Abstract
Background
Ventricular arrhythmia is the major cause of sudden cardiac death for patients with heart failure, including those receiving implantation of cardiac resynchronization therapy (CRT). The purpose of this study was to assess the value of myocardial perfusion SPECT (MPS) in predicting ventricular arrhythmia for patients with CRT.
Methods and methods
Fifty-one patients (35 males, mean age 64 ± 12 years) who had received CRT for at least 6 months were enrolled for resting gated MPS. Three main quantitative parameters of MPS, including extent of myocardial scar, left ventricular ejection fraction (LVEF) and LV dyssynchrony (phase SD), were generated by Emory Cardiac Toolbox. Using the recorded ventricular arrhythmia in the device, including ventricular tachycardia (VT) and ventricular fibrillation (VF), as the primary end point, the value of quantitative parameters of MPS in predicting the development of VT/VF was assessed.
Results
Twenty (39 %) of the 51 patients developed VT/VF during the follow-up (15.3 ± 12.7 months). The patients with VT/VF had significantly lower LVEF (24 ± 12 vs. 36 ± 17 %, p < 0.005), larger scar areas (36 ± 19 vs. 22 ± 12 %, p < 0.05) and larger phase SD (57° ± 20° vs. 43° ± 17°, p < 0.01). When categorizing the patients by the median values of LVEF, scar and phase SD, univariate regression analysis showed that lower LVEF (<29 %), larger scar (>23 %) and larger phase SD (>50°) were related to the development of VT/VF (p = 0.006, 0.011 and 0.064, respectively). However, only LVEF was marginally significant as an independent predictor of VT//VF on multivariate regression analysis (p = 0.0573). Survival analysis with Kaplan–Meier curves showed that the survival probability for VT/VF in those with LVEF >29 %, scar areas <23 % and phase SD < 50° was significantly better than in the others (HR 5.16, 95 % CI 1.20–22.16) by log-rank test (χ 2 = 5.9894, p = 0.014).
Conclusion
Lower LVEF, larger scar and/or more dyssynchrony assessed by MPS were related to the development of ventricular arrhythmia for patients with CRT, and further defibrillator implantation may be considered for these patients.
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References
Abraham WT, Young JB, Leon AR, Adler S, Bank AJ, Hall SA, et al. Effects of cardiac resynchronization on disease progression in patients with left ventricular systolic dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic chronic heart failure. Circulation. 2004;110:2864–8.
Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350:2140–50.
Linde C, Daubert C. Cardiac resynchronization therapy in patients with New York Heart Association class I and II heart failure: an approach to 2010. Circulation. 2010;122:1037–43.
Cobb LA, Fahrenbruch CE, Olsufka M, Copass MK. Changing incidence of out-of-hospital ventricular fibrillation, 1980–2000. JAMA. 2002;288:3008–13.
Nakajima K, Nakata T. Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan. J Nucl Med. 2015;56(Suppl 4):11S–9S.
Bokhari F, Newman D, Greene M, Korley V, Mangat I, Dorian P. Long-term comparison of the implantable cardioverter defibrillator versus amiodarone: eleven-year follow-up of a subset of patients in the Canadian Implantable Defibrillator Study (CIDS). Circulation. 2004;110:112–6.
Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37.
Kiso K, Imoto A, Nishimura Y, Kanzaki H, Noda T, Kamakura S, et al. Novel algorithm for quantitative assessment of left ventricular dyssynchrony with ECG-gated myocardial perfusion SPECT: useful technique for management of cardiac resynchronization therapy. Ann Nucl Med. 2011;25:768–76.
Soman P, Chen J. Left ventricular dyssynchrony assessment using myocardial single-photon emission CT. Semin Nucl Med. 2014;44:314–9.
Gradel C, Jain D, Batsford WP, Wackers FJ, Zaret BL. Relationship of scar and ischemia to the results of programmed electrophysiological stimulation in patients with coronary artery disease. J Nucl Cardiol. 1997;4:379–86.
Aljaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkataraman R, Heo J, et al. Relation of left-ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol. 2010;17:398–404.
Hage FG, Aggarwal H, Patel K, Chen J, Jacobson AF, Heo J, et al. The relationship of left ventricular mechanical dyssynchrony and cardiac sympathetic denervation to potential sudden cardiac death events in systolic heart failure. J Nucl Cardiol. 2014;21:78–85.
Doltra A, Bijnens B, Tolosana JM, Borràs R, Khatib M, Penela D, et al. Mechanical abnormalities detected with conventional echocardiography are associated with response and midterm survival in CRT. JACC Cardiovasc Imaging. 2014;7:969–79.
Ermis C, Seutter R, Zhu AX, Benditt LC, VanHeel L, Sakaguchi S, et al. Impact of upgrade to cardiac resynchronization therapy on ventricular arrhythmia frequency in patients with implantable cardioverter-defibrillators. J Am Coll Cardiol. 2005;46:2258–63.
Huang GU, Huang JL, Lin WY, Tsai SC, Wang KY, Chen SA, et al. Impact of right-ventricular apical pacing on the optimal left-ventricular lead positions measured by phase analysis of SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging. 2014;41:1224–31.
Glukhov AV, Hage LT, Hansen BJ, Pedraza-Toscano A, Vargas-Pinto P, Hamlin RL, et al. Sinoatrial node reentry in a canine chronic left ventricular infarct model: role of intranodal fibrosis and heterogeneity of refractoriness. Circ Arrhythm Electrophysiol. 2013;6:984–94.
Hsu TH, Huang WS, Chen CC, Hung GU, Chen TC, Kao CH, et al. Left ventricular systolic and diastolic dyssynchrony assessed by phase analysis of gated SPECT myocardial perfusion imaging: a comparison with speckle tracking echocardiography. Ann Nucl Med. 2013;27:764–71.
Boogers MJ, Chen J, van Bommel RJ, Borleffs CJ, Dibbets-Schneider P, van der Heil B, Younis AI, Schalij MJ, van der Wall EE, Garcia EV, Bax JJ. Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT. Eur J Nucl Med Mol Imaging. 2011;38:230–8.
Friehling M, Chen J, Saba S, Bazaz R, Schwartzman D, Adelstein EC, Garcia EV, Follansbee WP, Soman P. The relationship between acute change in LV mechanical synchrony after cardiac resynchronization therapy and patient outcome: prospective evaluation by a novel, single-injection, gated-SPECT protocol. Circ Cardiovasc Imaging. 2011;4:532–9.
Acknowledgments
This study was supported in part by research grants from Chang Bing Show Chwan Memorial Hospital (RD-103029), Taiwan Ministry of Science and Technology (103-2314-B-758-001-), and Taichung Veterans General Hospital (TCVGH-1023105C, 1033106C, 1043106C, 1043102B).
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Dr. Ji Chen receives royalties from the sale of Emory Cardiac Toolbox with SyncTool. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest practice.
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Hou, PN., Tsai, SC., Lin, WY. et al. Relationship of quantitative parameters of myocardial perfusion SPECT and ventricular arrhythmia in patients receiving cardiac resynchronization therapy. Ann Nucl Med 29, 772–778 (2015). https://doi.org/10.1007/s12149-015-1007-1
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DOI: https://doi.org/10.1007/s12149-015-1007-1