Journal of Nuclear Cardiology

, Volume 25, Issue 6, pp 2029–2038 | Cite as

Assessment of left ventricular contraction patterns using gated SPECT MPI to predict cardiac resynchronization therapy response

  • Ningchao Tao
  • Yuanhao Qiu
  • Haipeng Tang
  • Zhiyong Qian
  • Hongping Wu
  • Rui Zhu
  • Yao Wang
  • Xiaofeng Hou
  • Weihua ZhouEmail author
  • Jiangang ZouEmail author
Original Article



The U-shaped left ventricular (LV) contraction pattern, identified by MRI or echocardiography, is associated with improved CRT response. Gated SPECT MPI can measure both myocardial viability and mechanical dyssynchrony in a single scan. The aim of this study is to examine the relationship of the LV contraction pattern and the response of CRT in patients with left bundle branch block (LBBB).


Fifty-eight patients who met CRT guidelines and who had pre-CRT MPI were enrolled. Myocardial segments with tracer uptake < 50% of maximum were considered as scar. The LV contraction pattern was considered as U-shaped or non-U-shaped (U-shaped has a block line in the direction of contraction propagation). CRT response was defined as an increase in left ventricular ejection fraction ≥ 5% after 6-month follow-up.


Twenty-eight patients (48%) had a U-shaped contraction pattern and thirty patients (52%) had a non-U-shaped contraction pattern. The U-shaped group showed a significantly higher response rate than the non-U-shaped group (90% vs. 57%; P = 0.005). By univariate and multivariate logistic regression analysis, the U-shaped pattern was an independent predictor of CRT response.


Non-invasive gated SPECT MPI can characterize LV mechanical contraction patterns. A U-shaped contraction pattern identified is associated with improved CRT response. This may prove useful for improved patient selection for CRT.


SPECT MPI heart failure CRT contraction pattern left bundle branch block 



Single-photon emission computed tomography


Myocardial perfusion imaging/images


Left ventricle/ventricular


Cardiac resynchronization therapy


Left bundle branch block


Left ventricular mechanical dyssynchrony


Phase standard deviation


Phase histogram bandwidth



This research was supported by a grant from Science and Technology Department of Jiangsu Province (Project Number: BE2016764, PI: Jiangang Zou) and a New Faculty startup grant from the University of Southern Mississippi (Project Number: DE01791, PI: Weihua Zhou).


The authors have declare that they have no conflict of interest.

Supplementary material

12350_2017_949_MOESM1_ESM.pptx (267 kb)
Supplementary material 1 (PPTX 266 kb)


  1. 1.
    Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346:1845–53.CrossRefGoogle Scholar
  2. 2.
    Peterson PN, Greiner MA, Qualls LG, Al-Khatib SM, Curtis JP, Fonarow GC, et al. QRS duration, bundle-branch block morphology, and outcomes among older patients with heart failure receiving cardiac resynchronization therapy. JAMA. 2013;310(6):617–26.CrossRefGoogle Scholar
  3. 3.
    Auricchio A, Prinzen FW. Non-responders to cardiac resynchronization therapy: the magnitude of the problem and the issues. Circ J. 2011;75:521–7.CrossRefGoogle Scholar
  4. 4.
    Butter C, Auricchio A, Stellbrink C, Fleck E, Ding J, Yu Y, et al. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation. 2001;104:3026–9.CrossRefGoogle Scholar
  5. 5.
    Fung JW, Yu CM, Yip G, Zhang Y, Chan H, Kum CC, et al. Variable left ventricular activation pattern in patients with heart failure and left bundle branch block. Heart. 2004;90:17–9.CrossRefGoogle Scholar
  6. 6.
    Seo Y, Ishizu T, Sakamaki F, Yamamoto M, Aonuma K. Left bundle branch block and echocardiography in the era of CRT. J Echocardiogr. 2015;13:6–14.CrossRefGoogle Scholar
  7. 7.
    Auricchio A, Fantoni C, Regoli F, Carbucicchio C, Goette A, Geller C, et al. Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation. 2004;109:1133–9.CrossRefGoogle Scholar
  8. 8.
    Seo Y, Ishizu T, Kawamura R, Yamamoto M, Kuroki K, Igarashi M, et al. Three-dimensional propagation imaging of left ventricular activation by speckle-tracking echocardiography to predict responses to cardiac resynchronization therapy. J Am Soc Echocardiogr. 2015;28:606–14.CrossRefGoogle Scholar
  9. 9.
    Fung JW, Chan JY, Yip GW, Chan HC, Chan WW, Zhang Q, et al. Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy. Heart. 2007;93:432–7.CrossRefGoogle Scholar
  10. 10.
    Sohal M, Shetty A, Duckett S, Chen Z, Sammut E, Amraoui S, et al. Noninvasive assessment of LV contraction patterns using CMR to identify responders to CRT. JACC Cardiovasc Imaging. 2013;6:864–73.CrossRefGoogle Scholar
  11. 11.
    Jackson T, Sohal M, Chen Z, Child N, Sammut E, Behar J, et al. A U-shaped type II contraction pattern in patients with strict left bundle branch block predicts super-response to cardiac resynchronization therapy. Heart Rhythm. 2014;11:1790–7.CrossRefGoogle Scholar
  12. 12.
    Hartlage GR, Suever JD, Clement-Guinaudeau S, Strickland PT, Ghasemzadef N, Magrath RP, et al. Prediction of response to cardiac resynchronization therapy using left ventricular pacing lead position and cardiovascular magnetic resonance derived wall motion patterns: a prospective cohort study. J Cardiovasc Magn Reson. 2015;17:57.CrossRefGoogle Scholar
  13. 13.
    Lardo AC, Abraham TP, Kass DA. Magnetic resonance imaging assessment of ventricular dyssynchrony: current and emerging concepts. J Am Coll Cardiol. 2005;46(12):2223–8.CrossRefGoogle Scholar
  14. 14.
    Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol. 2005;12(6):687–95.CrossRefGoogle Scholar
  15. 15.
    Zhou W, Garcia EV. Nuclear image-guided approaches for cardiac resynchronization therapy (CRT). Curr Cardiol Rep. 2016;18(1):7.CrossRefGoogle Scholar
  16. 16.
    Garcia EV, Cooke CD, Van Train KF, Folks R, Peifer J, DePuey EG, et al. Technical aspects of myocardial SPECT imaging with technetium-99m sestamibi. Am J Cardiol. 1990;66(13):23E–31E.CrossRefGoogle Scholar
  17. 17.
    Lambiase PD, Rinaldi A, Hauck J, Mobb M, Elliott D, Mohammad S, et al. Non-contact left ventricular endocardial mapping in cardiac resynchronisation therapy. Heart. 2004;90:44–51.CrossRefGoogle Scholar
  18. 18.
    Henneman MM, Chen J, Dibbets-Schneider P, Stokkel MP, Bleeker GB, Ypenburg C, et al. Can LV dyssynchrony as assessed with phase analysis on gated myocardial perfusion SPECT predict response to CRT? J Nucl Med. 2007;48:1104–11.CrossRefGoogle Scholar
  19. 19.
    Adelstein EC, Saba S. Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy. Am Heart J. 2007;153:105–12.CrossRefGoogle Scholar
  20. 20.
    Khan FZ, Virdee MS, Palmer CR, Pugh PJ, O’Halloran D, Elsik M, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial. J Am Coll Cardiol. 2012;59:1509–18.CrossRefGoogle Scholar
  21. 21.
    Friehling M, Chen J, Saba S, Bazaz R, Schwartzman D, Adelstein EC, et al. A prospective pilot study to evaluate the relationship between acute change in left ventricular synchrony after cardiac resynchronization therapy and patient outcome using a single-injection gated SPECT protocol. Circ Cardiovasc Imaging. 2011;4(5):532–9.CrossRefGoogle Scholar
  22. 22.
    Marsan NA, Bleeker GB, van Bommel RJ, Ypenburg C, Delgado V, Borleffs CJ, et al. Comparison of time course of response to cardiac resynchronization therapy in patients with ischemic versus nonischemic cardiomyopathy. Am J Cardiol. 2009;103(5):690–4.CrossRefGoogle Scholar
  23. 23.
    Suever JD, Hartlage GR, Magrath RP, Iravanian S, Lloyd MS, Oshinski JN. Relationship between mechanical dyssynchrony and intra-operative electrical delay times in patients undergoing cardiac resynchronization therapy. J Cardiovasc Magn Reson. 2014;16:4.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Ningchao Tao
    • 1
  • Yuanhao Qiu
    • 1
  • Haipeng Tang
    • 2
  • Zhiyong Qian
    • 1
  • Hongping Wu
    • 1
  • Rui Zhu
    • 1
  • Yao Wang
    • 1
  • Xiaofeng Hou
    • 1
  • Weihua Zhou
    • 2
    Email author
  • Jiangang Zou
    • 1
    Email author
  1. 1.Department of CardiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
  2. 2.School of ComputingUniversity of Southern MississippiLong BeachUSA

Personalised recommendations