Phase analysis to measure left ventricular dyssynchrony by Gated-SPECT myocardial perfusion imaging showed by two different software

Conclusión Realizar el análisis fase de análisis por GS-PMI es factible. Sin embargo la DE mostró diferencias significativas entre los dos programas. Aunque los valores mostrados podrían ser utilizados como valores normales, se recomienda que éstos se obtengan y utilicen para cada programa por separado.

SCINTIGRAPHY AFTER VARIOUS METHODS OF MYOCARDIAL REVASCULARIZATION

Background. This article presents a comprehensive assessment of the perfusion-functional state of the LV myocardium after direct and indirect revascularization methods at various times after surgery to evaluate the complex relationship between myocardial viability and the method of revascularization. Methods. The study included 214 patients who underwent myocardial revascularization in various ways. Gated-SPECT was performed before the operation, as well as 1 month, 6 months, 1 year, and 2 or more years after the operation. Results. The groups of patients after CABG and CABG+YurLeon had differences in SRS indicators two years after surgery: 6.58±5.37 (after CABG) and 1,57±1,12 (CABG+YurLeon)(p<0.05).The most significant changes in systolic thickening (WT) occurred in segments with an accumulation of 26-40%: 1.8±1.14 (CABG), 0.51±0.35 (CABG+YurLeon), 2.6±1.19 (PCI); and in segments 41-50%: 1.23±1.10 (CABG), 0.14±0.11 (CABG+YurLeon), 2.1±0.8 (PCI) (p<0.05).In the long-term period after revascularization, the total percentage of LV myocardial segments with “functional-perfusion mismatch” stood at: 11.08±10.69% of segments (CABG), 1.26±1.2% (CABG+YurLeon), 18.44±8.70% (PCI) (p<0.05). Conclusions. Comprehensive diagnostics of patients before surgery, including gated-SPECT, allow medical professionals to more effectively choose the method of revascularization and predict the nearest and separated results. Coronary bypass surgery together with the YurLeon technique of indirect myocardial revascularization in patients with severe diffuse lesions of the coronary artery shows more effective results than other methods of surgically treating IHD.

Analysis of quantitative and qualitative indicators of myocardial function for planning and evaluation of the surgical treatment results in patients with coronary heart disease

Coronary heart disease (CHD) is the main cause of the occurrence and progression of heart failure, as well as mortality among the adult population, both in Russia and around the world. Determining the functional state of the myocardium before surgery allows one to choose the right treatment strategy, methods of surgical correction of coronary disorders, and predict outcomes.Aim. The research aims at the improvement of methods for predicting revascularization outcomes by creating a mathematical model depending on the number of viable myocardium.Material and methods. We examined 118 patients with a diagnosis of CHD who underwent surgical correction of coronary blood fl ow disorders with the use of direct and indirect revascularization methods at the Pirogov National Medical Center. We analyzed correlation between gated-SPECT, Echocardiography and operation results.Results. An inverse strong correlation has been found between LV contractility after surgery and the preoperative amount of scar myocardium and the end diastolic volume (EDV) LV (p < 0.05, Spearman criterion). A direct correlation has been determined between the improvement of EF and the volume of the hibernated myocardium (p < 0.05, Spearman criterion). There is a model for predicting EF after revascularization: Ejection fraction (after revascularization)(%) = 70.99126 − 0.10490 × EDV (ml) + 0.38827 × hibernated myocardium(%) − – 0,50137 × scar myocardium (%).Conclusion. Statistical modeling based on quantitative and qualitative assessment of the functional state of the myocardium in patients with CHD with the use of gated-SPECT and Echocardiography is an actual and necessary way to fi nd optimal solutions in the treatment and rehabilitation of patients with CHD.

Prognostic value of left ventricular ventricular dyssynchrony in left bundle branch block patients

Funding Acknowledgements Type of funding sources: None. Background Patients with left bundle branch block (LBBB) patterns on the electrocardiogram include a heterogeneous group of patients with different prognosis and some of them with or without left ventricular mechanical dyssynchrony (LVMD). LVMD obtained by gated technetium 99m single photon emission computed tomography (SPECT) imaging could be an early tool to detect myocardial damage, identifying a high risk group. Purpose The aim of this study was to assess the prognostic value of LVMD in LBBB patients. Methods Five hundred and eighty consecutive patients with LBBB were referred for gated SPECT from August 2011 to June 2019. Phase analysis parameters Standard deviation (SD) and histogram bandwidth (HB) were obtained in rest gated SPECT imaging. LVMD was defined as the upper limit of the highest normal for phase analysis results in our control patients mean values plus two standard deviations (SD ≥ 21° or HB ≥ 67°). Follow up was performed by telephone contact or medical history review. Hard endpoint was all-cause death. Event-free survival curves were obtained. Univariate and multivariate regression analysis were performed. Results LVMD was observed in 254 (44%) patients. Compared to non LVMD patients had: similar age (67.68 ± 11.01 vs. 67.2 ± 10.3 y; p NS), more male (75.2% vs 39.6%), more hypertension (75.2% vs. 66.8%), more diabetes (22.8% vs. 13%) and more smoking history (31.9% vs. 23.7%) all p &lt;0.05. A total of 495 patients completed the follow up (mean 29.8 ± 25.8 months). Fourteen patients died (2.8%), 12 had LVMD. Fig 1 shows Kaplan-Meier curve of event-free survival in relation to LVMD. Variables associated with all-cause death in the univariate analysis were: Score Rest Summed ≥ 4 (p 0.02), LV ejection fraction ≤ 35% (p &lt; 0.01), diabetes (p 0.03) and LVMD (p &lt;0.01). The absence of LVMD was a predictor of the lower risk of all-cause death in the multivariate analysis (adjusted hazard ratio: 0.13, 95% confidence interval: 0.03- 0.56; p &lt; 0.01). Conclusion In our population of patients with LBBB, the absence of LVMD assessed by gated SPECT imaging identifies patients with lower risk of hard adverse events.

Myocardial perfusion findings evaluated by gated-SPECT in dyslipidemic very high-risk patients

Funding Acknowledgements Type of funding sources: None. Background. Dyslipidemia is one of the main risk factors for atherosclerotic disease. Timely diagnosis and appropriate treatment are therefore essential in the prevention and recurrence of cardiovascular disease (CVD). The detection of ischemia with myocardial perfusion gated-SPECT is a valuable diagnostic option that provides complete information to select the best therapeutic option, reducing morbidity and mortality in this group of patients. Purpose. To evaluate the findings of myocardial perfusion imaging (MPI) using gated-SPECT in a group of patients with dyslipidemia and very high cardiovascular risk. Methods. We retrospectively evaluated gated-SPECT results of 66 very high-risk dyslipidemic patients with a diagnosis or clinical suspicion of coronary artery disease (CAD). Exclusion criteria: structural heart disease, dilated hypertrophic cardiomyopathy, hemodynamic instability, low-intermediate risk. Rest-stress imaging with gated-SPECT Technetium-99m Sestamibi was acquired on a dedicated cardio gamma camera and subjectively evaluated in a 17-segment analysis. Ischemia was classified as mild, moderate, and severe. Statistical analysis: SPSS system, continuous data were expressed as mean ± SD, percentages were rounded; Chi-square and Student’s t-tests were used. Results. Mean age 61.06 ± 12.87 years old, 40 (61%) were men; 61 (92%) with primary and 5 (8%) with familial hypercholesterolemia. More than 80% have at least one or more cardiovascular (CV) risk factors; 73% have dyslipidemia, diabetes, and arterial hypertension, 52% tabaquism, 36% obesity, 11% kidney disease, and 30% family history of CV disease; all women were post-menopausal (44%). Asymptomatic (56%), 30% with dyspnea or equivalents, 9% atypical chest pain, and 5% typical angina. Gated-SPECT: 56% with ischemia; mild ischemia was present in 33% and 11% of men and women, and moderate in 35% and 27% respectively. Primary hypercholesterolemia: 26 % with mild, 28% moderate, and 46% without ischemia; 80% of familial hypercholesterolemia with moderate and 20% without ischemia. Conclusion. Myocardial ischemia was present in 56% of very high-risk dyslipidemic patients, predominantly in men (67.5%). Although 56% were asymptomatic, ischemia was detected in 54% of the patients with primary and 80% with familial hypercholesterolemia. It is advisable to perform MPI with gated-SPECT for the early detection of ischemia in high-risk dyslipidemic patients, even asymptomatic.

Cardiac synchronism assessment by myocardial perfusion imaging in patients with cardiac resynchronization therapy

Funding Acknowledgements Type of funding sources: None. Background the treatment of heart failure has undergone major therapeutic advances in recent decades, among them, cardiac resynchronization therapy (CRT), a strategy capable of reducing symptoms, hospitalization and mortality. It is known that up to 30% of patients undergoing CRT do not have a satisfactory response, based on current selection criteria. Purpose Myocardial perfusion scintigraphy by Gated-SPECT technique (Gated-SPECT) can provide important information such as mechanical timing, region of last mechanical activation and fibrosis which are very useful in the best selection of who would really benefit from this device. Objective to evaluate the presence of improvement in the mechanical synchronism of the left ventricle (LV) in patients with CRT, using the Synctool software used in the Gated-SPECT, as well as to correlate the data obtained with clinical improvement, defined by reduction of at least 1 New York Heart Association class and reduction of at least 5 points in the Minessota Living With Heart Failure Questionnaire (MLHFQ), and also correlate to other epidemiological, clinical, electrocardiographic and perfusional variables. Methods 31 patients (p) with CRT underwent Gated-SPECT at 2 different times: CRT on and off. A quality of life questionnaire was also applied and clinical data before and after implantation of the device were collected. Results improved synchronism with reduced histogram bandwidth (BWH) (215.6 ± 74.7 ° vs. 149.9 ± 67.9 °; p &lt;0.001) and phase standard deviation (SD) (65, 3 ± 21.7 ° vs. 53.1 ± 22.7 °; p &lt;0.001), after CRT is turned on. Patients who presented synchrony improvement had a higher frequency of clinical improvement (p = 0.026) and obtained lower values of LV end diastolic volume (204.4 ± 100.4 ml vs. 304.3 ± 77.2 ml; p = 0.028) and LV end-systolic volume (120.2 ± 88.8 ml vs. 197.5 ± 51.6 ml; p = 0.026). When clinical improvement was examined, 23 (74.1%) p were considered as responders and 8 (25.9%) as non-responders. Responders showed a significant increase in the LV ejection fraction (38.4 ± 14.1 vs. 47.9 ± 15.3; p &lt;0.001). Non-responders had a higher mean of myocardial involvement by fibrosis (12.9 ± 5.5% vs. 5.7 ± 8.4%; p = 0.033) and higher frequency of fibrosis in the lateral and inferolateral walls (50% vs. 8.7%; p = 0.026), presented an even lower percentage of localization of the region of last mechanical activation (LMA) in the lateral and inferolateral walls (12.5% vs 56.5%; p = 0.045), thus assuming a discordant position between fibrosis and the CRT pacing electrode in the LV. Conclusion Synctoll software are very useful to predict the evaluation of patients with CRT wich was able to improve the mechanical timing of the LV. Improvement in mechanical synchrony is associated with clinical improvement and marked reverse remodeling. Presence of fibrosis and region of last mechanical activation in the lateral and inferolateral walls are predictive factors of response to CRT.