Key result
QGS phase analysis on GMPS correlates with TDI and predicts CRT response with ~83% sensitivity.
Why the study?
Does QGS phase analysis on GMPS accurately detect LV dyssynchrony and predict response to CRT compared to TDI echocardiography in patients with severe heart failure?
Observational (n=40)
Does QGS phase analysis on GMPS accurately detect LV dyssynchrony and predict response to CRT compared to TDI echocardiography in patients with severe heart failure?
Effect estimate: r = 0.69
p-value: p=<0.01
QGS phase analysis on GMPS is a feasible and accurate method for assessing LV dyssynchrony and predicting response to CRT in patients with severe heart failure.
May support GMPS phase analysis as TDI alternative in severe HF; leaves open randomized validation for CRT selection.
UNLABELLED: 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, histogram bandwidth) 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.
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Boogers et al. (2009) conducted an observational in severe heart failure (n=40). Quantitative Gated SPECT (QGS) phase analysis on GMPS vs. Echocardiography with tissue Doppler imaging (TDI) was evaluated on Correlation with TDI for LV dyssynchrony and prediction of CRT response (r = 0.69, p=<0.01). QGS phase analysis on GMPS correlated significantly with TDI for assessing LV dyssynchrony (r=0.69, P<0.01) and predicted CRT response with 83% sensitivity and 81% specificity.
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