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Relationship of quantitative parameters of myocardial perfusion SPECT and ventricular arrhythmia in patients receiving cardiac resynchronization therapy

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Abstract

Background

Ventricular arrhythmia is the major cause of sudden cardiac death for patients with heart failure, including those receiving implantation of cardiac resynchronization therapy (CRT). The purpose of this study was to assess the value of myocardial perfusion SPECT (MPS) in predicting ventricular arrhythmia for patients with CRT.

Methods and methods

Fifty-one patients (35 males, mean age 64 ± 12 years) who had received CRT for at least 6 months were enrolled for resting gated MPS. Three main quantitative parameters of MPS, including extent of myocardial scar, left ventricular ejection fraction (LVEF) and LV dyssynchrony (phase SD), were generated by Emory Cardiac Toolbox. Using the recorded ventricular arrhythmia in the device, including ventricular tachycardia (VT) and ventricular fibrillation (VF), as the primary end point, the value of quantitative parameters of MPS in predicting the development of VT/VF was assessed.

Results

Twenty (39 %) of the 51 patients developed VT/VF during the follow-up (15.3 ± 12.7 months). The patients with VT/VF had significantly lower LVEF (24 ± 12 vs. 36 ± 17 %, p < 0.005), larger scar areas (36 ± 19 vs. 22 ± 12 %, p < 0.05) and larger phase SD (57° ± 20° vs. 43° ± 17°, p < 0.01). When categorizing the patients by the median values of LVEF, scar and phase SD, univariate regression analysis showed that lower LVEF (<29 %), larger scar (>23 %) and larger phase SD (>50°) were related to the development of VT/VF (p = 0.006, 0.011 and 0.064, respectively). However, only LVEF was marginally significant as an independent predictor of VT//VF on multivariate regression analysis (p = 0.0573). Survival analysis with Kaplan–Meier curves showed that the survival probability for VT/VF in those with LVEF >29 %, scar areas <23 % and phase SD < 50° was significantly better than in the others (HR 5.16, 95 % CI 1.20–22.16) by log-rank test (χ 2 = 5.9894, p = 0.014).

Conclusion

Lower LVEF, larger scar and/or more dyssynchrony assessed by MPS were related to the development of ventricular arrhythmia for patients with CRT, and further defibrillator implantation may be considered for these patients.

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Acknowledgments

This study was supported in part by research grants from Chang Bing Show Chwan Memorial Hospital (RD-103029), Taiwan Ministry of Science and Technology (103-2314-B-758-001-), and Taichung Veterans General Hospital (TCVGH-1023105C, 1033106C, 1043106C, 1043102B).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan

    Po-Nien Hou

  2. Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Shih-Chuan Tsai & Wan-Yu Lin

  3. Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan

    Shih-Chuan Tsai & Guang-Uei Hung

  4. Division of Cardiology, Department of Medicine, Fong Yuan Hospital of the Ministry of Health and Welfare, Taichung, Taiwan

    Chien-Ming Cheng

  5. Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan

    Kuo-Feng Chiang, Yu-Cheng Chang & Jin-Long Huang

  6. Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Jin-Long Huang

  7. Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, 6 Lukon Road, Lukong Town, Changhua, 505, Taiwan

    Guang-Uei Hung

  8. Divisions of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Shih-Ann Chen

  9. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Ji Chen

Authors
  1. Po-Nien Hou
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  2. Shih-Chuan Tsai
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  3. Wan-Yu Lin
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  4. Chien-Ming Cheng
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  5. Kuo-Feng Chiang
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  6. Yu-Cheng Chang
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  7. Jin-Long Huang
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  8. Guang-Uei Hung
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  9. Shih-Ann Chen
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  10. Ji Chen
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Corresponding author

Correspondence to Guang-Uei Hung.

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Conflict of interest

Dr. Ji Chen receives royalties from the sale of Emory Cardiac Toolbox with SyncTool. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest practice.

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Hou, PN., Tsai, SC., Lin, WY. et al. Relationship of quantitative parameters of myocardial perfusion SPECT and ventricular arrhythmia in patients receiving cardiac resynchronization therapy. Ann Nucl Med 29, 772–778 (2015). https://doi.org/10.1007/s12149-015-1007-1

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  • DOI: https://doi.org/10.1007/s12149-015-1007-1

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