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Incremental value of left ventricular shape parameters measured by gated SPECT MPI in predicting the super-response to CRT

  • ORIGINAL ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The purpose of this study was to evaluate the predictive value of left ventricular (LV) shape parameters measured by gated SPECT myocardial perfusion imaging (MPI) in super-responders enrolled in the VISION-CRT trial.

Methods

One hundred and ninety-nine patients who met standard criteria for CRT from multiple centers were enrolled in this study. End-systolic eccentricity (ESE) and end-diastolic eccentricity (EDE) were measures of LV shape. Super-responders were the patients who had a relative increase in left ventricular ejection fraction (LVEF) ≥ 15%.

Results

Complete data were obtained in 165 patients, and 43.6% of them were classified as super-responders. ESE was an independent predictor of CRT super-responders in univariate (OR 12.59, 95% CI 1.56–101.35, P = .017) and multivariate analysis (OR 35.71, 95% CI 1.66–766.03, P = .006). ESE had an incremental value over significant clinical and SPECT imaging variables, including angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker, coronary artery disease, myocardial infarction, LVEF, end-diastolic volume index, and scar burden (AUC 0.82 vs. 0.80, sensitivity 0.68 vs. 0.65, specificity 0.82 vs. 0.78).

Conclusions

LV shape parameters derived from gated SPECT MPI have the promise to improve the prediction of the super-response to CRT. Moreover, ESE provides incremental value over existing clinical and nuclear imaging variables.

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Abbreviations

CRT:

Cardiac resynchronization therapy

ECTb4:

Emory Cardiac Toolbox Version 4.0

EDE:

End-diastolic eccentricity

ESE:

End-systolic eccentricity

LV:

Left ventricular

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end-systolic volume

PSD:

Phase histogram standard deviation

MPI:

Myocardial perfusion imaging

References

  1. Burchfield JS, Xie M, Hill JA. Pathological ventricular remodeling: Mechanisms: Part 1 of 2. Circulation 2013;128:388-400.

    Article  Google Scholar 

  2. Xie M, Burchfield JS, Hill JA. Pathological ventricular remodeling: Therapies: Part 2 of 2. Circulation 2013;128:102130.

    Article  Google Scholar 

  3. Udelson JE, Konstam MA. Ventricular remodeling: Fundamental to the progression (and regression) of heart failure. J Am Coll Cardiol 2011;57:1477-9.

    Article  Google Scholar 

  4. Azevedo PS, Polegato BF, Minicucci MF, Paiva SAR, Zornoff LAM. Cardiac remodeling: Concepts, clinical impact, pathophysiological mechanisms and pharmacologic treatment. Arq Bras Cardiol 2016;106:62-9.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Knap B, Južnič G, Bren AF, Drzewiecki G, Noordergraaf A. Elongation as a new shape index for the left ventricle. Int J Cardiovasc Imaging 2002;18:421-30.

    Article  CAS  Google Scholar 

  6. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling-concepts and clinical implications: A consensus paper from an International Forum on Cardiac Remodeling. J Am Coll Cardiol 2000;35:569-82.

    Article  CAS  Google Scholar 

  7. Nappi C, Gaudieri V, Acampa W, Assante R, Zampella E, Mainolfi CG, et al. Comparison of left ventricular shape by gated SPECT imaging in diabetic and nondiabetic patients with normal myocardial perfusion: A propensity score analysis. J Nucl Cardiol 2017;25:394-403.

    Article  Google Scholar 

  8. Nitta K, Kurisu S, Erasta R, Sumimoto Y, Ikenaga H, Ishibashi K, et al. Associations of left ventricular shape with left ventricular volumes and functions assessed by ECG-gated SPECT in patients without significant perfusion abnormality. Heart Vessels 2020;35:86-91.

    Article  Google Scholar 

  9. Gimelli A, Liga R, Clemente A, Marras G, Kusch A, Marzullo P. Left ventricular eccentricity index measured with SPECT myocardial perfusion imaging: An additional parameter of adverse cardiac remodeling. J Nucl Cardiol 2016;27:71-9.

    Article  Google Scholar 

  10. Gimelli A, Liga R, Giorgetti A, Casagranda M, Marzullo P. Stress-induced alteration of left ventricular eccentricity: An additional marker of multivessel CAD. J Nucl Cardiol 2017;26:227-32.

    Article  Google Scholar 

  11. Germano G, Slomka PJ. Assessing LV remodeling in nuclear cardiology. J Nucl Cardiol 2017;26:233-5.

    Article  Google Scholar 

  12. Abidov A, Slomka PJ, Nishina H, Hayes SW, Kang X, Yoda S, et al. Left ventricular shape index assessed by gated stress myocardial perfusion SPECT: Initial description of a new variable. J Nucl Cardiol 2006;13:652-9.

    Article  Google Scholar 

  13. Alexanderson-Rosas E, Espinola-Zavaleta N, Garcia EV, Peix A, Massardo T, Pabon LM, et al. Diastolic dyssynchrony assessment by gated myocardial perfusion-SPECT in subjects who underwent cardiac resynchronization therapy. J Nucl Cardiol. 2019. https://doi.org/10.1007/s12350-019-01845-2.

    Article  PubMed  Google Scholar 

  14. António N, Teixeira R, Coelho L, Lourenço C, Monteiro P, Ventura M, et al. Identification of “super-responders” to cardiac resynchronization therapy: The importance of symptom duration and left ventricular geometry. Europace 2009;11:343-9.

    Article  Google Scholar 

  15. Gasparini M, Regoli F, Ceriotti C, Galimberti P, Bragato R, De Vita S, et al. Remission of left ventricular systolic dysfunction and of heart failure symptoms after cardiac resynchronization therapy: Temporal pattern and clinical predictors. Am Heart J 2008;155:507-14.

    Article  Google Scholar 

  16. Zhou W, Garcia EV. Nuclear image-guided approaches for cardiac resynchronization therapy (CRT). Curr Cardiol Rep. 2016;18:7.

    Article  Google Scholar 

  17. Zhou W, Hung G-UU. Left-ventricular mechanical dyssynchrony in the prognosis of dilated cardiomyopathy: Which parameter is more useful? J Nucl Cardiol 2018;25:1688-91.

    Article  Google Scholar 

  18. Peix A, Karthikeyan G, Massardo T, Kalaivani M, Patel C, Pabon LM, et al. Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT). J Nucl Cardiol. 2019. https://doi.org/10.1007/s12350-018-01589-5.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jimenez-Heffernan A, Butt S, Mesquita CT, Massardo T, Peix A, Kumar A, et al. Technical aspects of gated SPECT MPI assessment of left ventricular dyssynchrony used in the VISION-CRT study. J Nucl Cardiol. 2020. https://doi.org/10.1007/s12350-020-02122-3.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Boogers MJ, Chen J, Van Bommel RJ, Borleffs CJW, Dibbets-Schneider P, Van Der Hiel B, et al. Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging 2011;38:230-8.

    Article  Google Scholar 

  21. Seabold S, Perktold J. Statsmodels: Econometric and statistical modeling with python. Proceedings of the 9th Python in Science Conference 2010: 92-96.

  22. Zecchin M, Proclemer A, Magnani S, Vitali-Serdoz L, Facchin D, Muser D, et al. Long-term outcome of “super-responder” patients to cardiac resynchronization therapy. Europace 2014;16:363-71.

    Article  Google Scholar 

  23. Ambale-Venkatesh B, Yoneyama K, Sharma RK, Ohyama Y, Wu CO, Burke GL, et al. Left ventricular shape predicts different types of cardiovascular events in the general population. Heart 2017;103:507-15.

    Article  CAS  Google Scholar 

  24. Levine YC, Matos J, Rosenberg MA, Manning WJ, Josephson ME, Buxton AE. Left ventricular sphericity independently predicts appropriate implantable cardioverter-defibrillator therapy. Hear Rhythm 2016;13:490-7.

    Article  Google Scholar 

  25. Sutton MSJ, Pfeffer MA, Plappert T, Rouleau JL, Moyé LA, Dagenais GR, et al. Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction: The protective effects of captopril. Circulation 1994;89:68-75.

    Article  Google Scholar 

  26. Bulava A, Lukl J, Škvařilová M, Marek D. Dramatically improved left ventricular function after biventricular pacemaker implantation: A case report. Eur J Heart Fail 2005;7:231-3.

    Article  Google Scholar 

  27. Rickard J, Kumbhani DJ, Popovic Z, Verhaert D, Manne M, Sraow D, et al. Characterization of super-response to cardiac resynchronization therapy. Hear Rhythm 2010;7:885-9.

    Article  Google Scholar 

  28. Killu AM, Grupper A, Friedman PA, Powell BD, Asirvatham SJ, Espinosa RE, et al. Predictors and outcomes of “super-response” to cardiac resynchronization therapy. J Card Fail 2014;20:379-86.

    Article  Google Scholar 

  29. Ypenburg C, van Bommel RJ, Borleffs CJW, Bleeker GB, Boersma E, Schalij MJ, et al. Long-term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up. J Am Coll Cardiol 2009;53:483-90.

    Article  Google Scholar 

  30. Fei L, Keeling PJ, Gill JS, Bashir Y, Statters DJ, Poloniecki J, et al. Heart rate variability and its relation to ventricular arrhythmias in congestive heart failure. Br Heart J 1994;71:322-8.

    Article  CAS  Google Scholar 

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Author information

Author notes

  1. Zhuo He and Fernando de Amorim Fernandes have contributed equally to this work.

Authors and Affiliations

  1. Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA

    Zhuo He BS & Weihua Zhou PhD

  2. Nuclear Medicine Department, Hospital Universitario Antonio Pedro-EBSERH-UFF, Niteroi, Brazil

    Fernando de Amorim Fernandes MSc & Claudio T. Mesquita PhD, MD

  3. Department of Cardiology, Hospital Universitario Antonio Pedro-EBSERH-UFF, Niteroi, Brazil

    Erivelton Alessandro do Nascimento MSc, MD

  4. Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA

    Ernest V. Garcia PhD

  5. Nuclear Medicine Department, Hospital Pró-Cardíaco, Rio de Janeiro, Brazil

    Claudio T. Mesquita PhD, MD

Authors
  1. Zhuo He BS
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  2. Fernando de Amorim Fernandes MSc
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Contributions

ZH: Conception and design; analysis and interpretation of data; drafting of the manuscript and revising it critically for important intellectual content. FAF: Analysis and interpretation of data; revising the manuscript critically for important intellectual content. EAN: Revising it critically for important intellectual content. EVG: Conception and design. CTM: Conception and design; and final approval of the manuscript submitted. WZ: Conception and design; analysis and interpretation of data; revising the manuscript critically for important intellectual content; and final approval of the manuscript submitted.

Corresponding authors

Correspondence to Claudio T. Mesquita PhD, MD or Weihua Zhou PhD.

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Disclosure

Dr. Ernest Garcia receives royalties from the sale of the Emory Cardiac Toolbox and has equity positions with Syntermed, Inc. The terms of these arrangements have been reviewed and approved by Emory University in accordance with its conflict of interest policies. Zhuo He, Fernando Fernandes, Erivelton Nascimento, Claudio T. Mesquita, and Weihua Zhou declare that they have no conflicts of interest.

Ethical Approval

The study was approved by the participating countries’ scientific councils and complied with the Declaration of Helsinki.

Informed Consent

Written informed consent was obtained from all participants, and patient anonymity was maintained during data analysis.

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All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Saurabh Malhotra, MD, MPH.

Funding This study presents the results derived from the International Atomic Energy Agency (IAEA) multicenter trial: “Value of intraventricular synchronism assessment by gated SPECT myocardial perfusion imaging in the management of heart failure patients submitted to cardiac resynchronization therapy” (IAEA VISION-CRT), Coordinated Research Protocol E1.30.34, and received funds from IAEA. This research was supported by a grant from the American Heart Association (Project Number: 17AIREA33700016, PI: Weihua Zhou) and a new faculty grant from Michigan Technological University Institute of Computing and Cybersystems (PI: Weihua Zhou).

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He, Z., de Amorim Fernandes, F., do Nascimento, E.A. et al. Incremental value of left ventricular shape parameters measured by gated SPECT MPI in predicting the super-response to CRT. J. Nucl. Cardiol. 29, 1537–1546 (2022). https://doi.org/10.1007/s12350-020-02469-7

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  • DOI: https://doi.org/10.1007/s12350-020-02469-7

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