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Left-ventricular dyssynchrony in viable myocardium by myocardial perfusion SPECT is predictive of mechanical response to CRT

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Abstract

Objectives

Gated myocardial perfusion SPECT (GMPS) provides a one-stop-shop evaluation for cardiac resynchronization therapy (CRT). However, conflicting results have been observed regarding whether the baseline left-ventricular (LV) mechanical dyssynchrony as assessed by phase analysis on GMPS was predictive of therapeutic response to CRT. Since dyssynchrony parameters by phase analysis spuriously increased by scarred myocardium, the purpose of this study was to explore the value of dyssynchrony after stripping off the scar region in correlation to mechanical response to CRT.

Methods

Forty-seven patients following standard indications for CRT received GMPS with phase analysis as pre-CRT evaluation. A decrease of end-systolic volume (ESV) > 15% on follow-up echocardiography after CRT was considered as a mechanical response to CRT. Myocardial regions with less than 50% of maximal activity on GMPS were considered as a scar. The phase standard deviation (PSD) and histogram bandwidth (BW) without or with stripping off scar were assessed by phase analysis of GMPS and were used for evaluation of LV dyssynchrony of all myocardium or only the viable myocardium, respectively.

Results

No significant difference was noted between mechanical responders (31 of 47 patients, 66%) and nonresponders ( 16 of 47 patients, 34%) for PSD (48.6° ± 19.4° vs 43.9° ± 20.7°, p = 0.46) and BW (225° ± 91.1° vs 163.5° ± 94.6°, p = 0.38) of the entire myocardium. However, responders had significantly larger PSD (40.5° ± 15.7° vs 30.5° ± 13.2°, p = 0.03) and borderlinely larger BW (215° ± 91.2° vs. 139.5° ± 78.2°, p = 0.05) than non-responders after stripping off scar. Logistic regression analysis showed that scar area and PSD after stripping off scar were independent predictors of mechanical response.

Conclusions

Our result showed that LV dyssynchrony of the entire myocardium did not predict response to CRT. However, LV dyssynchrony only in the viable myocardium was a significant predictor of CRT mechanical response.

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Acknowledgements

This study was supported by grants in part from the Taiwan Ministry of Science and Technology (Project No. 107-2314-B-758-001-MY3, PI: Guang-Uei Hung), from Taichung Veterans General Hospital (Project No. TCVGH-1073104C, TCVGH-1063106C, TCVGH-1053106C, PI: Jin-Long Huang), from the American Heart Association (Project No. 17AIREA33700016, PI: Weihua Zhou), and from Science and Technology Department of Jiangsu Province (Project No. BE2016764; PI: Jiangang Zou). This project was also supported in part by a new faculty startup grant from Michigan Technological University Institute of Computing and Cybersystems (PI: Weihua Zhou).

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Author notes

  1. Guang-Uei Hung and Jiangang Zou contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan

    Guang-Uei Hung

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

    Jiangang Zou & Xinwei Zhang

  3. College of Computing, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA

    Zhuo He & Weihua Zhou

  4. Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Shih-Chuan Tsai

  5. Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan

    Chi-Yen Wang & Jin-Long Huang

  6. Division of Cardiology, Department of Medicine Sections, Asia University Hospital, Taichung, Taiwan

    Kuo-Feng Chiang

  7. School of Computing, University of Southern Mississippi, Hattiesburg, MS, USA

    Haipeng Tang

  8. Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA

    Ernest V. Garcia

Authors
  1. Guang-Uei Hung
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  2. Jiangang Zou
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Corresponding authors

Correspondence to Weihua Zhou or Jin-Long Huang.

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Conflict of interest

Dr. 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. All other authors report no conflicts of interest.

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Hung, GU., Zou, J., He, Z. et al. Left-ventricular dyssynchrony in viable myocardium by myocardial perfusion SPECT is predictive of mechanical response to CRT. Ann Nucl Med 35, 947–954 (2021). https://doi.org/10.1007/s12149-021-01632-5

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  • DOI: https://doi.org/10.1007/s12149-021-01632-5

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