Authors: Mark J Boogers Ji Chen Caroline E Veltman Rutger J van Bommel Eline A Q Mooyaart Imad Al Younis Bernies van der Hiel Petra DibbetsSchneider Ernst E van der Wall Martin J Schalij Ernest V Garcia Jeroen J Bax Victoria Delgado
Publish Date: 2011/08/18
Volume: 38, Issue: 11, Pages: 2031-
Abstract
The aim of the current study was to evaluate the feasibility of phase analysis on gated myocardial perfusion SPECT GMPS for the assessment of left ventricular LV diastolic dyssynchrony in a headtohead comparison with tissue Doppler imaging TDIThe population consisted of patients with endstage heart failure of New York Heart Association functional class III or IV with a reduced LV ejection fraction of ≤35 LV diastolic dyssynchrony was calculated using TDI as the maximal time delay between early peak diastolic velocities of two opposing left ventricle walls diastolic mechanical delay Significant LV diastolic dyssynchrony was defined as a diastolic mechanical delay of 55 ms on TDI Furthermore phase analysis on GMPS was performed to evaluate LV diastolic dyssynchrony diastolic phase standard deviation SD and histogram bandwidth HBW were used as markers of LV diastolic dyssynchronyA total of 150 patients 114 men mean age 660 ± 104 years with endstage heart failure were enrolled Both diastolic phase SD r = 081 p 001 and diastolic HBW r = 075 p 001 showed good correlations with LV diastolic dyssynchrony on TDI Additionally patients with LV diastolic dyssynchrony on TDI 55 ms showed significantly larger diastolic phase SD 681 ± 134° vs 407 ± 140° p 001 and diastolic HBW 2306 ± 543° vs 1290 ± 556° p 001 as compared to patients without LV diastolic dyssynchrony on TDI ≤55 ms Finally phase analysis on GMPS showed a good intra and interobserver reproducibility for the determination of diastolic phase SD ICC 097 and 088 and diastolic HBW ICC 098 and 093Left ventricular LV systolic dyssynchrony is considered an important pathophysiological condition in patients with heart failure HF 1 2 In addition it has been shown that a dyssynchronous relaxation pattern of the left ventricle which is commonly referred to as LV diastolic dyssynchrony plays an important role in patients with HF 3 4 5 In these patients LV diastolic dyssynchrony has been related to abnormalities in LV diastolic filling and LV filling rate which may contribute to a further impairment of the haemodynamics of the failing heart 5 Importantly it has been recognized that LV diastolic dyssynchrony is a common pathophysiological condition in patients with HF with an estimated prevalence of more than 50 3 6At present the majority of available studies used echocardiography for the assessment of LV diastolic dyssynchrony in patients with HF 3 4 6 7 8 Among the echocardiographic techniques tissue Doppler imaging TDI has been used predominantly for the evaluation of diastolic relaxation patterns of the left ventricle 6 7 8 Although TDI is an accurate approach for the assessment of LV diastolic dyssynchrony the postprocessing of Doppler images requires special expertise and standardized protocols to optimize the interobserver variabilityPhase on gated myocardial perfusion single photon emission computed tomography SPECT GMPS has emerged as a practical technique for the assessment of LV mechanical dyssynchrony as it automatically provides robust and reproducible indices of mechanical dyssynchrony 9 10 Moreover phase analysis can be performed on conventional GMPS studies without the use of additional image acquisitions Although studies have shown that phase analysis on GMPS can be used for the assessment of LV systolic dyssynchrony its feasibility to assess LV diastolic dyssynchrony has not been demonstrated Accordingly the aim of the current study was to evaluate the feasibility of phase analysis on GMPS for the assessment of LV diastolic dyssynchrony in a headtohead comparison with TDIThe patient population consisted of patients with endstage HF New York Heart Association functional class III or IV with a depressed LV ejection fraction LVEF of ≤35 Patient data were prospectively collected in the departmental Cardiology Information System EPDVision Leiden University Medical Center LUMC Leiden The Netherlands and retrospectively analysed All patients were treated according to the MISSION heart failure care track operational at Leiden University Medical Center All patients were stable on maximum tolerated doses of HF medication Patients with recent myocardial infarction within 3 months prior to GMPS imaging atrial fibrillation decompensated HF or acute coronary syndrome were excluded Patients were diagnosed with ischaemic cardiomyopathy in the presence of ≥50 stenosis in one or more of the major epicardial coronary arteries previous myocardial infarction percutaneous coronary intervention or coronary artery bypass grafting
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