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Journal of Nuclear Cardiology

, Volume 24, Issue 1, pp 122–129 | Cite as

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
Original Article

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.

Keywords

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

Abbreviations

CRT-D

Cardiac resynchronization therapy with a defibrillator

ICD

Implantable cardiac defibrillator

LVEF

Left ventricular ejection fraction

MLVD

Mechanical left ventricular dyssynchrony

MPI

Myocardial perfusion imaging

NYHA

New York Heart Association

SPECT

Single-photon emission computed tomography

Tc

Technetium

VT/VF

Ventricular tachycardia/ventricular fibrillation

HF

Heart failure

SD

Standard deviation

Notes

Conflict of interest

The authors report no potential conflict of interest relevant to this article.

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Copyright information

© American Society of Nuclear Cardiology 2015

Authors and Affiliations

  • Nili Zafrir
    • 1
  • Tamir Bental
    • 1
  • Boris Strasberg
    • 1
  • Alejandro Solodky
    • 1
  • Israel Mats
    • 1
  • Ariel Gutstein
    • 1
  • Ran Kornowski
    • 1
  1. 1.Cardiology DepartmentRabin Medical CenterPetah TiqvaIsrael

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