Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease.

PURPOSE: The aim of this study was to evaluate the prognostic value of additional evaluation of left ventricular mechanical dyssynchrony (LVMD) by gated myocardial perfusion single-photon emission computed tomography (GMPS) in patients with acute myocardial infarction (MI) and multivessel disease. METHODS: One hundred and nine acute MI patients with >50 % stenosis in at least one non-culprit artery who underwent GMPS within 2 weeks were enrolled. All patients underwent successful revascularization of the culprit arteries. Those with previous MI, atrial fibrillation, or frequent ventricular premature complexes, cardiac devices, significant patient motion, or procedure-related events were excluded. Phase standard deviation (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. Patients were followed up for a median of 26 months after index MI, for composite major adverse cardiac events (MACE), which consisted with all-cause death, unplanned hospitalization due to heart failure and severe ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation). Independent predictors of MACE were evaluated. RESULTS: MACE occurred in 22 patients (20 %). Stress PSD (53.3 ± 17.3° vs. 35.3 ± 18.9°; p <0.001), stress PBW (147.6 ± 54.6° vs. 96.8 ± 59.2°; p = 0.001) and resting PBW (126.8 ± 37.5° vs. 96.6 ± 48.9°; p = 0.001) were significantly higher in patients with MACE compared to those without. Multivariate analysis revealed that stress PSD ≥45.5° and stress PBW ≥126.0° were predictive of MACE, as well as suboptimal non-culprit artery revascularization (SNR) and renin-angiotensin system (RAS) blockade medication. Higher stress PSD and stress PBW were associated with poorer prognosis both in patients with and without SNR, and those with RAS blockade medication, but not in those without RAS blockade medication. CONCLUSIONS: LVMD measured by GMPS showed added prognostic value in acute MI with multivessel disease. GMPS could serve as a comprehensive evaluation imaging tool in patients with acute MI and multivessel disease.

Motion-frozen Imaging by Gated Myocardial Perfusion Single Photon Emission Computed Tomography Using Multi-focus Fan Beam Collimator in Thallium-201 Study.

PURPOSE: This study aimed to evaluate the statistical noise of motion-frozen (MF) image generated by gated myocardial perfusion single photon emission computed tomography (SPECT) imaging using IQ · SPECT and to determine the optimal acquisition and reconstruction parameters for MF image using IQ · SPECT. METHODS: A movement cardiac phantom and static cardiac phantom were used to acquire the MF images. The acquisition times used were different in 8 and 16 frames per R-R interval, and varying reconstruction parameters (subset and iteration) were used. We determined the %CV value, contrast, and normalized mean square error (NMSE) to evaluate the image quality. RESULTS: The %CV value for a MF image with IQ · SPECT was lower than that for a conventional non-gated myocardial perfusion SPECT (MPS) image with low energy high resolution (LEHR). With regard to the acquisition parameters, the contrast did not change when the acquisition time was increased in 8 and 16 frames per R-R interval. NMSE converged in 56 beats/view in 8 frames per R-R interval. With regard to the reconstruction parameters, the contrast and the %CV value of the anterior and septal wall converged in update 40. The minimum NMSE in subsets 1, 2, and 3 were almost similar. CONCLUSIONS: Uniformity in the MF image with IQ · SPECT was higher than that in the conventional image. The results of this MF image with IQ · SPECT study suggest that the optimal acquisition parameter should be 56 beats/view in 8 frames per R-R interval, and the optimal reconstruction parameters should be subset 3 and iteration 14.

Left ventricular dyssynchrony in patients with moderate coronary stenosis and border line fractional flow reserve.

The cutoff values of fractional flow reserve (FFR) to detect physiological myocardial ischemia are still controversial. Some studies have reported that left ventricular (LV) dyssynchrony occurs in patients with coronary artery disease (CAD). The purpose of this study was to investigate LV dyssynchrony in patients with moderate coronary stenosis and borderline FFR, using stress electrocardiographically-gated myocardial perfusion single-photon emission computed tomography (SPECT). The study population comprised 10 patients with moderate (50-75% diameter) stenosis and an FFR in the range 0.75-0.90, who were compared to 10 control subjects. All underwent stress myocardial (99m)Tc-sestamibi (MIBI) or tetrofosmin SPECT imaging. The regional time to end systole (TES), time to peak ejection (TPE), and time to peak filling (TPF) were obtained as indexes of perfusion and function, using gated SPECT (pFAST) in combination with Cardio Gated SPECT Regional Assessment for LV Function (cardioGRAF). The dyssynchrony index (DI) was also calculated. The DI of post-stress TES was significantly greater than that of rest in patients with moderate CAD (4.8 ± 2.8 vs. 2.7 ± 1.5, P = 0.01), but there were no significant differences in the control subjects (3.0 ± 1.7 vs. 2.9 ± 1.9, P = 0.99). There were no significant differences in TPE and TPF between the groups. In conclusion, LV dyssynchrony may occur after stress in patients with coronary stenosis and borderline FFR, even without a significant reduction in perfusion.

Normal values of cardiac mechanical synchrony parameters using gated myocardial perfusion single-photon emission computed tomography: Impact of population and study protocol.

PURPOSE OF THE STUDY: Normal values of cardiac mechanical synchrony parameters in gated myocardial perfusion single-photon emission computed tomography (GMPS) are well established in literature from the Western population. The aim of the study is to establish normal values of mechanical synchrony with GMPS in Indian population and to find out whether it differs significantly from established values. PROCEDURE: We retrospectively analyzed 1 day low-dose stress/high-dose rest GMPS studies of 120 patients (sixty males, 52 ± 11.7 years) with low pretest likelihood of coronary artery disease and having normal GMPS study. In GMPS, first-harmonic fast Fourier transform was used to extract a phase array using commercially available software. Phase standard deviation (PSD) and phase histogram bandwidth (PHB) were used to quantify cardiac mechanical dyssynchrony. RESULTS: The values obtained were as follows, PSD: In men, 14.3 ± 4.7 (stress) and 8.9 ± 2.9 (rest), in women 11 ± 4 (stress) and 7.7 ± 2.7 (rest), and PHB: In men, 40.1 ± 11.9 (stress) and 30.6 ± 7.6 (rest), in women, 34.7 ± 12.6 (stress) and 25.3 ± 8.6 (rest). The value of PSD and PHB was significantly less in Indian population as compared with established values in literature. We also observed that synchrony indices derived from the low-dose stress studies are higher than high-dose rest studies. CONCLUSIONS: The value of synchrony parameters differs significantly according to population and methodology suggesting that specific population and methodology-based normal database for assessment of cardiac mechanical dyssynchrony should be established.