Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function
| Autor: | José Cláudio Meneghetti, Silvana Angelina D'Orio Nishioka, Ernest V. Garcia, Rubens Abe, Marcelo L. C. Vieira, Maria Clementina Pinto Giorgi, Viviane Tiemi Hotta, Simone Cristina Soares Brandão, Ji Chen, Martino Martinelli Filho |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Technetium Tc 99m Sestamibi medicine.medical_specialty Heart Ventricles Gated SPECT medicine.medical_treatment Cardiac resynchronization therapy Article Isotopes of technetium Ventricular Dysfunction Left Myocardial scintigraphy Internal medicine medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Aged Heart Failure Lv function Ventricular Remodeling business.industry Myocardial Perfusion Imaging General Medicine Middle Aged medicine.disease Heart failure cardiovascular system Cardiology Radiology business Perfusion Follow-Up Studies |
| Zdroj: | European Journal of Nuclear Medicine and Molecular Imaging. 36:986-996 |
| ISSN: | 1619-7089 1619-7070 |
| DOI: | 10.1007/s00259-008-1029-1 |
| Popis: | (99m)Tc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial (99m)Tc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT.A group of 30 patients with severe HF were prospectively studied before and 3 months after CRT. Variables analysed were HF functional class, QRS duration, LV ejection fraction (LVEF) by echocardiography, myocardial (99m)Tc-MIBI uptake, LV end-diastolic volume (EDV) and end-systolic volume (ESV), phase analysis LV dyssynchrony indices, and regional motion by GMS. After CRT, patients were divided into two groups according to improvement in LVEF: group 1 (12 patients) with increase in LVEF of 5 or more points, and group 2 (18 patients) without a significant increase.After CRT, both groups showed a significant improvement in HF functional class, reduced QRS width and increased septal wall (99m)Tc-MIBI uptake. Only group 1 showed favourable changes in EDV, ESV, LV dyssynchrony indices, and regional motion. Before CRT, EDV, and ESV were lower in group 1 than in group 2. Anterior and inferior wall (99m)Tc-MIBI uptakes were higher in group 1 than in group 2 (p0.05). EDV was the only independent predictor of an increase in LVEF (p=0.01). The optimal EDV cut-off point was 315 ml (sensitivity 89%, specificity 94%).The evaluation of EDV by GMS added information on patient selection for CRT. After CRT, LVEF increase occurred in hearts less dilated and with more normal (99m)Tc-MIBI uptake. |
| Databáze: | OpenAIRE |
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