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Gated myocardial perfusion SPECT asynchrony measurements in patients with left bundle branch block

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Abstract

Purpose This investigation sought to determine which newly available asynchrony parameter derived from gated myocardial perfusion SPECT (GMPS) systolic wall thickening data best distinguishes patients with left bundle branch block (LBBB) from normal subjects. Methods and materials Emory Cardiac Toolbox (ECTb) algorithms were used to compute left ventricular (LV) global and regional function and perfusion indices with regional contraction phases for 20 patients with LBBB, and in 9 control (CTL) subjects who had no function or perfusion abnormalities. Histogram plots of phase frequencies versus R–R interval times included phase standard deviation (SD), bandwidth (BW), skewness and kurtosis. Z-score asynchrony measures were derived for phases sampled using the conventional 17-segment model. Results In CTLs contraction occurred nearly simultaneously in all segments, while LBBBs exhibited a wide variety of heterogeneous contraction patterns. Global parameters that differed between LBBBs versus CTLs included EF, end-systolic volume and end-diastolic volume, and asynchrony measures that were different included BW, phase SD and z-scores. Z-scores most strongly discriminated LBBBs from CTLs (93% of cases correctly predicted, logistic regression χ2 = 29.7, P < 0.0001). Z-scores, phase SD and lateral–septal wall timing were highly reproducible (r = 0.99, 0.99 and r = 0.87, respectively), with no significant inter-observer differences. Conclusion While traditional global function parameters were different in LBBBs and CTLs, asynchrony parameters characterized LBBB most strongly.

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Abbreviations

BW:

Bandwidth

CABG:

Coronary artery bypass graft

CAD:

Coronary artery disease

CTL:

Control subject

CHF:

Congestive heart failure

CRT:

Cardiac resynchronization therapy

EDV:

End-diastolic volume

ESV:

End-systolic volume

EF:

Ejection fraction

GMPS:

Gated myocardial perfusion SPECT

LBBB:

Left bundle branch block

LV:

Left ventricular

MI:

Myocardial infarction

ms:

Millisecond

SSS:

Summed stress score

SWT:

Systolic wall thickening

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Acknowledgements

We would like to thank Jing Han for her expert assistance with the statistical analysis reported for this project. This work was supported by a grant from the Saint Francis Research Foundation. Some of the authors (Chen, Garcia) receive royalties from the sale of Phase Analysis tool with the Emory Cardiac Toolbox.

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Authors and Affiliations

  1. Division of Nuclear Medicine and Molecular Imaging, North Shore-Long Island Jewish Health System, 270-05 76th Avenue, New Hyde Park, NY, 11040, USA

    Kenneth J. Nichols & Christopher J. Palestro

  2. Research Department, St. Francis Hospital, Roslyn, NY, USA

    Kenneth J. Nichols, Andrew Van Tosh, Saadi Siddiqi & Nathaniel Reichek

  3. Division of Cardiology, Stony Brook University, Stony Brook, NY, USA

    Kenneth J. Nichols, Andrew Van Tosh, Saadi Siddiqi & Nathaniel Reichek

  4. Emory University, Atlanta, GA, USA

    Ji Chen & Ernest V. Garcia

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  1. Kenneth J. Nichols
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  2. Andrew Van Tosh
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  4. Ji Chen
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  5. Ernest V. Garcia
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Correspondence to Kenneth J. Nichols.

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Nichols, K.J., Van Tosh, A., Siddiqi, S. et al. Gated myocardial perfusion SPECT asynchrony measurements in patients with left bundle branch block. Int J Cardiovasc Imaging 25, 43–51 (2009). https://doi.org/10.1007/s10554-008-9354-9

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  • DOI: https://doi.org/10.1007/s10554-008-9354-9

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