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Mechanical dyssynchrony according to validated cut-off values using gated SPECT myocardial perfusion imaging

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The aim of this study was to establish different degrees of mechanical dyssynchrony according to validated cut-off (CO) values of myocardial perfusion gated SPECT phase analysis parameters (SD, standard deviation; B, bandwidth; S, skewness; K, kurtosis).

Methods

Using Emory Cardiac Toolbox™, we prospectively analyzed 408 patients (mean age 64.1 years, 26.7% female), divided into a control group of 150 normal subjects and a validation group of 258 patients (left bundle branch block: 17.8%, right bundle branch block: 8.9%. atrial fibrillation: 16.3%, coronary revascularization: 30%, dilated cardiomyopathy: 7.4%. valvulopathies: 2.7%, ischemic test: 45.3%) with ischemic and non-ischemic cardiac diseases, by means of phase analysis.

Results

Agreement of CO values (SD > 18.4°; B > 51°; S ≤ 3.2; K ≤ 9.3) used to discriminate between normal subjects and patients was strong (c-statistic 0.9; 95% CI 0.98-0.99). Four degrees of dyssynchrony were found according to the number of abnormal phase parameters. All patients with mechanical and electrical criteria for cardiac resynchronization therapy (CCRT) (n: 82) had Grade 2 to 4 (two to four abnormal phase parameters). Agreement of CO values (SD > 40.2°; B > 132°; S ≤ 2.3; K ≤ 4.6) used to discriminate between patients with and without CCRT was strong (c-statistic 0.8; 95% CI 0.79-0.87) but 12% of patients with CCRT did not have any of these abnormal phase parameters.

Conclusions

The discriminatory capacity of gated SPECT phase analysis parameters between normal subjects and patients, and between patients with and without CCRT, is very good, making it possible to define different degrees of mechanical dyssynchrony.

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Abbreviations

B :

Bandwidth

CO:

Cut-off

CCRT:

Criteria for cardiac resynchronization therapy

EF:

Ejection fraction

K :

Kurtosis

LV:

Left ventricle

ROC:

Receiver operating characteristic

S :

Skewness

SD:

Standard deviation

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Disclosure

The authors declare that they have no financial conflicts of interest.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Santiago Aguadé-Bruix MD

  2. Cardiology Department, Hospital Universitari Vall d’Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain

    Guillermo Romero-Farina MD, PhD, FESC, FASNC, Jaume Candell-Riera MD, PhD, FESC, María N. Pizzi MD & David García-Dorado PhD, FACC, FESC

Authors
  1. Santiago Aguadé-Bruix MD
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  2. Guillermo Romero-Farina MD, PhD, FESC, FASNC
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  3. Jaume Candell-Riera MD, PhD, FESC
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  4. María N. Pizzi MD
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  5. David García-Dorado PhD, FACC, FESC
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Correspondence to Santiago Aguadé-Bruix MD.

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See related editorial, doi: 10.1007/s12350-016-0717-7.

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Aguadé-Bruix, S., Romero-Farina, G., Candell-Riera, J. et al. Mechanical dyssynchrony according to validated cut-off values using gated SPECT myocardial perfusion imaging. J. Nucl. Cardiol. 25, 999–1008 (2018). https://doi.org/10.1007/s12350-016-0684-z

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  • DOI: https://doi.org/10.1007/s12350-016-0684-z

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