Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul-Sep;18(3):238-243.
doi: 10.4103/wjnm.WJNM_49_18.

Evaluation of left ventricular mechanical dyssynchrony with phase analysis in end-stage renal disease patients with normal gated SPECT-MPI

Dharmender Malik  1 , Bhagwant Rai Mittal  1 , Ashwani Sood  1 , Ashish Sharma  2 , Madan Parmar  1 , Komalpreet Kaur  1 , Ajay Bahl  3
Affiliations

Evaluation of left ventricular mechanical dyssynchrony with phase analysis in end-stage renal disease patients with normal gated SPECT-MPI

Dharmender Malik et al. World J Nucl Med. 2019 Jul-Sep.

Abstract

Phase analysis using gated single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is a relatively new tool for the assessment of ventricular synchrony. Hypertension, diabetes, renal diseases, and dyslipidemia may affect the phase parameters though their impact is not well understood. The present study aimed to evaluate the incidence of the left ventricular mechanical dyssynchrony (LVMD) in end-stage renal disease (ESRD) patients with normal gated SPECT-MPI and QRS duration (<120 ms) on electrocardiogram. Data of 129 patients (86 males) referred for gated SPECT-MPI for their pretransplant evaluation with normal gated stress SPECT-MPI (SSS <3 and ejection fraction ≥50%) were included in the study analysis. Documented clinical history along with confounding factors such as hypertension, dyslipidemia, smoking, and alcoholism were evaluated. Left ventricle functional (end-diastolic, end-systolic, and LV myocardial volume) and phase parameters (phase standard deviation [PSD], phase bandwidth [PBW] and entropy) were calculated using the QPS-QGS program. LVMD was noted in 36 (28%) of ESRD patients with normal QRS duration and gated SPECT-MPI. The mean attenuated corrected LV myocardial volume, ejection fraction, mean PSD, and PBW values were 84.3 ± 38.1 ml, 65.3 ± 13.5%, 9.8° ± 3.9°, and 61.4° ± 24.7°, respectively. The LV myocardial volume shows statistically significant correlation with the phase parameters (r = 0.31-0.47; P < 0.001). LVMD is present in a significant number of ESRD patients, and its extent is more with increase in LV myocardial volume. It may have an additional role in risk-stratification for cardiovascular disease in ESRD patients.

Keywords: End-stage renal disease; gated single-photon emission computed tomography myocardial perfusion imaging; left ventricular dyssynchrony; phase histogram bandwidth; phase standard deviation.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The representative dataset of a patient with ESRD with significant LVMD as suggested by the high PSD and PBW value (17° and 66° respectively) in the absence of any perfusion defect and preserved LV ejection fraction (~54%) and entropy observed was 60%
Figure 2
Figure 2
Scatter plot diagrams showing the relationship of phase standard deviation with LV ejection fraction (a), end-systolic volume (b), and end-diastolic volume (c), using QPS-QGS program. The red line represents the regression line, and dotted red lines indicate 95% confidence limits for the regression line
Figure 3
Figure 3
Scatter plot diagrams showing the relationship of attenuated corrected LV myocardial volume with phase standard deviation (a), phase bandwidth (b), and entropy (c) using QPS-QGS program. The red line represents the regression line, and dotted red lines indicate 95% confidence limits for the regression line
See this image and copyright information in PMC

References

    1. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction – Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) Circulation. 2004;110:588–636. - PubMed
    1. Hyre AD, Fox CS, Astor BC, Cohen AJ, Muntner P. The impact of reclassifying moderate CKD as a coronary heart disease risk equivalent on the number of US adults recommended lipid-lowering treatment. Am J Kidney Dis. 2007;49:37–45. - PubMed
    1. Wang LW, Fahim MA, Hayen A, Mitchell RL, Baines L, Lord S, et al. Cardiac testing for coronary artery disease in potential kidney transplant recipients. Cochrane Database Syst Rev. 2011;12:CD008691. - PMC - PubMed
    1. Vanholder R, Massy Z, Argiles A, Spasovski G, Verbeke F, Lameire N, et al. Chronic kidney disease as cause of cardiovascular morbidity and mortality. Nephrol Dial Transplant. 2005;20:1048–56. - PubMed
    1. Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kidney Int. 1999;55:1553–9. - PubMed