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Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

99mTc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial 99mTc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT.

Methods

A group of 30 patients with severe HF were prospectively studied before and 3 months after CRT. Variables analysed were HF functional class, QRS duration, LV ejection fraction (LVEF) by echocardiography, myocardial 99mTc-MIBI uptake, LV end-diastolic volume (EDV) and end-systolic volume (ESV), phase analysis LV dyssynchrony indices, and regional motion by GMS. After CRT, patients were divided into two groups according to improvement in LVEF: group 1 (12 patients) with increase in LVEF of 5 or more points, and group 2 (18 patients) without a significant increase.

Results

After CRT, both groups showed a significant improvement in HF functional class, reduced QRS width and increased septal wall 99mTc-MIBI uptake. Only group 1 showed favourable changes in EDV, ESV, LV dyssynchrony indices, and regional motion. Before CRT, EDV, and ESV were lower in group 1 than in group 2. Anterior and inferior wall 99mTc-MIBI uptakes were higher in group 1 than in group 2 (p<0.05). EDV was the only independent predictor of an increase in LVEF (p=0.01). The optimal EDV cut-off point was 315 ml (sensitivity 89%, specificity 94%).

Conclusion

The evaluation of EDV by GMS added information on patient selection for CRT. After CRT, LVEF increase occurred in hearts less dilated and with more normal 99mTc-MIBI uptake.

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Acknowledgments

This study was partially supported by São Paulo State Research Foundation (FAPESP, project number no. 04/12160-3), and it was part of the PhD thesis of Dr. Brandão.

Conflicts of interest

Dr. Ernest V. Garcia receives royalties from the sale of the Emory Cardiac Toolbox. The other authors have no financial conflicts.

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Authors and Affiliations

  1. Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, CEP 05403-000, São Paulo, SP, Brazil

    Simone C. S. Brandão, Silvana A. D. Nishioka, Maria C. P. Giorgi, Rubens Abe, Martino Martinelli Filho, Viviane T. Hotta, Marcelo L. Vieira & José C. Meneghetti

  2. Emory University, Atlanta, GA, USA

    Ji Chen & Ernest V. Garcia

Authors
  1. Simone C. S. Brandão
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  2. Silvana A. D. Nishioka
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  3. Maria C. P. Giorgi
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  4. Ji Chen
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  5. Rubens Abe
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  8. Marcelo L. Vieira
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  9. Ernest V. Garcia
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  10. José C. Meneghetti
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Correspondence to Simone C. S. Brandão.

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Brandão, S.C.S., Nishioka, S.A.D., Giorgi, M.C.P. et al. Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function. Eur J Nucl Med Mol Imaging 36, 986–996 (2009). https://doi.org/10.1007/s00259-008-1029-1

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  • DOI: https://doi.org/10.1007/s00259-008-1029-1

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