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Mechanical contraction to guide CRT left-ventricular lead placement instead of electrical activation in myocardial infarction with left ventricular dysfunction: An experimental study based on non-invasive gated myocardial perfusion imaging and invasive electroanatomic mapping

  • Jianfeng Wang
  • Yuetao WangEmail author
  • Minfu Yang
  • Shan Shao
  • Yi Tian
  • Xiaoliang Shao
  • Shengdeng Fan
  • Feifei Zhang
  • Wei Yang
  • Wenchong Xin
  • Haipeng Tang
  • Min Xu
  • Ling Yang
  • Xiaosong Wang
  • Weihua Zhou
Original Article

Abstract

Background

Whether the region of the latest electrical activation (LEA) corresponds with the segment of the latest mechanical contraction (LMC) in ischemic cardiomyopathy (ICM) is uncertain. We aimed to investigate the relationship between the left-ventricular (LV) viable segments with LEA and with LMC after myocardial infarction (MI) and analyze the acute hemodynamic responses (dP/dtmax) after cardiac resynchronization therapy (CRT) pacing at different LV sites.

Methods and results

Bama suckling pigs (n = 6) were subjected to create MI models. Both gated myocardial perfusion imaging (GMPI) and electroanatomic mapping (EAM) were performed successfully before MI and 4 weeks after MI. LMC was assessed by phase analysis of GMPI, while LEA was evaluated by EAM. The dP/dtmax was measured before CRT and when the CRT LV electrode was implanted in viable segments of LMC, viable segments of lateral wall and scar, respectively. The viable segments of LEA were consistent with the sites of LMC for five in six cases. The dP/dtmax increased significantly compared with that before CRT when the CRT LV electrode was implanted in viable segments of LMC (1103.33 ± 195.76 vs 717.83 ± 80.74 mmHg·s−1, P = .001), which was also significantly higher than in viable segments of lateral wall (751.17 ± 105.62 mmHg·s−1, P = .000) and scar (679.50 ± 60.87 mmHg·s−1, P = .001).

Conclusions

Non-invasive GMPI may be a better option than invasive EAM for guiding LV electrode implantation for CRT in ICM.

Keywords

Cardiac resynchronization therapy gated SPECT dyssynchrony myocardial infarction latest mechanical contraction 

Abbreviations

ICM

Ischemic cardiomyopathy

CRT

Cardiac resynchronization therapy

LV

Left ventricular

LVMD

Left ventricular mechanical dyssynchrony

EAM

Electroanatomical mapping

LEA

Latest electrical activation

GMPI

Gated myocardial perfusion imaging

LVED

Left ventricular electrical dyssynchrony

MI

Myocardial infarction

SPECT

Single photon emission computed tomography

Notes

Acknowledgments

The project was supported by the National Natural Science Foundation of China (81471690, PI: Yuetao Wang), Youth Science Fund Project of National Natural Science Foundation of China (81701737, PI: Jianfeng Wang; 81701734, PI: Xiaoliang Shao), Jiangsu Province Science and Technology Program-Project of Standardized Diagnosis and Treatment of Key Diseases (BE2015635, PI: Yuetao Wang), and Key Project of Changzhou Municipal Health Bureau (ZD201409, PI: Xiaosong Wang). It was also supported by a Grant from the American Heart Association (17AIREA33700016, PI: Weihua Zhou).

Disclosures

The authors declare that they have no conflict of interest.

Supplementary material

12350_2019_1710_MOESM1_ESM.pptx (1.3 mb)
Supplementary material 1 (PPTX 1289 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Jianfeng Wang
    • 1
  • Yuetao Wang
    • 1
    Email author
  • Minfu Yang
    • 2
  • Shan Shao
    • 3
  • Yi Tian
    • 4
  • Xiaoliang Shao
    • 1
  • Shengdeng Fan
    • 5
  • Feifei Zhang
    • 1
  • Wei Yang
    • 1
  • Wenchong Xin
    • 1
  • Haipeng Tang
    • 6
  • Min Xu
    • 7
  • Ling Yang
    • 3
  • Xiaosong Wang
    • 1
  • Weihua Zhou
    • 6
  1. 1.Department of Nuclear MedicineThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
  2. 2.Department of Nuclear Medicine, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
  3. 3.Department of CardiologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
  4. 4.Department of Nuclear Medicine, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
  5. 5.Department of AnesthesiologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
  6. 6.School of ComputingUniversity of Southern MississippiLong BeachUSA
  7. 7.Department of EchocardiogramThe Third Affiliated Hospital of Soochow UniversityChangzhouChina

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