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Predictive values of left ventricular mechanical dyssynchrony for CRT response in heart failure patients with different pathophysiology

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

A Correction to this article was published on 19 October 2021

This article has been updated

Abstract

Background

Cardiac resynchronization therapy (CRT) patients with different pathophysiology may influence mechanical dyssynchrony and get different ventricular resynchronization and clinical outcomes.

Methods

Ninety-two dilated cardiomyopathy (DCM) and fifty ischemic cardiomyopathy (ICM) patients with gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) were included in this retrospective study. Patients were classified based on the concordance between the left ventricular (LV) lead and the latest contraction or relaxation position. If the LV lead was located on or adjacent to both the latest contraction and relaxation position, the patient was categorized into the both match group; if the LV lead was located on or adjacent to the latest contraction or relaxation position, the patient was classified into the one match group; if the LV lead was located on or adjacent to neither the latest contraction nor relaxation position, the patient was categorized to the neither group. CRT response was defined as \(\ge 5\%\) improvement of LV ejection fraction at the 6-month follow-up. Variables with P < .05 in the univariate analysis were included in the stepwise multivariate model.

Results

During the follow-up period, 58.7% (54 of 92) for DCM patients and 54% (27 of 50) for ICM patients were CRT responders. The univariate analysis and stepwise multivariate analysis showed that QRS duration, systolic phase bandwidth (PBW), diastolic PBW, diastolic phase histogram standard deviation (PSD), and left ventricular mechanical dyssynchrony (LVMD) concordance were independent predictors of CRT response in DCM patients; diabetes mellitus and left ventricular end-systolic volume were significantly associated with CRT response in ICM patients. The intra-group comparison revealed that the CRT response rate was significantly different in the both match group of DCM (N = 18, 94%) and ICM (N = 24, 62%) patients (P = .016). However, there was no significant difference between DCM and ICM in the one match and neither group. For the inter-group comparison, Kruskal-Wallis H-test revealed that CRT response was significantly different in all the groups of DCM patients (P < .001), but not in ICM patients (P = .383).

Conclusions

Compared with ICM patients, systolic PBW, diastolic PBW and PSD have better predictive and prognostic values for the CRT response in DCM patients. Placing the LV lead in or adjacent to the latest contraction and relaxation position can improve the clinical outcomes of DCM patients, but it does not apply to ICM patients.

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Abbreviations

CRT:

Cardiac resynchronization therapy

DCM:

Dilated cardiomyopathy

ICM:

Ischemic cardiomyopathy

LV:

Left ventricular

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end-systolic volume

LVMD:

Left ventricular mechanical dyssynchrony

MPI:

Myocardial perfusion imaging

PBW:

Phase bandwidth

PSD:

Phase histogram standard deviation

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Disclosure

All authors declare that there are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Applied Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA

    Zhuo He BS & Weihua Zhou PhD

  2. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, Nanjing, 210029, China

    Dianfu Li MD, Chang Cui MD, Hui-yuan Qin MD, Zhongqiang Zhao BS, Xiaofeng Hou MD, Jiangang Zou MD, Ming-long Chen MD & Cheng Wang MD

  3. Center for Biocomputing and Digital Health, Institute of Computing and Cybersystems, and Health Research Institute, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA

    Weihua Zhou PhD

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  1. Zhuo He BS
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Contributions

ZH—Contribution: Conception and design; analysis and interpretation of data; drafting of the manuscript and revising it critically for important intellectual content. DL—Contribution: Revising it critically for important intellectual content. CC—Contribution: Revising it critically for important intellectual content. H-YQ—Contribution: Revising it critically for important intellectual content. ZZ—Contribution: Revising it critically for important intellectual content. XH—Contribution: Revising it critically for important intellectual content. JZ—Contribution: Revising it critically for important intellectual content. M-LC—Contribution: Revising it critically for important intellectual content. CW—Contribution: Acquisition, analysis, and interpretation of data; revising the manuscript critically for important intellectual content. WZ—Contribution: Conception and design; analysis and interpretation of data; revising the manuscript critically for important intellectual content; and final approval of the manuscript submitted.

Corresponding authors

Correspondence to Cheng Wang MD or Weihua Zhou PhD.

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Ethical approval

The study was approved by the scientific councils of the participating county scientific councils and complied with the Declaration of Helsinki. Written informed consent was obtained from all participants, and patient anonymity was maintained during data analysis.

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Funding

This research was supported by a grant from the American Heart Association (Project Number: 17AIREA33700016, PI: Weihua Zhou) and a new faculty grant from Michigan Technological University Institute of Computing and Cybersystems (PI: Weihua Zhou), and grants from the National Nature Science Foundation of China (81900295) and the Natural Science Foundation of Jiangsu Province (BK 20191071).

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He, Z., Li, D., Cui, C. et al. Predictive values of left ventricular mechanical dyssynchrony for CRT response in heart failure patients with different pathophysiology. J. Nucl. Cardiol. 29, 2637–2648 (2022). https://doi.org/10.1007/s12350-021-02796-3

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