Research article summary (published 29 Sep 2009):

Myocardial perfusion, function, and dyssynchrony in patients with heart failure: baseline results from the single-photon emission computed tomography imaging ancillary study of the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) Trial.

Full Abstract

BACKGROUND: There are currently limited data on the relationships between resting perfusion abnormalities, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) functional class, and exercise capacity as defined by peak VO(2) and 6-minute walk test in patients with heart failure (HF) and reduced LVEF. Furthermore, the association between resting perfusion abnormalities and left ventricular dyssynchrony is currently unknown. This article addresses the Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION) gated SPECT imaging (gSPECT) substudy baseline results. METHODS: HF-ACTION was a multicenter, randomized controlled trial of aerobic exercise training versus usual care in 2,331 stable patients with LVEF of < or = 35% and NYHA class II to IV HF symptoms treated with optimal medical therapy. Subjects enrolled in the HF-ACTION substudy underwent resting Tc-99m tetrofosmin gSPECT at baseline (n = 240). Images were evaluated for extent and severity of perfusion abnormalities using a 17-segment and a 5-degree gradation severity score (summed rest score [SRS]). Left ventricular function and dyssynchrony were assessed using validated available commercial software. RESULTS: The average age of patients enrolled was 59, 69% were male, 63% were white, and 33% were African American. Of the 240 participants, 129 (54%) were ischemic and 111 (46%) were nonischemic in etiology. The median LVEF by gSPECT for the entire cohort was 26%. Among the nuclear variables, there was a modest correlation between LVEF and SRS (r = -0.31, P < .0001) and there were stronger correlations between phase SD and SRS (r = 0.66, P < .0001) as well as phase SD and LVEF (r = -0.50, P < .0001). Patients with NYHA class III symptoms had more severe and significant degrees of dyssynchrony (median phase SD 54 degrees ) than those with NYHA class II symptoms (median phase SD 39 degrees, P = .001). Patients with an ischemic etiology had a higher SRS (P < .0001) and significantly more dyssynchrony (P < .0001) than those who were nonischemic. However, there was no difference in LVEF or objective measures of exercise capacity between these groups. With respect to peak VO(2), there was a weak correlation with LVEF (r = 0.18, P = .006) and no correlation with SRS (r = -0.04, P = 0.59) or with dyssynchrony (r = -0.13, P = .09). A weak but statistically significant correlation between SRS and 6-minute walk was observed (r = -0.15, P = .047). CONCLUSIONS: Gated SPECT imaging can provide important information in patients with HF due to severe LV dysfunction including quantitative measures of global systolic function, perfusion, and dyssynchrony. These measurements are modestly but significantly related to symptom severity and objective measures of exercise capacity.

Author information

Author/s: Atchley, Allen E (AE); Kitzman, Dalane W (DW); Whellan, David J (DJ); Iskandrian, Ami E (AE); Ellis, Stephen J (SJ); Pagnanelli, Robert A (RA); Kao, Andrew (A); Abdul-Nour, Khaled (K); O'Connor, Christopher M (CM); Ewald, Greg (G); Kraus, William E (WE); Borges-Neto, Salvador (S); HF-ACTION Investigators;

Affiliation: Duke University Medical Center, Durham, NC 27710, USA.

Grants: 5U01HL063747 (Agency:NHLBI NIH HHS) ; 5U01HL064250 (Agency:NHLBI NIH HHS) ; 5U01HL064257 (Agency:NHLBI NIH HHS) ; 5U01HL064264 (Agency:NHLBI NIH HHS) ; 5U01HL064265 (Agency:NHLBI NIH HHS) ; 5U01HL066461 (Agency:NHLBI NIH HHS) ; 5U01HL066482 (Agency:NHLBI NIH HHS) ; 5U01HL066491 (Agency:NHLBI NIH HHS) ; 5U01HL066494 (Agency:NHLBI NIH HHS) ; 5U01HL066497 (Agency:NHLBI NIH HHS) ; 5U01HL066501 (Agency:NHLBI NIH HHS) ; 5U01HL068973 (Agency:NHLBI NIH HHS) ; 5U01HL068980 (Agency:NHLBI NIH HHS) ; P60AG10484 (Agency:NIA NIH HHS) ; R37AG18915 (Agency:NIA NIH HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural

Journal: American heart journal (Am Heart J), published in United States. (Language: eng)

Reference: 2009-Oct; vol 158 (issue 4 Suppl) : pp S53-63

Dates: Created 2009/09/28; Completed 2009/10/29;

PMID: 19782789, status: MEDLINE (last retrieval date: 10/29/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged Arrhythmias, Cardiac - diagnosis; physiopathology; radionuclide imaging Data Collection Exercise Test - statistics & numerical data Exercise Therapy Exercise Tolerance Heart - physiopathology; radionuclide imaging Heart Failure - physiopathology; radionuclide imaging; therapy Heart Ventricles - physiopathology; radionuclide imaging Humans

Humans Male Middle Aged Myocardial Perfusion Imaging - statistics & numerical data Organophosphorus Compounds - diagnostic use Organotechnetium Compounds - diagnostic use Stroke Volume - physiology Tomography, Emission-Computed, Single-Photon - statistics & numerical data Ventricular Dysfunction, Left - diagnosis; physiopathology; radionuclide imaging Ventricular Function, Left - physiology

Associated Chemicals: Organophosphorus Compounds (0) ; Organotechnetium Compounds (0) ; technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane (0)

Related articles

These are the highest related articles currently in the database:

• Can the estimation of ejection fraction during gated single photon emission computed tomography at rest add information to the cardiac perfusion study? 30 Aug 2002
• Ambulatory monitoring of left ventricular function: walk and bicycle exercise in congestive heart failure. 30 May 1997
• Evaluation of global and regional left ventricular function obtained by quantitative gated SPECT using 99mTc-tetrofosmin for left ventricular dysfunction. 30 Jul 2000
• Correlation of abnormal response of left ventricular ejection fraction after exercise and left ventricular cavity-to-myocardium count ratio of technetium-99m-tetrofosmin single photon emission computed tomography in patients with coronary artery disease. 30 Aug 2002
• Comparison of left and right ventricular end-systolic pressure-volume relations in congestive heart failure. 30 May 1985
• Gated myocardial perfusion tomography for the assessment of left ventricular function and volumes: comparison with echocardiography. 30 Oct 1999
• Reduction of the LVEF measured with gSPECT after 1-3 hours after physical exercise in CAD. 29 Sep 2004
• Comparison of technetium 99m-tetrofosmin and thallium-201 single photon emission computed tomographic imaging for the assessment of viable myocardium in patients with left ventricular dysfunction. 30 Dec 1997
• 99mTc-tetrofosmin SPECT for prediction of functional recovery defined by MRI in patients with severe left ventricular dysfunction: additional value of gated SPECT. 30 Oct 1999
• Comparison of methods for quantification of transient ischaemic dilation in myocardial perfusion SPET. 29 Sep 2000

See 100+ related articles.

Related Article Map

Legend: - FREE Full text Article. - Abstract only. - Title only. More help.

See a large map of 100+ related articles.