Analysis of ventricular synchrony: A complex puzzle
Received Feb
Analysis of ventricular synchrony: A complex puzzle
Guillermo Romero-Farina 0
FASNC 0 1 2
Santiago Aguade´-Bruix 0
0 Reprint requests: Guillermo Romero-Farina MD , PhD, FESC, FASNC , Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Auto`noma de Barcelona , Paseo Vall d'Hebron 119-129, 08035, Barcelona , Spain; guir-
1 Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Auto`noma de Barcelona , Barcelona , Spain
2 Cardiology Department, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Auto`noma de Barcelona , Barcelona , Spain
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The following editorial was focused on the most
relevant points of the article by Malik et al.:1 firstly,
normal cut-off values of phase analysis parameters and
different variables that influence in the ventricular
synchrony analysis; secondly, the impact of the duration of
type II diabetes mellitus on left ventricular mechanical
synchrony analysis; thirdly, the repercussions on the
cardiac function of the diseases associated with diabetes
mellitus (DM), and its complications; and fourthly, a
normal gated SPECT definition.
In the last 13 years, we have a new tool in the area
of nuclear cardiology called analysis of left ventricle
synchrony. Since 2005, several articles2–20 have been
published in relation to the normal cut-off values
(Table 1), and diagnosis and prognosis (Table 2). From
a physiological point of view, the study of the
mechanical synchronization of the ventricles is very
complex. Among the different publications, there is a
general agreement between the average values and the
cut-off values normality obtained; however, in spite of
that they are not exactly concordant. This is due to the
fact that these cut-off values depend on multiple
variables, which are difficult to control in the statistical
analysis (Figure 1). Until now, all the information
provided by different groups of researchers have taught us
that these influential variables can be grouped into four
main categories (Figure 1): type of software, type of
statistical methodology to find the appropriate cut-off
values, the moment that images are acquired, and
clinical patient data. But probably, as experimental studies
show21, the most complex thing to control is the effect
of the intrinsic myocardial properties on ventricular
synchrony, which are specific to each patient.
Through different mechanisms, patients with DM
have high cardiovascular morbidity and mortality. The
left ventricular diastolic dysfunction,22,23 systolic
dysfunction,24 and left ventricular mechanical
dyssynchrony (LVMD)1 are frequent.
In this issue of Journal of Nuclear Cardiology,
Malik et al. evaluated retrospectively 146 consecutive
patients with normal gated SPECT-MPI.1 LVMD was
determined by the cut-off values (mean ? 2 SD)
observed for phase standard deviation (SD) and phase
bandwidth (BW) from the control subjects. LVMD was
detected in 24 (28%) DM patients with the pre-defined
cut-off values for SD ([ 10.8) and BW ([ 35.6) derived
from the controls. Hyperlipidemia, overweight/obesity,
duration of DM, and its long-term complications were
independently associated with LVMD, with long-term
complications being the highest risk factor (OR 28.00;
p \ 0.001). The authors concluded that the evolution
time of the patients with type II DM affects the left
ventricular mechanical synchrony.
In this study, long-term type II diabetes
complications (nephropathy, neuropathy, neuropathy, and/or
retinopathy) were present in 27.9% (24/86) of patients,
and 18 of them (18/24, 75%) had LVMD. Therefore, the
cause and the degree of LVMD is not only due to the
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myocardial changes caused by diabetes directly, but also
by the myocardial repercussion caused by the effects of
DM on other organs (nephropathy, neuropathy, etc).
Previously, From et al.22 evaluated the diastolic function
in 486 patients with DM free of heart failure using tissue
Doppler echocardiography, and concluded that a
duration of DM of C 4 years is correlated with s (...truncated)