Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 2/2011

Open Access 01-02-2011 | Original Article

Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT

Authors: Mark J. Boogers, Ji Chen, Rutger J. van Bommel, C. Jan Willem Borleffs, Petra Dibbets-Schneider, Bernies van der Hiel, Imad Al Younis, Martin J. Schalij, Ernst E. van der Wall, Ernest V. Garcia, Jeroen J. Bax

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 2/2011

Login to get access

Abstract

Purpose

The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT).

Methods

The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of ≥15% in LVESV.

Results

Enrolled in the study were 90 patients (72% men, 67±10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p<0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables.

Conclusion

Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements.
Literature
1.
Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009;119(14):e391–479.CrossRefPubMed
2.
Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA III, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 2008;117(21):e350–408.CrossRefPubMed
3.
Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001;344(12):873–80.CrossRefPubMed
4.
Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346(24):1845–53.CrossRefPubMed
5.
Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De MT, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140–50.CrossRefPubMed
6.
Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539–49.CrossRefPubMed
7.
Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JW, Garrigue S, et al. Cardiac resynchronization therapy: Part 1–issues before device implantation. J Am Coll Cardiol. 2005;46(12):2153–67.CrossRefPubMed
8.
Bax JJ, Abraham T, Barold SS, Breithardt OA, Fung JW, Garrigue S, et al. Cardiac resynchronization therapy: part 2–issues during and after device implantation and unresolved questions. J Am Coll Cardiol. 2005;46(12):2168–82.CrossRefPubMed
9.
Butter C, Auricchio A, Stellbrink C, Fleck E, Ding J, Yu Y, et al. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation. 2001;104(25):3026–9.CrossRefPubMed
10.
Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Fedele F, Santini M. Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing. J Am Coll Cardiol. 2002;39(3):489–99.CrossRefPubMed
11.
Gasparini M, Mantica M, Galimberti P, Bocciolone M, Genovese L, Mangiavacchi M, et al. Is the left ventricular lateral wall the best lead implantation site for cardiac resynchronization therapy? Pacing Clin Electrophysiol. 2003;26(1 Pt 2):162–8.CrossRefPubMed
12.
Dekker AL, Phelps B, Dijkman B, van der Nagel T, van Veen FH, Geskes GG, et al. Epicardial left ventricular lead placement for cardiac resynchronization therapy: optimal pace site selection with pressure-volume loops. J Thorac Cardiovasc Surg. 2004;127(6):1641–7.CrossRefPubMed
13.
Lane RE, Chow AW, Mayet J, Francis DP, Peters NS, Schilling RJ, et al. The interaction of interventricular pacing intervals and left ventricular lead position during temporary biventricular pacing evaluated by tissue Doppler imaging. Heart. 2007;93(11):1426–32.CrossRefPubMed
14.
Ypenburg C, Van Bommel RJ, Delgado V, Mollema SA, Bleeker GB, Boersma E, et al. Optimal left ventricular lead position predicts reverse remodeling and survival after cardiac resynchronization therapy. J Am Coll Cardiol. 2008;52(17):1402–9.CrossRefPubMed
15.
Murphy RT, Sigurdsson G, Mulamalla S, Agler D, Popovic ZB, Starling RC, et al. Tissue synchronization imaging and optimal left ventricular pacing site in cardiac resynchronization therapy. Am J Cardiol. 2006;97(11):1615–21.CrossRefPubMed
16.
Becker M, Kramann R, Franke A, Breithardt OA, Heussen N, Knackstedt C, et al. Impact of left ventricular lead position in cardiac resynchronization therapy on left ventricular remodelling. A circumferential strain analysis based on 2D echocardiography. Eur Heart J. 2007;28(10):1211–20.CrossRefPubMed
17.
Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol. 2005;12(6):687–95.CrossRefPubMed
18.
Chen J, Henneman MM, Trimble MA, Bax JJ, Borges-Neto S, Iskandrian AE, et al. Assessment of left ventricular mechanical dyssynchrony by phase analysis of ECG-gated SPECT myocardial perfusion imaging. J Nucl Cardiol. 2008;15(1):127–36.CrossRefPubMed
19.
Bax JJ, Bleeker GB, Marwick TH, Molhoek SG, Boersma E, Steendijk P, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am Coll Cardiol. 2004;44(9):1834–40.CrossRefPubMed
20.
Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation. 2002;105(4):539–42.CrossRefPubMed
21.
Hoffman EJ, Huang SC, Phelps ME. Quantitation in positron emission computed tomography: 1. Effect of object size. J Comput Assist Tomogr. 1979;3(3):299–308.CrossRefPubMed
22.
Galt JR, Garcia EV, Robbins WL. Effects of myocardial wall thickness on SPECT quantification. IEEE Trans Med Imaging. 1990;9(2):144–50.CrossRefPubMed
23.
Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J III. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation. 2006;113(7):960–8.CrossRefPubMed
24.
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2(5):358–67.PubMed
25.
Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118(15):e523–661.CrossRefPubMed
26.
Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation. 2006;113(7):969–76.CrossRefPubMed
27.
Ypenburg C, Schalij MJ, Bleeker GB, Steendijk P, Boersma E, Dibbets-Schneider P, et al. Extent of viability to predict response to cardiac resynchronization therapy in ischemic heart failure patients. J Nucl Med. 2006;47(10):1565–70.PubMed
28.
Ypenburg C, Schalij MJ, Bleeker GB, Steendijk P, Boersma E, Dibbets-Schneider P, et al. Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients. Eur Heart J. 2007;28(1):33–41.CrossRefPubMed
Metadata
Title
Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT
Authors
Mark J. Boogers
Ji Chen
Rutger J. van Bommel
C. Jan Willem Borleffs
Petra Dibbets-Schneider
Bernies van der Hiel
Imad Al Younis
Martin J. Schalij
Ernst E. van der Wall
Ernest V. Garcia
Jeroen J. Bax
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 2/2011
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-010-1621-z

Other articles of this Issue 2/2011

European Journal of Nuclear Medicine and Molecular Imaging 2/2011 Go to the issue

Society communications

The Clinical Audit Courses of the Committee for Accreditation of Nuclear Medicine Departments (CANMD)

Erratum

Erratum to: Two-compartment model of radioimmunotherapy delivered through cerebrospinal fluid

Original Article

In vivo changes in microglial activation and amyloid deposits in brain regions with hypometabolism in Alzheimer’s disease

Original Article

18F-FDG PET/CT in paediatric lymphoma: comparison with conventional imaging

Editorial Commentary

Expanding indications for cardiac MIBG imaging of sympathetic activity

Original Article

123I-MIBG imaging detects cardiac involvement and predicts cardiac events in Churg-Strauss syndrome