Cut-off values of myocardial perfusion gated-SPECT phase analysis parameters of normal subjects, and conduction and mechanical cardiac diseases

Romero-Farina, Guillermo; Aguadé-Bruix, Santiago; Candell‐Riera, Jaume; Pizzi, M.N.; Garcı́a-Dorado, David

doi:10.1007/s12350-015-0143-2

Cited by 29 publications

(17 citation statements)

References 30 publications

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“…Romeo-Farina reported that both bandwidth and phase SD showed excellent ROC AUCs, and these indices were the most important parameters [26]. ROC AUCs of bandwidth, phase SD, and entropy showed good diagnostic accuracy with values ≥0.850 in our results.…”

Section: Discussionsupporting

confidence: 67%

Comparison of diagnostic performance of four software packages for phase dyssynchrony analysis in gated myocardial perfusion SPECT

et al. 2017

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BackgroundPhase analysis of gated myocardial perfusion single-photon emission computed tomography (SPECT) for assessment of left ventricular (LV) dyssynchrony was investigated using the following dedicated software packages: Corridor4DM (4DM), cardioREPO (cREPO), Emory Cardiac Toolbox (ECTb), and quantitative gated SPECT (QGS). The purpose of this study was to evaluate the normal values of 95% histogram bandwidth, phase standard deviation (SD), and entropy and to compare the diagnostic performance of the four software packages. A total of 122 patients with normal myocardial perfusion and cardiac function (58.9 ± 12.3 years, 60 women, ejection fraction (EF) 74.3 ± 5.7%, and end-diastolic volume (EDV) 83.5 ± 3.6 mL) and 34 patients with suspected LV dyssynchrony (64.1 ± 12.2 years, 9 women, EF 52.0 ± 18.0%, and EDV 145.0 ± 6.8 mL) who underwent Tc-99m methoxy-isobutyl-isonitrile/tetrofosmin gated SPECT were retrospectively evaluated. Dyssynchrony indices of the 95% histogram bandwidth, phase SD, and entropy were computed with the four software programs. Diagnostic performance of LV phase dyssynchrony assessments was determined by receiver operator characteristic (ROC) analysis. The area under the ROC curve (AUC) was used to compare the software programs. The optimal cutoff point was determined by ROC curve based on the Youden index.ResultsThe average of normal bandwidth significantly differed among the four software programs except in the comparison of 4DM and ECTb. Moreover, the normal phase SD significantly differed among the four software programs except in the comparison of cREPO and ECTb. The software programs showed high correlation levels for bandwidth, phase SD, and entropy (r ≥ 0.73, p < 0.001). ROC AUCs of bandwidth, phase SD, and entropy were ≥0.850, ≥0.858, and ≥0.900, respectively. Moreover, the ROC AUCs of bandwidth, phase SD, and entropy did not significantly differ among the four software programs. Optimal cutoff points for phase parameters were 24°–42° for bandwidth, 8.6°–15.3° for phase SD, and 31–48% for entropy.ConclusionsAlthough the optimal cutoff value for determining LV phase dyssynchrony by ROC analysis varied depending on the use of the different software programs, all software programs can be used reliably for phase dyssynchrony analysis.

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Section: Discussionsupporting

confidence: 67%

Comparison of diagnostic performance of four software packages for phase dyssynchrony analysis in gated myocardial perfusion SPECT

et al. 2017

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“…12 While there are expected differences in phase analysis indices when GSPECT data are reconstructed by different software, 13,14 the normal cut-off used by Fudim et al 4 are strikingly higher than those reported previously in similarly large derivation cohorts. 15 These values are significantly higher than reported from the same software (likely older version) by Chen et al (initial work on LVD) 12 and by Romero-Farina et al, 15 among normal controls. If this severe variability in measures of phase analysis is solely due to change in SPECT software versions need further investigation, as this will significantly hamper application and serial assessment of LVD in at-risk patients.…”

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confidence: 69%

Dyssynchrony as a marker of adverse prognosis among patients with coronary artery disease and heart failure

Malhotra

2020

Journal of Nuclear Cardiology

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“…to help come up with a decision about CRT implantation. 28,29 Unfortunately, to date we lack prospective randomized trials to show the value of such MPI dyssynchrony parameters on clinical decision making for CRT patient selection and CRT lead positioning. Thus future work will be tremendously important to clarify the significance of MPI-derived dyssynchrony in patients with and without electrical dyssynchrony and whether it is of value in guiding treatment pathways.…”

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confidence: 99%

A troubled marriage: When electrical and mechanical dyssynchrony don’t go along

Fudim

Borges‐Neto²

2019

Journal of Nuclear Cardiology

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The following editorial refers to the article published by Sillanmäki et al. titled ''Relationships between electrical and mechanical dyssynchrony in patients with left bundle branch block and healthy controls'' in the XX edition of the Journal of Nuclear Cardiology.Mechanical contraction of the heart muscle is initiated by electrical activation of myocytes. Left ventricular mechanical dyssynchrony (LVMD) refers to a difference in the timing of mechanical contraction or relaxation between different segments of the left ventricle (LV). It is important to acknowledge that mechanical dyssynchrony does not equal electrical dyssynchrony which is defined by an asynchronous electrical activation of the LV leading to a prolonged QRS duration ([ 120 ms) on the ECG, and is usually the result of a left bundle branch block (LBBB). Although electrical and mechanical dyssynchrony often coincide, electrical and mechanical dyssynchrony are commonly not present at the same time in a given patient. 1,2 Cardiac resynchronization therapy (CRT) was developed with the goal to treat mechanical dyssynchrony with the hope it will improve cardiac performance and improve outcomes. [3][4][5] Right at the getgo the simple assumption was made that electrical dyssynchrony and mechanical dyssynchrony track well with each other, and since it is so much easier to mea-sure and quantify electrical dyssynchrony (presence of absence of a LBBB and QRS width), the electrical dyssynchrony on ECG became the designated target of CRT. Currently, presence of electrical dyssynchrony is among the inclusion criteria for CRT in heart failure (HF) patients. Other criteria include left ventricular ejection fraction (LVEF) B 35% and New York Heart Association class II-IV despite optimal medical therapy. Under those criteria, biventricular pacing has been shown to reduce all-cause mortality. 6 Nonetheless, among patients who meet the criteria, around 30% to 40% fail to show an improvement in clinical symptoms and cardiac function, 7 suggesting the need for a more efficient selection of CRT candidates to improve patient outcomes and decrease costs. Today we know that diseased hearts with electrical dyssynchrony do not equally respond to CRT. The two key determinants of treatment response that emerged are QRS width and presence of LBBB. Meta-analysis of three randomized trials suggests that a wide QRS duration [ 150 ms, regardless of QRS morphology, is most important for CRT response. 8 Further, the majority of clinical trials that studied CRT have found that it is mostly efficacious in patients with LBBB. 9-11 More recent work now suggests that LBBB in itself may represent a previously unrecognized cause of LV dysfunction and may impair left ventricular recovery. 12 In the present analysis the authors set out to investigate the LBBB and its relationship with mechanical dyssynchrony using myocardial perfusion imaging (MPI) and vector electrocardiography (VECG, another surrogate of mechanical myocyte activation, derived form an ECG analysis). In a retrospective analys...

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Cut-off values of myocardial perfusion gated-SPECT phase analysis parameters of normal subjects, and conduction and mechanical cardiac diseases

Abstract: In this pilot study, different CO values of phase histogram parameters were observed between normal subjects and patients with conduction and MCD, and between patients with and without criteria of cardiac resynchronization therapy.

Cited by 29 publications

References 30 publications

Comparison of diagnostic performance of four software packages for phase dyssynchrony analysis in gated myocardial perfusion SPECT

Comparison of diagnostic performance of four software packages for phase dyssynchrony analysis in gated myocardial perfusion SPECT

Dyssynchrony as a marker of adverse prognosis among patients with coronary artery disease and heart failure

A troubled marriage: When electrical and mechanical dyssynchrony don’t go along

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