Quantitative Gated SPECT-Derived Phase Analysis on Gated Myocardial Perfusion SPECT Detects Left Ventricular Dyssynchrony and Predicts Response to Cardiac Resynchronization Therapy
Quantitative Gated SPECT-Derived Phase Analysis on Gated Myocardial Perfusion SPECT Detects Left Ventricular Dyssynchrony and Predicts Response to Cardiac Resynchronization Therapy
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DOI：
10.2967/jnumed.108.060657
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发表时间：
2009-05-01
影响因子：
9.3
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
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作者：
Boogers, Mark M.;Van Kriekinge, Serge D.;Bax, Jeroen J.
左心室 (LV) 不同步对于预测心脏再同步治疗 (CRT) 反应的重要性已得到证实。反映 LV 不同步的参数（相位 SD、直方图带宽）可以使用相位分析从门控心肌灌注 SPECT (GMPS) 中导出。使用定量门控 SPECT (QGS) 软件进行 LV 不同步评估和 GMPS 相位分析的可行性尚未在接受 CRT 的患者中得到证实。本研究的目的是验证用于 GMPS 相位分析的 QGS 算法，与使用组织多普勒成像 (TDI) 进行左心室不同步评估的超声心动图进行直接比较。此外，还评估了使用 GMPS 和相位分析对 CRT 反应的预测。方法：使用 GMPS 和 TDI 超声心动图对患有严重心力衰竭（纽约心脏协会 III-IV 级）、左室射血分数不超过 35%、QRS 波群大于或等于 120 ms 的患者 (n = 40) 进行左室不同步评估。在基线时和 CRT 6 个月后，评估临床状态、左心室容量和左心室射血分数。功能改善的患者被归类为 CRT 反应者。结果：源自 GMPS 的直方图带宽（r = 0.69，r(2) = 0.48，SEE = 25.4，P < 0.01）和相位 SD（r = 0.65，r(2) = 0.42，SEE = 26.8，P < 0.01）与用于评估左室不同步的 TDI 显着相关。在基线时，与无反应者相比，CRT 反应者表现出明显更大的直方图带宽（94 度+/- 23 度与 68 度+/- 21 度，P < 0.01）和更大的相位 SD（26 度+/- 6 度与 18 度+/- 5 度，P < 0.01）。接受者操作特征曲线分析确定了直方图带宽预测 CRT 反应的最佳截止值为 72.5 度，灵敏度为 83%，特异性为 81%。对于 SD 相，在 19.6 度的截止值处获得了与直方图带宽相似的灵敏度和特异性。结论：GMPS 的 QGS 时相分析与 TDI 显着相关，可用于评估 LV 不同步。此外，使用直方图带宽或相位 SD 可以获得高精度的 CRT 响应预测。
The significance of left ventricular (LV) dyssynchrony for the prediction of response to cardiac resynchronization therapy (CRT) has been demonstrated. Parameters reflecting LV dyssynchrony (phase SD, histogrambandwidth) can be derived from gated myocardial perfusion SPECT (GMPS) using phase analysis. The feasibility of LV dyssynchrony assessment with phase analysis on GMPS using Quantitative Gated SPECT (QGS) software has not been demonstrated in patients undergoing CRT. The aim of the present study was to validate the QGS algorithm for phase analysis on GMPS in a direct comparison with echocardiography using tissue Doppler imaging (TDI) for LV dyssynchrony assessment. Also, prediction of response to CRT using GMPS and phase analysis was evaluated. Methods: Patients (n = 40) with severe heart failure (New York Heart Association class III-IV), an LV ejection fraction of no more than 35%, and a QRS complex greater than or equal to 120 ms were evaluated for LV dyssynchrony using GMPS and echocardiography with TDI. At baseline and after 6 mo of CRT, clinical status, LV volumes, and LV ejection fraction were evaluated. Patients with functional improvement were classified as CRT responders. Results: Both histogram bandwidth (r = 0.69, r(2) = 0.48, SEE = 25.4, P < 0.01) and phase SD (r = 0.65, r(2) = 0.42, SEE = 26.8, P < 0.01) derived from GMPS correlated significantly with TDI for assessment of LV dyssynchrony. At baseline, CRT responders showed a significantly larger histogram bandwidth (94 degrees +/- 23 degrees vs. 68 degrees +/- 21 degrees, P < 0.01) and a larger phase SD (26 degrees +/- 6 degrees vs. 18 degrees +/- 5 degrees, P < 0.01) than did nonresponders. Receiver-operating-characteristic curve analysis identified an optimal cutoff value of 72.5 degrees for histogram bandwidth to predict CRT response, yielding a sensitivity of 83% and a specificity of 81%. For phase SD, sensitivity and specificity similar to those for histogram bandwidth were obtained at a cutoff value of 19.6 degrees. Conclusion: QGS phase analysis on GMPS correlated significantly with TDI for the assessment of LV dyssynchrony. Moreover, a high accuracy for prediction of response to CRT was obtained using either histogram bandwidth or phase SD.