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Use of phase analysis of gated SPECT perfusion imaging to quantify dyssynchrony in patients with mild-to-moderate left ventricular dysfunction

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

CRT has been shown to be beneficial in the majority of patients with NYHA class III-IV symptoms, prolonged QRS duration, and an EF ≤35%. The use of imaging modalities to quantify dyssynchrony may help identify patients who may benefit from CRT, but do not meet current selection criteria. We hypothesize that patients with mild-to-moderate LV dysfunction have significant degrees of mechanical dyssynchrony.

Methods

We compared phase analysis measures of mechanical dyssynchrony from gated SPECT imaging in patients with mild-to-moderate LV dysfunction (EF 35-50%, n = 93), with patients with severe LV dysfunction (EF ≤ 35%, n = 167), and with normal controls (EF ≥ 55%, n = 75). Furthermore, we evaluated the relationships between QRS duration and dyssynchrony and determined the prevalence of dyssynchrony in patients with mild-moderate LV dysfunction.

Results

Patients with mild-moderate LV dysfunction have more dyssynchrony than normal controls (phase SD 37.7° vs 8.8°, P < .001 and bandwidth 113.5° vs 28.7°, P < .001), but less dyssynchrony than patients with severe LV dysfunction (phase SD 37.7° vs 52.0°, P < .001 and bandwidth 113.5° vs 158.2°, P < .001). In the cohort of patients with LV EF 35-50%, there were only weak correlations between QRS duration and dyssynchrony (phase SD, r = 0.28 and bandwidth, r = 0.20). There were 73 patients with LVEF 35-50% and QRS duration <120 milliseconds of which 21 (28.8%) had mechanical dyssynchrony. Overall, 37% of patients with mild-to-moderate LV dysfunction had significant degrees of mechanical dyssynchrony.

Conclusions

This is the largest reported study evaluating mechanical dyssynchrony in patients with mild-moderate LV dysfunction using phase analysis of gated SPECT imaging. In this study, approximately one-third of patients with mild-to-moderate LV dysfunction had significant LV mechanical dyssynchrony. With further study, phase analysis of gated SPECT imaging may help improve patient selection for CRT.

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Acknowledgments

Dr. Atchley is a fellow in training supported by a National Institutes of Health T32 grant. This study was funded by the Medtronic-Duke Strategic Alliance of which Dr. Trimble was the primary investigator. Dr. Garcia reports an ownership interest in and serves as a consultant/advisor board member to Syntermed Inc. Dr. Garcia also receives royalties from the sale of clinical software which was used as part of this research.

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Authors and Affiliations

  1. Division of Cardiology, Duke University Medical Center, Durham, NC, USA

    Allen E. Atchley MD, Mark A. Trimble MD, Zainab Samad MD & Salvador Borges-Neto MD

  2. Duke Clinical Research Institute, Durham, NC, USA

    Linda K. Shaw MS, Eric J. Velazquez MD & Salvador Borges-Neto MD

  3. Department of Radiology, Division of Nuclear Cardiology, Duke University Medical Center, Durham, NC, USA

    Robert Pagnanelli CNT

  4. Department of Radiology, Emory University School of Medicine, Emory University, Atlanta, GA, USA

    Ji Chen PhD & Ernest V. Garcia PhD

  5. Department of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Ami E. Iskandrian MD

  6. Department of Internal Medicine, Division of Cardiology, Duke University Medical Center, Duke University, Durham, NC, USA

    Eric J. Velazquez MD

  7. Department of Radiology, Division of Nuclear Medicine, Duke University Medical Center, Durham, NC, USA

    Salvador Borges-Neto MD

Authors
  1. Allen E. Atchley MD
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  2. Mark A. Trimble MD
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  3. Zainab Samad MD
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  4. Linda K. Shaw MS
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  5. Robert Pagnanelli CNT
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  6. Ji Chen PhD
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  8. Ami E. Iskandrian MD
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  9. Eric J. Velazquez MD
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  10. Salvador Borges-Neto MD
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Corresponding author

Correspondence to Salvador Borges-Neto MD.

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Atchley, A.E., Trimble, M.A., Samad, Z. et al. Use of phase analysis of gated SPECT perfusion imaging to quantify dyssynchrony in patients with mild-to-moderate left ventricular dysfunction. J. Nucl. Cardiol. 16, 888–894 (2009). https://doi.org/10.1007/s12350-009-9136-3

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  • DOI: https://doi.org/10.1007/s12350-009-9136-3

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