Heart failure (HF) affects more than 5 million people in the United States, and the number increases by more than 0.5 million every year. Acute decompensated HF accounts for over one million hospital admissions per year. The estimated direct and indirect cost for HF in 2006 is $29.6 billion. Our long-term objective is to improve the prognosis of HF patients by more accurately predicting their response to cardiac resynchronization therapy (CRT) and/or revascularization. CRT has been approved by FDA as a treatment of HF patients refractory to conventional therapy. However, 20-40% of the patients who selected for CRT based on the conventional criteria do not respond to CRT. Echocardiography has shown to improve patient selection for CRT, but it requires expertise to obtain reliable results. The PROSPECT trial has shown that under "real-world" conditions the current available echocardiographic techniques are not ready for routine prediction of CRT response. Our primary goal is to predict the response to CRT in patients with HF-induced conduction disturbances and ventricular dyssynchrony. It will be accomplished by improved diagnosis and characterization of left ventricular (LV) dyssynchrony using our novel, quantitative multi-harmonic phase analysis (MHPA) of ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) study and by integrating this evaluation of LV dyssynchrony to our established quantification of myocardial perfusion and viability from the same study. This integrated quantification will also be used to predict the response to revascularization in HF patients with ischemic cardiomyopathy - our secondary goal. We propose to measure LV dyssynchrony from ECG-gated SPECT MPI, because 1) it is widely available, 2) it is highly reproducible, and 3) it can provide additional perfusion/viability information, which is needed for the management of the HF patient, without any additional procedure. Specifically, in this research we will 1) develop LV dyssynchrony simulation tools that can simulate gated SPECT MPI studies with a variety of LV dyssynchrony patters, 2) develop MHPA and optimize it by using the simulation tools to determine the imaging requirements for accurate MHPA measurements, 3) define and validate quantitative indices that describe LV dyssynchrony and development normal databases for these indices, 4) use the LV dyssynchrony quantification coupled with our established perfusion/viability quantification to predict the response to CRT in HF patients, and 5) use the integrated quantification of LV dyssynchrony, perfusion, and viability to predict the response to revascularization in HF patients with ischemic cardiomyopathy. Upon completion of this research, we will establish a strong scientific foundation for our phase analysis approach thus supporting a large clinical trial to prove the usefulness of ECG-gated SPECT MPI with our integrated quantification of LV dyssynchrony, perfusion, and viability in prognosis for HF patients and thus promoting widespread utilization clinically.

Public Health Relevance

RESEARCH NARRATIVE Heart failure affects more than 5 million people in the United States, and the number increases by more than 0.5 million every year. Acute decompensated heart failure accounts for over one million hospital admissions per year, and the estimated direct and indirect cost for heart failure in 2006 is $29.6 billion. This research is to establish a strong scientific foundation for our integrated quantification of left ventricular dyssynchrony, perfusion, and viability from the conventional ECG-gated SPECT myocardial perfusion imaging studies to improve the prognosis of heart failure patients by more accurately predicting their response to cardiac resynchronization therapy and/or revascularization.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL094438-04
Application #
8311067
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Desvigne-Nickens, Patrice
Project Start
2009-07-15
Project End
2014-04-30
Budget Start
2012-05-01
Budget End
2014-04-30
Support Year
4
Fiscal Year
2012
Total Cost
$383,625
Indirect Cost
$136,125
Name
Emory University
Department
Radiation-Diagnostic/Oncology
Type
Schools of Medicine
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Hung, Guang-Uei; Huang, Jin-Long; Lin, Wan-Yu et al. (2014) Impact of right-ventricular apical pacing on the optimal left-ventricular lead positions measured by phase analysis of SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 41:1224-31
Lin, Xianhe; Xu, Huiqin; Zhao, Xuefeng et al. (2014) Sites of latest mechanical activation as assessed by SPECT myocardial perfusion imaging in ischemic and dilated cardiomyopathy patients with LBBB. Eur J Nucl Med Mol Imaging 41:1232-9
Zhou, Yanli; Zhou, Weihua; Folks, Russell D et al. (2014) I-123 mIBG and Tc-99m myocardial SPECT imaging to predict inducibility of ventricular arrhythmia on electrophysiology testing: a retrospective analysis. J Nucl Cardiol 21:913-20
Huang, Wen-Sheng; Huang, Ching-Hui; Lee, Cheng-Liang et al. (2014) Relation of early post-stress left ventricular dyssynchrony and the extent of angiographic coronary artery disease. J Nucl Cardiol 21:1048-56
Zhang, Hongxiang; Hou, Xiaofeng; Wang, Yao et al. (2014) The acute and chronic effects of different right ventricular site pacing on left ventricular mechanical synchrony as assessed by phase analysis of SPECT myocardial perfusion imaging. J Nucl Cardiol 21:958-66
Chen, Chien-Cheng; Huang, Wen-Sheng; Hung, Guang-Uei et al. (2013) Left-ventricular dyssynchrony evaluated by Tl-201 gated SPECT myocardial perfusion imaging: a comparison with Tc-99m sestamibi. Nucl Med Commun 34:229-32
Hsu, Tang-Ho; Huang, Wen-Sheng; Chen, Chien-Cheng et al. (2013) Left ventricular systolic and diastolic dyssynchrony assessed by phase analysis of gated SPECT myocardial perfusion imaging: a comparison with speckle tracking echocardiography. Ann Nucl Med 27:764-71
Zhou, Yanli; Faber, Tracy L; Patel, Zenic et al. (2013) An automatic alignment tool to improve repeatability of left ventricular function and dyssynchrony parameters in serial gated myocardial perfusion SPECT studies. Nucl Med Commun 34:124-9
Cooke, C David; Esteves, Fabio P; Chen, Ji et al. (2011) Left ventricular mechanical synchrony from stress and rest 82Rb PET myocardial perfusion ECG-gated studies: differentiating normal from LBBB patients. J Nucl Cardiol 18:1076-85
Murrow, Jonathan; Esteves, Fabio; Galt, James et al. (2011) Characterization of mechanical dyssynchrony measured by gated single photon emission computed tomography phase analysis after acute ST-elevation myocardial infarction. J Nucl Cardiol 18:912-9

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