Abstract
Objectives
Using ECG-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), we sought to develop and validate a new method to recommend left ventricular (LV) lead positions in order to improve volumetric response and long-term prognosis after cardiac resynchronization therapy (CRT).
Methods
Seventy-nine patients received gated SPECT MPI at baseline, and echocardiography at baseline and follow-up. The volumetric response referred to a reduction of ≥ 15% in LV end-systolic volume 6 months after CRT. After excluding apical, septal, and scarred segments, there were three levels of recommended segments: (1) the optimal recommendation: the latest contracting viable segment; (2) the 2nd recommendation: the late contracting viable segments whose contraction delays were within 10° of the optimal recommendation; and (3) the 3rd recommendation: the viable segments adjacent to the optimal recommendation when there was no late contracting viable segment.
Results
After excluding 11 patients whose LV lead was placed in apical or scarred segments, 75.6% of the patients concordant to recommended LV segments (n = 41) responded to CRT while 51.9% of those with non-recommended LV lead locations (n = 27) were responders (P = .043). Response rates were 76.9%, 76.9% , and 73.3% (P = .967), respectively, when LV lead was implanted in the optimal recommendation (n = 13), the 2nd recommendation (n = 13), and the 3rd recommendation (n = 15). LV leads placed at recommended segments reduced composite events of all-cause mortality or heart failure (HF) rehospitalization compared with pacing at non-recommended segments (log-rank χ2 = 5.623, P = .018).
Conclusions
Pacing in the recommended LV lead segments identified on gated SPECT MPI was associated with improved volumetric response to CRT and long-term prognosis.
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Abbreviations
- CRT:
-
Cardiac resynchronization therapy
- CS:
-
Coronary sinus
- LV:
-
Left ventricle/ventricular
- MPI:
-
Myocardial perfusion imaging
- SPECT:
-
Single-photon emission computed tomography
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Acknowledgments
We appreciate Daniel McGonigle, a master student of Computer Science at USM and Zhuo He, a PhD student of Computer Science at USM for proofreading the manuscript.
Disclosure
This research was supported by grants from the Science and Technology Department of Jiangsu Province (Social Development-Clinical Frontier Technology Foundation) (Project Number: BE2016764, PI: Jiangang Zou) and the American Heart Association (Project Number: 17AIREA33700016, PI: Weihua Zhou). Ernest V. Garcia receives royalties from the sales of Emory Cardiac Toolbox. The terms of this arrangement have been reviewed and approved by Emory University in accordance with it is conflict-of-interest practice. Xinwei Zhang, Zhiyong Qian, Haipeng Tang, Wei Hua, Yangang Su, Geng Xu, Xingbin Liu, Xiaolin Xue, Jie Fan, Lin Cai, Li Zhu, Yao Wang, Xiaofeng Hou, Weihua Zhou and Jiangang Zou do not have anything to declare.
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Zhang, X., Qian, Z., Tang, H. et al. A new method to recommend left ventricular lead positions for improved CRT volumetric response and long-term prognosis. J. Nucl. Cardiol. 28, 672–684 (2021). https://doi.org/10.1007/s12350-019-01735-7
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DOI: https://doi.org/10.1007/s12350-019-01735-7