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

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 1 2011
Externally publishedYes

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Single-Photon Emission-Computed Tomography
Stroke Volume
Perfusion
Technetium Tc 99m Sestamibi
Ventricular Remodeling
Percutaneous Coronary Intervention
ST Elevation Myocardial Infarction
Arteries

Keywords

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

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Characterization of mechanical dyssynchrony measured by gated single photon emission computed tomography phase analysis after acute ST-elevation myocardial infarction. / Murrow, Jonathan R; Esteves, Fabio; Galt, James; Chen, Ji; Garcia, Ernest; Lin, Ji; Lerakis, Stamatios; Sher, Salman; Pohlel, F. Khan; Waller, Edmund K.; Vaughan, Douglas; Perin, Emerson; Willerson, James; Kereiakes, Dean; Preti, Robert; Pecora, Andrew L.; Quyyumi, Arshed A.

In: Journal of Nuclear Cardiology, Vol. 18, No. 5, 01.10.2011, p. 912-919.

Research output: Contribution to journalArticle

Murrow, JR, Esteves, F, Galt, J, Chen, J, Garcia, E, Lin, J, Lerakis, S, Sher, S, Pohlel, FK, Waller, EK, Vaughan, D, Perin, E, Willerson, J, Kereiakes, D, Preti, R, Pecora, AL & Quyyumi, AA 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, vol. 18, no. 5, pp. 912-919. https://doi.org/10.1007/s12350-011-9414-8
Murrow, Jonathan R ; Esteves, Fabio ; Galt, James ; Chen, Ji ; Garcia, Ernest ; Lin, Ji ; Lerakis, Stamatios ; Sher, Salman ; Pohlel, F. Khan ; Waller, Edmund K. ; Vaughan, Douglas ; Perin, Emerson ; Willerson, James ; Kereiakes, Dean ; Preti, Robert ; Pecora, Andrew L. ; Quyyumi, Arshed A. / Characterization of mechanical dyssynchrony measured by gated single photon emission computed tomography phase analysis after acute ST-elevation myocardial infarction. In: Journal of Nuclear Cardiology. 2011 ; Vol. 18, No. 5. pp. 912-919.
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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.)",
keywords = "Cardiomyopathy, Infarction, Left ventricular function, Myocardial, SPECT",
author = "Murrow, {Jonathan R} and Fabio Esteves and James Galt and Ji Chen and Ernest Garcia and Ji Lin and Stamatios Lerakis and Salman Sher and Pohlel, {F. Khan} and Waller, {Edmund K.} and Douglas Vaughan and Emerson Perin and James Willerson and Dean Kereiakes and Robert Preti and Pecora, {Andrew L.} and Quyyumi, {Arshed A.}",
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TY - JOUR

T1 - Characterization of mechanical dyssynchrony measured by gated single photon emission computed tomography phase analysis after acute ST-elevation myocardial infarction

AU - Murrow, Jonathan R

AU - Esteves, Fabio

AU - Galt, James

AU - Chen, Ji

AU - Garcia, Ernest

AU - Lin, Ji

AU - Lerakis, Stamatios

AU - Sher, Salman

AU - Pohlel, F. Khan

AU - Waller, Edmund K.

AU - Vaughan, Douglas

AU - Perin, Emerson

AU - Willerson, James

AU - Kereiakes, Dean

AU - Preti, Robert

AU - Pecora, Andrew L.

AU - Quyyumi, Arshed A.

PY - 2011/10/1

Y1 - 2011/10/1

N2 - 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.)

AB - 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.)

KW - Cardiomyopathy

KW - Infarction

KW - Left ventricular function

KW - Myocardial

KW - SPECT

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