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CLINICAL RESEARCH: CARDIAC IMAGING

Phase Analysis of Gated Myocardial Perfusion Single-Photon Emission Computed Tomography Compared With Tissue Doppler Imaging for the Assessment of Left Ventricular Dyssynchrony

Maureen M. Henneman, MD^_*, Ji Chen, PhD^||, Claudia Ypenburg, MD^_*, Petra Dibbets, MSc, Gabe B. Bleeker, MD^_*,, Eric Boersma, PhD, Marcel P. Stokkel, MD, PhD, Ernst E. van der Wall, MD, PhD^_*,, Ernest V. Garcia, PhD^|| and Jeroen J. Bax, MD, PhD^_*,_*

^_* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
The Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands
^|| Department of Radiology, Emory University School of Medicine, Atlanta, Georgia.

Manuscript received August 23, 2006; revised manuscript received December 20, 2006, accepted January 3, 2007.

^_* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).

Objectives: The purpose of this study was to compare left ventricular (LV) dyssynchrony assessment by gated myocardial perfusion single-photon emission computed tomography (SPECT) (GMPS) and tissue Doppler imaging (TDI).

Background: Recently, it has been suggested that LV dyssynchrony is an important predictor of response to cardiac resynchronization therapy (CRT); dyssynchrony is predominantly assessed by TDI with echocardiography. Information on LV dyssynchrony can also be provided by GMPS with phase analysis of regional LV maximal count changes throughout the cardiac cycle, which tracks the onset of LV thickening.

Methods: In 75 patients with heart failure, depressed LV function, and wide QRS complex, GMPS and 2-dimensional echocardiography, including TDI, were performed as part of clinical screening for eligibility for CRT. Clinical status was evaluated with New York Heart Association functional classification, 6-min walk distance, and quality-of-life score. Different parameters (histogram bandwidth, phase SD, histogram skewness, and histogram kurtosis) of LV dyssynchrony were assessed from GMPS and compared with LV dyssynchrony on TDI with Pearson’s correlation analyses.

Results: Histogram bandwidth and phase SD correlated well with LV dyssynchrony assessed with TDI (r = 0.89, p < 0.0001 and r = 0.80, p < 0.0001, respectively). Histogram skewness and kurtosis correlated less well with LV dyssynchrony on TDI (r = –0.52, p < 0.0001 and r = –0.45, p < 0.0001, respectively).

Conclusions: The LV dyssynchrony assessed from GMPS correlated well with dyssynchrony assessed by TDI; histogram bandwidth and phase SD showed the best correlation with LV dyssynchrony on TDI. These parameters seem most optimal for assessment of LV dyssynchrony with gated SPECT. Outcome studies after CRT are needed to further validate the use of GMPS for assessment of LV dyssynchrony.

Abbreviations and Acronyms   CRT = cardiac resynchronization therapy   GMPS = gated myocardial perfusion single-photon emission computed tomography   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association   SPECT = single-photon emission computed tomography   TDI = tissue Doppler imaging

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