Document Detail


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.
MedLine Citation:
PMID:  19782789     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Allen E Atchley; Dalane W Kitzman; David J Whellan; Ami E Iskandrian; Stephen J Ellis; Robert A Pagnanelli; Andrew Kao; Khaled Abdul-Nour; Christopher M O'Connor; Greg Ewald; William E Kraus; Salvador Borges-Neto;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American heart journal     Volume:  158     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-28     Completed Date:  2009-10-29     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S53-63     Citation Subset:  AIM; IM    
Affiliation:
Duke University Medical Center, Durham, NC 27710, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00047437
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MeSH Terms
Descriptor/Qualifier:
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
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
Grant Support
ID/Acronym/Agency:
5U01HL063747/HL/NHLBI NIH HHS; 5U01HL064250/HL/NHLBI NIH HHS; 5U01HL064257/HL/NHLBI NIH HHS; 5U01HL064264/HL/NHLBI NIH HHS; 5U01HL064265/HL/NHLBI NIH HHS; 5U01HL066461/HL/NHLBI NIH HHS; 5U01HL066482/HL/NHLBI NIH HHS; 5U01HL066491/HL/NHLBI NIH HHS; 5U01HL066494/HL/NHLBI NIH HHS; 5U01HL066497/HL/NHLBI NIH HHS; 5U01HL066501/HL/NHLBI NIH HHS; 5U01HL068973/HL/NHLBI NIH HHS; 5U01HL068980/HL/NHLBI NIH HHS; P60AG10484/AG/NIA NIH HHS; R37 AG018915/AG/NIA NIH HHS; R37AG18915/AG/NIA NIH HHS; U01 HL063747/HL/NHLBI NIH HHS; U01 HL063747-06S1/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Organophosphorus Compounds; 0/Organotechnetium Compounds; 0/technetium Tc 99m 1,2-bis(bis(2-ethoxyethyl)phosphino)ethane
Investigator
Investigator/Affiliation:
Christopher M O'Connor / ; Kerry L Lee / ; Stephen J Ellis / ; David S Rendall / ; David J Whellan / ; Ileana L Piña / ; Steven J Keteyian / ; Lawton S Cooper / ; Robin Boineau / ; Lawrence J Fine / ; Jerome L Fleg / ; Eric S Leifer / ; Virginia Erickson / ; Jonathan G Howlett / ; Nancy Houston Miller / ; Debra Isaac / ; Robert McKelvie / ; Faiez Zannad / ; Sharon Boozer / ; Patty Connolly / ; Anthony Doll / ; Stephen J Ellis / ; Camille Frazier / ; Deb Mark / ; Michelle McClanahan-Crowder / ; Marcia Meyer / ; Brenda S Mickley / ; David S Rendall / ; Molly Rich / ; Hoss Rostami / ; Sharon Settles / ; Kathy Spinella / ; Jessica Staib / ; Omar Thompson / ; William Abraham / ; Danuta Biniakiewicz / ; Joann Homan / ; Vera Bittner / ; Meredith Fitz-Gerald / ; Gregory Ewald / ; Heidi Craddock / ; Jean Flanagan / ; Gregg Fonarow / ; Virginia Erickson / ; Wilson Colucci / ; Nancy Z Lim / ; Elena Tokareva / ; Rami Alharethi / ; Ray Hershberger / ; Deirdre Nauman / ; Steven J Keteyian / ; Matthew Saval / ; Dalane W Kitzman / ; Brittney L Fray / ; Brian Moore / ; Ileana L Piña / ; Marianne Vest / ; Andrew Smith / ; Gail Snell / ; Eugene Wolfel / ; Mona Cantu / ; Kirkwood Adams / ; Jana Glotzer / ; Valerie Johnson / ; Kate Schumacher / ; Gordon Blackburn / ; Carrie Geither / ; Susan Moore / ; A Bleakley Chandler / ; Shanda Browning Vaughn / ; Paula J Easler / ; Debbie Williams / ; Marc Colmer / ; Julius M Gardin / ; Kelly Dimick / ; Sharon K Sklar / ; Sherri Teller / ; Jalal K Ghali / ; Karen Hale-Stenson / ; Mihai Gheorghiade / ; Theresa Strzelczyk / ; Maryl R Johnson / ; Cassondra Vander Ark / ; Lee R Goldberg / ; Andrew Kao / ; Jennifer Dekerlegand / ; William E Kraus / ; Johanna Johnson / ; Brian D Duscha / ; Mandeep R Mehra / ; Hector Ventura / ; Bobbett Harris / ; Monica Colvin-Adams / ; Kathy Duderstadt / ; Karen Meyer / ; Melissa Steger / ; Barry Cabuay / ; Ron Oren / ; Page Scovel / ; Andrew Kao / ; Tracey Stevens / ; Karen Haffey / ; Christy Mandacina / ; Ann Stewart / ; Ann M Swank / ; John Manire / ; Paul D Thompson / ; Ludmila Cosio-Lima / ; Marie Lagasse / ; Tehmina Naz / ; Lynne Wagoner / ; Susan K Roll / ; Frank G Yanowitz / ; Johnny Walker / ; Adam Mueller / ; Peter McCullough / ; Cathy Coleman / ; Kimberly A Dorrell / ; Tamika Washington / ; Eileen Handberg / ; James A Hill / ; Jacqueline Bakos / ; Alice Boyette / ; Pamela Smith / ; Cynthia Williams / ; Dalynn Badenhop / ; Susan Schroeder / ; Kelly Walter / ; Peter Kokkinos / ; Elisse Collins / ; Lauren Korsak / ; Eric Eichhorn / ; Allison Leonard / ; Tina Worley / ; Gerald Fletcher / ; Phil Peasley / ; Pam Oldano / ; John Kostis / ; Nora M Cosgrove / ; Udho Thadani / ; Lisa Rogan / ; Michelle Thresher / ; John Turner / ; Denise Barnard / ; Denise Herman / ; Annette Contasti / ; Marcy Sagerian / ; Elizabeth Ofili / ; Anekwe Onwuanyi / ; Sunday Nkemdiche / ; Howard Eisen / ; James Fitzpatrick / ; Joyce Wald / ; Jennie Wong / ; Myrvin Ellestad / ; Leslie Kern / ; Ezra A Amsterdam / ; Mary J Burns / ; Savitri Fedson / ; Ravi K Garg / ; Peggy Bennett / ; Linda Bond / ; Leway Chen / ; Janice Schrack / ; Douglas Pearce / ; Linda Bond / ; Greg Palevo / ; Margarett Serfass / ; Daniel Forman / ; Maria M Lopez / ; Yemi Talabi-Oates / ; April Williams / ; David Truitte / ; Cindy Baumann / ; Jenny Adams / ; Anne Lawrence / ; Dennis McNamara / ; Emily Gruendler / ; Virginia Schneider / ; Steven Hutchins / ; Alyce Hartwick / ; Paul Campbell / ; Michele Esposito / ; Carol Buchter / ; Rebecca A Letterer / ; Robert Taylor / ; Cheri Wells / ; Bruce Johnson / ; Beth Kaping / ; Susan Leathes / ; Joseph O'Bryan / ; Lynn Langley / ; Edward T Hastings / ; Cassandra Clancy / ; Neil Agruss / ; Christine Lawless / ; Robin Fortman / ; Timothy R McConnell / ; Deb Wantz / ; Mary N Walsh / ; Regina Margiotti / ; Stuart Russell / ; Elizabeth Heck / ; Justine Lachmann / ; Diane Lippman / ; Jeannette McLaughlin / ; Joel Landzberg / ; Susan Mathus / ; David W Cullinane / ; Wyatt Voyles / ; Dione Lenz / ; Scott Kaczkowski / ; Jack L David / ; Eve Gillespie / ; Pat Keane-Richmond / ; Steven K Krueger / ; Lori Heiss / ; Stephen Gottlieb / ; Nancy Greenberg / ; Neil Gordon / ; Emily Parks / ; Melanie Willoughby / ; Marvin W Kronenberg / ; Jennie Glenn / ; Carol Madison / ; Malcolm Arnold / ; Julie K Smith / ; Eduardo Azevedo / ; Glen Drobot / ; Estrellita Estrella-Holder / ; Jonathan Howlett / ; Darlene Cooley-Warnell / ; Sheila Yarn / ; Debra Isaac / ; Jane Grant / ; Kim Lyzun / ; Marie-Helene LeBlanc / ; Rachel Vienneau / ; Robert S McKelvie / ; Linda Beare / ; Jill Hancock / ; Gordon Moe / ; Delores Golob / ; Kenneth Melvin / ; Anne Cymet / ; Judith Renton / ; Anil Nigam / ; Julie LaLonge / ; Karim Djaballah / ; Patrick Aebehard / ; Marie Christine Iliou / ; Remi Sabatier / ; Annette Belin / ; Alain Cohen-Solal / ; Luc Hittinger / ; Bertram Pitt / ; Philip A Ades / ; Lotfy L Basta / ; Victor Froelicher / ; Mary Elizabeth Hamel / ; Barry M Massie / ; Lemuel Moyé / ; Lynda H Powell / ; William E Kraus / ; Johanna Johnson / ; Lucy Piner / ; Daniel Bensimhon / ; Stuart Russell / ; Julius M Gardin / ; Renee L Bess / ; Gerald I Cohen / ; Steven J Keteyian / ; Jonathan K Ehrman / ; Clinton A Brawner / ; Nancy Houston Miller / ; James A Blumenthal / ; Barbour Barbour / ; Tanya M Spruill / ; Bess Marcus / ; Jim Raczynski / ; Kirkwood Adams / ; Mark Donahue / ; Mike Felker / ; Kevin A Schulman / ; Kevin P Weinfurt / ; Kathryn E Flynn / ; Shelby Reed / ; Ann Burnette / ; Linda Davidson-Ray / ; Joëlle Y Friedman / ; Yanhong Li / ; Li Lin / ; Betsy O'Neal / ; Michael Zile / ; Ralph H Johnson / ; Daniel R Bensimhon / ; Vera Bittner / ; Robin Boineau / ; Mark E Dunlap / ; William E Kraus / ; Christopher M O'Connor / ; Gordon Moe / ; John Wertheimer / ; David J Whellan /
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