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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

View larger version (19K): [in this window] [in a new window]   FIGURE 1.  (A) Stroke volume index control vs. CRT. CRT significantly increased stroke volume index. Open bar = CRT on; hatched bar = control. (Based on (16).) (B) Right ventricular (RV) and LV myocardial oxidative metabolism with CRT on vs. CRT off. RV and LV myocardial oxidative metabolism index (kmono) were unchanged by CRT. Open bars = CRT on; hatched bars = CRT off. NS = not significant. (Adapted from (16).) All data are expressed as mean ± SD.

View larger version (71K): [in this window] [in a new window]   FIGURE 2.  Echocardiography with speckle tracking–derived radial strain imaging in parasternal short-axis view. Septal regions reach peak radial strain early in systole (white arrow A), whereas lateral regions reach peak radial strain late in systole (white arrow B). This finding indicates a dyssynchronous LV contraction.

View larger version (15K): [in this window] [in a new window]   FIGURE 3.  (A) Change in interventricular dyssynchrony: sinus rhythm (SR) vs. CRT. Interventricular dyssynchrony decreased significantly during CRT compared with SR. Open bar = SR; hatched bar = CRT on. (Based on (29).) (B) Change in LVEF: SR vs. CRT. LVEF increased significantly during CRT compared with SR. Open bar = SR; hatched bar = CRT on. (Based on (29).) All data are expressed as mean ± SD.

View larger version (74K): [in this window] [in a new window]   FIGURE 4.  Example of phase analysis with gated myocardial perfusion SPECT in patient with important LV dyssynchrony. Nonnormalized (upper) and normalized (lower) phase distributions show significant nonuniformity and corresponding phase histograms are widely spread distributions.

View larger version (72K): [in this window] [in a new window]   FIGURE 5.  Example of assessment of LV dyssynchrony with VE MRI in healthy individual (A and B) and in patient with substantial LV dyssynchrony (C and D). (A) VE cardiac MR image in longitudinal long-axis orientation at midsystole of healthy individual. Sample volumes are placed at basal level of septum and lateral wall. (B) Corresponding velocity graph shows absence of LV dyssynchrony (arrow). (C) VE MR image in longitudinal long-axis orientation at midsystole of patient with substantial LV dyssynchrony (arrow). Sample volumes are placed at basal level of septum and lateral wall. (D) Corresponding velocity graph shows substantial LV dyssynchrony of 115 ms (left arrow indicating peak systolic velocity of the septum and right arrow indicating peak systolic velocity of the lateral wall). (Modified from (42).)

View larger version (69K): [in this window] [in a new window]   FIGURE 6.  (A) Change in LVEF at baseline and after 6 mo of CRT: patients with transmural posterolateral scar compared with patients without transmural posterolateral scar. Open bars = baseline; hatched bars = 6-mo follow-up after CRT. All data are expressed as mean ± SD. (Based on (38).) (B) Short-axis contrast-enhanced MR image shows extensive transmural scar tissue in posterolateral region (white arrows).

View larger version (36K): [in this window] [in a new window]   FIGURE 7.  Example of venous anatomy with MSCT in patient with previous anterior myocardial infarction: volume-rendered reconstruction of heart. (A) Posterior view. (B) Lateral view. (C) Anterior view. First tributary of coronary sinus (CS) is posterior interventricular vein (PIV), running in posterior interventricular groove (A). Second tributary of CS is posterior vein of left ventricle (PVLV); great cardiac vein (GCV) will then continue as anterior interventricular vein (AIV) (B and C). Left marginal vein is absent. Also note ramus descendens anterior (RDA), ramus circumflexus (RCX), and right coronary artery (RCA).

View larger version (10K): [in this window] [in a new window]   FIGURE 8.  Information that is needed before CRT implantation: a noninvasive approach. Presence of LV dyssynchrony can be assessed not only with echocardiographic techniques but also with nuclear imaging and with VE MRI. For evaluation of extent of scar tissue and extent of viable myocardium, nuclear imaging and MRI can be used, whereas MSCT can be of value for evaluating venous anatomy before LV lead implantation.