title: Evaluation of left ventricular mechanical dyssynchrony as determined by phase analysis of ECG-gated SPECT myocardial perfusion imaging in patients with left ventricular dysfunction and conduction disturbances.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) is approved for the treatment of patients with advanced systolic heart failure and evidence of dyssynchrony on electrocardiograms. However, a significant percentage of patients do not demonstrate improvement with CRT. Echocardiographic techniques have been used for more accurate determination of dyssynchrony. Single photon emission computed tomography (SPECT) myocardial perfusion imaging has not previously been used to evaluate cardiac dyssynchrony. The objective of this study is to evaluate mechanical dyssynchrony as described by phase analysis of gated SPECT images in patients with left ventricular dysfunction, conduction delays, and ventricular paced rhythms.
  
  
  RESULTS
  A novel count-based method is used to extract regional systolic wall thickening amplitude and phase from gated SPECT images. Five indices describing the phase dispersion of the onset of mechanical contraction are determined: peak phase, phase SD, bandwidth, skewness, and kurtosis. These indices were determined in consecutive patients with left ventricular dysfunction (n = 120), left bundle branch block (n = 33), right bundle branch block (n = 19), and ventricular paced rhythms (n = 23) and were compared with normal control subjects (n = 157). Phase SD, bandwidth, skewness, and kurtosis were significantly different between patients with left ventricular dysfunction, left bundle branch block, right bundle branch block, and ventricular paced rhythms and normal control subjects (all P < .001) Peak phase was significantly different between patients with right ventricular paced rhythms and normal control subjects (P = .001).
  
  
  CONCLUSIONS
  A novel SPECT technique for describing left ventricular mechanical dyssynchrony has been developed and may prove useful in the evaluation of patients for CRT.
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Trimble
authors.forename: Salvador
authors.initials: S
authors.lastname: Borges-Neto
authors.forename: Stuart
authors.initials: S
authors.lastname: Smallheiser
authors.forename: Ji
authors.initials: J
authors.lastname: Chen
authors.forename: Emily F
authors.initials: EF
authors.lastname: Honeycutt
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.forename: Jaekyeong
authors.initials: J
authors.lastname: Heo
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pagnanelli
authors.forename: E Lindsey
authors.initials: EL
authors.lastname: Tauxe
authors.forename: Ernest V
authors.initials: EV
authors.lastname: Garcia
authors.forename: Fabio
authors.initials: F
authors.lastname: Esteves
authors.forename: Frank
authors.initials: F
authors.lastname: Seghatol-Eslami
authors.forename: G Neal
authors.initials: GN
authors.lastname: Kay
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging*