Left ventricular systolic and diastolic dyssynchrony to improve cardiac resynchronization therapy response in heart failure patients with dilated cardiomyopathy

Autor: Xiaofeng Hou, Dianfu Li, Haipeng Tang, Kai Gu, Ernest V. Garcia, Yanyun Liu, Jiacheng Ge, Cheng Wang, Jiangang Zou, Jianzhou Shi, Zhongqiang Zhao, Chunxiang Li, Weihua Zhou, Zhuo He, Lei Zhou, Minglong Chen
Rok vydání: 2020
Předmět:
Cardiomyopathy
Dilated
Male
medicine.medical_specialty
Gated SPECT
medicine.medical_treatment
Bundle-Branch Block
Diastole
Cardiac resynchronization therapy
030204 cardiovascular system & hematology
030218 nuclear medicine & medical imaging
Cardiac Resynchronization Therapy
Ventricular Dysfunction
Left
03 medical and health sciences
QRS complex
0302 clinical medicine
Predictive Value of Tests
Internal medicine
Outcome Assessment
Health Care
medicine
Humans
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
Aged
Heart Failure
Ejection fraction
Left bundle branch block
business.industry
Myocardial Perfusion Imaging
Dilated cardiomyopathy
Middle Aged
Prognosis
medicine.disease
Heart failure
cardiovascular system
Cardiology
Female
Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
Cardiology and Cardiovascular Medicine
business
Zdroj: Journal of Nuclear Cardiology.
ISSN: 1532-6551
1071-3581
Popis: The systolic and diastolic dyssynchrony is physiologically related, but measure different left ventricular mechanisms. Left ventricular systolic mechanical dyssynchrony (systolic LVMD) has shown significant clinical values in improving cardiac resynchronization therapy (CRT) response in the heart failure patients with dilated cardiomyopathy (DCM). Our recent study demonstrated that LV diastolic dyssynchrony (diastolic LVMD) parameters have important prognostic values for DCM patients. However, there are a limited number of studies about the clinical value of diastolic LVMD for CRT. This study aims to explore the predictive values of both systolic LVMD and diastolic LVMD for CRT in DCM patients. Eighty-four consecutive CRT patients with both DCM and complete left bundle branch block (CLBBB) who received gated resting SPECT MPI at baseline were included in the present study. The phase analysis technique was applied on resting gated short-axis SPECT MPI images to measure systolic LVMD and diastolic LVMD, characterized by phase standard deviation (PSD) and phase histogram bandwidth (PBW). CRT response was defined as ≥ 5% improvement of LVEF at 6-month follow-up. Variables with P < 0.10 in the univariate analysis were included in the multivariate cox analysis. During the follow-up period, 59.5% (50 of 84) patients were CRT responders. The univariate cox regression analysis showed that at baseline QRS duration, non-sustained ventricular tachycardia (NS-VT), systolic PSD, systolic PBW, diastolic PSD, diastolic PBW, scar burden and LV lead in the scarred myocardium were statistically significantly associated with CRT response. The multivariate cox regression analysis showed that QRS duration, NS-VT, systolic PSD, systolic PBW, diastolic PSD, and diastolic PBW were independent predictive factors for CRT response. Furthermore, the rate of CRT response was 94.4% (17 of 18) in patients whose LV lead was in the segments with both the first three late contraction and the first three late relaxation; by contrast, the rate of CRT response was only 6.7% (1 of 15, P < 0.000) in patients whose LV lead was in the segments with neither the first three late contraction nor the first three late relaxation. Both systolic LVMD and diastolic LVMD from gated SPECT MPI have important predictive values for CRT response in DCM patients. Pacing at LV segments with both late contraction and late relaxation has potential to increase the CRT response.
Databáze: OpenAIRE
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