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A new method to recommend left ventricular lead positions for improved CRT volumetric response and long-term prognosis

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Journal of Nuclear Cardiology Aims and scope

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.

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Abbreviations

CRT:

Cardiac resynchronization therapy

CS:

Coronary sinus

LV:

Left ventricle/ventricular

MPI:

Myocardial perfusion imaging

SPECT:

Single-photon emission computed tomography

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Acknowledgments

We appreciate Daniel McGonigle, a master student of Computer Science at USM and Zhuo He, a PhD student of Computer Science at USM for proofreading the manuscript.

Disclosure

This research was supported by grants from the Science and Technology Department of Jiangsu Province (Social Development-Clinical Frontier Technology Foundation) (Project Number: BE2016764, PI: Jiangang Zou) and the American Heart Association (Project Number: 17AIREA33700016, PI: Weihua Zhou). Ernest V. Garcia receives royalties from the sales of Emory Cardiac Toolbox. The terms of this arrangement have been reviewed and approved by Emory University in accordance with it is conflict-of-interest practice. Xinwei Zhang, Zhiyong Qian, Haipeng Tang, Wei Hua, Yangang Su, Geng Xu, Xingbin Liu, Xiaolin Xue, Jie Fan, Lin Cai, Li Zhu, Yao Wang, Xiaofeng Hou, Weihua Zhou and Jiangang Zou do not have anything to declare.

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Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, Jiangsu, China

    Xinwei Zhang MD, Zhiyong Qian MD, PhD, Yao Wang MD, PhD, Xiaofeng Hou MD & Jiangang Zou MD, PhD, FHRS

  2. School of Computing, University of Southern Mississippi, 730 Beach Blvd E, Long Beach, MS, 39560, USA

    Haipeng Tang MS & Weihua Zhou PhD

  3. Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China

    Wei Hua MD, FHRS

  4. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China

    Yangang Su MD

  5. Department of Cardiology, Second Affiliated Hospital, Zhejiang University, Hangzhou, China

    Geng Xu MD

  6. Department of Cardiology, Westeastern Hospital, Sichuan University, Chengdu, China

    Xingbin Liu MD, FHRS

  7. Department of Cardiology, Affiliated Hospital, Xian Jiaotong University, Xi’an, China

    Xiaolin Xue MD

  8. Department of Cardiology, Yunnan Province Hospital, Kunming, China

    Jie Fan MD

  9. Department of Cardiology, Chengdu Third Hospital, Chengdu, China

    Lin Cai MD

  10. Department of Cardiology, Taizhou People’s Hospital, Taizhou, People’s Republic of China

    Li Zhu MD, PhD

  11. Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA

    Ernest V. Garcia PhD

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  1. Xinwei Zhang MD
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  2. Zhiyong Qian MD, PhD
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Correspondence to Weihua Zhou PhD or Jiangang Zou MD, PhD, FHRS.

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Zhang, X., Qian, Z., Tang, H. et al. A new method to recommend left ventricular lead positions for improved CRT volumetric response and long-term prognosis. J. Nucl. Cardiol. 28, 672–684 (2021). https://doi.org/10.1007/s12350-019-01735-7

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  • DOI: https://doi.org/10.1007/s12350-019-01735-7

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