geffers H, Adam WE, Bitter F, et al. Data processing and functional imaging in radionuclide ventriculography In Information in Medical Processing, Oakridge, Biological Computing Technology Information Center, 1977 p. 332.Google Scholar
  20. 20.
    Deconinck F, Bossuyt A, Hermanne A: A cyclic color cycle as an essential requirement in functional imaging of periodic phenomena. Med. Phys. 6: 331, 1979.Google Scholar
  21. 21.
    Verba JW, Bornstein I, Alazraki NP, Taylor A, Bhargava V, Shabetai R, LeWinter M: Onset and progression of mechanical systole derived from gated radionuclide techniques and displayed in cine format. J. Nucl. Med. 20: 625, 1979 (abstract).Google Scholar
  22. 22.
    Pavel DC, Swiryn S. Byrom E, Lam W: Ventricular phase analysis of radionuclide gated studies. (Abstract.) Am. J. Cardiol. 45: 398, 1980.CrossRefGoogle Scholar
  23. 23.
    Walton S, Jell P, Jarritt PH, Swanton RH: Phase analysis of the first pass radionuclide angiogram. Br. Heart J. 48: 441, 1982.PubMedCrossRefGoogle Scholar
  24. 24.
    Pavel BG, Briandet PA: Quo vadis phase analysis. Clin. Nucl. Med. 8: 564, 1983.PubMedCrossRefGoogle Scholar
  25. 25.
    Bacharach S, Green M, Bonow R, DeGraaf CN, Johnston GS: A method for objective evaluation of functional images. J. Nucl. Med. 23: 285, 1982.PubMedGoogle Scholar
  26. 26.
    Miller TR, Goldman KJ, Kondapuram SS, Biello DR, Ludbrook PA, Sobel BE: Analysis of cardiac diastolic function: Application in coronary artery disease. J. Nucl. Med. 24: 2, 1983.Google Scholar
  27. 27.
    Bacharach SL, Green MV, Bonow RO, Pace L, Bennetti A, Larson SM: Detection of cardiac wall motion defects with combined amplitude/phase analysis. (Abstract.) J. Nucl. Med. 26: P86, 1985.Google Scholar
  28. 28.
    Botvinick E, Frais M, Shosa D, O’Connell W, Pacheco-Alvarez JA, Scheinman M, Hattner R, Morady F, Faulkner D: An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis. Am. J. Cardiol. 50: 289, 1982.PubMedCrossRefGoogle Scholar
  29. 29.
    Botvinick E, Dunn R, O’Connell W, Shosa D, Herfkens R, Scheinman M: The phase image, its relationship to patterns of contraction and conduction. Circulation 65: 551, 1982.PubMedCrossRefGoogle Scholar
  30. 30.
    Turner DA, Shuma MA, Ruggie N, VonBehron PL, Jarosky MJ, Ali A, Grotch MW, Messer JV, Fordham EW: Coronary artery disease: Detection by phase analysis of rest/exercise radionuclide angiograms. Radiology 148: 539, 1983.PubMedGoogle Scholar
  31. 31.
    Mancini GBJ, Peck WW, Slutsky RA: Analysis of phase angle histograms from equilibrium radionuclide studies: Correlation with semiquantitative grading of wall motion. Am. J. Cardiol. 55: 535, 1985.PubMedCrossRefGoogle Scholar
  32. 32.
    Norris SL, Slutsky RA, Gerber KH, Geiss KR, Ashburn WL, Higgins CB: Sensitivity and specificity of nuclear phase analysis vs. ejection fraction in coronary artery disease. Am. J. Cardiol. 53: 1547, 1984.PubMedCrossRefGoogle Scholar
  33. 33.
    Ratib O, Henze E, Schon H, Schelbert H: Phase analysis of radionuclide ventriculograms for the detection of coronary artery disease. Am. Heart J. 104: 1, 1982.PubMedCrossRefGoogle Scholar
  34. 34.
    Schwaiger M, Ratib 0, Henze E, Schelbert HR: Limitations of quantitative phase analysis of radionuclide angiograms for detecting coronary artery disease in patients with impaired left ventricular function. Am. Heart J. 108: 942, 1984.PubMedCrossRefGoogle Scholar
  35. 35.
    Botvinick E, Frais M, O’Connell W, Faulkner D, Scheinman M, Morady F, Sung R, Shosa D, Dae M: Phase image evaluation of patients with ventricular preexcitation syndromes. J. Am. Coll. Cardiol. 3: 799, 1984.PubMedCrossRefGoogle Scholar
  36. 36.
    Clayton PD, Bulawa WF, Klausner SC, Urie PM, Marshall HW, Warner HR: The characteristics sequence for the onset of contraction in the normal left ventricle. Circulation 59: 671, 1979.PubMedGoogle Scholar
  37. 37.
    Frais M, Botvinick E, Shosa D, O’Connell W, Pacheco-Alvarez J, Dae M, Hattner R, Faulkner D: Phase image characterization of localized and generalized left ventricular contraction abnormalities. J. Am. Coll. Cardiol. 4: 987, 1984.CrossRefGoogle Scholar
  38. 38.
    Jones L Jr, Weber PM, Schurr DA: Phase imaging of the left ventricular ECG gated equilibrium blood pool radionuclide scan as a noninvasive method for detecting aneurysmsCirculation Google Scholar
  39. 63:.
    III, P229, 1980 (abstract).Google Scholar
  40. 39.
    Yiannikes J, Maclntyre W, Underwood D, Cook S, Go R, Loop F: Prediction of improvement in left ventricular function following ventricular aneurysmectomy using Fourier phase and amplitude analysis. (Abstract.) Am. J. Cardiol. 49: 1045, 1982.CrossRefGoogle Scholar
  41. 40.
    Bough EW, Gandsman EJ, Schulman RS: Measurement of normal left atrial function with gated radionuclide angiography. Am. J. Cardiol. 48: 473, 1981.PubMedCrossRefGoogle Scholar
  42. 41.
    Rabinovitch MA, Stewart J, Chan W, Dunlap TE, Kalff V, Clare J, Thrall JH, Pitt B: Scintigraphic demonstration of ventriculo-atrial conduction in the ventricular pacemaker syndrome. J. Nucl. Med. 23: 795, 1982.PubMedGoogle Scholar
  43. 42.
    Handler B, Pavel B, Pietras R, Swiryn S, Byrom E, Lam W, Rosen K: Equilibrium radionuclide gated angiography in patients with tricuspid regurgitation. Am. J. Cardiol. 51: 305, 1983.PubMedCrossRefGoogle Scholar
  44. 43.
    DeMaria AN, Mason DT: Echocardiographic evaluation of disturbances of cardiac rhythm and conduction (editorial). Chest 71: 439, 1977.PubMedCrossRefGoogle Scholar
  45. 44.
    DeMaria AN, Vera Z, Neumann A, Mason DT: Alterations in ventricular contraction pattern in the Wolff-Parkinson-White Syndrome: Detection by echocardiography. Circulation 53: 249, 1976.PubMedGoogle Scholar
  46. 45.
    Wyndham CR, Meeran MK, Smith T, Saxena A, Engelman R, Levitsky S, Rosen K: Epicardial activation of the intact human heart without conduction defects. Circulation 59: 161, 1979.PubMedGoogle Scholar
  47. 46.
    Links JM, Douglass KH, Wagner HN: Patterns of ventricular emptying by Fourier analysis of gated blood studies. J. Nucl. Med. 21: 978, 1980.PubMedGoogle Scholar
  48. 47.
    Swiryn S, Pavel D, Byrom E, Witham D, MeyerPowel C, Wyndham C, Handler B, Rosen K: Sequential regional phase mapping of radionuclide gated biventriculograms in patients with left bundle branch block. Am. Heart]. 102: 1000, 1982.CrossRefGoogle Scholar
  49. 48.
    Frais M, Botvinick E, Shosa D, O’Connell WJ, Scheinman MM, Hattner RS, Morady F: Phase image characterization of ventricular contraction in left and right bundle branch block. Am. J. Cardiol. 50: 95, 1982.PubMedCrossRefGoogle Scholar
  50. 49.
    Machac J, Horowitz SF, Mielli K, Pollack B, Lee K, Goldman ME, Goldsmith SJ, Teichholz LE: Quantification of cardiac conduction abnormalities using segmental vector Fourier analysis of radionuclide gated blood pool scintigrams. J. Am. Coll. Cardiol. 2: 1099, 1983.CrossRefGoogle Scholar
  51. 50.
    Dae M, Wen YM, Botvinick E, Scheinman M: Assessment of left anterior fascicular block by scintigraphic phase analysis. (Abstract.) J. Am. Coll. Cardiol. 3: 591, 1984.Google Scholar
  52. 51.
    Dae M, Davis J, Botvinick E, Matsubura T, Scheinman M, Faulkner D: Comparison of scintigraphic phase maps through epicardial activa-Google Scholar
  53. tion maps in dogs. (Abstract.) J. Nucl. Med. 26:p57, 1985.Google Scholar
  54. 52.
    Turner DA, VonBehren PL, Ruggie NT, Hauser RG, Denes P, Ali A, Messer JV, Forham EW, Groch MW: Noninvasive identification of the initial site of abnormal ventricular activation by least square phase analysis of radionuclide cineangiograms. Circulation 65: 1511, 1982.PubMedCrossRefGoogle Scholar
  55. 53.
    Bashore TM, Sterne RA, Schaffer PB, Bush CA, Lier CV, Shaal SF: The noninvasive localization of ventricular pacing sites by radionuclide phase imaging. Circulation 70: 681, 1984.PubMedCrossRefGoogle Scholar
  56. 54.
    Rolfe SJ, Rasor T, Schaffer PA, Sanitate PA, Bashore TM: Relation between premature ventricular contraction site of origin defined by radionuclide phase analysis and subsequent left ventricular function. Am. J. Cardiol. 53: 1028, 1984.PubMedCrossRefGoogle Scholar
  57. 55.
    Links JM, Raichlin JS, Wagner HN Jr, Reed PR: Assessment of the site of ventricular activation by Fourier analysis of gated blood pool studies. J. Nucl. Med. 26: 27, 1985.PubMedGoogle Scholar
  58. 57.
    M, Komishi T, Nakano T, Tahizawa H: Visualization of Kent bundle position in WPW syndrome using phase analysis. (Abstract.) J. Nucl. Med. 26: P58, 1985.Google Scholar
  59. 57.
    Chan WWC, Kalff V, McDonald D II, Rabinovitch MH, Thrall JH, Pitt B: Topography of pre-emptying ventricular segments in patients with Wolff-Parkinson-White Syndrome using scintigraphic phase mapping and esophageal pacing. Circulation 67: 1139, 1983.PubMedCrossRefGoogle Scholar
  60. 58.
    Nakajima K, Bunko H, Tada A, Tonami N, Hisada K, Misaki T, Iwa T: Nuclear tomographic phase analysis: Localization of accessory conduction pathways in patients with WolffParkinson-White Syndrome. Am. Heart J. 109: 809, 1985.PubMedCrossRefGoogle Scholar
  61. 59.
    Botvinick E, Dae MW, Scheinman M, Davis J, Schechtman N, O’Connell W, Faulkner D, Iskanian J: Augmented pre-excitation assessed by scintigraphic phase analysis during atrial pacing. (Abstract.) J. Nucl. Med. 26:p58, 1985Google Scholar
  62. 60.
    Bhandari A, Moradi F, Shen EN, Schwartz AB, Botvinick E, Scheinman MM: Catheter-induced His bundle ablation in a patient with reentrant tachycardia associated with a nodoventricular tract. J. Am. Coll. Cardiol. 4: 611, 1984.PubMedCrossRefGoogle Scholar
  63. 61.
    Schechtmann N, Scheinman M, Botvinick E, Davis J, Winston S, Schwartz A, Dae M: The phase characterization of ventricular pre-excitation via Mahaim pathways. (Abstract.) J. Nucl. Med. 26: 58, 1985.Google Scholar
  64. 62.
    Swiryn S, Pavel D, Byrom E, et al.: Sequential regional phase mapping of radionuclide gated biventriculograms in patients with ventricular tachycardia: Close correlation with electrophysiologic characteristics. Am. Heart J. 103: 319, 1982.PubMedCrossRefGoogle Scholar
  65. Botvinick E, Scheinman M, Morady F, Sung R, Lanzer P, O’Connell W, Faulkner D: The scintigraphic assessment of sequential changes in ventricular tachycardia. (Abstract.) J. Am. Coll. Cardiol. 1:711,1983.Google Scholar
  66. 64.
    McCarthy DM, Makler PT, Waxman HL: Fourier phase image during ventricular tachycardia: Relationship to endocardial site of origin. (Abstract.) J. Am. Coll. Cardiol. 1: 712, 1983.Google Scholar
  67. 65.
    Nakajima K, Bunko H, Tada A, Taki J, Tonami N, Hisada K, Misaki T, Iwa T: Phase analysis in patients with Wolff-Parkinson-White Syndrome with surgically proven accessory conduction pathways. J. Nucl. Med. 25: 7, 1984.PubMedGoogle Scholar
  68. 66.
    Dae M, Botvinick E, Schechtman N, O’Connell W, Faulkner D: Correlation of scintigraphic phase maps with intraoperative epicardial/endocardial maps and surgical results in patients with activation disturbances. (Abstract.) Circulation 70, suppl II: 371, 1984.Google Scholar

Copyright information

© Martinus Nijhoff Publishing 1986

Authors and Affiliations

  • Elias H. Botvinick
  • Melvin M. Scheinman
  • Michael W. Dae
  • J. William O’Connell
  • Donald B. Faulkner

There are no affiliations available

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