Characterization of mechanical dyssynchrony measured by gated single photon emission computed tomography phase analysis after acute ST-elevation myocardial infarction

Jonathan R Murrow, Fabio Esteves, James Galt, Ji Chen, Ernest Garcia, Ji Lin, Stamatios Lerakis, Salman Sher, F. Khan Pohlel, Edmund K. Waller, Douglas Vaughan, Emerson Perin, James Willerson, Dean Kereiakes, Robert Preti, Andrew L. Pecora, Arshed A. Quyyumi

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15 Scopus citations

Abstract

Background. Left ventricular dyssynchrony is an adverse consequence of ST-elevation myocardial infarction (STEMI) and bears an unfavorable prognosis. Mechanical dyssynchrony as measured by phase analysis from gated single photon emission computed tomography (GSPECT) correlates well with other imaging methods of assessing dyssynchrony but has not been studied in STEMI. We hypothesized that systolic dyssynchrony as measured by GSPECT would correlate with adverse remodeling after STEMI. Methods. In 28 subjects suffering STEMI, GSPECT with technetium-99m sestamibi was performed immediately after presentation (day 5) and remotely (6 months). Parameters of left ventricular dyssynchrony (QRS width, histogram bandwidth (HBW) and phase standard deviation (PSD)) were measured from GSPECT using the Emory Cardiac Toolbox. Left ventricular volumes, ejection fraction (LVEF) and infarct size were also assessed. Results. After successful primary percutaneous coronary intervention to the infarct-related artery, subjects had an LVEF of 46.4% ± 11% and a resting perfusion defect of 27.4% ± 16% at baseline. Baseline QRS width was normal (91.5 ± 17.5 ms). Subjects with STEMI had dyssynchrony compared with a cohort of 22 normal subjects (age 57.2 ± 10.6 years, <5% perfusion defect) by both HBW (100.3° ± 70.7° vs 26.5° ± 5.3°, P < .0001) and PSD (35.3° ± 16.9° vs 7.9° ± 2.1°, P < .0001). Baseline HBW correlated with resting perfusion defect size (r = 0.67, P < .001), end-systolic volume (r = 0.72, P < .001), end-diastolic volume (r = 0.63, P = .001), and inversely with LVEF (r = 20.74, P < .001). HBW and PSD improved over the follow-up period (224.1 ± 35.9 degrees, P = .003 and 28.7° ± 14.6°, P = .006, respectively), and improvement in HBW correlated with reduction in LV end-systolic volumes (r = 0.43, P = .034). Baseline HBW and PSD, however, did not independently predict LVEF at 6 months follow-up. Conclusions. After STEMI, subjects exhibit mechanical dyssynchrony as measured by GSPECT phase analysis without evidence of electrical dyssynchrony. Improvement in mechanical dyssynchrony correlates with beneficial ventricular remodeling. The full predictive value of this measure in post-infarct patients warrants further study. (J Nucl Cardiol 2011;18:912-9.)

Original languageEnglish (US)
Pages (from-to)912-919
Number of pages8
JournalJournal of Nuclear Cardiology
Volume18
Issue number5
DOIs
StatePublished - Oct 2011
Externally publishedYes

Keywords

  • Cardiomyopathy
  • Infarction
  • Left ventricular function
  • Myocardial
  • SPECT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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    Murrow, J. R., Esteves, F., Galt, J., Chen, J., Garcia, E., Lin, J., Lerakis, S., Sher, S., Pohlel, F. K., Waller, E. K., Vaughan, D., Perin, E., Willerson, J., Kereiakes, D., Preti, R., Pecora, A. L., & Quyyumi, A. A. (2011). Characterization of mechanical dyssynchrony measured by gated single photon emission computed tomography phase analysis after acute ST-elevation myocardial infarction. Journal of Nuclear Cardiology, 18(5), 912-919. https://doi.org/10.1007/s12350-011-9414-8