Iranian Heart Journal

Iranian Heart Journal

Gated SPECT Phase Analysis of Abnormal Left Ventricular Wall Motion Polar Maps in Patients With Normal Perfusion, Normal Global Function, and Low Pretest Probability of Ischemic Heart Disease

Document Type : Original Article

Authors
Fereidoon Rastgou 1
Ahmad Bitarafan-Rajabi 2
Omid Inanloo 1
Hadi Malek 1
Nahid Yaghoobi 1
Leila Hassanzadeh 3
Fahimeh Rayegan 1
Hassan Firoozabadi 1
1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
3 Department of Nuclear Medicine, School of Medicine, Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: One of the probable reasons for wall motion polar map abnormalities is left ventricular (LV) dyssynchrony. The objective of this study was to evaluate LV dyssynchrony via the phase analysis on myocardial perfusion imaging (MPI) in patients with a low pretest probability of ischemic heart disease (IHD) and normal electrocardiography (ECG)-gated MPI as the possible contributor to LV regional wall motion polar map abnormalities.
 
Methods: A total of 181 patients with a low likelihood of IHD, normal MPI, a normal global function, and a normal global ejection fraction were divided into 2 groups: Group A: 81 patients with abnormal regional wall motion and Group B: 100 patients with normal wall motion polar maps. Dyssynchrony in the LV wall was assessed in terms of the phase analysis indices of entropy, the phase histogram bandwidth, and the phase standard deviation quantified by quantitative gated SPECT software, and the results for both groups were compared.
 
Results: The mean entropy values in the LV anterior, lateral, inferior, and particularly septal walls (P < 0.0001), as well as the mean entropy value in the LV apical wall (P = 0.030), in Group A were significantly higher than those in Group B. Moreover, the phase histogram bandwidth and the phase standard deviation were considerably higher in Group A than in Group B in all LV walls (P < 0.0001), except the LV apical wall (P = 0.063 and P = 0.036) respectively.
 
Conclusions: Assessment of the phase analysis indices for LV dyssynchrony could be used in patients with a low probability of IHD, a normal LV perfusion, and abnormal wall motion polar maps as a complementary tool for the interpreting physician. (Iranian Heart Journal 2020; 21(4): 67-75)

Highlights

 

 

Keywords
Left ventricle
Dyssynchrony
Phase analysis
Phase histogram bandwidth
Phase standard deviation
Myocardial perfusion imaging

 

 
  1. Tavares A, Peclat T, Lima RSL. Prevalence and predictors of left intraventricular dyssynchrony determined by phase analysis in patients undergoing gatedSPECT myocardial perfusion imaging. The international journal of cardiovascular imaging 2016; 32:845-52.
  2. Yaghoobi N, Malek H. The age of reason for gated SPECT MPI to deal with cardiac dyssynchrony. Research in cardiovascular medicine 2015; 4.
  3. Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. Journal of nuclear cardiology 2005; 12:687-95.
  4. Malek H, Rayegan F, Firoozabadi H, Rastgoo F, Haghjoo M, Bakhshandeh H et al. Determination of normal ranges of regional and global phase parameters using gated myocardial perfusion imaging with Cedars-Sinai’s QGS software. Iranian Journal of Nuclear Medicine 2018; 26:16-21.
  5. Lin X, Xu H, Zhao X, Folks RD, Garcia EV, Soman P et al. Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies. Journal of nuclear cardiology: official publication of the American Society of Nuclear Cardiology 2010; 17:811-6.
  6. AlJaroudi W, Koneru J, Heo J, Iskandrian AE. Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. Journal of Nuclear Cardiology 2011; 18:36-42.
  7. Atchley AE, Trimble MA, Samad Z, Shaw LK, Pagnanelli R, Chen J et al. Use of phase analysis of gated SPECT perfusion imaging to quantify dyssynchrony in patients with mild-to-moderate left ventricular dysfunction. Journal of nuclear cardiology 2009; 16:888.
  8. Chen J, Garcia EV, Bax JJ, Iskandrian AE, Borges-Neto S, Soman P. SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony. Journal of Nuclear Cardiology 2011; 18:685-94.
  9. Boogers MM, Van Kriekinge SD, Henneman MM, Ypenburg C, Van Bommel RJ, Boersma E et al. Quantitative gated SPECT-derived phase analysis on gated myocardial perfusion SPECT detects left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy. J Nucl Med 2009; 50:718-25.
  10. Chen J, Henneman MM, Trimble MA, Bax JJ, Borges-Neto S, Iskandrian AE et al. Assessment of left ventricular mechanical dyssynchrony by phase analysis of ECG-gated SPECT myocardial perfusion imaging. Journal of Nuclear Cardiology 2008; 15:127-36.
  11. Singh H, Patel CD, Sharma P, Naik N, Singh S, Narang R. Does perfusion pattern influence stress-induced changes in left ventricular mechanical dyssynchrony on thallium-201-gated SPECT myocardial perfusion imaging? Journal of Nuclear Cardiology 2015; 22:36-43.
  12. Zhou W, Jiang Z, Chen J, Garcia EV, Li D. Development and validation of a phase analysis tool to measure interventricular mechanical dyssynchrony from gated SPECT MPI. Journal of Nuclear Cardiology 2017; 24:1680-6.
  13. Malek H, Yaghoobi N, Hedayati R. Artifacts in Quantitative analysis of myocardial perfusion SPECT, using Cedars-Sinai QPS Software. Journal of Nuclear Cardiology 2017; 24:534-42.
  14. Rastgou F, Shojaeifard M, Amin A, Ghaedian T, Firoozabadi H, Malek H et al. Assessment of left ventricular mechanical dyssynchrony by phase analysis of gated-SPECT myocardial perfusion imaging and tissue Doppler imaging: Comparison between QGS and ECTb software packages. Journal of Nuclear Cardiology 2014; 21:1062-71.
  15. Shojaeifard M, Ghaedian T, Yaghoobi N, Malek H, Firoozabadi H, Bitarafan-Rajabi A et al. Comparison of gated SPECT myocardial perfusion imaging with echocardiography for the measurement of left ventricular volumes and ejection fraction in patients with severe heart failure. Research in cardiovascular medicine 2016; 5.
  16. van der Veen BJ, Al Younis I, Ajmone-Marsan N, Westenberg JJM, Bax JJ, Stokkel MPM et al. Ventricular dyssynchrony assessed by gated myocardial perfusion SPECT using a geometrical approach: a feasibility study. European Journal of Nuclear Medicine and Molecular Imaging 2012; 39:421-9.
  17. Zafrir N, Nevzorov R, Bental T, Strasberg B, Gutstein A, Mats I et al. Prognostic value of left ventricular dyssynchrony by myocardial perfusion-gated SPECT in patients with normal and abnormal left ventricular functions. Journal of Nuclear Cardiology 2014; 21:532-40.
  18. Bitarafan-Rajabi A, Rajabi H, Rastgou F, Firoozabady H, Yaghoobi N, Malek H et al. Influence of respiratory motion correction on quantification of myocardial perfusion SPECT. Journal of Nuclear Cardiology 2015; 22:1019-30.
  19. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol 2009; 53:623-32.
  20. Hess PL, Shaw LK, Fudim M, Iskandrian AE, Borges-Neto S. The prognostic value of mechanical left ventricular dyssynchrony defined by phase analysis from gated single-photon emission computed tomography myocardial perfusion imaging among patients with coronary heart disease. Journal of Nuclear Cardiology 2017; 24:482-90.
  21. Zhang J, Guo J, Hou X, Wang Y, Qian Z, Li K et al. Comparison of the effects of selective and non-selective His bundle pacing on cardiac electrical and mechanical synchrony. EP Europace 2017.
  22. Chen CC, Shen TY, Chang MC, Hung GU, Chen WC, Kao CH et al. Stress-induced myocardial ischemia is associated with early post-stress left ventricular mechanical dyssynchrony as assessed by phase analysis of 201Tl gated SPECT myocardial perfusion imaging. European journal of nuclear medicine and molecular imaging 2012; 39:1904-9.

 

Iranian Heart Journal
Volume 21, Issue 4
Autumn 2020
Pages 56-64