Xinwei Zhang1, Zhiyong Qian1, Haipeng Tang2, Wei Hua3, Yangang Su4, Geng Xu5, Xingbin Liu6, Xiaolin Xue7, Jie Fan8, Lin Cai9, Li Zhu10, Yao Wang1, Xiaofeng Hou1, Ernest V Garcia11, Weihua Zhou12, Jiangang Zou13. 1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China. 2. School of Computing, University of Southern Mississippi, 730 Beach Blvd E, Long Beach, MS, 39560, USA. 3. Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China. 4. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China. 5. Department of Cardiology, Second Affiliated Hospital, Zhejiang University, Hangzhou, China. 6. Department of Cardiology, Westeastern Hospital, Sichuan University, Chengdu, China. 7. Department of Cardiology, Affiliated Hospital, Xian Jiaotong University, Xi'an, China. 8. Department of Cardiology, Yunnan Province Hospital, Kunming, China. 9. Department of Cardiology, Chengdu Third Hospital, Chengdu, China. 10. Department of Cardiology, Taizhou People's Hospital, Taizhou, People's Republic of China. 11. Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA. 12. School of Computing, University of Southern Mississippi, 730 Beach Blvd E, Long Beach, MS, 39560, USA. weihua.zhou@usm.edu. 13. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China. jgzou@njmu.edu.cn.
Abstract
OBJECTIVES: Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT). METHODS: Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment. RESULTS: After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018). CONCLUSIONS: Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.
OBJECTIVES: Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT). METHODS: Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment. RESULTS: After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018). CONCLUSIONS: Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.
Entities:
Keywords:
Cardiac resynchronization therapy; SPECT; heart failure; left ventricular lead position; myocardial perfusion imaging