Journal of Nuclear Cardiology

, Volume 24, Issue 4, pp 1282–1288 | Cite as

Impact of cardiac reverse remodeling after cardiac resynchronization therapy assessed by myocardial perfusion imaging on ventricular arrhythmia

  • Kuo-Feng Chiang
  • Guang-Uei Hung
  • Shih-Chung Tsai
  • Chien-Ming Cheng
  • Yu-Cheng Chang
  • Wan-Yu Lin
  • Yu-Cheng Hsieh
  • Tsu-Juey Wu
  • Shih-Ann Chen
  • Jin-Long HuangEmail author
  • Ying-Chieh LiaoEmail author
  • Ji Chen
Original Article



Although cardiac resynchronization therapy (CRT) has been a useful treatment of heart failure, patients with CRT are still in risk of sudden cardiac death due to ventricular arrhythmia. The aim of this study was to investigate the impact of cardiac reverse remodeling after CRT on the prevalence of ventricular tachycardia or fibrillation (VT/VF).

Methods and Results

Forty-one heart failure patients (26 men, age 66 ± 10 years), who were implanted with CRT for at least 12 months, were enrolled. All patients received myocardial perfusion imaging (MPI) under CRT pacing to evaluate left ventricle (LV) function, dyssynchrony, and scar. VT/VF episodes during the follow-up period after MPI were recorded by the CRT devices. Sixteen patients (N = 16/41, 39%) were found to have VT/VF. Multivariate Cox regression analysis and receiver operating characteristic curve analysis showed that five risk factors were significant predictors of VT/VF, including increased left ventricle ejection fraction (LVEF) by ≤7% after CRT, low LVEF after CRT (≤30%), change of intrinsic QRS duration (iQRSd) by ≤7 ms, wide iQRSd after CRT (≥121 ms), and high systolic dyssynchrony after CRT (phase standard deviation ≥45.6°). For those patients with all of the 5 risk factors, 85.7% or more developed VT/VF.


The characteristics of cardiac reverse remodeling after CRT as assessed by MPI are associated with the prevalence of ventricular arrhythmia.


Heart failure cardiac resynchronization therapy phase analysis reverse remodeling 



Left bundle branch block


Mechanical reverse remodeling


Electrical reverse remodeling


Intrinsic QRS duration before CRT


Intrinsic QRS duration after CRT with transient turn-off of CRT pacing


Phase standard deviation


Phase histogram bandwidth


Change of LVEF after CRT by echography


Change of iQRSd during CRT pacing


Change of iQRSd during CRT off



This study was supported in part by grants from the Taiwan National Science Council (NSC-100-2314-B-075A-005-MY3, 101-2314-B-758-002-, 102-2314-B-758-001-, 103-2314-B-758-001- and NSC-100-2314-B-075A-005-MY3) and grants from the Taichung Veterans General Hospital (TCVGH-1023105C, 1033106C, 1043106C, 1043102B, 1053106C).


Dr. Chen receives royalties from the sale of the Emory Cardiac Toolbox with SyncTool. The terms of this arrangement have been approved by Emory University in accordance with its conflict-of-interest practice. All authors declare that they have no conflict of interest.


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Copyright information

© American Society of Nuclear Cardiology 2016

Authors and Affiliations

  • Kuo-Feng Chiang
    • 1
  • Guang-Uei Hung
    • 2
    • 3
  • Shih-Chung Tsai
    • 4
  • Chien-Ming Cheng
    • 5
  • Yu-Cheng Chang
    • 1
  • Wan-Yu Lin
    • 4
  • Yu-Cheng Hsieh
    • 1
    • 6
  • Tsu-Juey Wu
    • 1
    • 6
  • Shih-Ann Chen
    • 6
    • 7
  • Jin-Long Huang
    • 1
    • 6
    Email author
  • Ying-Chieh Liao
    • 6
    • 8
    Email author
  • Ji Chen
    • 9
  1. 1.Cardiovascular CenterTaichung Veterans General HospitalTaichungTaiwan
  2. 2.Department of Nuclear MedicineChang Bing Show Chwan Memorial HospitalChanghuaTaiwan
  3. 3.Department of Biomedical Imaging and Radiological ScienceChina Medical UniversityTaichungTaiwan
  4. 4.Department of Nuclear MedicineTaichung Veterans General HospitalTaichungTaiwan
  5. 5.Division of Cardiology, Department of Medicine, Department of Health of Executive YuanFong Yuan HospitalTaichungTaiwan
  6. 6.School of MedicineNational Yang-Ming UniversityTaipeiTaiwan
  7. 7.Divisions of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipei CityTaiwan
  8. 8.Division of Cardiology, Department of MedicineBuddhist Tzu-Chi General Hospital, Taichung BranchTaichungTaiwan
  9. 9.Department of Radiology and Imaging SciencesEmory UniversityAtlantaUSA

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