RT Journal Article
SR Electronic
T1 Myocardial Perfusion Imaging Using Gated SPECT in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 164
OP 168
VO 45
IS 2
A1 Roberto Sciagrà
A1 Marzia Giaccardi
A1 Maria Cristina Porciani
A1 Andrea Colella
A1 Antonio Michelucci
A1 Paolo Pieragnoli
A1 Gianfranco Gensini
A1 Alberto Pupi
A1 Luigi Padeletti
YR 2004
UL http://jnm.snmjournals.org/content/45/2/164.abstract
AB Cardiac resynchronization therapy (CRT) by biventricular pacing is indicated in patients with severe heart failure and left bundle branch block who remain symptomatic despite optimal medical therapy. The relationship between baseline resting perfusion pattern and hemodynamic response to CRT has not been fully investigated. We tested the usefulness of perfusion gated SPECT for baseline evaluation and follow-up of these patients. Methods: In 20 patients, we performed gated SPECT before CRT and at the 3-mo follow up. Left ventricular (LV) ejection fraction (EF), end-diastolic (ED) and end-systolic (ES) volume indexes (VI), and wall motion score index (WMSI) were measured and compared with clinical outcome. Results: One patient died before follow-up. The 19 remaining patients were classified into 1 of 2 groups according to the presence (group A) or absence (group B) of a significant severe perfusion defect at baseline before CRT. At the 3-mo follow-up, 6 of 10 group A and 8 of 9 group B patients had an improvement in New York Heart Association class. In both groups, quality of life, 6-min walking distance, and WMSI significantly improved. In group A, no significant change was registered in LVEF, LVEDVI, or LVESVI. In group B, LVEF increased from 23.1% ± 8% to 27.1% ± 11% (P < 0.03) and LVEDVI and LVESVI decreased from 159 ± 70 mL to 135 ± 68 mL (P < 0.02) and from 127 ± 67 mL to 104 ± 65 mL (P < 0.01), respectively. Conclusion: Perfusion gated SPECT appears useful to characterize and follow up candidates for CRT. Despite clinical improvement, patients with severe resting perfusion defects do not show significant improvement in LVEF or reduction in LV volumes.