Relationship of quantitative parameters of myocardial perfusion SPECT and ventricular arrhythmia in patients receiving c
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ORIGINAL ARTICLE
Relationship of quantitative parameters of myocardial perfusion SPECT and ventricular arrhythmia in patients receiving cardiac resynchronization therapy Po-Nien Hou1 • Shih-Chuan Tsai2,3 • Wan-Yu Lin2 • Chien-Ming Cheng4 • Kuo-Feng Chiang5 • Yu-Cheng Chang5 • Jin-Long Huang5,6 • Guang-Uei Hung3,7 Shih-Ann Chen8 • Ji Chen9
•
Received: 17 May 2015 / Accepted: 6 July 2015 / Published online: 21 July 2015 Ó The Japanese Society of Nuclear Medicine 2015
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 (v2 = 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,
& Guang-Uei Hung [email protected]
5
Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
Jin-Long Huang [email protected]
6
Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Department of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua, Taiwan
7
Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, 6
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