Clinical Research Of Radionuclide Imaging On Assessing Systolic Synchrony And Ventricular Function In Patients With Chronic Heart Failure

Objective: To discuss a series of problems which related to cardiac systolic dyssynchrony in patients with chronic heart failure systematically by two radionuclide imaging include gated SPECT myocardial perfusion image(GSMPI) and gated radionuclide ventriculography(GRVG).(1)Use the GSMPI to discuss the correlation of the degree of cardiac systolic dyssynchrony and cardiac function in patients with chronic heart failure(CHF). Compare the patients who with and without cardiac mechanical dyssynchrony, analysis the proportion of the CHF patients with mechanical dyssynchrony in the different heart function classifications, and the relationship among the cardiac synchrony, heart function and myocardium perfusion.(2)To investigate the clinical value of GSMPI on guiding cardiac resynchronization therapy and predicting the curative effect in patients with chronic heart failure.(3) To compare the interventricular and intraventricular synchrony and the function of the double ventricular systolic synchrony in patients with chronic heart failure of different etiologies by GRVG, and the mechanism is also clarified.Methods:(1) Selected 123 people include 82 CHF patients and 41 healthy people, who composed of the normal control group. GSMPI data of all were reviewed retrospectively from January 2012 to February 2015 in TEDA international cardiovascular hospital. According to the NYHA heart function classification, the patients were classified into grade I- IV. Use the Emory Cardiac Toolbox to process the data, then the systolic synchrony and cardiac functional parameters include PHB, PSD, LVEF, EDV, SSS or SRS were acquired. Compare the difference of PHB, PSD, and LVEF between the four CHF groups and the control group separately; Compare the difference among the four CHF groups. Systolic dyssynchrony was defined when the PSD was greater than the maximum of the control group, the CHF group was divided into two groups include with and without systolic dyssynchrony. Compare the difference of some clinical factors between the two groups; Analysis the proportion of the CHF patients with mechanical dyssynchrony in the different heart function classifications; Discuss the relationship among the cardiac synchrony andmyocardium perfusion. Use SPSS 19.0 for statistical analysis. The difference of the left ventricular systolic synchrony in patients with different heart function classifications was compared using independent-simple T test, and the single sample measurement data showed by“the average ± standard deviation”, taking P<0.05 as the significance difference. Apply the one-way analysis of variance to compare the difference among multiple samples. Use binary variables correlation analysis to assess the correlation.(2)30CHF patients’ GSMPI data were reviewed retrospectively, who did the GSMPI examination from January 2012 to December 2014 in TEDA international cardiovascular hospital, and they were assigned to CRT, and the imaging before the operation. The functional parameters include phase histogram bandwidth, phase standard deviation, left ventricular ejection function, end diastolic volume, summed rest scores and scar size were acquired by imaging. All patients reexamined the cardiac ultrasonic at six months after the operation, and the left ventricular end diastolic diameter decreased, LVEF increased, and within half a year no hospitalization records indicated the effective therapy. The patients were divided into two groups include the effective group and the ineffective group. Compare the differences between the quantitative parameters of the two groups, analysis the predictive value for the efficacy of CRT. Record the latest systolic area in the left ventricular. Use SPSS 19.0 for statistical analysis. Compare the difference between the two groups, taking P<0.05 as the significance difference.(3) 102 patients CHF patients’ GRVG data were reviewed retrospectively, who did the GSMPI examination from March 2009 to January 2013 in TEDA international cardiovascular hospital. The NYHA heart function classifications were Grade III and Grade IV. Divided into two groups according to the etiology, include the ischemic cardiomyopathy group(n=63) and the dilated cardiomyopathy group(n=39). Did the GRVG examination, then apply the software named EF Analysis. The Phase images and phase histogram images of two groups were built respectively. The parameters were include double DVPSW, LVPSW, RVPSW and RVEF, LVEF, which defined the interventricular and intraventricular synchrony and cardiac function. Compare the difference of the parameters between the two groups. Compare the distribution characteristics of the color which represents delayed systole in the phase images between the two groups,Count the number of cases and the proportion. Use SPSS 19.0 for statistical analysis. The difference between the two groups was compared using independent-simple T test, and the single sample measurement data showed by“the average ± standard deviation”. Taking P<0.05 as the significance difference.Result:(1) The PHB of control group was(49.7+14.9)°,PSD was(21.9+11.8)°, LVEF was(66.5+3.7)%, The PHB of grade I was(55.4+13.9)°,PSD was(23.2+10.3)°, LVEF was(57.5+2.4)%; The PHB of grade II was(23.2+10.3)°, PSD was(45.3+4.9)°, LVEF was(46.5+4.2)%,The PHB of grade III was(163.6+16.5)°,PSD was(64.9+6.2)°, LVEF was(41.4 +2.2)%, The PHB of grade IV was(220.6+4.0)°,PSD was(84.1+9.6)°,LVEF was(30.8+2.9)%. There’s no obvious difference of PHB, PSD, between the CHF patients who in NYHA I class and the normal control group(P>0.05), while significant different exits between the CHF patients who in NYHA II –IV class and the normal control group(P<0.05). Follow the increase of the heart failure classification, PHB, PSD were increased, that is to say, the degree of the ventricular systolic dyssynchrony aggravated accompanied by the progress of the heart failure. The different of PHB, PSD and LVEF were significant among the 4 CHF groups(P<0.05). The difference of the proportion of DM, LVEF, EDV and SRS/SDS were significant between the patients who with and without systolic dyssynchrony(P<0.05). PHB and PSD were both positively correlated with SSS/SRS(r=0.808,P=0.000;r=0.773,P=0.000), indicate that the heavier of the degree of the cardiac scar burden,the worse of the systolic synchrony.(2)There were significant differences of the parameters included the PHB,PSD,LVEF,EDV,SRS and SS between the effective group and the irresponsive group(P <0.05). PHB in the effective group was(185.1+24.6)°, in irresponsive group was(215.6+60.5)°,P=0.005;PSD in the effective group was(84.2+10.21)°, in irresponsive group was( 97.8+3.40)°, P=0.004;LVEF in the effective group was( 23.5+7.63)%, in irresponsive group was(17.5+5.36)%,P=0.045, EDV in the effective group was(101.9+34.0)ml, in irresponsive group was(227.0+81.30)ml, P=0.035, SRS in the effective group was 13.3+2.31, in the irresponsive group was 16.8+2.52,P=0.015,SS in the effective group was(19.7+9.80)%, in theirresponsive group was( 39.5+8.87)%,P=0.01). Among all the parameters, the PSD and PHB were most significant(P<0.01). That is to say, the worse of the cardiac systolic synchrony, the bigger of the scar size, the grater of the cardiac cavity, and the worse of the heart function, then the worse of the curative effect after CRT. Indicate that the parameters had the predictive value for outcomes after CRT,Wherein the PSD,PHB were the most valuable. Through the dynamic movie, we found that 17 patients’( 56.7%) latest systolic areas of the left ventricle located in the apical, the anterior wall and the septal wall, 8 patients( 26.7%) located in the inferior wall, 5 patients(16.6%) located in the lateral wall.(3)The interventricular and intraventricular synchrony was significantly different among the patients who had the similar heart function but different etiology. The interventricular and intraventricular synchrony of the ICM group are both worse than those of the DCM group; LVEF has no significant difference(P>0.05); RVEF of the ICM group is better than that of the DCM group(P=0.002). PSW in ICM group was(145.51+26.10)°,in DCM group was(116.28+27.28)°, P=0.000; LVPSW in ICM group was(124.28+20.53)°, in DCM group was(95.33+28.24)°, P=0.000;RVPSW in ICM group was(106.02+17.06)°, in DCM group was(86.05+17.50)°,P=0.003;LVEF in ICM group was(26.60+8.21)%, in DCM group was(27.31+7.80)%, P=0.669;RVEF in DCM group was(42.21+10.12)%, in DCM group was(35.80+10.19)%,P=0.003. The distribution of the color which represents delayed systole in the two groups are different: in ICM group, mostly distributed in the left ventricle, and the distribution was related to the myocardium segments;but in DCM group,the distribution of the delayed color is diffused in both two ventric- les, and the distribution showed no clear relationship to the myocardium segments.Conclusion:(1) The systolic synchrony maybe normal in the majority of patients with heart failure in NYHA class I. The systolic dyssynchrony degree increased from NYHA class II to class IV, accompanied by the heart failure progression; Diabetes mellitus, LVEF, EDV, ESV, SSS/SRS are influence factors of the systolic dyssynchrony; and the left ventricular ejection fraction; The extent of decreased myocardial blood flow perfusion and the left ventricular ejection fraction are closely related tothe systolic dyssynchrony, the former reduces, latter increases will add the severity of systolic dyssynchrony. The progression of the left ventricular systolic dyssynchrony along with the deterioration of cardiac function; the scar burden increase will decrease the left ventricular systolic synchrony, and then make the deterioration of left ventricular systolic function. The left ventricular systolic parameters and the scar burden indicators can be used as the Quantitative indicators for choosing the patients with early heart failure, guiding the clinical early diagnosis and treatment of heart failure, finally, achieve the target that delay the progress of CHF.(2)GSMPI can provide multiple functional parameters with the“one-stop" mode, which can be used to guide the CRT electrode implantation and predict curative effect, and the PSD and PHB have a higher predictive value. GSMPI can display the latest systolic areas of the left ventricle, locate the myocardial infarction, and can be used for guiding to confirm the optimal location for LV lead placement, That is mean, in the premise of avoiding scar area, select the latest systolic area as the optimal location for LV lead placement.(3) The interventricular and intraventricular synchrony were significantly different among the patients who was the result of different etiology, and the distribution of the color which represents delayed systole in the two groups are different too. The interventricular and intraventricular synchrony of the ICM group are both worse than those of the DCM group who were in same heart function classification. The latest systole area in ICM group was related to the myocardial segments which corresponding with the diseased coronary artery, while in DCM group, it is unrelated to the myocardial segments, the distribution was diffused.