Cardiac Resynchronization Therapy for Improving Non-Uniform Thickening of Left Ventricular Wall: Assessment by Quantitative Gated Myocardial Perfusion SPECT
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- Wakayama Yuji
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Nakano Makoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Fukuda Koji
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Kumagai Koji
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Sugai Yoshinao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Hirose Masanori
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Yamaguchi Nobuhiro
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Kondo Masateru
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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- Kaneta Tomohiro
- Diagnostic Radiology, Tohoku University Graduate School of Medicine
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- Fukuda Hiroshi
- Department of Nuclear Medicine and Radiology, Tohoku University Institute of Development Aging and Cancer
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- Kagaya Yutaka
- Office of Medical Education, Tohoku University School of Medicine
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- Shimokawa Hiroaki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Abstract
<p>Cardiac resynchronization therapy (CRT) improves cardiac dyssynchrony in heart failure patients with a wide QRS electrocardiogram (ECG). Assessment of left ventricular (LV) dyssynchrony using echocardiography or other imaging modalities is important to predict CRT effectiveness. In this study, we retrospectively evaluated cardiac nuclear imaging of ECG-gated myocardial perfusion single-photon emission computed tomography (SPECT) with 99mTc-sestamibi for CRT candidate (n = 120) with severe heart failure and wide QRS (> 120 msec) in ECG. To analyze LV non-uniformity, we used the quantitative gated SPECT (QGS) software to calculate changes in regional LV wall thickness during a cardiac cycle (i.e., wall thickening scores). Cardiac events (heart failure, ventricular arrhythmias and cardiac death) after CRT during 38 ± 22 (SD) months were also evaluated. In 97 of 120 patients who underwent QGS before and 6 months after CRT, CRT homogenized non-uniform wall thickening between septal and lateral of the LV especially in CRT responders. This observation was indicated as increase in the lateral deflection (XWT) of wall thickening scores before CRT and its decrease after CRT. In 120 patients with QGS before CRT, the larger XWT before CRT (≥ 16.5) predicted better prognoses after CRT. This finding was similarly observed even in patients with narrower baseline QRS (≤ 140 msec; n = 41 of 120), who usually have less benefits from CRT. In conclusion, CRT improved non-uniformity of wall thickening between the LV septal and lateral regions evaluated using QGS, which is predictive of better prognosis in the chronic phase after CRT.</p>
Journal
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- The Tohoku Journal of Experimental Medicine
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The Tohoku Journal of Experimental Medicine 251 (2), 69-79, 2020
Tohoku University Medical Press