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

Published

Journal Article

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 < or =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 < or = 35%, n = 167), and with normal controls (EF > or = 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 degrees vs 8.8 degrees , P < .001 and bandwidth 113.5 degrees vs 28.7 degrees , P < .001), but less dyssynchrony than patients with severe LV dysfunction (phase SD 37.7 degrees vs 52.0 degrees , P < .001 and bandwidth 113.5 degrees vs 158.2 degrees , 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.

Full Text

Duke Authors

Cited Authors

  • Atchley, AE; Trimble, MA; Samad, Z; Shaw, LK; Pagnanelli, R; Chen, J; Garcia, EV; Iskandrian, AE; Velazquez, EJ; Borges-Neto, S

Published Date

  • November 2009

Published In

Volume / Issue

  • 16 / 6

Start / End Page

  • 888 - 894

PubMed ID

  • 19690935

Pubmed Central ID

  • 19690935

Electronic International Standard Serial Number (EISSN)

  • 1532-6551

Digital Object Identifier (DOI)

  • 10.1007/s12350-009-9136-3

Language

  • eng

Conference Location

  • United States