Left-ventricular dyssynchrony in viable myocardium by myocardial perfusion SPECT is predictive of mechanical response to CRT
| Autor: | Xinwei Zhang, Chi Yen Wang, Jiangang Zou, Shih-Chuan Tsai, Ernest V. Garcia, Weihua Zhou, Zhuo He, Jin Long Huang, Haipeng Tang, Kuo Feng Chiang, Guang Uei Hung |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Cardiac resynchronization therapy 030218 nuclear medicine & medical imaging Cardiac Resynchronization Therapy 03 medical and health sciences 0302 clinical medicine Internal medicine Phase.standard deviation medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Ventricular dyssynchrony Aged Tomography Emission-Computed Single-Photon business.industry Myocardium Significant difference General Medicine Middle Aged medicine.disease Lv dyssynchrony Echocardiography 030220 oncology & carcinogenesis Heart failure cardiovascular system Cardiology Phase analysis business Perfusion |
| Zdroj: | Annals of nuclear medicine. 35(8) |
| ISSN: | 1864-6433 |
| Popis: | Gated myocardial perfusion SPECT (GMPS) provides a one-stop-shop evaluation for cardiac resynchronization therapy (CRT). However, conflicting results have been observed regarding whether the baseline left-ventricular (LV) mechanical dyssynchrony as assessed by phase analysis on GMPS was predictive of therapeutic response to CRT. Since dyssynchrony parameters by phase analysis spuriously increased by scarred myocardium, the purpose of this study was to explore the value of dyssynchrony after stripping off the scar region in correlation to mechanical response to CRT. Forty-seven patients following standard indications for CRT received GMPS with phase analysis as pre-CRT evaluation. A decrease of end-systolic volume (ESV) > 15% on follow-up echocardiography after CRT was considered as a mechanical response to CRT. Myocardial regions with less than 50% of maximal activity on GMPS were considered as a scar. The phase standard deviation (PSD) and histogram bandwidth (BW) without or with stripping off scar were assessed by phase analysis of GMPS and were used for evaluation of LV dyssynchrony of all myocardium or only the viable myocardium, respectively. No significant difference was noted between mechanical responders (31 of 47 patients, 66%) and nonresponders ( 16 of 47 patients, 34%) for PSD (48.6° ± 19.4° vs 43.9° ± 20.7°, p = 0.46) and BW (225° ± 91.1° vs 163.5° ± 94.6°, p = 0.38) of the entire myocardium. However, responders had significantly larger PSD (40.5° ± 15.7° vs 30.5° ± 13.2°, p = 0.03) and borderlinely larger BW (215° ± 91.2° vs. 139.5° ± 78.2°, p = 0.05) than non-responders after stripping off scar. Logistic regression analysis showed that scar area and PSD after stripping off scar were independent predictors of mechanical response. Our result showed that LV dyssynchrony of the entire myocardium did not predict response to CRT. However, LV dyssynchrony only in the viable myocardium was a significant predictor of CRT mechanical response. |
| Databáze: | OpenAIRE |
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