Intérêt potentiel des images paramétriques des temps d’éjection et de relaxation en tomoscintigraphie des cavités cardiaques dans l’évaluation des cardiopathies asynchrones

Abstract

Intraleft dyssynchrony is strongly correlated to contractile dysfunction associated to severe heart failure. Dyssynchrony is also a predictive marker for cardiac resynchronization therapy response. We measured dyssynchrony values for both ventricles from gated blood pool SPECT images. Material and methods Three groups of patients were sampled from normal patients ( n = 7), mild heart failure patients ( n = 24) and severe heart failure patients ( n = 9). Time-derivative parametric images were obtained from 24-time bins gated blood pool SPECT data. We measured intraleft and interventricular contractile and relaxing dyssynchrony values from these images. Results Intraleft dispersions values linked to ventricular peak emptying rate were 107 ± 21 ms, 141 ± 58 ms and 515 ± 104 ms for each of the three groups. The values linked to left ventricular peak filling rate were 122 ± 62 ms, 219 ± 117 ms and 603 ± 164 ms respectively. Statistical significant differences ( p < 0.01) were observed both for contractile and relaxing phases for severe heart failure patients. Mild heart failure patients had isolated statistical significant ( p < 0.01) alterations of the ventricular relaxing phase. Correlation between isotopic dyssynchrony values and left ejection fraction led to a R square coefficient of 0.71 and 0.64 for time to peak emptying and to peak filling respectively. Correlation to QRS width values led to a R square coefficient of 0.76 and 0.62 respectively. Conclusion Ventricular dyssynchrony correlated to the importance of the ventricular mechanical dysfunctions is a robust predictor of heart failure. Separate analysis of contractile and relaxing dyssynchrony may lead to a better understanding and characterization of the mechanical dysfunctions involved in heart failure.