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Nuclear Imaging in Cardiac Resynchronization Therapy^*

¹ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; ² The Interuniversity Cardiology Institute of The Netherlands, Utrecht, The Netherlands; ³ Department of Cardiology, Ghent University, Gent, Belgium; ⁴ Department of Radiology, Emory University School of Medicine, Atlanta, Georgia; and ⁵ Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands

Correspondence: For correspondence or reprints contact: Jeroen J. Bax, MD, PhD, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail: jbax{at}knoware.nl

Recently, cardiac resynchronization therapy (CRT) has become implemented in the treatment of patients with severe heart failure. Although the improvement in systolic function after CRT implantation can be considerable, 20%–30% of patients do not respond to CRT. Evidence is accumulating that the presence of left ventricular (LV) dyssynchrony is mandatory for a response to CRT. Since the early 1980s attempts have been made to assess cardiac dyssynchrony with nuclear imaging, and it has been reported recently that information on LV dyssynchrony can be obtained from gated myocardial perfusion SPECT with phase analysis. Other studies with SPECT have shown that extensive scar tissue will limit the response to CRT; similarly, it has been demonstrated that viable tissue (assessed with SPECT) in the target zone for the LV pacing lead (usually the lateral wall) is needed for a response to CRT. Moreover, studies with PET have provided insight into the changes in myocardial perfusion, metabolism, and efficiency after CRT. In the current review, a comprehensive summary is provided on the potential role of nuclear imaging in the selection of heart failure patients for CRT. The value of other imaging techniques is also addressed.

Key Words: nuclear imaging • cardiac resynchronization therapy • heart failure

^* NOTE: FOR CE CREDIT, YOU CAN ACCESS THIS ACTIVITY THROUGH THE SNM WEB SITE (http://www.snm.org/ce_online) THROUGH DECEMBER 2008.

No potential conflict of interest relevant to this article was reported.

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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