Determination of normal ranges of regional and global phase parameters using gated myocardial perfusion imaging with Cedars-Sinai’s QGS software

Document Type : Original Article


1 Department of Nuclear Medicine and Molecular Imaging, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran

2 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical & Research Center, Tehran, Iran

3 Rajaie Cardiovascular Medical & Research Center, Tehran, Iran


Introduction: Myocardial perfusion imaging using gated SPECT and phase analysis is an effective tool in evaluation of mechanical dyssynchrony. The purpose of this study was to determine the normal ranges of global and regional phase parameters.
Methods: A total of 100 patients with normal resting and stress electrocardiograms, low pretest likelihood for coronary artery disease and a normal gated MPI study were recruited in the study. All of the patients underwent a standard 2-day stress/rest gated MPI study according to standard protocols. The reconstructed images were further analyzed by Cedar-Sinai’s quantitative gated SPECT. Left ventricular phase indices were provided both globally and regionally for both genders and the normal interquartile range of these parameters were defined.
Results:Normal ranges of global and wall-based regional phase parameters are presented both in unisex and in gender-specific formats. Both global (P<0.001) and major LV regional phase parameters (P<0.05) are found to be significantly different between the two genders with a significant positive association between end-diastolic volume with phase global indices (P<0.01). There is also more synchronized phase distribution in phase analysis results of post-exercise gated MPI as compared to the phase analysis of the same patients at resting state.

Conclusion: Normal ranges of phase indices are defined in this article by using Cedar-Sinai’s QGS software. As normal ranges of phase dyssynchrony parameters are gender-specific and are related to LV volume, stress or resting state and stress type, the need for careful incorporation of these data is indicated in interpretation of phase studies.


Main Subjects

  1. Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011 Jan;8(1):30-41.
  2. Van Spall HG, Shanbhag D, Gabizon I, Ibrahim Q, Graham ID, Harlos K, Haynes RB, Connolly SJ. Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol. BMJ Open. 2016 Mar 31;6(3):e009364.
  3. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A; Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012 Aug;14(8):803-69.
  4. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos G, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2016 Sep 27;68(13):1476-1488.
  5. Chen J, Garcia EV, Bax JJ, Iskandrian AE, Borges-Neto S, Soman P. SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony. J Nucl Cardiol. 2011 Aug;18(4):685-94.
  6. Galderisi M, Cattaneo F, Mondillo S. Doppler echocardiography and myocardial dyssynchrony: a practical update of old and new ultrasound technologies. Cardiovasc Ultrasound. 2007 Sep 6;5:28.
  7. Lardo AC, Abraham TP, Kass DA. Magnetic resonance imaging assessment of ventricular dyssynchrony: current and emerging concepts. J Am Coll Cardiol. 2005 Dec 20;46(12):2223-8.
  8. Henneman MM, Chen J, Dibbets-Schneider P, Stokkel MP, Bleeker GB, Ypenburg C, van der Wall EE, Schalij MJ, Garcia EV, Bax JJ. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med. 2007 Jul;48(7):1104-11.
  9. Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL, Iskandrian AE. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol. 2005 Nov-Dec;12(6):687-95.
  10. Health Quality Ontario. Stress echocardiography with contrast for the diagnosis of coronary artery disease: an evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(10):1-59.
  11. Nakajima K, Okuda K, Matsuo S, Kiso K, Kinuya S, Garcia EV. Comparison of phase dyssynchrony analysis using gated myocardial perfusion imaging with four software programs: Based on the Japanese Society of Nuclear Medicine working group normal database. J Nucl Cardiol. 2017 Apr;24(2):611-621.
  12. Rastgou F, Shojaeifard M, Amin A, Ghaedian T, Firoozabadi H, Malek H, Yaghoobi N, Bitarafan-Rajabi A, Haghjoo M, Amouzadeh H, Barati H. Assessment of left ventricular mechanical dyssynchrony by phase analysis of gated-SPECT myocardial perfusion imaging and tissue Doppler imaging: comparison between QGS and ECTb software packages. J Nucl Cardiol. 2014 Dec;21(6):1062-71.
  13. Genders TS, Steyerberg EW, Hunink MG, Nieman K, Galema TW, Mollet NR, de Feyter PJ, Krestin GP, Alkadhi H, Leschka S, Desbiolles L, Meijs MF, Cramer MJ, Knuuti J, Kajander S, Bogaert J, Goetschalckx K, Cademartiri F, Maffei E, Martini C, Seitun S, Aldrovandi A, Wildermuth S, Stinn B, Fornaro J, Feuchtner G, De Zordo T, Auer T, Plank F, Friedrich G, Pugliese F, Petersen SE, Davies LC, Schoepf UJ, Rowe GW, van Mieghem CA, van Driessche L, Sinitsyn V, Gopalan D, Nikolaou K, Bamberg F, Cury RC, Battle J, Maurovich-Horvat P, Bartykowszki A, Merkely B, Becker D, Hadamitzky M, Hausleiter J, Dewey M, Zimmermann E, Laule M. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012 Jun 12;344:e3485.
  14. Almeida J, Fonseca P, Dias T, Ladeiras-Lopes R, Bettencourt N, Ribeiro J1, Gama V. Comparison of coronary artery disease consortium 1 and 2 scores and duke clinical score to predict obstructive coronary disease by invasive coronary angiography. Clin Cardiol. 2016 Apr;39(4):223-8.
  15. van Werkhoven JM, Schuijf JD, Gaemperli O, Jukema JW, Boersma E, Wijns W, Stolzmann P, Alkadhi H, Valenta I, Stokkel MP, Kroft LJ, de Roos A, Pundziute G, Scholte A, van der Wall EE, Kaufmann PA, Bax JJ. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J Am Coll Cardiol. 2009 Feb 17;53(7):623-32.
  16. Henzlova MJ, Duvall WL, Einstein AJ, Travin MI, Verberne HJ. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers. J Nucl Cardiol. 2016 Jun;23(3):606-39.
  17. Malek H, Hedayati R, Yaghoobi N, Bitarafan-Rajabi A, Firoozabadi SH, Rastgou F. The Effect of milk, water and lemon juice on various subdiaphragmatic activity-related artifacts in myocardial perfusion imaging. Res Cardiovasc Med. 2015 Sep 14;4(4):e29235.
  18. Malek H, Ghaedian T, Yaghoobi N, Rastgou F, Bitarafan-Rajabi A, Firoozabadi H. Focal breast uptake of 99mTc-sestamibi in a man with spindle cell lipoma. J Nucl Cardiol. 2012 Jun;19(3):618-20.
  19. Van Kriekinge SD, Nishina H, Ohba M, Berman DS, Germano G.Automatic global and regional phase analysis from gated myocardial perfusion SPECT imaging: application to the characterization of ventricular contraction in patients with left bundle branch block. J Nucl Med. 2008 Nov;49(11):1790-7.
  20. Malek H, Yaghoobi N, Hedayati R. Artifacts in Quantitative analysis of myocardial perfusion SPECT, using Cedars-Sinai QPS Software. J Nucl Cardiol. 2017 Apr;24(2):534-542.
  21. Botvinick EH, Frais MA, Shosa DW, O'Connell JW, Pacheco-Alvarez JA, Scheinman M, Hattner RS, Morady F, Faulkner DB. An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis. Am J Cardiol. 1982 Aug;50(2):289-98.
  22. Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, Van Train KF, Berman DS. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med. 1995 Nov;36(11):2138-47.
  23. Singh H, Patel CD, Sharma P, Naik N, Singh S, Narang R. Does perfusion pattern influence stress-induced changes in left ventricular mechanical dyssynchrony on thallium-201-gated SPECT myocardial perfusion imaging? J Nucl Cardiol. 2015 Feb;22(1):36-43.
  24. Li D, Zhou Y, Feng J, Yuan D, Cao K, Garcia EV, Chen J. Impact of image reconstruction on phase analysis of ECG-gated myocardial perfusion SPECT studies. Nucl Med Commun. 2009 Sep;30(9):700-5.