PMID- 19782789 OWN - NLM STAT- MEDLINE DCOM- 20091029 LR - 20220321 IS - 1097-6744 (Electronic) IS - 0002-8703 (Print) IS - 0002-8703 (Linking) VI - 158 IP - 4 Suppl DP - 2009 Oct TI - 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. PG - S53-63 LID - 10.1016/j.ahj.2009.07.009 [doi] AB - 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. FAU - Atchley, Allen E AU - Atchley AE AD - Duke University Medical Center, Durham, NC 27710, USA. FAU - Kitzman, Dalane W AU - Kitzman DW FAU - Whellan, David J AU - Whellan DJ FAU - Iskandrian, Ami E AU - Iskandrian AE FAU - Ellis, Stephen J AU - Ellis SJ FAU - Pagnanelli, Robert A AU - Pagnanelli RA FAU - Kao, Andrew AU - Kao A FAU - Abdul-Nour, Khaled AU - Abdul-Nour K FAU - O'Connor, Christopher M AU - O'Connor CM FAU - Ewald, Greg AU - Ewald G FAU - Kraus, William E AU - Kraus WE FAU - Borges-Neto, Salvador AU - Borges-Neto S CN - HF-ACTION Investigators LA - eng SI - ClinicalTrials.gov/NCT00047437 GR - U01 HL064257/HL/NHLBI NIH HHS/United States GR - 5U01HL066461/HL/NHLBI NIH HHS/United States GR - 5U01HL064264/HL/NHLBI NIH HHS/United States GR - U01 HL064250/HL/NHLBI NIH HHS/United States GR - P60AG10484/AG/NIA NIH HHS/United States GR - U01 HL064265/HL/NHLBI NIH HHS/United States GR - U01 HL066497/HL/NHLBI NIH HHS/United States GR - U01 HL064264/HL/NHLBI NIH HHS/United States GR - T32 HL069749/HL/NHLBI NIH HHS/United States GR - 5U01HL066482/HL/NHLBI NIH HHS/United States GR - 5U01HL066497/HL/NHLBI NIH HHS/United States GR - U01 HL068980/HL/NHLBI NIH HHS/United States GR - 5U01HL064250/HL/NHLBI NIH HHS/United States GR - 5U01HL064265/HL/NHLBI NIH HHS/United States GR - U01 HL066491/HL/NHLBI NIH HHS/United States GR - 5U01HL068973/HL/NHLBI NIH HHS/United States GR - 5U01HL064257/HL/NHLBI NIH HHS/United States GR - U01 HL066482/HL/NHLBI NIH HHS/United States GR - 5U01HL063747/HL/NHLBI NIH HHS/United States GR - 5U01HL066491/HL/NHLBI NIH HHS/United States GR - R37AG18915/AG/NIA NIH HHS/United States GR - R37 AG018915/AG/NIA NIH HHS/United States GR - U01 HL063747-06S1/HL/NHLBI NIH HHS/United States GR - U01 HL066494/HL/NHLBI NIH HHS/United States GR - 5U01HL066501/HL/NHLBI NIH HHS/United States GR - U01 HL066461/HL/NHLBI NIH HHS/United States GR - U01 HL068973/HL/NHLBI NIH HHS/United States GR - 5U01HL068980/HL/NHLBI NIH HHS/United States GR - U01 HL063747/HL/NHLBI NIH HHS/United States GR - 5U01HL066494/HL/NHLBI NIH HHS/United States GR - U01 HL066501/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, N.I.H., Extramural PL - United States TA - Am Heart J JT - American heart journal JID - 0370465 RN - 0 (Organophosphorus Compounds) RN - 0 (Organotechnetium Compounds) RN - 42FOP1YX93 (technetium tc-99m tetrofosmin) SB - IM MH - Aged MH - Arrhythmias, Cardiac/diagnosis/diagnostic imaging/physiopathology MH - Data Collection MH - Exercise Test/statistics & numerical data MH - Exercise Therapy MH - Exercise Tolerance MH - Heart/diagnostic imaging/physiopathology MH - Heart Failure/*diagnostic imaging/physiopathology/therapy MH - Heart Ventricles/diagnostic imaging/physiopathology MH - Humans MH - Male MH - Middle Aged MH - Myocardial Perfusion Imaging/statistics & numerical data MH - *Organophosphorus Compounds MH - *Organotechnetium Compounds MH - Stroke Volume/physiology MH - Tomography, Emission-Computed, Single-Photon/*statistics & numerical data MH - Ventricular Dysfunction, Left/diagnosis/*diagnostic imaging/physiopathology MH - Ventricular Function, Left/physiology PMC - PMC2908486 MID - NIHMS196888 COIS- Conflicts The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written. Dr. Atchley is a fellow in training and is funded by a National Institutes of Health T32 research grant. Dr. Borges-Neto is part of the speakers' bureau and advisory board and receives grants from GE Health. Dr. Ellis receives funding support from GE Health. Drs. Kraus, Iskandrian, Whellan, and Kitzman have no conflicts of interest to disclose. 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Ehrman, Jonathan K IR - Ehrman JK FIR - Brawner, Clinton A IR - Brawner CA FIR - Miller, Nancy Houston IR - Miller NH FIR - Blumenthal, James A IR - Blumenthal JA FIR - Barbour, Barbour IR - Barbour B FIR - Spruill, Tanya M IR - Spruill TM FIR - Marcus, Bess IR - Marcus B FIR - Raczynski, Jim IR - Raczynski J FIR - Adams, Kirkwood IR - Adams K FIR - Donahue, Mark IR - Donahue M FIR - Felker, Mike IR - Felker M FIR - Schulman, Kevin A IR - Schulman KA FIR - Weinfurt, Kevin P IR - Weinfurt KP FIR - Flynn, Kathryn E IR - Flynn KE FIR - Reed, Shelby IR - Reed S FIR - Burnette, Ann IR - Burnette A FIR - Davidson-Ray, Linda IR - Davidson-Ray L FIR - Friedman, Joelle Y IR - Friedman JY FIR - Li, Yanhong IR - Li Y FIR - Lin, Li IR - Lin L FIR - O'Neal, Betsy IR - O'Neal B FIR - Zile, Michael IR - Zile M FIR - Johnson, Ralph H IR - Johnson RH FIR - Bensimhon, Daniel R IR - Bensimhon DR FIR - Bittner, Vera IR - Bittner V FIR - Boineau, Robin IR - Boineau R FIR - Dunlap, Mark E IR - Dunlap ME FIR - Kraus, William E IR - Kraus WE FIR - O'Connor, Christopher M IR - O'Connor CM FIR - Moe, Gordon IR - Moe G FIR - Wertheimer, John IR - Wertheimer J FIR - Whellan, David J IR - Whellan DJ EDAT- 2009/10/15 06:00 MHDA- 2009/10/30 06:00 PMCR- 2010/10/01 CRDT- 2009/09/29 06:00 PHST- 2009/09/29 06:00 [entrez] PHST- 2009/10/15 06:00 [pubmed] PHST- 2009/10/30 06:00 [medline] PHST- 2010/10/01 00:00 [pmc-release] AID - S0002-8703(09)00562-6 [pii] AID - 10.1016/j.ahj.2009.07.009 [doi] PST - ppublish SO - Am Heart J. 2009 Oct;158(4 Suppl):S53-63. doi: 10.1016/j.ahj.2009.07.009.