Yield of left ventricular dyssynchrony by gated SPECT MPI in patients with heart failure prior to implantable cardioverter-defibrillator or cardiac resynchronization therapy with a defibrillator: Characteristics and prediction of cardiac outcome

Nili Zafrir, Tamir Bental, Boris Strasberg, Alejandro Solodky, Israel Mats, Ariel Gutstein, Ran Kornowski

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Mechanical left ventricular dyssynchrony (MLVD) might contribute in the therapeutic decision-making in patients with heart failure (HF) prior to cardiac resynchronization therapy (CRT). Our aim was to assess MLVD in patients with HF prior to implantable cardioverter-defibrillator (ICD) compared to patients with CRT-D. Methods: In a prospective study, patients with LVEF ≤ 35% who were scheduled for ICD or CRT-D, underwent gated SPECT myocardial perfusion imaging with technetium 99m sestamibi within 3 months prior procedure. MLVD was measured by phase analysis. Results: The study cohort consisted of 143 patients, 71 with ICD and 72 with CRT-D. Age 68.3 ± 11 and LVEF 24 ± 6%. Phase standard deviation (SD) was 62.5 ± 18 and 59.7 ± 20 (P = NS), respectively. During follow-up of 23.7 ± 12.1 months, there were 10 vs 14 cardiac death in ICD and CRT-D, respectively (P = NS), hospitalization for HF, in 34 vs 53 (P < .001). In multivariate analysis, Phase SD was the independent predictor for cardiac death [HR 2.66 (95% CI 1.046-6.768), P = .04]. Kaplan-Meier curves of phase SD of 60° significantly identified ICD patients with and without cardiac deaths and hospitalization for HF exacerbation. Conclusions: MLVD by phase SD can identify patients with cardiac events and predict cardiac death in patients treated with ICD.

Original languageEnglish
Pages (from-to)122-129
Number of pages8
JournalJournal of Nuclear Cardiology
Volume24
Issue number1
DOIs
StatePublished - 1 Feb 2017
Externally publishedYes

Keywords

  • CRT-D
  • ICD
  • Mechanical left ventricular dyssynchrony
  • cardiac outcome
  • gated SPECT MPI
  • phase SD

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