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Yield of left ventricular dyssynchrony by gated SPECT MPI in patients with heart failure prior to implantable cardioverter-defibrillator or cardiac resynchronization therapy with a defibrillator: Characteristics and prediction of cardiac outcome

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Mechanical left ventricular dyssynchrony (MLVD) might contribute in the therapeutic decision-making in patients with heart failure (HF) prior to cardiac resynchronization therapy (CRT). Our aim was to assess MLVD in patients with HF prior to implantable cardioverter-defibrillator (ICD) compared to patients with CRT-D.

Methods

In a prospective study, patients with LVEF ≤ 35% who were scheduled for ICD or CRT-D, underwent gated SPECT myocardial perfusion imaging with technetium 99m sestamibi within 3 months prior procedure. MLVD was measured by phase analysis.

Results

The study cohort consisted of 143 patients, 71 with ICD and 72 with CRT-D. Age 68.3 ± 11 and LVEF 24 ± 6%. Phase standard deviation (SD) was 62.5 ± 18 and 59.7 ± 20 (P = NS), respectively. During follow-up of 23.7 ± 12.1 months, there were 10 vs 14 cardiac death in ICD and CRT-D, respectively (P = NS), hospitalization for HF, in 34 vs 53 (P < .001). In multivariate analysis, Phase SD was the independent predictor for cardiac death [HR 2.66 (95% CI 1.046-6.768), P = .04]. Kaplan-Meier curves of phase SD of 60° significantly identified ICD patients with and without cardiac deaths and hospitalization for HF exacerbation.

Conclusions

MLVD by phase SD can identify patients with cardiac events and predict cardiac death in patients treated with ICD.

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Abbreviations

CRT-D:

Cardiac resynchronization therapy with a defibrillator

ICD:

Implantable cardiac defibrillator

LVEF:

Left ventricular ejection fraction

MLVD:

Mechanical left ventricular dyssynchrony

MPI:

Myocardial perfusion imaging

NYHA:

New York Heart Association

SPECT:

Single-photon emission computed tomography

Tc:

Technetium

VT/VF:

Ventricular tachycardia/ventricular fibrillation

HF:

Heart failure

SD:

Standard deviation

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Conflict of interest

The authors report no potential conflict of interest relevant to this article.

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Authors and Affiliations

  1. Cardiology Department, Rabin Medical Center, Beilinson Campus, Petah Tiqva, Israel

    Nili Zafrir MD, Tamir Bental MD, Boris Strasberg MD, Alejandro Solodky MD, Israel Mats MD, Ariel Gutstein MD & Ran Kornowski MD

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  1. Nili Zafrir MD
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  2. Tamir Bental MD
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  3. Boris Strasberg MD
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  4. Alejandro Solodky MD
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  5. Israel Mats MD
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  6. Ariel Gutstein MD
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  7. Ran Kornowski MD
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Corresponding author

Correspondence to Nili Zafrir MD.

Additional information

See related editorial, doi:10.1007/s12350-015-0326-x.

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Zafrir, N., Bental, T., Strasberg, B. et al. Yield of left ventricular dyssynchrony by gated SPECT MPI in patients with heart failure prior to implantable cardioverter-defibrillator or cardiac resynchronization therapy with a defibrillator: Characteristics and prediction of cardiac outcome. J. Nucl. Cardiol. 24, 122–129 (2017). https://doi.org/10.1007/s12350-015-0310-5

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  • DOI: https://doi.org/10.1007/s12350-015-0310-5

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