Cargando…

Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT)

BACKGROUND: Placing the left ventricular (LV) lead in a viable segment with the latest mechanical activation (vSOLA) may be associated with optimal cardiac resynchronization therapy (CRT) response. We assessed the role of gated SPECT myocardial perfusion imaging (gSPECT MPI) in predicting clinical o...

Descripción completa

Detalles Bibliográficos
Autores principales: Peix, Amalia, Karthikeyan, Ganesan, Massardo, Teresa, Kalaivani, Mani, Patel, Chetan, Pabon, Luz M., Jiménez-Heffernan, Amelia, Alexanderson, Erick, Butt, Sadaf, Kumar, Alka, Marin, Victor, Mesquita, Claudio T., Morozova, Olga, Paez, Diana, Garcia, Ernest V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921049/
https://www.ncbi.nlm.nih.gov/pubmed/30684258
http://dx.doi.org/10.1007/s12350-018-01589-5
_version_ 1783658395334606848
author Peix, Amalia
Karthikeyan, Ganesan
Massardo, Teresa
Kalaivani, Mani
Patel, Chetan
Pabon, Luz M.
Jiménez-Heffernan, Amelia
Alexanderson, Erick
Butt, Sadaf
Kumar, Alka
Marin, Victor
Mesquita, Claudio T.
Morozova, Olga
Paez, Diana
Garcia, Ernest V.
author_facet Peix, Amalia
Karthikeyan, Ganesan
Massardo, Teresa
Kalaivani, Mani
Patel, Chetan
Pabon, Luz M.
Jiménez-Heffernan, Amelia
Alexanderson, Erick
Butt, Sadaf
Kumar, Alka
Marin, Victor
Mesquita, Claudio T.
Morozova, Olga
Paez, Diana
Garcia, Ernest V.
author_sort Peix, Amalia
collection PubMed
description BACKGROUND: Placing the left ventricular (LV) lead in a viable segment with the latest mechanical activation (vSOLA) may be associated with optimal cardiac resynchronization therapy (CRT) response. We assessed the role of gated SPECT myocardial perfusion imaging (gSPECT MPI) in predicting clinical outcomes at 6 months in patients submitted to CRT. METHODS: Ten centers from 8 countries enrolled 195 consecutive patients. All underwent gSPECT MPI before and 6 months after CRT. The procedure was performed as per current guidelines, the operators being unaware of gSPECT MPI results. Regional LV dyssynchrony (Phase SD) and vSOLA were automatically determined using a 17 segment model. The lead was considered on-target if placed in vSOLA. The primary outcome was improvement in ≥1 of the following: ≥1 NYHA class, left ventricular ejection fraction (LVEF) by ≥5%, reduction in end-systolic volume by ≥15%, and ≥5 points in Minnesota Living With Heart Failure Questionnaire (MLHFQ). RESULTS: Sixteen patients died before the follow-up gSPECT MPI. The primary outcome occurred in 152 out of 179 (84.9%) cases. Mean change in LV phase standard deviation (PSD) at 6 months was 10.5°. Baseline dyssynchrony was not associated with the primary outcome. However, change in LV PSD from baseline was associated with the primary outcome (OR 1.04, 95% CI 1.01-1.07, P = .007). Change in LV PSD had an AUC of 0.78 (0.66-0.90) for the primary outcome. Improvement in LV PSD of 4° resulted in the highest positive likelihood ratio of 7.4 for a favorable outcome. In 23% of the patients, the CRT lead was placed in the vSOLA, and in 42% in either this segment or in a segment within 10° of it. On-target lead placement was not significantly associated with the primary outcome (OR 1.53, 95% CI 0.71-3.28). CONCLUSION: LV dyssynchrony improvement by gSPECT MPI, but not on-target lead placement, predicts clinical outcomes in patients undergoing CRT. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-018-01589-5) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-7921049
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-79210492021-03-19 Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT) Peix, Amalia Karthikeyan, Ganesan Massardo, Teresa Kalaivani, Mani Patel, Chetan Pabon, Luz M. Jiménez-Heffernan, Amelia Alexanderson, Erick Butt, Sadaf Kumar, Alka Marin, Victor Mesquita, Claudio T. Morozova, Olga Paez, Diana Garcia, Ernest V. J Nucl Cardiol Original Article BACKGROUND: Placing the left ventricular (LV) lead in a viable segment with the latest mechanical activation (vSOLA) may be associated with optimal cardiac resynchronization therapy (CRT) response. We assessed the role of gated SPECT myocardial perfusion imaging (gSPECT MPI) in predicting clinical outcomes at 6 months in patients submitted to CRT. METHODS: Ten centers from 8 countries enrolled 195 consecutive patients. All underwent gSPECT MPI before and 6 months after CRT. The procedure was performed as per current guidelines, the operators being unaware of gSPECT MPI results. Regional LV dyssynchrony (Phase SD) and vSOLA were automatically determined using a 17 segment model. The lead was considered on-target if placed in vSOLA. The primary outcome was improvement in ≥1 of the following: ≥1 NYHA class, left ventricular ejection fraction (LVEF) by ≥5%, reduction in end-systolic volume by ≥15%, and ≥5 points in Minnesota Living With Heart Failure Questionnaire (MLHFQ). RESULTS: Sixteen patients died before the follow-up gSPECT MPI. The primary outcome occurred in 152 out of 179 (84.9%) cases. Mean change in LV phase standard deviation (PSD) at 6 months was 10.5°. Baseline dyssynchrony was not associated with the primary outcome. However, change in LV PSD from baseline was associated with the primary outcome (OR 1.04, 95% CI 1.01-1.07, P = .007). Change in LV PSD had an AUC of 0.78 (0.66-0.90) for the primary outcome. Improvement in LV PSD of 4° resulted in the highest positive likelihood ratio of 7.4 for a favorable outcome. In 23% of the patients, the CRT lead was placed in the vSOLA, and in 42% in either this segment or in a segment within 10° of it. On-target lead placement was not significantly associated with the primary outcome (OR 1.53, 95% CI 0.71-3.28). CONCLUSION: LV dyssynchrony improvement by gSPECT MPI, but not on-target lead placement, predicts clinical outcomes in patients undergoing CRT. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s12350-018-01589-5) contains supplementary material, which is available to authorized users. Springer International Publishing 2019-01-25 2021 /pmc/articles/PMC7921049/ /pubmed/30684258 http://dx.doi.org/10.1007/s12350-018-01589-5 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Peix, Amalia
Karthikeyan, Ganesan
Massardo, Teresa
Kalaivani, Mani
Patel, Chetan
Pabon, Luz M.
Jiménez-Heffernan, Amelia
Alexanderson, Erick
Butt, Sadaf
Kumar, Alka
Marin, Victor
Mesquita, Claudio T.
Morozova, Olga
Paez, Diana
Garcia, Ernest V.
Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT)
title Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT)
title_full Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT)
title_fullStr Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT)
title_full_unstemmed Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT)
title_short Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT)
title_sort value of intraventricular dyssynchrony assessment by gated-spect myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (vision-crt)
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921049/
https://www.ncbi.nlm.nih.gov/pubmed/30684258
http://dx.doi.org/10.1007/s12350-018-01589-5
work_keys_str_mv AT peixamalia valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT karthikeyanganesan valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT massardoteresa valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT kalaivanimani valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT patelchetan valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT pabonluzm valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT jimenezheffernanamelia valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT alexandersonerick valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT buttsadaf valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT kumaralka valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT marinvictor valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT mesquitaclaudiot valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT morozovaolga valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT paezdiana valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt
AT garciaernestv valueofintraventriculardyssynchronyassessmentbygatedspectmyocardialperfusionimaginginthemanagementofheartfailurepatientsundergoingcardiacresynchronizationtherapyvisioncrt