scholarly journals Mechanical Dyssynchrony for Prediction of the Cardiac Resynchronization Therapy Response in Patients with Dilated Cardiomyopathy

Kardiologiia ◽  
2021 ◽  
Vol 61 (7) ◽  
pp. 14-21
Author(s):  
K. V. Zavadovskij ◽  
V. V. Saushkin ◽  
Yu. V. Varlamova ◽  
A. I. Mishkina ◽  
V. V. Shipulin ◽  
...  

Aim      To evaluate the predictive value of indexes of left ventricular mechanical dyssynchrony (MD) as determined by data of electrocardiogram (ECG)-gated myocardial perfusion scintigraphy (ECG-MPS) for prediction of the efficacy of resynchronization therapy (RT) in patients with chronic heart failure (CHF).Material and methods  This prospective study included 32 patients with nonischemic CHF and standard indications for RT. All patients underwent complete clinical an instrumental examination, including 24-h ECG monitoring and echocardiography (EchoCG). In order to evaluate the left ventricular (LV) myocardial perfusion, contractile function, and MD, myocardial perfusion scintigraphy was performed for all patients at rest prior to RT. In addition to the perfusion defect size at rest and hemodynamic parameters, LV MD was determined. The following indexes were used for analysis of dyssynchronization: phase standard deviation (PSD), phase histogram bandwidth (HBW), and phase histogram asymmetry and steepness. The treatment efficacy was evaluated by the clinical status of patients (clinical condition evaluation scale for CHF patient) and EchoCG at 6 months following RT. The criteria for a positive response to RT were an increase in LV ejection fraction (EF) by 5% and/or a decrease in the LV end-diastolic volume by 15% compared to preoperative values.Results According to ECG-MPS findings, all patients had scintigraphic signs of severe CHF with dilated LV cavity (end-diastolic volume, EDV 246 [217; 269] ml) and also of pronounced mechanical and electrical dyssynchrony. The values of mechanical dyssynchrony were PSD 53 [41; 61], HBW 176 [136; 202], asymmetry 1.62 [1.21; 1.89], and steepness 2.81 [1.21; 3.49]. The QRS duration was 165 [155; 175] msec. Furthermore, the LV perfusion was moderately impaired (perfusion defect size 4 [3; 10] %). Mean follow-up duration after implantation of the resynchronizing device was 6±1.7 mos. According to the selected criteria, 20 (63 %) patients were considered as responders and 12 (37 %) patients as non-responders. Before implantation of the cardiac synchronizing device, responders and non-responders differed only in LV MD (PSD 44 [35; 54] vs. 63 [58; 72]; p=0.0001); HBW 158 [118; 179] vs. 205 [199; 249]; p=0.0001; asymmetry 1.77 [1.62; 2.02] vs. 1.21 [0.93; 1.31]; p=0.0001; steepness 3.03 [2.60; 3.58] vs. 1.21 [0.19; 1.46]; p=0.0001), respectively. A one-factor logistic regression analysis showed that MD values were statistically significant predictors of a positive response to RT. A multi-factor logistic analysis of phase histogram steepness (odds ratio, OR 1.196; 95 % confidence interval, CI 1.04–1.37) and PSD (OR 0.67; 95 % CI 0.47–0.97) were identified as independent predictors for the response to RT. According to results of the ROC analysis, a PSD <55 and a phase histogram steepness >1.54 may predict the effectiveness of RT (AUC= 0.92; р=0.0001).Conclusion      LV MD parameters determined with ECG-MPS allow predicting the effectiveness of RT in patients with nonischemic CHF. In this patient group, high values of standard deviation and low values of phase histogram steepness were independent predictors for the absence of response to RT after 6 mos. of follow-up.

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
A Mishkina ◽  
K Zavadovsky ◽  
V Shipulin ◽  
V Saushkin ◽  
YU Lishmanov

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction The assessment of left ventricular mechanical dyssynchrony (LV MD) is essential in identifying patients who may benefit from cardiac resynchronization therapy (CRT). Both gated myocardial perfusion scintigraphy (MPS) and gated blood pool SPECT (GBPS) are widely used to LV MD assessment [1,2]. Lack of data is available regarding the comparison of left ventricular MD parameters obtained by MPS and GBPS on cadmium-zinc-telluride (CZT) gamma-cameras and their prognostic value. Purpose to compare two scintigraphic methods – MPS and GBPS in LV MD assessment and to assess the capability of these methods to predict CRT response. Methods This study included 30 heart failure patients referred for CRT. Before CRT all patients underwent rest gated MPS and GBPS with LV MD evaluation on CZT cardiac gamma. Based on the phase analysis, the following indexes were estimated: phase standard deviation (SD) and phase histogram bandwidth (HBW). One year after CRT patients were divided to responders and non-responders. The response criteria were defined as LV end systolic volume decreased by ≥ 15% or LV ejection fraction increase by ≥ 5%, based on echocardiography. Results The correlation between gated MPI indexes and GBPS indexes was suboptimal: SD r = 0.39, p &lt; 0.05; HBW r = 0.48, p &lt; 0.05. Based on Mann-Whitney statistics significant differences between LV MD indexes, assessed by both MPS and GBPS were found: SD LV 56.1 (IQR 50.6 – 64) deg. vs 50.6 (37 - 61) deg., p &lt; 0.05 and HBW LV 188.64 (176 - 213) deg. vs 201.68 (180 - 240) deg., p = 0.03, respectively. The Bland-Altman analysis showed poor agreement between gated MPS and GBPS for SD assessment (p = 0.02) with mean difference value 7.02 (96% CI 1.11 to 12.9). However both MPS and GBPS were comparable in terms of HBW estimation (p = 0.18), with mean difference value of -12.5 (96% CI -31.5 to 6.3).MD indexes derived by MPS differed significantly between CRT responders and non-responders: SD 53.56 (47 – 63.4) deg. vs 62.4 (56-71) deg., p &lt; 0.05; HBW 182.1 (166 - 211) deg. vs 204.3 (179 - 225) deg., p &lt; 0.05. MD indexes obtained by GBPS did not show significant difference in CRT responders and non-responders: SD 51.2 (37 – 62) deg. vs 49.4 (40 – 58) deg., p = 0.92 and HBW 203.4 (186 - 237) deg. vs 198.5 (174 - 240) deg., p = 073. Univariate logistic regression analysis showed that SD and HBW assessed by gated MPS were independent predictors of CRT response: SD (OR = 0.91; 95% CI 0.85-0.97; p &lt; 0.05) and HBW (OR = 0.98; 95% CI 0.96-0.99; p =0.03). However MD indexes obtained by GBPS, did not show statistically significance in prediction of CRT response. Conclusion Gated MPS and GBPS are not interchangeable in terms of left ventricular MD assessment. Left ventricular SD and HBW obtained by gated MPI on CZT gamma-camera showed prognostic significance to predict CRT response.


2019 ◽  
Vol 23 (4) ◽  
pp. 84 ◽  
Author(s):  
A. B. Romanov ◽  
E. A. Morzhanaev ◽  
I. L. Mikheenko ◽  
A. V. Ponomarenko ◽  
A. G. Filippenko ◽  
...  

<p>Heart failure and left bundle branch block is a common disease in the modern world. Cardiac resynchronization therapy is used to correct this condition, but some patients have no positive clinical effect from its use. One of the reasons for the lack of response to therapy is not the optimal position of the left ventricular electrode. In this clinical case we presented the experience of using myocardial perfusion scintigraphy to determine the optimal position of the left ventricular electrode.<br />A 60-year-old patient, who was admitted to the center with symptoms of heart failure and signs of complete left bundle branch block, underwent an implantation of the cardiac resynchronization system. Both intraoperative data and the data of preliminary myocardial scintigraphy were used to select the site of implantation of the left ventricular electrode. A significant improvement in the patient’s condition, evaluated after 6 months after the implantation of the device, allowed us to conclude that the use of myocardial perfusion scintigraphy with standard methods of ultrasound diagnosis can increase the efficiency of implantation of cardiac resynchronization devices and a response to the therapy.</p><p>Received 2 October 2019. Revised 20 December 2019. Accepted 23 December 2019.</p><p><strong>Funding:</strong> The work is supported by a grant of the President of the Russian Federation for young scientists No. МД-2893.2018.7.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>


Author(s):  
Federico Caobelli ◽  
◽  
Philip Haaf ◽  
Gianluca Haenny ◽  
Matthias Pfisterer ◽  
...  

Abstract Background The Basel Asymptomatic High-Risk Diabetics’ Outcome Trial (BARDOT) demonstrated that asymptomatic diabetic patients with an abnormal myocardial perfusion scintigraphy (MPS) were at increased risk of major adverse cardiovascular events (MACEs) at 2-year follow-up. It remains unclear whether this finding holds true even for a longer follow-up. Methods Four hundred patients with type 2 diabetes, neither history nor symptoms of coronary artery disease (CAD), were evaluated clinically and with MPS. Patients were followed up for 5 years. Major adverse cardiovascular events (MACEs) were defined as all-cause death, myocardial infarction, or late coronary revascularization. Results At baseline, an abnormal MPS (SSS ≥ 4 or SDS ≥ 2) was found in 87 of 400 patients (22%). MACE within 5 years occurred in 14 patients with abnormal MPS (16.1%) and in 22 with normal scan (1.7%), p = 0.009; 15 deaths were recorded. Patients with completely normal MPS (SSS and SDS = 0) had lower rates of MACEs than patients with abnormal scans (2.5% vs. 7.0%, p = 0.032). Patients with abnormal MPS who had undergone revascularization had a lower mortality rate and a better event-free survival from MI and revascularization than patients with abnormal MPS who had either undergone medical therapy only or could not be revascularized (p = 0.002). Conclusions MPS may have prognostic value in asymptomatic diabetic patients at high cardiovascular risk over a follow-up period of 5 years. Patients with completely normal MPS have a low event rate and may not need retesting within 5 years. Patients with an abnormal MPS have higher event rates and may benefit from a combined medical and revascularization approach.


2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
V Saushkin ◽  
YV Varlamova ◽  
AI Mishkina ◽  
DI Lebedev ◽  
SV Popov ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Aim/Introduction: Assessment of mechanical dyssynchrony by myocardial perfusion gated-SPECT in patients with non-ischemic cardiomyopathy for predict response to cardiac resynchronization therapy (CRT). Materials and Methods  We examined 32 patients with non-ischemic cardiomyopathy before and six months after CRT.  Left ventricular mechanical dyssynchrony and contractility were assessed for all patients by myocardial perfusion gated-SPECT. The phase standard deviation (PSD), histogram bandwidth (HBW), phase histogram skewness (S) and phase histogram kurtosis (K) were used as an indicator of mechanical dyssynchrony for the both ventricles.  Results  Mechanical dyssynchrony of both ventricles before CRT was increased in all patients. Median value PSD 53°(41-61°), HBW 176°(136-202°), S 1,62(1,21-1,89), K 2,81(1,21-3,49). Six months after CRT 22(68%) respondents were identified. We divided the patients into two groups (responders and non-responders) and compared phase parameters. It was found that the PSD (44°(35-54°)) and HBW (158°(118-179°) in the responders were significantly lower than in the non-responders (PSD (68°(58-72°); HBW (205°(199-249°)). The value of phase histogram skewness and kurtosis in responders were significantly higher (Responders: S 1,77(1,62-2,02); K 3,03(2,60-3,58). Non-responders: S 1,21(0,93-1,31); K 1,21(0,19-1,46)).  We found that all four indicators of mechanical dyssynchrony can predict CRT response according to the results of univariate logistic regression analysis. Moreover, It was found that only phase histogram kurtosis (OR = 1.196, 95% CI 1.04-1.37) is an independent predictor of CRT response according to multivariate logistic regression. Conclusion  Radionuclide assessment of mechanical dyssynchrony may be the optimal diagnostic method for selecting patients with non-ischemic cardiomyopathy on CRT.


Author(s):  
Nikant Sabharwal ◽  
Parthiban Arumugam ◽  
Andrew Kelion

This chapter focuses on image interpretation in myocardial perfusion scintigraphy. It covers planar acquisitions, the general approach to reporting single photon emission computed tomography (SPECT) images, and both qualitative and quantitative evaluation of tomographic slices. Detail is also provided on gated SPECT and attenuation correction, as well as a range of artefacts including image, instrumentation-related, and patient-related artefacts. Information is provided on abnormal appearances in coronary artery disease, perfusion defects, and indirect markers of severe coronary artery disease. The chapter also covers interpretation in left ventricular dysfunction and appearances in non-coronary cardiac disease, and includes a section on writing a useful report.


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