Clinical nuclear medicine · 2015
Can the Prognosis of Cardiac Resynchronization Therapy Be Predicted by Gated SPECT?
Оценочное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Qin Shengmei, Shi Hongcheng, Su Yangang, Chen Shuguang, Pan Wenzhi, Ge Junbo
Аннотация
PURPOSE: The aim of this study was to evaluate the role of gated myocardial perfusion SPECT (GMPS) phase parameters (phase SD and histogram bandwidth) in predicting the short-term response to cardiac resynchronization therapy (CRT) as left ventricle (LV) remodeling and the long-term effect as all-cause mortality or cardiac transplantation and hospitalization for heart failure.
PATIENTS AND METHODS: This prospective observational study included 63 consecutive patients undergoing CRT from May 2008 to April 2014. Before CRT, patients underwent evaluation of New York Heart Association functional class, standard 12-lead ECG, Tc-MIBI GMPS, and 2-dimensional echocardiography. The patients were grouped according to complete left bundle-branch block (CLBBB). Follow-up was done every 6 months after pacemaker implantation. The short-term end point was reverse LV remodeling in 6 to 12 months follow-up, and the long-term primary end point was all-cause mortality or cardiac transplantation. The secondary end point was hospitalization for heart failure.
RESULTS: Reverse LV remodeling showed in 60.9% (39/63) patients (74.5% CLBBB [35/47] vs 25.0% non-CLBBB [4/16], P < 0.001). Phase SD less than 55 degrees, CLBBB, and left atrium diameter were independent predictive factors for reverse LV remodeling. At a median follow-up of 39.76 months, there were 17 deaths and 2 transplantations (17.0% CLBBB vs 68.8% non-CLBBB, P < 0.001). Seventeen patients required hospitalization more than once for heart failure, and 2 underwent heart transplantation (14.9% CLBBB vs 62.5% non-CLBBB, P < 0.001). Multivariate logistic regression showed that only CLBBB was an independent predictive factor for both end points.
CONCLUSIONS: The GMPS parameters were not independent predictive factors for all-cause mortality or cardiac transplantation and hospitalization for heart failure.
PATIENTS AND METHODS: This prospective observational study included 63 consecutive patients undergoing CRT from May 2008 to April 2014. Before CRT, patients underwent evaluation of New York Heart Association functional class, standard 12-lead ECG, Tc-MIBI GMPS, and 2-dimensional echocardiography. The patients were grouped according to complete left bundle-branch block (CLBBB). Follow-up was done every 6 months after pacemaker implantation. The short-term end point was reverse LV remodeling in 6 to 12 months follow-up, and the long-term primary end point was all-cause mortality or cardiac transplantation. The secondary end point was hospitalization for heart failure.
RESULTS: Reverse LV remodeling showed in 60.9% (39/63) patients (74.5% CLBBB [35/47] vs 25.0% non-CLBBB [4/16], P < 0.001). Phase SD less than 55 degrees, CLBBB, and left atrium diameter were independent predictive factors for reverse LV remodeling. At a median follow-up of 39.76 months, there were 17 deaths and 2 transplantations (17.0% CLBBB vs 68.8% non-CLBBB, P < 0.001). Seventeen patients required hospitalization more than once for heart failure, and 2 underwent heart transplantation (14.9% CLBBB vs 62.5% non-CLBBB, P < 0.001). Multivariate logistic regression showed that only CLBBB was an independent predictive factor for both end points.
CONCLUSIONS: The GMPS parameters were not independent predictive factors for all-cause mortality or cardiac transplantation and hospitalization for heart failure.