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Effect of cardiac resynchronization therapy on septal perfusion and septal thickening: Association with left ventricular function, reverse remodelling and dyssynchrony

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We evaluated the effect of cardiac resynchronization therapy (CRT) on septal perfusion and thickening at 6 months post implantation assessed on Tc99m-MIBI Gated myocardial perfusion SPECT (GMPS).We also studied the association of change in septal perfusion and thickening with primary outcome defined as at least one [improvement in ≥1NYHA class, left ventricular ejection fraction (LVEF) by ≥ 5%, reduction of end-systolic volume (ESV) by ≥ 15%, and improvement ≥ 5 points in Minnesota living with heart failure questionnaire (MLHFQ)].

Method

One hundred and five patients underwent clinical and GMPS evaluation before and at 6 months post CRT.

Result

Post CRT there was significant improvement in mean normalized septal perfusion uptake and in septal thickening (P value = 0.001, both). There was no significant relation between improvement in septal perfusion and primary outcome. However, improvement in septal thickening was statistically significant with favorable primary outcome (P = 0.001).There was no significant correlation between improvement of septal perfusion and improvement in LVEF, reduction in End diastolic volume (EDV), ESV, and Left ventricular Dyssynchrony (LVD). But, there was significant correlation between improvement of septal thickening and these parameters.

Conclusion

Improvement in septal thickening was associated with reverse remodeling, improvement in LVEF, and reduction of LVD.

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Abbreviations

CRT:

Cardiac resynchronization therapy

HF:

Heart failure

LBBB:

Left bundle branch block

LVEF:

Left ventricular ejection fraction

GMPS:

Gated myocardial perfusion SPECT

LVD:

Left ventricular dyssynchrony

MLHFQ:

Minnesota living with heart failure questionnaire

PSD:

Phase standard deviation

RBBB:

Right bundle branch block

OSEM:

Ordered subset expectation maximization

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Authors and Affiliations

  1. All India Institute of Medical Sciences, New Delhi, India

    C. Patel MD

  2. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

    M. Kalaivani PhD

  3. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

    G. Karthikeyan MD, MSc

  4. Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba

    A. Peix MD, PhD, FACC, FASNC

  5. Dr. B L Kapur Memorial Hospital, New Delhi, India

    A. Kumar MD

  6. Hospital Clínico Universidad de Chile, Santiago, Chile

    T. Massardo MD

  7. Hospital Juan Ramón Jiménez, Huelva, Spain

    A. Jiménez-Heffernan MD

  8. Hospital Universitario Antonio Pedro, Niteroi, Brazil

    C. T. Mesquita MD

  9. Fundación Valle del Lili, Cali, Colombia

    M. Pabon MD

  10. Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan

    S. Butt MD

  11. Instituto Nacional de Cardiología Ignacio Chávez, Mexico DF, Mexico

    E. Alexanderson MD

  12. Fundación Cardioinfantil, Bogotá, Colombia

    V. Marin MD

  13. Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria

    O. Morozova MA & D. Paez MD, MSc

  14. Emory University, Atlanta, United States of America

    E. V. Garcia PhD

Authors
  1. C. Patel MD
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  2. M. Kalaivani PhD
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  15. E. V. Garcia PhD
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Corresponding author

Correspondence to C. Patel MD.

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Disclosure

Dr Garcia receives royalties from the sale of the Emory Cardiac Toolbox used in this research. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its COI practice. He is also a consultant for Syntermed Inc and GE Healthcare. There are no other relationships with industry.

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Patel, C., Kalaivani, M., Karthikeyan, G. et al. Effect of cardiac resynchronization therapy on septal perfusion and septal thickening: Association with left ventricular function, reverse remodelling and dyssynchrony. J. Nucl. Cardiol. 27, 1274–1284 (2020). https://doi.org/10.1007/s12350-019-01704-0

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