A unique method by which to quantitate synchrony with equilibrium radionuclide angiography

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• 作者：J. William O’Connell (1)
  Carole Schreck (1)
  Michael Moles (1)
  Nitish Badwar (1)
  Theresa DeMarco (1)
  Jeffrey Olgin (1)
  Byron Lee (1)
  Zian Tseng (1)
  Uday Kumar (1)
  Elias H. Botvinick (1)
  
• 刊名：Journal of Nuclear Cardiology
• 出版年：2005
• 出版时间：July 2005
• 年：2005
• 卷：12
• 期：4
• 页码：441-450
• 全文大小：247KB
• 参考文献：1. Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, et al. The pacing therapies in congestive heart failure study group. Long term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002;39:2026-3. CrossRef
  2. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140-0. CrossRef
  3. Young JB, Abraham WT, Leon AR, Smith AL, Canby RC, Liem LB, et al. Cardiac resynchronization improves functional status in patients with ventricular dyssynchrony and an ICD indication. Results from the Miracle ICD Trial [abstract]. Circulation 2002; 106;II-644.
  4. Yu CM, Fung JW, Zhang Q, Zhang Q, Chan C, Kong S, et al. Left ventricular reverse remodeling predicted rehospitalization for heart failure after cardiac resynchronization therapy [abstract]. J Am Coll Cardiol 2004;43:131A. CrossRef
  5. Stellbrink C, Breithard O, Franke A, Sack S, Bakker P, Auricchio A, et al. Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances. J Am Coll Cardiol 2001;38:1957-5. CrossRef
  6. Reuter S, Garrigue S, Barold SS, Jais P, Hocini M, Haissaguerre M, et al. Comparison of characteristics in responders versus nonresponders with biventricular pacing for drug resistant congestive heart failure. Am J Cardiol 2002;89:346-0. CrossRef
  7. Butter C Aurricchio A, Stellbrink C, Fleck E, Ding J, Yu Y, et al. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 2001;104:3026-. CrossRef
  8. Cazeau S, Gras D, Lazarus A, Ritter P, Mugica J. Multisite stimulation for collection of cardiac synchrony. Heart 2000;84:579-1. CrossRef
  9. Pitzalis M, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G, et al. Cardiac resynchronization therapy tailored by echocardio- graphic evaluation of ventricular asynchrony. J Am Coll Cardiol 2002;40:1615-2. CrossRef
  10. Cleland J, Daubert J, Erdmann E, Freemantle N, Gras D, Kappen-berger L, et al. The CARE-HF (CArdiac Resynchronization in Heart Failure) study: rationale, design and end-points. Eur J Heart Fail 2001;3:481-. CrossRef
  11. Miyatake K, Yamagishi M, Tanaka N, Uematsu M, Yamazaki N, Mine Y, et al. A new method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies. J Am Coll Cardiol 1995;25:717-4. CrossRef
  12. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Laurenti A, Fedele F, et al. Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment. Am Heart J 2001;142:881-6. CrossRef
  13. Yu C, Chau E, Sanderson JE, Fan K, Tang M, Fung W, et al. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002;105:438-5. CrossRef
  14. Sogaard P, Egeblad H, Kim W, Jensen HK, Pedersen AK, Kristensen BO, et al. Tissue Doppler imaging predicts improved systolic performance and reversed left ventricular remodeling during long term cardiac resynchronization therapy. J Am Coll Cardiol 2002;40:723-0. CrossRef
  15. Bax J, Molhoek SG, van Erven L, Voogd PJ, Somer S, Boersma E, et al. Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchrony before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2003;91:94-. CrossRef
  16. Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, et al. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol 2003;92:1238-0. CrossRef
  17. Rose E, Marcus GM, Viloria EM, Schafer J, DeMarco T, Saxon LA, et al. Intraventricular conduction delay does not predict clinical benefit with cardiac resynchronization [abstract]. Circulation 2003; 108:IV-628.
  18. Nelson G, Berger RD, Fetics BJ, Talbot M, Spinelli J, Hare JM, et al. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle branch block. Circulation 2000; 102:3053-.
  19. Kass DA. Predicting cardiac resynchronization response by QRS duration: the long and short of it. J Am Coll Cardiol 2003;42:2125-. CrossRef
  20. Toussaint JF, Peix A, Lavergne T, Vicente FP, Froissait M, Alonso C, et al. Reproducibility of the ventricular synchronization parameters assessed by multiharmonic phase analysis of radionuclide angiography in the normal heart. Int J Cardiovasc Imaging 2002; 18:187-4. CrossRef
  21. Toussaint JF, Lavergne T, Kerrou K, DeDieuleveult B, Ponce F, Froissait M, et al. Ventricular coupling of electrical and mechanical dyssynchronization in heart failure. Pacing Clin Electrophysiol 2002;25:178-2. CrossRef
  22. Le Rest C, Couturier O, Turzo A, Guillo P, Bizais Y, Etienne Y, et al. Use of left ventricular pacing in heart failure: evaluation by gated blood pool imaging. J Nucl Cardiol 1999;6:651-. CrossRef
  23. Toussaint JF, Lavergne T, Ollitraut J, Hignette C, Darondel J, Dieuleveult B, et al. Biventricular pacing in severe heart failure patients reverses electromechanical dyssynchronization from apex to base. Pacing Clin Electrophysiol 2000;23:1731-.
  24. Kerwin WF, Botvinick EH, O’Connell JW, Merrick SH, Marco T, Chatterjee K, et al. Ventricular contraction abnormalities in dilated cardiomyopathy: effect of biventricular pacing to correct interventricular dyssynchrony. J Am Coll Cardiol 2000;35:1221-. CrossRef
  25. Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Interventricular and intraventricular dyssynchrony in idiopathic dilated cardiomyopathy. A prognosis study with Fourier phase analysis of radionuclide angioscintigraphy. J Am Coll Cardiol 2002;40:2022-0. CrossRef
  26. Shannon CE. A mathematical theory of communication. Bell Syst Tech J 1948;27:379-23, 623-56.
  27. Botvinick E, Frais M, O’Connell W, Faulkner D, Scheinman M, Morady F, et al. Phase image evaluation of patients with ventricular preexcitation syndromes. J Am Coll Cardiol 1984;3:799-11. CrossRef
  28. Bunder RJ, Haluszcynski I, Langhammer H. In vivo/in vitro labeling of red blood cells with Tc-99m. Eur J Nucl Med 1983;8:218-5.
  29. Rosenquist M, Isaaz K, Botvinick EH, Dae M, Cockrell J, Abbott J, et al. Relative importance of activation sequence compared to AV synchrony in left ventricular function. Am J Cardiol 1991;67:148-5. CrossRef
  30. O’Connell JW, Shosa D, Frais M, Botvinick EH, Faulkner D, Hattner RS. Symmetry violation errors in first Fourier harmonic phase analysis [abstract]. Clin Res 1982;30:16A.
  31. Botvinick E, Schechtmann N, Dae M, Scheinman M, Davis J, Herre J, et al. Augmented pre-excitation assessed by scintigraphic phase analysis during atrial pacing. Am Heart J 1987;114:738-4. CrossRef
  32. Frais M, Botvinick E, Shosa D, O’Connell W, Scheinman M, Hattner R, et al. Phase image characterization of ventricular contraction in left and right bundle branch block. Am J Cardiol 1982;50:95-02. CrossRef
  33. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al, and the MIRACLE Study Group, Multicenter InSynch Randomized Clinical Evaluation. Cardiac resynchronization in congestive heart failure. N Engl J Med 2002;346:1845-3. CrossRef
  34. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al. The multisite stimulation in cardiomyopathies (MUSTIC) study investigators. Effects of multisite ventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001 ;344:873-0. CrossRef
  35. Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol 2002;39:194-01. CrossRef
  36. Dae MW, Botvinick EH, Scheinman MH, Morady FJ, Davis JA, Schectmann N, et al. Correlation of scintigraphic phase maps with intraoperative epicardial/endocardial maps in patients with activation disturbances [abstract]. Circulation 1984;70(Suppl II):II-71.
  37. Munoz L, Chin M, Stillson C, Lesh M, Dae MW, Botvinick EH. The focus of ventricular tachycardia effects the pattern of wall motion and influences the hemodynamic response [abstract]. J Nucl Med 1995;36:90P.
  38. Dae MW, Botvinick EH. Characterization of conduction and concentration abnormalities by scintigraphic phase analysis. Int J Cardiol 1984;5:244-3. CrossRef
  39. Le Guludec D, Gauthier H, Porcher R, Frank R, Daou D, Benelhadj S, et al. Prognostic value of radionuclide angiography in patients with right ventricular arrhythmias. Circulation 2001; 103:1972-.
  40. Dae M, Wen YM, Botvinick E, Scheinman M. EKG left anterior fascicular block reveals diverse patterns on scintigraphic phase analysis. Am Heart J 1989;117:861-. CrossRef
  41. Schechtmann N, Botvinick EH, Dae M, Scheinman M, O’Connell JW, Davis J, et al. The scintigraphic characteristics of ventricular pre-excitation through Mahaim fibers with the use of phase analysis. J Am Coll Cardiol 1989;13:882-1.
  42. Botvinick EH, Scheinman M, Morady F, Sung R, Lanzer P, O’Connell JW, et al. The scintigraphic assessment of sequential changes in ventricular volume, function and contraction pattern during ventricular tachycardia [abstract]. J Am Coll Cardiol 1983;1:711.
  43. Botvinick E, Dae M, Davis J, Scheinman M, Morady F, Lanzer P, et al. The scintigraphic evaluation of multiple ventricular tachycardia foci [abstract]. J Nucl Med 1986;27:989.
  44. Badhwar N, O’Connell JW, DeMarco T, Kumar UN, Schreck C, Lee BK, et al. Novel scintigraphic parameters accurately assess left ventricular synchrony in patients requiring cardiac resynchronization therapy. Abstract submitted to American Heart Association, Dallas, Tex.
  45. Botvinick EH. Scintigraphic blood pool and phase image analysis: the optimal tool for the evaluation of resynchronization therapy. J Nucl Cardiol 2003;10:424-. CrossRef
  
• 作者单位：J. William O’Connell (1)
  Carole Schreck (1)
  Michael Moles (1)
  Nitish Badwar (1)
  Theresa DeMarco (1)
  Jeffrey Olgin (1)
  Byron Lee (1)
  Zian Tseng (1)
  Uday Kumar (1)
  Elias H. Botvinick (1)
  
  1. Departments of Medicine (Cardiovascular Division) and Radiology (Nuclear Medicine Section), University of California, UCSF Medical Center, Box 0252, 94143, San Francisco, CA
  

文摘

Background Cardiac resynchronization therapy (CRT) improves symptoms and the survival rate in patients with advanced heart failure by improving synchrony. However, CRT is not always successful, is costly, and is applied without individualization. There is no specific measure of synchrony. The goal of this study was to analyze new quantitative parameters of synchrony and compare them with established measures. Methods and Results Equilibrium radionuclide angiography, phase angle (?), and amplitude quantitate regional contraction timing and magnitude and are the basis for new synchrony (S) and entropy (E) parameters. S is the vector sum of all amplitudes based on the angular distribution of ? divided by the scalar sum of the length of all vectors. Complete S equals 1, and its absence equals 0. E measures the disorder in the region of interest, is 1 with random contraction and 0 with full synchrony, and differentiates among differing contraction patterns. Left ventricular S and E were measured in 22 normal equilibrium radionuclide angiography studies, where regions of interest were drawn from the left ventricle, left atrium, and background to analyze model ventricles with normal wall motion (N), ventricles with aneurysm (An), ventricles with severe diffuse dysfunction (Diff), and ventricles with severe regional dysfunction (Reg). The new S and E parameters were highly reproducible and well differentiated among N, An, Diff, and Reg, which were not separated by SD ? (SD of ventricular phase), which has gained popularity as a measure of synchrony. Conclusion Unique scintigraphic parameters for the evaluation of ventricular synchrony were derived, and their added value was determine compared with established measures.Indications for pacemaker therapy now include the treatment of severe congestive heart failure (CHF). Atrial triggered biventricular pacemakers reduce CHF symptoms1 and prolong life2 in patients with cardiomyopathy, severe CHF, left ventricular (LV) ejection fraction (EF) lower than 35%, and QRS greater than 120 milliseconds. Such pacing, or cardiac resynchronization therapy (CRT), seeks to reduce the heterogeneity and increase the synchrony of ventricular activation, conduction, and contraction. CRT has improved hemodynamics, increased exercise tolerance, reduced symptoms and the need for hospitalization,1,32 reversed ventricular remodeling, and4,5 reduced the all-cause mortality rate2 in CHF. However, CRT is costly, fails to improve symptoms or activity level in more than 30% of patients,2,3,6 and is applied blindly without individualization or consideration of lead placement sight.7A variety of echocardiographic methods have sought to measure synchrony and its serial changes with CRT.4,8-16 A recent study presented evidence of the poor reproducibility of several widely applied echocardiographic measurements by which to determine ventricular synchrony.17 Magnetic resonance imaging has excellent resolution of regional wall motion and has been applied to assess ventricular synchrony and its response to pacing therapy.18 However, these methods are complex and are not well established or widely available, and magnetic resonance imaging has not been widely applied after pacing. An accurate and reproducible method is needed by which to objectively measure regional ventricular synchrony.19Phase image analysis, a functional method based on the first Fourier harmonic fit of the gated blood pool time versus radioactivity curve, generates the parameters of amplitude (A), which parallels the extent of regional ventricular contraction or stroke volume, and phase angle (?), which represents the timing of regional contraction. It was applied early with demonstrated reproducibility20 to show the linkage between electrical and mechanical dyssynchrony21 and to characterize the contraction pattern in heart failure and its alteration with CRT.22,23 The SD of ventricular ?, applied as a marker of synchrony, has been shown to demonstrate the beneficial effects of biventricular pacing,24 and its strong prognostic value has been shown in patients with congestive cardiomyopathy and CHF, superior to LVEF.25 The SD ? may not be optimal for synchrony evaluation.We sought improved, more sensitive parameters to better differentiate synchrony among the spectrum of possible patterns of dyssynergy. We derived, initially evaluated, and here present new synchrony (S) and entropy (E) parameters, based on the phase method, to quantitate regional and global ventricular synchrony and applied them in simulation and clinical protocols.