Making the invisible visible-Phase dyssynchrony has potential as a new prognostic marker.
Making the invisible visible-Phase dyssynchrony has potential as a new prognostic marker.
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使不可见的相位不同步具有作为新的预后标记的潜力。
DOI：
10.1007/s12350-017-0929-5
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Slomka P.
中科院分区：
文献类型：
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作者：
Nakajima K;Okuda K;Matsuo S;Slomka P.
定量核成像分析可以增强图像中可见内容的置信度。例如，心肌灌注研究中的缺陷评分可以确认灌注异常的程度和严重程度，左心室射血分数（LVEF）可以确认心肌收缩力的严重程度，从而使观点普遍标准化。相比之下，相位不同步分析使得肉眼不可见的东西可见，从而提供了常规功能参数不能产生的观点。虽然方法可能是非常有吸引力的，相位不同步的结果来自心脏病患者需要适当的理解。心室收缩时间的相位分析最初是在20世纪80年代引入的，用于使用99 mTc-红细胞的门控血池研究。[1]通过可视化从基于像素或基于区域的时间-活动曲线导出的收缩时间序列，已经产生了一些有趣的结果。研究表明，收缩时间顺序包括束分支阻滞2，其中心室电阻滞时收缩延迟，以及预激综合征3，其中附件传导通路部位的收缩提前。局部室壁运动异常的测量使用两个参数的相位和振幅，这表明运动功能减退和运动障碍作为一个非常低的振幅和延迟相，分别。门控心肌灌注单光子发射计算机断层扫描（SPECT）出现后，它已被用来评估区域不同步，并确定是否需要心脏起搏治疗（CRT）。4门控血池研究使用区域或基于像素的容积曲线，而门控心肌灌注成像（MPI）研究使用壁增厚值或计数变化。目前的供应商最近在其软件包中包括了相分析，用于定量分析。4-7门控MPI研究中有关相位的信息是一种不同于传统室壁运动分析的新观点，相位分析在心肌损伤或原发性和继发性心肌病中的作用尚未确定。在这一期的《核心脏病学杂志》中，相位分析被应用于慢性肾脏病（CKD）患者，据报道，增加的不同步性与预后有关。8在直接进行临床应用之前，我们将回顾技术上的混杂因素，以了解相位分析对临床研究的真实的价值。
Quantitative nuclear imaging analysis can enhance confidence in what is visible in the images. For example, defect scoring in myocardial perfusion studies can confirm the extent and severity of perfusion abnormalities, and left ventricular ejection fraction (LVEF) can confirm the severity of cardiac contractility so that the viewpoint is universally standardized. In contrast, phase dyssynchrony analysis renders what is invisible to the naked eye visible and thus provides a viewpoint that conventional functional parameters cannot produce. Although the methodology could be very attractive, phase dyssynchrony findings derived from patients with heart disease need to be appropriately understood. Phase analysis of the timing of ventricular contractions was initially introduced during the 1980s for gated blood-pool studies using 99mTc-red blood cells. 1 Some interesting results have been generated by visualizing sequences of contraction timing derived from pixelbased or region-based time-activity curves. Studies that have shown sequences of contraction timing include bundle branch block, 2 in which contraction is delayed in the electrically blocked ventricle, and pre-excitation syndrome, 3 in which contraction is early at the site of an accessory conduction pathway. Regional ventricular wall motion abnormalities are measured using the two parameters of phase and amplitude, which show hypokinesis and dyskinesis as a very low amplitude and a delayed phase, respectively. After the advent of gated myocardial perfusion single-photon emission computed tomography (SPECT), it has been used to evaluate regional dyssynchrony and to determine the need for cardiac resynchronization therapy (CRT). 4 Gated bloodpool studies use regional or pixel-based volume curves, whereas gated myocardial perfusion imaging (MPI) studies use wall thickening values or changes in counts. Current providers have recently included phase analysis in their software packages for quantitative analysis. 4-7 Information about phase in gated MPI studies is a new viewpoint that differs from conventional wall motion analysis, and the role of phase analysis in myocardial damage or primary and secondary cardiomyopathy has yet to be determined. In this issue of the Journal of Nuclear Cardiology, phase analysis was applied to patients with chronic kidney disease (CKD), and increased dyssynchrony was reportedly related to prognosis. 8 Before directly proceeding to clinical applications, we will review technologically confounding factors to understand the real value of phase analysis to clinical studies.