Left ventricular dyssynchrony in diabetes mellitus
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Division of Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY Division of Nuclear Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY Division of Cardiology and Nuclear Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
Received Oct 26, 2018; accepted Oct 26, 2018 doi:10.1007/s12350-018-01519-5
See related article, https://doi.org/10.10 07/s12350-018-1436-z. Myocardial perfusion imaging (MPI) with gated single-photon emission computed tomography (SPECT) or positron emission tomography (PET) is used for the detection of myocardial perfusion abnormalities and for the evaluation of left ventricular function. Automated programs exist for the estimation of ejection fraction as well as measuring scar size and ischemia. These programs are objective, highly reproducible, and reliable.1–5 Gated SPECT MPI is used for the diagnosis and risk stratification of patients with known or suspected coronary artery disease. In 2005, Chen et al. described the technique of phase analysis with gated SPECT imaging to assess the synchrony of left ventricular contraction.6 The assessment of left ventricular synchrony using phase analysis with gated SPECT adds another dimension to cardiac assessment using gated SPECT. This technique has evolved over the last few years making SPECT MPI a powerful tool that allows for the evaluation of perfusion, ventricular function and synchrony of mechanical contraction. Left ventricular dyssynchrony is seen in the presence of conduction abnormalities such as left bundle branch block, right bundle branch block, ventricular
Reprint requests: Yogita Rochlani, MD, Division of Cardiology, New York Medical College/Westchester Medical Center, 100 Woods Road, Macy Pavilion, Valhalla, NY 10595; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2018 American Society of Nuclear Cardiology.
pacing, left ventricular dysfunction, and heart failure. Left ventricular dyssynchrony has been studied using several imaging modalities including echocardiography (M-mode, color tissue Doppler, strain imaging, and 3D echo), myocardial perfusion imaging (SPECT and PET), gated blood pool imaging, and cardiac magnetic resonance imaging.7 Dyssynchrony analysis using gated SPECT imaging has several advantages over the other modalities including use of automated technology, ease of standardization to ensure reliability and reproducibility, and lack of limitations such as requiring adequate windows as in the case of echocardiography.7 Phase analysis using gated SPECT or PET imaging has been used in a wide spectrum of cardiac disorders characterized by left ventricular dysfunction and heart failure. This can identify heart failure patients who might benefit from cardiac resynchronization therapy.8,9 This can also help optimize left ventricular lead position during resynchronization therapy10 and assess response to cardiac resynchronization therapy.11 Studies in patients with ischemic cardiomyopathy12 and non-ischemic cardiomyopathy13 sh
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