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Research of predictive factors for cardiac resynchronization therapy: a prospective study comparing data from phase-analysis of gated myocardial perfusion single-photon computed tomography and echocardiography

Trying to anticipate response to CRT

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Abstract

Background

Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in chronic systolic heart failure. About 20% of implanted patients are considered as “non-responders”. This study aimed to evaluate gated myocardial perfusion single-photon emission computed tomography (GMPS) phase parameters as compared to echocardiography in the assessment of predictors for response to CRT before and after CRT activation.

Methods

Forty-two patients were prospectively included during 15 months. A single injection of 99mTc-tetrofosmin was used to acquire GMPS phase pre- and post-CRT activation. Indicators of positive CRT response were improvement of functional status and 15% reduction in left ventricular end-systolic volume at 3 months.

Results

Phase parameters at baseline were similar in the two groups with no influence of perfusion data. Phase parameters after CRT activation were significantly improved in the responders’ group (Δ Bandwidth −19° ± 24° vs. 13° ± 31°, p = 0.001; Δ SD −20° ± 30° vs. 26° ± 46°, p = 0.001; Δ Entropy −11 ± 12 vs. 2 ± 6%, p = 0.001). Feasibility and reproducibility were higher for GMPS.

Conclusion

Acute phase modifications after CRT activation may predict response to CRT immediately after implantation, but not at baseline, even when adjusted to perfusion data.

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Abbreviations

β:

Bandwidth

Ә:

Entropy

ε :

Strain

CRT:

Cardiac resynchronization therapy

GMPS:

Gated myocardial perfusion SPECT

HF:

Heart failure

ICC:

Intraclass correlation

ICM:

Ischemic cardiomyopathy

IVMD:

Interventricular mechanical delay

LLWC:

Left lateral wall contraction

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

LVEDV:

Left ventricular end-diastolic volume

LVESV:

Left ventricular end-systolic volume

LVFT:

Left ventricular filling time

LWMP:

Lateral wall myocardial perfusion

NYHA:

New York Heart Association

TTE:

Trans-thoracic echocardiography

SD:

Standard deviation

SPECT:

Single-photon emission computed tomography

SPWMD:

Septal-posterior wall motion delay

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Authors and Affiliations

  1. Department of Cardiology, Toulouse University Hospital, Toulouse, France

    Rémy Gendre, O. Lairez, P. Mondoly, A. Duparc, D. Carrié, M. Galinier & T. Cognet

  2. Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France

    Rémy Gendre, O. Lairez, I. Berry & T. Cognet

  3. Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France

    Rémy Gendre, O. Lairez, D. Carrié, M. Galinier, I. Berry & T. Cognet

  4. Medical School of Rangueil, University Paul Sabatier, Toulouse, France

    O. Lairez, M. Galinier & I. Berry

  5. Medical School of Purpan, University Paul Sabatier, Toulouse, France

    O. Lairez, D. Carrié & I. Berry

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  1. Rémy Gendre
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  2. O. Lairez
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Correspondence to Rémy Gendre.

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Gendre, R., Lairez, O., Mondoly, P. et al. Research of predictive factors for cardiac resynchronization therapy: a prospective study comparing data from phase-analysis of gated myocardial perfusion single-photon computed tomography and echocardiography. Ann Nucl Med 31, 218–226 (2017). https://doi.org/10.1007/s12149-017-1148-5

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  • DOI: https://doi.org/10.1007/s12149-017-1148-5

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