LV Dyssynchrony Assessed With Phase Analysis on Gated Myocardial Perfusion SPECT Can Predict Response to CRT in Patients With End-Stage Heart Failure

BACKGROUND: Cardiac resynchronization therapy (CRT) is an established treatment in patients with end-stage heart failure and wide QRS complex. However, about 30% of patients do not benefit from CRT (non-responder). Recent studies with tissue Doppler imaging yielded disappointing results in predicting CRT responders. Phase analysis was developed to allow assessment of LV dyssynchrony by gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (GMPS). OBJECTIVES: The aim of present study was to investigate the role of quantitative GMPS-derived LV dyssynchrony data to predict CRT responder. PATIENTS AND METHODS: Thirty eligible patients for CRT implantation underwent GMPS and echocardiography. Response to CRT was evaluated six months after the device implantation. Clinical response to CRT was defined as 50 meters increase in 6-minute walking test (6-MWT) distance. Echocardiographic response to CRT was defined as ≥ 15% decrease in left ventricular end-systolic volume (LVESV). The lead position was considered concordant if it was positioned at the area of latest mechanical activation, and discordant if located outside the area of latest mechanical activation. RESULTS: Clinical response to CRT was observed in 74% of patients. However, only 57% of patients were responder according to the echo criteria. There were statistically significant differences between CRT responders and non-responders for GMPS-derived variables, including phased histogram bandwidth (PHB), phase SD (PSD), and Entropy. Moreover, a cutoff value of 112° for PHB with a sensitivity of 72% and specificity of 70%, a cutoff value of 21° for PSD with a sensitivity of 90% and specificity of 74%, and a cutoff of 52% for Entropy with a sensitivity of 90% and a specificity of 80% were considered to discriminate responders and non-responders. CRT response was more likely in patients with concordant LV lead position compared to those with discordant LV lead position. CONCLUSIONS: GMPS-derived LV dyssynchrony variables can predict response to CRT with good sensitivity and specificity.