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Evaluation of baseline contractile reserve vs dyssynchrony as a predictor of functional improvement and long term outcome after resynchronization pacing therapy: A radionuclide stress study

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Journal of Nuclear Cardiology Aims and scope

Abstract

Aim

To assess the predictive value of baseline ventricular dyssynchrony and myocardial contractile reserve (mCR) in identifying responders to cardiac resynchronization therapy (CRT).

Methods

We prospectively studied 57 patients selected for CRT according to current recommendations. Regional dyssynchrony was evaluated by parametric phase imaging of ecg-gated equilibrium radionuclide angiography (ERNA). The mean inter-ventricular phase delay and the standard deviation to mean left ventricular (LV) phase angle were used as a measure of inter- and intra-ventricular dyssynchrony, respectively. Change in LV ejection fraction (LVEF) during low-dose dobutamine (LDD) was measured to assess mCR. ERNA was repeated at 6 months to evaluate changes in LVEF after CRT. Combined end-points of re-hospitalization for heart failure, heart transplantation, and cardiac death were assessed over a period of 76 months (mean 43 ± 31).

Results

Baseline dyssynchrony was present in most patients (85%). After CRT only one half of patients showed a reduction in intra-ventricular dyssynchrony and 33% an increase in LVEF by >5%. Improvement of LVEF was not predicted by baseline LVEF, clinical presentation, dyssynchrony parameters or QRS duration. There was a significant relationship between changes in LVEF during LDD testing and after CRT (r = 0.65; P < .0001). Logistic regression analysis identified mCR as independent predictor of improvement in LVEF (P = .039; OR = 3.84; CI 95% = 1.06-13.9), resynchronization (P = .046; OR = 4.20; CI 95% = 1.03-17.2), and event-free survival (P = .002; OR = 0.10; CI 95% = 0.02-0.43).

Conclusions

In patients with left ventricular dysfunction and baseline dyssynchrony as assessed by ERNA, evaluation of mCR during LDD may help predicting functional improvement and selecting potential responders to CRT.

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References

  1. Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, et al. ACC/AHA/NASPE 2002 Guideline update for implantation of cardiac pacemakers and antiarrhythmia devices. J Am Coll Cardiol 2002;40:1703-19.

    Article  PubMed  Google Scholar 

  2. Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The task force for cardiac pacing and cardiac resynchronisation therapy of the European Society of Cardiology. Eur Heart J 2007;28:2256-95.

    Article  PubMed  Google Scholar 

  3. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. Cardiac Resynchronisation-Heart Failure (CARE-HF) Study Investigators. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539-49.

    Article  PubMed  CAS  Google Scholar 

  4. Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, et al. Long term benefit of biventricular pacing in congestive heart failure: Results from the Multisite Stimulation in Cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002;40:111-8.

    Article  PubMed  Google Scholar 

  5. Abraham WT, Fisher WG, Smith LA, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845-53.

    Article  PubMed  Google Scholar 

  6. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. The COMPANION Investigators Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140-50.

    Article  PubMed  CAS  Google Scholar 

  7. Bradley DJ, Bradley EA, Baughman KL, Berger RD, Calkins H, Goodman SN, et al. Cardiac resynchronization and death from progressive heart failure: A meta-analysis of randomized controlled trials. JAMA 2003;289:730-40.

    Article  PubMed  Google Scholar 

  8. McAlister FA, Ezekowitz JA, Wiebe N, Rowe B, Spooner C, Crumley E, et al. Systematic review: Cardiac resynchronization in patients with symptomatic heart failure. Ann Intern Med 2004;141:381-90.

    PubMed  Google Scholar 

  9. Pires LA, Abraham WT, Young JB, Johnson KM, the MIRACLE and MIRACLE-ICD investigators. Clinical comparison and timing of New York Heart Association class improvement with cardiac resynchronization therapy in patients with advanced chronic heart failure: results from the multicenter InSync randomized clinical evaluation (MIRACLE) and multicenter In Sync ICD randomised clinical evaluation (MIRACLE-ICD) trials. Am Heart J 2006;151:837-43.

    Article  PubMed  Google Scholar 

  10. Hawkins NM, Petrie MC, McDonald MR, Hogg KJ, McMurray JJV. Selecting patients for cardiac resynchronization therapy: Electrical or mechanical dyssynchrony? Eur Heart J 2006;27:1270-81.

    Article  PubMed  Google Scholar 

  11. Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, et al. Effect of postero-lateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006;113:969-76.

    Article  PubMed  Google Scholar 

  12. Lim P, Bars C, Mitchell-Heggs L, Roiron C, Elbaz N, Hamdaoui B, et al. Importance of contractile reserve for CRT. Europace 2007;9:739-43.

    Article  PubMed  Google Scholar 

  13. Da Costa A, Thévenin J, Roche F, Faure E, Roméyer-Bouchard C, Messier M, et al. Prospective validation of stress echocardiography as an identifier of cardiac resynchronization therapy responders. Heart Rhythm 2006;3:406-13.

    Article  PubMed  Google Scholar 

  14. Ypenburg C, Sieders A, Bleeker GB, Holman E, van del Wall E, Schalij MJ, et al. Myocardial contractile reserve predicts improvement in left ventricular function after cardiac resynchronization therapy. Am Heart J 2007;154:1160-5.

    Article  PubMed  Google Scholar 

  15. Moonen M, Senechal M, Cosyns B, Melon P, Nellessen E, Pierard L, et al. Impact of contractile reserve on acute response to cardiac resynchronization therapy. Cardiovasc Ultrasound 2008;6:65-9.

    PubMed  Google Scholar 

  16. Breithardt OA, Stellbrink C, Kramer AP, Sinha AM, Franke A, Salo R, et al. Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy. J Am Coll Cardiol 2002;40:536-45.

    Article  PubMed  Google Scholar 

  17. Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol 2004;44:1834-40.

    Article  PubMed  Google Scholar 

  18. Yu CM, Zhang Q, Fung JWH, Chan HCK, Chan YS, Yip GWK, et al. A novel tool to assess systolic asynchrony and identify responders of cardiac resynchronization therapy by tissue synchronisation imaging. J Am Coll Cardiol 2005;45:677-84.

    Article  PubMed  Google Scholar 

  19. Kerwin WF, Botvinick EH, O’Connell JW, Merrick SH, DeMarco T, Chatterjee K, et al. Ventricular contraction abnormalities in dilated cardiomyopathy: Effect of biventricular pacing to correct interventricular dyssynchrony. J Am Coll Cardiol 2000;35:1221-7.

    Article  PubMed  CAS  Google Scholar 

  20. Fauchier L, Marie O, Casset-Senon D, Babuty D, Cosnay P, Fauchier JP. Interventricular and intra-ventricular dyssynchrony in idiopathic dilated cardiomyopathy: A prognostic study with Fourier phase analysis of radionuclide angioscintigraphy. J Am Coll Cardiol 2002;40:2022-30.

    Article  PubMed  Google Scholar 

  21. Wassenaar R, O’Connor D, Dej B, Ruddy TD, Birnie D. Optimisation and validation of radionuclide angiography phase analysis parameters for quantification of mechanical dyssynchrony. J Nucl Cardiol 2009;16:895-6.

    Article  PubMed  Google Scholar 

  22. Marcassa C, Campini R, Verna E, Ceriani L, Giannuzzi P. Assessment of cardiac asynchrony by radionuclide phase analysis: Correlation with ventricular function in patients with narrow or prolonged QRS interval. Eur J Heart Fail 2007;9:484-90.

    Article  PubMed  Google Scholar 

  23. Trimble MA, Borges-Neto S, Honeycutt EF, Shaw LK, Pagnanelli R, Chen J, et al. Evaluation of mechanical dyssynchrony and myocardial perfusion using phase analysis of gated SPECT imaging in patients with left ventricular dysfunction. J Nucl Cardiol 2008;15:663-70.

    Article  PubMed  Google Scholar 

  24. Naqvi TZ, Goel RK, Forrester JS, Siegel RJ. Myocardial contractile reserve on dobutamine echocardiography predicts late spontaneous improvement in cardiac function in patients with recent onset idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1999;34:1537-44.

    Article  PubMed  CAS  Google Scholar 

  25. Ceriani L, Verna E, Giovanella L, Binaghi G, Garancini S. Diagnostic criteria for detection of post-infarction ischemia by quantitative analysis of stepwise dobutamine radionuclide ventriculography. J Nucl Cardiol 1999;6:514-21.

    Article  PubMed  CAS  Google Scholar 

  26. Eichhorn EJ, Grayburn PA, Mayer SA, StJohn Sutton M, Appleton C, Plehn J, et al. Myocardial contractile reserve by dobutamine stress echocardiography predict improvement in ejection fraction with beta-blockade in patients with heart failure. The Beta-blocker evaluation of survival trial (BEST). Circulation 2003;108:2236-41.

    Article  Google Scholar 

  27. Yu CM, Yang H, Lau CP, Wang Q, Wang S, Lam S, et al. Regional left ventricular mechanical asynchrony in patients with heart disease and normal QRS duration: Implication for biventricular pacing therapy. Pacing Clin Electrophysiol 2003;26:562-70.

    Article  PubMed  Google Scholar 

  28. Chung ES, Leon AR, Tavazzi L, Sun JP, Nokoyannopulos P, Merlino J, et al. Result of the predictors of response to CRT (PROSPECT) trial. Circulation 2008;117:2608-16.

    Article  PubMed  Google Scholar 

  29. Vallejo E, Jiménez L, Rodríguez G, Roffe F, Bialostozky D. Evaluation of ventricular synchrony with equilibrium radionuclide angiography: Assessment of variability and accuracy. Arch Med Res 2010;41:83-91.

    Article  PubMed  Google Scholar 

  30. Groch MW, DePuey EG, Belzberg AC, Erwin WD, Kamran M, Barnett CA, et al. Planar imaging versus gated blood-pool SPECT for the assessment of ventricular performance: A multicenter study. J Nucl Med 2001;42:1773-9.

    PubMed  CAS  Google Scholar 

  31. Bleeker GB, Mollema SA, Holman ER, Van De Veire N, Ypenburg C, Boersma E, et al. Left ventricular resynchronisation is mandatory for the response to cardiac resynchronization therapy. Analysis in patients with echocariographic evidence of left ventricular dyssynchrony at baseline. Circulation 2007;116:1440-8.

    Article  PubMed  Google Scholar 

  32. Mohan HK, Livieratos L, Gallagher S. Comparison of myocardial gated SPECT planar radionuclide ventriculography and echocardiography in evaluating left ventricular ejection fraction, wall motion and thickening. J Nucl Cardiol 2004;11:S25-30.

    Article  Google Scholar 

  33. Chua T, Yin LC, Thiang TH, Choo TB, Ping DZ, Leng LY. Accuracy of the automated assessment of left ventricular function with gated perfusion SPECT in the presence of perfusion defects and left ventricular dysfunction: Correlation with equilibrium radionuclide ventriculography and echocardiography. J Nucl Cardiol 2000;7:301-11.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

We are indebted to Luca Ceriani MD (Lugano, Switzerland) for its strong and skilled work in the evaluation of the first nuclear studies. We are also grateful to Rocco Lucianini (Varese, Italy) for its help in data processing and image analysis, to Laura Gaiara MD for data collection and to Claudio Marcassa, MD (Veruno, Italy) and Roberto De Ponti, MD (Varese, Italy) for their friendly help in reviewing the manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Viale Borri 56, 21100, Varese, Italy

    Edoardo Verna MD, Sergio Ghiringhelli MD & Fabrizio Caravati MD

  2. Department of Nuclear Medicine, Ospedale di Circolo & Fondazione Macchi, University of Insubria, Viale Borri 56, 21100, Varese, Italy

    Simone Scotti MD

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  1. Edoardo Verna MD
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  2. Sergio Ghiringhelli MD
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Correspondence to Edoardo Verna MD.

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Verna, E., Ghiringhelli, S., Scotti, S. et al. Evaluation of baseline contractile reserve vs dyssynchrony as a predictor of functional improvement and long term outcome after resynchronization pacing therapy: A radionuclide stress study. J. Nucl. Cardiol. 19, 53–62 (2012). https://doi.org/10.1007/s12350-011-9421-9

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  • DOI: https://doi.org/10.1007/s12350-011-9421-9

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