Peak Filling Rate Research Articles

Diastolic dysfunction measured by cardiac magnetic resonance imaging in women with signs and symptoms of ischemia but no obstructive coronary artery disease

BackgroundWomen with chest pain and no obstructive coronary artery disease often have coronary microvascular dysfunction (CMD), diagnosed by invasive coronary reactivity testing (CRT). The relationship between CMD and diastolic function measured by cardiac magnetic resonance imaging (CMR) is not well described. Methods41 women with suspected CMD underwent CRT and CMR. Left ventricular end-diastolic pressure (LVEDP), coronary flow reserve (CFR) and coronary blood flow (CBF) were measured invasively. Resting CMR of these women and 20 reference controls was assessed for LV mass, septal wall thickness, ejection fraction (LVEF), end-diastolic volume (EDV), peak filling rate (PFR) and time-to-peak-filling rate (tPFR). Pearson correlations and linear regression models were made. ResultsMean age was 55±9, all had LVEF≥50%, and 16/41 (40%) had LVEDP>15mmHg. CMD (CFR<2.5 or CBF<50%) was present in 34/41 (83%) women. tPFR (mean 178±110ms) and PFR (mean 3.2±0.64 EDV/s) were not significantly different in women with or without CMD. tPFR increased with age (r=0.37, p=0.017) and septal wall thickness (r=0.47, p=0.002), while PFR decreased with age (r=−0.45, p=0.003). There was an inverse relationship between CFR and tPFR (r=−0.3, p=0.058). Increasing mass was associated with decreasing CBF (p=0.02). Compared to controls, cases had lower LVEF (p=0.049) and lower EDV (p=0.0002). ConclusionIn women with signs and symptoms of ischemia but no obstructive coronary artery disease, CMD and elevated LVEDP are prevalent. While non-endothelial dependent CMD may be related to diastolic dysfunction, further investigation is needed regarding links between CMD, diastolic dysfunction and the development of heart failure with preserved LVEF.

Myocardial ischemia in the absence of obstructive coronary lesion: The role of post-stress diastolic dysfunction in detecting early coronary atherosclerosis

BackgroundThe interactions between non-obstructive coronary atherosclerosis (<50% stenosis) and myocardial perfusion and functional parameters on myocardial perfusion imaging (MPI) have never been evaluated. Methods and ResultsOne-hundred and ninety-five patients were submitted to stress-rest MPI and invasive coronary angiography. The presence of obstructive coronary lesions (>50% stenosis) was excluded. The summed stress score (SSS) was calculated in every patient. Moreover, the left ventricular (LV) ejection fraction (EF) and peak filling rate (PFR) were computed from gated MPI images as measures of systolic and diastolic functions. Sixty/195 patients (31%) showed the presence of non-obstructive atherosclerosis (>20% and <50% diameter reduction). Interestingly, they presented a higher SSS than those with normal coronary arteries (P < 0.001) despite a similar myocardial scar burden. If compared to patients with normal coronary arteries, those with non-obstructive atherosclerosis showed more abnormal post-stress PFR values (2.5 ± 0.9 vs 2.9 ± 0.8, P = 0.004), despite a similar EF. On multivariate analysis, the presence non-obstructive atherosclerosis was the only significant predictor (P = 0.026) of post-stress LV diastolic impairment, independently from perfusion parameters. ConclusionsIn patients without anatomically significant coronary lesions, the development of post-stress LV diastolic dysfunction on MPI associates with the presence of non-obstructive atherosclerosis on coronary angiography.

Native Magnetic Resonance T1-Mapping Identifies Diffuse Myocardial Injury in Hypothyroidism.

Background and AimHypothyroidism (HT) is characterized by thyroid hormone deficiencies, which can lead to diffuse myocardial interstitium lesions in patients with HT. Myocardial longitudinal relaxation time (T1) mapping is a potential diagnostic tool for quantifying diffuse myocardial injury. This study aimed to assess the usefulness of T1 mapping in identifying myocardial involvement in HT, and determine the relationship between T1 values and myocardial function.MethodsA cross-sectional study was conducted with 30 untreated HT patients alongside 23 age- and sex-matched healthy controls. All subjects underwent cardiac magnetic resonance (CMR) with non-contrast (native) T1 mapping using a modified Look-Locker inversion-recovery (MOLLI) sequence to assess the native T1 values of myocardium and cardiac function.ResultsNative myocardial T1 values were significantly increased in HT patients, especially those with pericardial effusion (p < 0.05), compared with healthy controls. In addition, significantly reduced peak filling rate (PFR) and prolonged peak filling time (PFT) were obtained (p < 0.05) in HT patients compared with controls. Furthermore, stroke volume (SV) and cardiac index (CI) were significantly lower in HT patients than controls (all p < 0.05). Interestingly, native T1 values were negatively correlated with free triiodothyronine (FT3), PFR, SV and CI (all p < 0.05).ConclusionDiffuse myocardial injuries are common in HT patients, and increased T1 values are correlated with FT3 and cardiac function impairment. These findings indicate that T1 mapping might be useful in evaluating myocardial injuries in HT patients.

Cardiac magnetic resonance imaging for myocardial perfusion and diastolic function-reference control values for women.

Angina, heart failure with preserved ejection fraction (HFpEF) and coronary microvascular dysfunction (CMD) in the absence of obstructive coronary artery disease (CAD) are more common in women and are associated with adverse cardiovascular prognosis. Cardiac magnetic resonance imaging (CMRI) is established for assessment of left ventricular (LV) morphology and systolic function and is increasingly used to assess myocardial perfusion and diastolic function. Indeed, stress CMRI allows measurement of myocardial perfusion reserve index (MPRI) using semi-quantitative techniques, and quantification of LV volumetric filling patterns provides valuable insight into LV diastolic function. The utility of these two techniques remains limited, because reference control values for MPRI and LV diastolic function in asymptomatic middle-aged, women have not previously been established. To address this limitation, we recruited twenty women, without clinical cardiovascular disease or cardiovascular risk factors, with normal maximal Bruce protocol exercise treadmill testing. Subjects underwent CMRI (1.5 tesla) using a standardized protocol of adenosine stress and rest perfusion and LV cinematic imaging. Commercially available with automated CMRI segmentation was used for calculation of MPRI, LV filling profiles, and ejection fraction. Mean age was 54±9 years and mean body mass index was 25±4 kg/m(3). The exercise treadmill testing results demonstrated a normotensive group with normal functional capacity and hemodynamic response. We report reference control values for semi-quantitative MPRI as well as measures of LV systolic and diastolic function including ejection fraction, stroke volume, peak filling rate (PFR), PFR adjusted for end-diastolic volume (EDV) and stroke volume, time to PFR, and EDV index. The data herein provide reference values for MPRI and diastolic function in a cohort of healthy, middle-aged of women. These reference values may be used for comparison with a variety of patient populations, including women with CMD and HFpEF.

Measurements in Pediatric Patients with Cardiomyopathies: Comparison of Cardiac Magnetic Resonance Imaging and Echocardiography

Aims: Cardiomyopathies are common cardiovascular diseases in children. Cardiac magnetic resonance imaging (cMRI) and echocardiography (Echo) are routinely applied in the detection and diagnosis of pediatric cardiomyopathies. In this study, we compared and explored the correlation between these two measurements in pediatric patients with various cardiomyopathies. Methods and Results: A total of 53 pediatric patients with cardiomyopathy hospitalized during the recent 3 years in our hospital were analyzed. All of them and 22 normal controls were assessed by both cMRI and Echo. Cardiac function of the patients was graded according to the New York Heart Association functional classification. The cardiac function indexes measured with both cMRI and Echo included left-ventricular (LV) end-diastolic volume (EDV), end-systolic volume, ejection fraction and fractional shortening. These parameters were somehow lower in cMRI measurements than in Echo measurements. The index of diastolic function, such as peak filling rate (PFR) measured with cMRI, had a good correlation with the clinical cardiac functional score, while the index of the diastolic function (early/atrial filling ratio and isovolumic relaxation time) measured with Echo was not well correlated with the clinical cardiac function score. Significant systolic dysfunction was detected by cMRI in 34 patients with dilated cardiomyopathy, LV noncompaction or endocardial fibroelastosis. Significant diastolic dysfunction was detected by cMRI in 19 patients with hypertrophic cardiomyopathy or restrictive cardiomyopathy showing an alteration in PFR and EDV. Conclusion: Both cMRI and Echo are of great value in the diagnosis and assessment of cardiac function in pediatric patients with cardiomyopathy. cMRI could accurately display the characteristic morphological changes in the hearts affected with cardiomyopathies, and late gadolinium enhancement on cMRI may reveal myocardial fibrosis, which has obvious advantages over Echo measurements in diagnosis. Furthermore, cMRI can quantitatively determine ventricular function because it does not make invalid geometrical assumptions.

Left ventricular remodeling and fibrosis: Sex differences and relationship with diastolic function in hypertrophic cardiomyopathy

ObjectivesWe investigated sex differences in left ventricular (LV) remodeling and fibrosis and their relationship with LV diastolic dysfunction by cardiovascular magnetic resonance (CMR). MethodsCMR imaging was performed simultaneously in 152 age-matched patients (76 men, 76 women; mean age: 49±9 years) without LV systolic dysfunction. LV remodeling index (LVRI) was calculated as the ratio of LV mass and end-diastolic volume. Diastolic function indexes including peak filling rate (PFR) and time to PFR (tPFR) were evaluated. Extent of late gadolinium enhancement (LGE) was measured. ResultsLVRI and extent of LGE were greater in women compared with men (1.48±0.22 vs. 1.36±0.28g/ml; 13.15±2.48 vs. 11.35±2.34g, respectively, both P<0.001). Women had lower PFR and higher tPFR (both P<0.001) than men. LVRI and the extent of LGE showed significant relationships with parameters of diastolic function in both sex. In a multivariate analysis, LVRI remained a strong independent predictor of PFR and TPFR in women (β=−0.272, P=0.032; β=0.348, P=0.016, respectively), and in men (β=−0.374, P<0.001; β=0.660, P<0.001, respectively). Furthermore, the extent of LGE also remained an independent predictor of PFR in women (β=−0.283, P=0.033) and men (β=−0.492, P<0.001). ConclusionsThere are prominent sex differences in LV remodeling and myocardial fibrosis. We suggest that the effects of LV remodeling and fibrosis may lead to diastolic dysfunction with greater susceptibility to worse clinical outcome in women.

The impact of hypertension on diastolic left ventricular function, evaluated by quantitative ECG-gated myocardial perfusion SPECT

BackgroundAbnormality of left ventricular (LV) diastolic function is frequently the earliest indicator of LV dysfunction in many diseases, including coronary artery disease (CAD), and hypertension. Electrocardiography (ECG)-gated technetium (Tc)-99m tetrofosmin single-photon emission computed tomography (SPECT) has been reported to be a useful method for evaluation of LV function. ObjectivesThe purpose of this study was to assess the impact of hypertension on diastolic left ventricular function using ECG-gated Tc-99m tetrofosmin SPECT. MethodsThirty consecutive patients with normal exercise myocardial perfusion and normal LV systolic function, were studied out of 233 patients underwent ECG-gated Tc-99m tetrofosmin SPECT at our institution between January 2012 and December 2013. Patients were divided into two groups according to the presence or absence of systemic hypertension (blood pressure ⩾140/90mm Hg on ⩾3 measurements or treatment with antihypertensive medication). Parameters of diastolic LV function were assessed. ResultsOf the studied 30 patients, 19/30 (63%) had hypertension. There was no difference with respect to age, gender, LV end-diastolic volume (EDV), LV end-systolic volume (ESV), and LV ejection fraction values obtained by quantitative gated SPECT between patients with and without hypertension. The first-third mean filling rate (1/3 MFR), peak filling rate (PFR) of patients with hypertension (1.22±0.38, 2.83±1.10 EDV/s) were lower than those of patients without hypertension (1.54±0.30, 2.90±0.35 EDV/s), and the time to peak filling (TTPF) of patients with hypertension (199.42±68.34ms) was higher than TTPF of patients without hypertension (164.90±36.39ms). ConclusionsQuantitative ECG-gated Tc-99m tetrofosmin SPECT reveals that hypertensive patients with preserved global LV systolic function may have significant changes in diastolic LV function. Gated myocardial perfusion SPECT reports are always lacking in these changes in diastolic function. We recommend inclusion of such changes in diastolic function in gated myocardial perfusion SPECT reports that can help in proper management of hypertensive patients.

Effects of alcohol septal ablation on left ventricular diastolic filling patterns in obstructive hypertrophic cardiomyopathy.

Alcohol septal ablation (ASA) has been shown to improve left ventricular (LV) diastolic function in patients with obstructive hypertrophic cardiomyopathy (HCM). However, its beneficial effect on diastolic function assessed by cardiac magnetic resonance (CMR) has not been reported. We investigated the mid-term changes of diastolic function by CMR combined with echocardiography in HCM patients after ASA at a median of 14-month follow-up. CMR parameters of diastolic function including peak filling rate (PFR), and time to peak filling rate (TPFR) were evaluated in 43 patients (aged 48±9years). LV diastolic function improved significantly measured by echocardiography with the decrease in ratio of transmitral early LV filling velocity (E) to early diastolic mitral lateral annular velocity (E') (14.20±1.17 to 11.58±1.16, p<0.001) and E-wave deceleration time (194.04±19.30 to 168.45±12.58 ms, p<0.001). PFR increased significantly with associated decrease in TPFR after ASA (both p<0.001) at follow-up. Furthermore, patients with larger decrease in LVOT gradients had a greater improvement of LV diastolic function, as measured by the reduction of E/E' (p<0.001) and increase of PFR (p<0.001). In conclusion, this study demonstrated that successful ASA results in both echocardiographic and CMR indices of diastolic function improvement after ASA at 14-month follow-up. ASA therapy can significantly reduce LVOT gradient and mitral regurgitation, both of which may contribute to the improvement of diastolic function.

Relationships between myocardial perfusion abnormalities and poststress left ventricular functional impairment on cadmium-zinc-telluride imaging.

To evaluate the interplay between myocardial ischaemic burden and poststress left ventricular (LV) systolic and diastolic abnormalities in patients with suspected or known coronary artery disease (CAD). A total of 471 patients underwent myocardial perfusion imaging by cadmium-zinc-telluride scintigraphy and coronary angiography. A fast imaging protocol was used with stress imaging performed 10 - 15 min after tracer injection. The summed difference score (SDS) and the percent stress-to-rest ratios for LV ejection fraction and peak filling rate (PFR), measures of stress-induced systolic and diastolic impairment, were computed from scintigraphic images. A SDS of >3 was considered abnormal and >7 a marker of moderate-to-severe ischaemia. Of the 471 patients, 321 (68%) showed significant CAD in one (27%), two (23%) or three (18%) vessels. The extent of CAD associated with gradual alterations in SDS (P < 0.001). Interestingly, while impairment in the percent stress-to-rest PFR ratio paralleled the increase in the extent of CAD (P < 0.001 for trend), the occurrence of significant stress-induced systolic dysfunction was limited to patients with multivessel disease (P < 0.001 vs. patients without CAD, and P = 0.002 vs. patients with single-vessel disease). Similarly, while a strict correlation between percent stress-to-rest PFR ratio and myocardial ischaemic burden was evident (P < 0.001), significant stress-induced LV systolic impairment was limited to patients with moderate-to-severe ischaemia (P < 0.001 vs. patients with no or mild ischaemia). Stress-induced LV diastolic impairment is associated with a less extensive ischaemic burden and CAD extent than poststress systolic dysfunction, which is limited to patients with multivessel CAD.

Analysis of RV components after reoperation of the right ventricular outflow tract in patients with Tetralogy of Fallot

Methods 31 patients (20.6 ± 10.3 years) underwent an MRI examination before and after (20 ± 18 months) pulmonary valve replacement or reconstruction (PVR) for the volume overload of the RV. For segmental analysis of the RV, a custom made analysis software was developed. The method provides an automatic contour detection algorithm for the determination of the RV blood volume and enables the user to segregate the blood volume of the RVOT and the corpus based on anatomic landmarks and to generate volume-time-curves over a cardiac cycle. The analysis of volume-time-curves of the RV allowed calculation of Peak-Filling-Rate (PFR) and Time-to-Peak-Filling-Rate (TPFR), which are surrogate parameters for diastolic dysfunction.

Does intravenous sildenafil clinically ameliorate pulmonary hypertension during perioperative management of congenital heart diseases in children? - a prospective randomized study.

Background:Pulmonary hypertension (PHT), if present, can be a significant cause of increased morbidity and mortality in children undergoing surgery for congenital heart diseases (CHD). Various techniques and drugs have been used perioperatively to alleviate the effects of PHT. Intravenous (IV) sildenafil is one of them and not many studies validate its clinical use.Aims and Objectives:To compare perioperative PaO2 – FiO2 ratio peak filling rate (PFR), systolic pulmonary artery pressure (PAP) – systolic aortic pressure (AoP) ratio, extubation time, and Intensive Care Unit (ICU) stay between two groups of children when one of them is administered IV sildenafil perioperatively during surgery for CHDs.Materials and Methods:Patients with ventricular septal defects and proven PHT, <14 years of age, all American Society of Anesthesiologists physical status III, undergoing cardiac surgery, were enrolled into two groups – Group S (IV sildenafil) and Group C (control) – over a period of 14 months, starting from October 2013. Independent t-test and Mann–Whitney U-test were used to compare the various parameters between two groups.Results:PFR was higher throughout, perioperatively, in Group S. PAP/AoP was 0.3 and 0.4 in Group S and Group C, respectively. In Group S, mean group extubation time was 7 ± 7.34 h, whereas in Group C it was 22.1 ± 10.6. Postoperative ICU stay in Group S and Group C were 42.3 ± 8.8 h and 64.4 ± 15.9 h, respectively.Conclusion:IV sildenafil, when used perioperatively, in children with CHD having PHT undergoing corrective surgery, improves not only PaO2 – FiO2 ratio and PAP – AoP ratio but also reduces extubation time and postoperative ICU stay.

CMR-DETERMINED LV DIASTOLIC DYSFUNCTION IN DIABETIC PATIENTS IS ASSOCIATED WITH INCREASED MYOCARDIAL EXTRACELLULAR VOLUME FRACTION

Diabetic myocardial changes include increased myocardial apoptosis, necrosis, collagen deposition and interstitial fibrosis. These may result in myocardial stiffness and alteration of myocardial extracellular volume fraction (ECV). In this pilot study, we hypothesize that CMR-determined LV diastolic dysfunction in diabetic patients is associated with increased ECV measured by T1 mapping. 17 DM patients (6 males, age 63±10 years old) without macrovascular diseases were examined on a 1.5T MR system. LV systolic and diastolic function was determined using a short-axis SSFP stack, T1 map and average LV myocardium T1 at pre- and post-contrast was derived from a T1 prep or a modified Look-Locker sequence performed in a mid-LV level. Post-contrast late gadolinium enhancement (LGE) CMR was performed 15 minutes post injection of Gd-DTPA. LV systolic function and LGE determination used commercial software CMR42. LV diastolic functional parameters including peak filling rate (PFR) and time to peak filling rate (TPFR) were calculated using MASS software and were blinded to T1 analysis. T1 calculation used CMR42 or a customized Matlab code. Myocardial ECV = (1-haematocrit) × (ΔR1myocardium/ΔR1blood). Increased ECV was defined as ECV > 30%. The average LV functional parameters in 17 subjects were in the normal range (LVEF=61±6%, LVESV=45±17 ml, LVEDV=113±33 ml, LVSV=68±19 ml, LVM=103±25 g). No focal LGE was observed in this patient cohort. 8 of 17 subjects had ECV> 30% (ECV=38±9%) and the other 7 subjects had ECV<30% (23±5%). There is no statistically significant difference (P>0.05) in LV systolic functional parameters of LVEF, LVESV, LVEDV, LVSV and LVM between the increased ECV and normal ECV group. However, a statistically significant difference (P<0.05) was observed among diastolic functional parameters of TPFR and PFR, with significantly longer TPFR (344±148 vs.156±32 ms) and lower PFR (220±50 vs. 295±74 ml/s) observed in the increased ECV group. Also a statistically significant difference (P<0.05) was observed in pre-contrast T1 measurements. Increased ECV was observed in diabetic patients with preserved systolic function and this was associated with altered LV diastolic function. The increased ECV may indicate the presence of diffuse interstitial fibrosis and myocardial stiffness, thus limiting the LV diastolic relaxation.

Clinical usefulness of a novel program "Heart Function View" for evaluating cardiac function from gated myocardial perfusion SPECT.

To investigate clinical usefulness of a novel program "Heart Function View (HFV)" for evaluating left ventricular (LV) function from myocardial perfusion SPECT (MPS), we compared LV functional parameters (F(x)) calculated by HFV with those obtained by the other similar programs QGS and cardioGRAF or by ultrasound echocardiography (UCG) and examined their correlations with clinical markers of heart failure: plasma BNP concentrations (BNPs) and exercise capacity. Studied patients (n = 60) underwent technetium-99m tetrofosmin quantitative gated MPS including treadmill exercise for examining heart disease. Myocardial stress images were acquired 30 min after the first tracer injection during maximal exercise. Three hours later, the second tracer was injected, and resting images were acquired. LV systolic F(x) [ejection fraction (EF), peak ejection rate (PER)] and diastolic F(x) [first third filling fraction (1/3FF), first third filling rate (1/3FR), peak filling rate (PFR), time to PFR (TPF)] were analyzed, and phase standard deviation (SD) and histogram bandwidth were obtained by phase analysis. LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF obtained from HFV were well correlated with those from QGS, cardioGRAF and UCG. A diastolic parameter Doppler E/e' from UCG was significantly with PFR from HFV. There were good correlations between LVEDV, LVESV, LVEF, PER, PFR, 1/3FR, TPF and 1/3FF from HFV and those from cardioGRAF. LVEF, PER, 1/3FR, and PFR were significantly correlated with plasma BNP concentrations. In patients with non-ischemic heart disease (n = 42), phase SD and histogram bandwidth were correlated negatively with exercise capacity or PFR. HFV-derived LVF(x) are correlated with LVF(x) from the other programs or UCG, or with the clinical markers of heart failure and are thus useful in the functional assessment for patients with heart disease.

Relation of late gadolinium enhancement in cardiac magnetic resonance on the diastolic volume recovery of left ventricle with hypertrophic cardiomyopathy.

The purpose of the study was to investigate the influence of late gadolinium enhancement (LGE) on the diastolic volume recovery of left ventricle in patients with hypertrophic cardiomyopathy (HCM). Twenty-four HCM patients were studied through report-card 4.0. The presence or absence of late gadolinium enhancement was recorded according to a standardized methodology with a threshold value of six standard deviations above background. The LGE positive and negative groups were correlated to left ventricular end diastolic volume index (EDVI), left ventricular mass, left ventricular ejection fraction (EF), peak filling rate (PFR), peak ejecting rate (PER), normalized peak filling or ejecting rate (NPFR or NPER), time to peak filling or ejecting rate (TPFR or TPER), and diastolic volume recovery (DVR). PFR, NPFR, SV, SVI, EF, CO, CI, FS in LGE positive group were lower than LGE negative group, DVR10-40, DVR100, end systolic volume (ESV), end systolic volume index (ESVI), ESD were higher in LGE positive group, and the differences were statistically significant. The average LGE mass (ROI, region of interest) was 20.78 g, about 13.67% of left ventricle mass in LGE positive HCM group. Pearson correlation was noted between the LGE percent (ROI%) and ESV (0.692, P<0.05), ROI% and EF (-0.718, P<0.05), ROI% and PFR (-0.534, P<0.05), DVR20-40 (0.547, 0.544, 0.906, P<0.05) etc. The correlation between ROI% and DVR40 was best (0.906, P<0.05), and the correlation between ROI% and ESVI, ROI% and EF were both bigger than 0.7, showed the correlation was good. In addition to common quotas used to assess the structure and function of left ventricle in HCM, volume-time curve parameters may have potential to evaluate cardiac function in HCM. The correlation between DVR generated from volume-time curve with LGE was good, and may be a marker of effect of enhancement/scar tissue on diastolic function.

Left ventricular diastolic parameters in dilated cardiomypoathy: are we missing out on something?

Equilibrium radionuclide ventriculography is an established modality to assess the left ventricular (LV) systolic function in several clinical situations. Diastolic parameters can also be extracted from this investigation. The aim of our study is to assess the diastolic function of the left ventricle in cases of idiopathic dilated cardiomyopathy (IDCM) and ischemic cardiomyopathy, where systolic dysfunction has been considered of prime pathologic significance. We conducted a retrospective analysis of 89 patients who had undergone radionuclide ventriculography at our department with established diagnosis of IDCM in 59 patients and ischemic cardiomyopathy in remaining 30 patients. Peak filling rate (PFR) was assessed. The PFR was significantly lower in both patients with IDCM (median = 1.61 end diastolic volumes [EDV]/s) and ischemic cardiomyopathy (median = 2.005 EDV/s). 33% of the patients with ischemic cardiomyopathy and ejection fraction (EF) >45% had diastolic dysfunction while 25% of patients with IDCM and EF >45% had low PFR. Diastolic dysfunction can coexist in patients with dilated cardiomyopathy and even in patients with preserved LV EF. Routine evaluation of diastolic function in patients with heart failure can help in elucidation of pathogenesis and management of patients.

Assessment of the left ventricular early diastolic synchrony of cardiac resynchronization therapy by real time three-dimensional echocardiographic volume-time curves in patients with dilated cardiomyopathy

Objective To evaluate the diastolic function and relationship between diastolic function and early diastolic synchrony in patients with dilated cardiomyopathy (DCM) by real-time three-dimensional echocardiography (RT-3DE) volume-time curves (VTC) after cardiac resynchronization therapy (CRT).Methods Thirty-nine patients with DCM were enrolled by RT-3DE VTC before and 1 week,6 months,12 months after CRT,draw the left ventricular (LV) 16,12,6 segments LV diastolic early volume standard deviation of the time (Tedv-SD),and with the R-R interval normalized as early diastolic unsynchronized index (DDI) ;draw end-systolic volume (LVESV),LV end-diastolic volume (LVEDV),LV ejection fraction (LVEF) ;and calculate the diastolic peak filling rate(PFR),the ratio of early diastolic volume and enddiastolic volume(EDVearly/EDV).Results LVEDV,LVESV had no significant improvement.Compared with the before and 1 week after CRT,but the improvement was statistically significant after 6 months and 12 months (P ＜0.05,P ＜0.01); LVEF after 1 week,6 months and 12 months were statistically significant (P ＜0.05) ;Compared with before,PFR after 6 months was significantly increased (P ＜0.05),EDVearly/EDV at 12 months after CRT was significantly reduced (P ＜ 0.01); There was a significantly shortened in each segment (Tedv-SD)/R-R 1 week after CRT (P ＜0.01),but the parameters had no obvious improvement later.Correlation analysis:△ DDI and △ EDVearly/EDV reduction was significant positive correlation (r =0.52,P ＜0.01),△DDI and PFR has negative correlation (r =-0.40,P ＜ 0.05),△ EDVearly/EDV and △PFR also had a good relationship (r =-0.56,P ＜0.01).Conclusions The LV synchrony and diastolic function were improved after CRT in patients with DCM; PFR,EDVearly/EDV can be used as evaluation of left ventricular diastolic function effectively targets. Key words: Echocardiography, real-time three-dimensional; Cardiomyopathy, dilated; Cardiac resynchronization therapy; Ventricular function, left

Evaluation of left ventricular diastolic function with a dedicated cadmium-zinc-telluride cardiac camera: comparison with Doppler echocardiography

To evaluate the relationships between measures of left ventricular (LV) filling dynamics at cadmium-zinc-telluride (CZT) imaging and indexes of LV diastolic function at transthoracic echocardiography. Two hundred and forty-seven patients underwent myocardial perfusion imaging at rest and after stress with a low-dose CZT protocol and a baseline transthoracic echocardiography study. All patients were submitted to invasive or computed coronary angiography. The peak filling rate (PFR) and the time to PFR (TPFR) were derived from gated CZT images as measures of LV filling dynamics. LV diastolic function was also evaluated at echocardiography and the presence of significantly increased LV filling pressures determined. Increased LV filling pressures at transthoracic echocardiography were evident in 103 (42%) patients. Interestingly, independently from the presence of coronary artery disease, there was a strict correlation between the presence and severity of LV diastolic dysfunction at echocardiography and CZT-derived measures of filling dynamics, i.e., PFR (P = 0.001) and TPFR (P = 0.001). At receiving operating characteristic analysis, a composite index of reduced PFR (≤2.11 end-diastolic volume s(-1)) and increased TPFR (>234 ms) showed a sensitivity of 84% and a specificity of 67% in unmasking the presence of elevated LV filling pressures at echocardiography. CZT-derived measures of LV filling dynamics correlate with echocardiographic parameters of diastolic function and may identify the presence of increased LV filling pressures.

Association of Iodine-123 BMIPP and MIBG Cardiac Uptakes with Left Ventricular Functional Parameters Assessed by Gated Myocardial Perfusion SPECT

We investigated how the degree of cardiac uptakes of radioactive fatty acid (FA) analog ( 123 I-BMIPP) or norepinephrine (NE) analog ( 123 I-MIBG) was related to left ventricular (LV) functional parameters in patients with heart disease, which might be a predictor of cardiac events. Patients with ejection fraction (EF) of 16.2%-82.2% underwent 123 I-BMIPP or 123 I-MIBG myocardial scintigraphy, and were followed up over 1177±486 days. LV systolic functional parameter EF, diastolic parameters 1/3FR (first third filling rate), PFR (peak filling rate), and TPF (time to PFR) were calculated using quantitative gated SPECT. 123 I-BMIPP uptake (n=30) was significantly correlated with EF, 1/3FR, and PFR but not TPF. 123 I-MIBG uptake (n=37) was also correlated with EF, 1/3FR, and PFR but not TPF. In contrast, TPF was positively correlated with age, and was significantly longer in women than in men. Such findings were also observed in normal EF patients (≥50%, n=100). Kaplan–Meier analysis showed the occurrence of earlier cardiac events in the case of patients with decreased 123 I-BMIPP and 123 I-MIBG uptake, decreased PFR, and prolonged TPF. The degree of decreased cardiac uptakes of FA and NE may be associated with the grade of systolic and diastolic dysfunctions assessed by EF, PFR, and 1/3FR. In contrast, prolonged TPF, another diastolic parameter, may rather be caused by aging and female gender, independent of EF. Despite these differences, myocardial FA metabolism impairment, cardiac sympathetic nerve inactivity, decreased PFR, and prolonged TPF may all indicate poor cardiac prognosis in patients with heart disease. Keywords123 I-BMIPP; 123 I-MIBG; Cardiac Function; Heart Failure

Comment on “Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction”

We read with great interest the manuscript entitled “Analisis de la function diastolica mediante gated-SPECT de perfusion miocardica tras revascularizacion coronaria en el infarto agudo de miocardio” [Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction] by Romero-Farina et al. in the first issue of 2013 of Rev Esp Med Nucl Imagen.1 They should be congratulated for the article which is drawing attention to the important field of nuclear cardiology. With the present communication, we would like to contribute a technical detail regarding this issue. Authors analyzed the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction. Significant improvement in diastolic function has been reported mainly associated to the amount of salvage myocardium afterpercutaneous coronary revascularization inpatientwith acute myocardial infarction. They acquired the gated SPECT images by dividing the R–R interval to 8 frames and the results of the time to peak filling rate (TTPF) and peak filling rate (PFR) was obtained by the software using this data. It has been recommended that

Comparative study of gated myocardial perfusion imaging using 99Tcm-tetrofosmin and 99Tcm-sestamibi

Objective Tocompare the results of 99Tcm-tetrofosmin (TF) and 99Tcm-MIBI G-MPI in evaluating left ventricular myocardial perfusion and other functional parameters.Methods TF and MIBI were both labeled by 99Tcm and the radiochemical purities were tested.During December 2011 to May 2012,112 patients who had examinations of CAG and echocardiograph in one week after G-MPI were divided into 99Tcm-TF group (47 patients) and 99Tcm-MIBI group (65 patients) by simple random sampling.Patients who suffered from severe arrhythmia,clinically suspicious of mycarditis or cardiomyopathy were excluded.The research was approvel by the ethics committee,and all patients signed informed consents.One-day 99Tcm-TF G-MPI and two-day 99Tcm-MIBI G-MPI were performed.The left ventricular functional parameters were acquired automatically by Cedars quantitative gated SPECT (QGS) software,including LVEF,EDV,ESV,peak filling rate (PFR),peak ejection rate (PER) and phase standard difference (SD).The data were analyzed using x2 test,two-sample t test,paired t test and linear correlation analysis by SPSS 17.0.Results The radiochemical purities of 99Tcm-TF and 99Tcm-MIBI were (97.5±0.4) ％ and (99.1±0.2) ％ respectively.The coincidence rates of 99Tcm-TF and 99Tcm-MIBI G-MPI with CAG were 88.9％ (40/45) and 90.5％ (57/63),respectively.There was no significant difference between G-MPI results of the two agents (x2 =0.389,P＞0.05).There was also no significant difference between left ventricular functional parameters of the two agents (LVEF:(62.60±13.56)％ vs (60.52±7.08)％,t=0.940; EDV:(103.3±17.29) ml vs (98.52±19.37) ml,t=1.348; ESV:(41.73±12.69) ml vs (46.05±10.81) ml,t=0.851; PER:(2.73±0.67)EDV/s vs (2.61±1.04) EDV/s,t=0.725; PFR:(2.13±0.80) EDV/s vs (2.07±1.09) EDV/s,t=0.339;phase SD:(5.58±4.16)° vs (5.97±4.64)°,t=0.450; all P＞0.05).There was no significant difference between left ventricular functional parameters by G-MPI and UCG (LVEF:(61.39± 10.28) ％ vs (62.13±8.51) ％,t=0.991 ; EDV:(100.50±18.61) ml vs (101.70±18.34) ml,t=1.806; ESV:(44.25±11.77) ml vs (43.94±11.28) ml,t=0.658; all P＞0.05).LVEF,EDV,ESV by G-MPI correlated with the results of UCG (r=0.673,0.710,0.452,all P＜0.05).Conclusion 99Tcm-TF can also be used as a G-MPI agent to evaluate left ventricular myocardial perfusion and other functional parameters. Key words: Myocardial diseases ; Tomography, emission-computed, single-photon; Technetium ; Tetrofosmin ; MIBI