The possible role of nuclear imaging in assessment of the cardiac resynchronization therapy effectiveness in patients wi
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ORIGINAL ARTICLE
The possible role of nuclear imaging in assessment of the cardiac resynchronization therapy effectiveness in patients with moderate heart failure Yuri Lishmanov • Stanislav Minin • Irina Efimova • Vladimir Chernov • Yulia Saushkina • Denis Lebedev • Sergey Popov
Received: 22 March 2012 / Accepted: 27 January 2013 / Published online: 1 March 2013 Ó The Japanese Society of Nuclear Medicine 2013
Abstract Background The aim of the study was to elucidate the role of nuclear medicine imaging in the selection of candidates for cardiac resynchronization therapy (CRT) and in the evaluation of CRT effectiveness Methods We studied 28 patients (19 male and 9 female) with dilated cardiomyopathy (DCM) and heart failure (HF). Before implantation of CRT device, all patients underwent SPECT with 99mTc-MIBI at rest to evaluate the myocardial perfusion, 123I-BMIPP to evaluate the myocardial metabolism, and gated cardiac blood-pool SPECT (GBPS) to assess the myocardial contractile function. Following CRT, all patients were examined with 99mTc-MIBI SPECT and GBPS 12 ± 3 months after the intervention. Results All patients after CRT were divided into three groups. The first group included 10 patients with LVEF increased by more than 10 % (hyperresponders), the 2nd group included 11 patients with an increase in EF of more than 5 % but less than 10 % (responders) and third group consisted of 7 males whose LVEF remained unchanged or worsened compared with pre-operative values (nonresponders). Prior to CRT, no statistically significant
Y. Lishmanov S. Minin (&) I. Efimova V. Chernov Y. Saushkina Laboratory of Nuclear Medicine, Federal State Budgetary Institution ‘‘Research Institute for Cardiology’’ of Siberian Branch Under the Russian Academy of Medical Sciences, Tomsk, Kievskaya 111a, Tomsk 634012, Russian Federation e-mail: [email protected] D. Lebedev S. Popov Department of Surgical Treatment of Arrhythmias, Federal State Budgetary Institution ‘‘Research Institute for Cardiology’’ of Siberian Branch Under the Russian Academy of Medical Sciences, Tomsk, Russian Federation
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differences were found between groups in hemodynamic parameters (EF, EDV, ESV, SV), intra- and interventricular dyssynchrony, as well as in the midsize of perfusion defects. Following long-term CRT, we found increase in LVEF and decrease in average size of perfusion defects in groups of hyperresponders and responders (p \ 0.05). Results of SPECT with 123I-BMIPP, performed prior to CRT, showed that nonresponders had more pronounced disturbance of myocardial metabolism compared with the group of hyperresponders (20 vs. 14.7 %, p \ 0.05). Conclusion The radionuclide methods can be used as possible indicators in the evaluation effectiveness and selection of candidates on the CRT. Keywords Cardiac resynchronization therapy Nuclear imaging Heart failure
Introduction The cardiac resynchronization therapy (CRT) is considered as adjunct therapy in patients with drug-refractory heart failure (HF) [1–3]. Initial studies demonstrated acute i
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