An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis

Botvinick, Elias H.; Frais, Michael A.; Shosa, D; O’Connell, Joe; Pacheco-Alvarez, Jose A.; Scheinman, Melvin M.; Hattner, Robert S.; Morady, F.; Faulkner, D.

doi:10.1016/0002-9149(82)90179-5

Cited by 94 publications

(34 citation statements)

References 12 publications

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“…The FFH phase angle derived from wall thickening information is often used to quantify the onset of ventricular contraction (19). This angle, however, can be influenced by a variety of other timing factors (33), a problem that can be more easily alleviated in high-frame-rate imaging techniques such as radionuclide angiography by discarding a fraction of the late diastolic filling phase frames (15).…”

Section: Study Limitationsmentioning

confidence: 99%

“…Early on, phase analysis was used with equilibrium radionuclide angiography (15) and applied to the characterization of abnormal patterns of ventricular activation (16), including the diagnosis of bundle branch blocks (17,18). More recently, phase analysis has been applied to gated myocardial perfusion SPECT (MPS), in which global synchrony measures derived from countbased thickening (19) have been shown to correlate with tissue Doppler imaging-derived measures of intraventricular delay (20) and, in a preliminary study, to predict response to CRT (21).…”

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confidence: 99%

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Automatic Global and Regional Phase Analysis from Gated Myocardial Perfusion SPECT Imaging: Application to the Characterization of Ventricular Contraction in Patients with Left Bundle Branch Block

Kriekinge¹,

Nishina²,

Ohba³

et al. 2008

J Nucl Med

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Although many patients with heart failure benefit from cardiac resynchronization therapy (CRT), predicting which patients will respond to CRT remains challenging. Recent evidence suggests that the analysis of mechanical dyssynchrony using gated myocardial perfusion SPECT (MPS) may be an effective tool. The aim of this study was to evaluate global and regional gated MPS dyssynchrony measurements by comparing parameters obtained from patients with a low likelihood (LLk) of conduction abnormalities and coronary artery disease and patients with left bundle branch block (LBBB). Methods: A total of 86 consecutive patients with LLk and 72 consecutive patients with LBBB, all without prior myocardial infarction or sternotomy, were studied using gated MPS. Global (histogram SD [s], bandwidth [b], and entropy [e]) and regional (wall-and segment-based differences of means [Dm W and Dm S , respectively] or modes [DM W and DM S , respectively]) dyssynchrony measures were calculated by Fourier harmonic phase-angle analysis of local myocardial count variations over the cardiac cycle for each patient, and then unpaired t tests were used to determine which parameters were sex-specific and how well they discriminated between the LLk and LBBB populations. Receiver-operating-characteristic analysis was also performed to calculate the area under the curve (AUC), sensitivity (Ss), specificity (Sp), and optimal threshold (Th). Results: Global parameters were found to be sex-specific, whereas regional differences were sex-independent. All parameters studied showed statistically significant differences between the groups (all global, P , 0.05; all regional, P , 0.0001). Receiver-operating-characteristic analysis yielded higher AUC, Ss, and Sp for e and regional parameters (e: AUC 5 The computed parameters all discriminate effectively between LLk and LBBB populations. Measurements that are less dependent on the shape of the phase-angle distribution histogram provided higher sensitivity and specificity for this purpose. Further study is needed to evaluate these parameters for the purpose of predicting response to CRT.Key Words: left ventricular dyssynchrony; left bundle branch block; cardiac resynchronization therapy; myocardial perfusion gated SPECT

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Section: Study Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

Automatic Global and Regional Phase Analysis from Gated Myocardial Perfusion SPECT Imaging: Application to the Characterization of Ventricular Contraction in Patients with Left Bundle Branch Block

Kriekinge¹,

Nishina²,

Ohba³

et al. 2008

J Nucl Med

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“…These mechanical delays were identified long ago by echocardiographic or phase-analysis angioscintigraphic studies. [12][13][14][15] Capture of the RV modified the contraction of both the RV and the LV. It is noteworthy that the considerable prolongation of the overall ventricular contraction was due to a marked difference between the two ventricles, such that LV contraction begins when contraction of the RV ends.…”

Section: Iatrogenic Dyssynchrony and The Evolution Of Resynchronizatimentioning

confidence: 99%

Cardiac Resynchronization Therapy: Biventricular Pacing

Lee¹

2006

Korean Circ J

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Although the estimates from limited studies vary on the proportion of patients with heart failure who also have ventricular dyssynchrony as reflected by a prolonged QRS complex, often in the form of left bundle branch block, the number of such patients is large (27% to 53%) and it is certainly in excess of the rate for the general population. Among these patients, 10% to 15% are candidates for cardiac resynchronization therapy (CRT) via biventricular pacing. Accumulated evidence from randomized controlled studies over the last few years has indicated that significant hemodynamic and clinical improvement is conferred by CRT to the class III or IV heart failure patients with idiopathic or ischemic dilated cardiomyopathy and who also have a low left ventricular ejection fraction (≤35%) and a wide QRS complex (≥120-150 ms). Newer data suggest a significant reduction in mortality and heart failure hospitalization, particularly when CRT is combined with an automatic defibrillator backup. This technique has transformed the traditional concepts associated with stimulation of the heart, and it is now being applied not only to restore an appropriate heart rate, but also to change the process of cardiac mechanical activation. Since this treatment must be integrated within a comprehensive and multidisciplinary CHF management program, CRT has altered the medical practice of heart experts in the field of cardiac pacing. Technical advances with percutaneous methods that access the tributaries of the cardiac veins have raised the success rate of implanting left ventricular leads to >90%. Further confirmation from ongoing trials is eagerly awaited, and more data from the studies on this procedure's cost effectiveness are needed before CRT is considered as a prime therapy in the heart failure population.

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“…Sequential regional phase mapping of radionuclide gated blood pool scintigraphy has become a widely used technique for noninvasive assessment of regional ven bundle branch block [4][5][6][7], Wolff-Parkinson-White syn drome [5,8] and artificial pacing [9], The ability of this technique to detect abnormal foci of electrical activation has been assessed in patients with ectopic ventricular beats [10] and sustained ventricular tachycardia (VT) [11][12][13][14], It has been reported that phase mapping of VT pro vides noninvasive data consistent with the electrophy siologic characteristics of this arrhythmia [11][12][13]. How ever, few data are still available on the correlation between phase mapping and the conventional electrical mapping in patients with VT [12][13][14] and controversy still exists about the actual role of radionuclide studies in this particular setting.…”

Section: Introductionmentioning

confidence: 99%

“…tricular contraction. Recent studies have indicated that phase mapping may also be of value in the assessment of activation and conduction abnormalities [1][2][3][4][5]. …”

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confidence: 99%

Radionuclide Phase Imaging of Ventricular Tachycardia

Verna¹,

Casucci²,

S³

et al. 1989

Am J Noninvas Cardiol

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The emptying sequence of ventricular blood pool was studied by scintigraphic regional phase mapping in 10 patients with monomorphic and sustained ventricular tachycardia (VT) and compared to an electrophysiological study in order to assess the scintigraphic accuracy for the noninvasive localization of abnormal site of activation. All patients underwent both phase imaging and electrical mapping studies. There were 6 coronary artery disease patients, 3 patients with arrhythmogenic right ventricular disease and 1 patient with dilatative cardiomyopathy. Phase image studies were performed by first harmonic Fourier analysis of radionuclide angiography either during sinus rhythm or during spontaneous or catheter-induced VT. Eleven morphologically distinct VTs with a heart rate ranging from 145 to 260 beats min^-1 (mean 173 ± 32 beats min^-1) were imaged. Endocardial catheter mapping was accomplished in 9 different VT morphologies. Three patients also had epicardial intraoperative mapping. The site of origin of VT by a scintigraphic method was defined as the area of earliest regional contraction on the biventricular scintigram. By separating the right ventricle into 5 segments and the left ventricle into 7 segments, with multiple view cardiac imaging, a close correspondence between the site of origin determined by electrophysiological study and the region of earliest emptying of radioactivity was observed in 7 of 9 (77%) VTs. In 2 patients the extension of regional akinesia during VT prevented us from an accurate mapping of the regional time sequence of contraction. Scintigraphic phase mapping has inherent limitations due to wall motion dependency and relatively low resolution power but it is feasible in selected patients with monomorphic, inducible and long-sustained VT in whom adequate time for data collection is provided. In this subset of patients the site of origin of VT could be localized on a 'segmental' basis with close correspondence to electrophysiological mapping studies.

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An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis

Cited by 94 publications

References 12 publications

Automatic Global and Regional Phase Analysis from Gated Myocardial Perfusion SPECT Imaging: Application to the Characterization of Ventricular Contraction in Patients with Left Bundle Branch Block

Automatic Global and Regional Phase Analysis from Gated Myocardial Perfusion SPECT Imaging: Application to the Characterization of Ventricular Contraction in Patients with Left Bundle Branch Block

Cardiac Resynchronization Therapy: Biventricular Pacing

Radionuclide Phase Imaging of Ventricular Tachycardia

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