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Responders versus nonresponders: equilibrium radionuclide angiography and tissue Doppler imaging variables before and after CRT implantation.
Source publication
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Objective:
The aim of this study was to compare tissue doppler imaging (TDI) and equilibrium radionuclide angiography (ERNA) for detection of right ventricular (RV) dyssynchrony and prediction of the acute response to cardiac resynchronization therapy (CRT).
Methods:
This study was approved by the local ethics committee of Huai'an First People's...
Contexts in source publication
Context 1
... baseline RVmPA% and RVPSD% were mean 50.52 ± 5.72% and 12.15 ± 3.15% (Table 3). Moderate positive correlations were observed among RVmPA%, RVPSD% and time of right ventricular (RV-T), respectively (r = 0.689 and 0.716, all P < .001) ...Context 2
... responders also showed a significant improvement in LVEF and RVEF (from 27.85 ± 4.49% to 36.50 ± 5.79% and from 32.60 ± 3.80% to 36.35 ± 2.60%, all P < .001) ( Table 3). All baseline characteristics of the patients were similar between acute responders and nonresponders (Table 2), whereas the baseline RVmPA% and RVPSD% were significantly higher in acute responders compared with nonresponders (53.60 ± 4.15% vs 45.77 ± 4.44%, 14.00 ± 2.41% vs 9.31 ± 1.70%, P < .05) ...Citations
... Cardiac resynchronization therapy has become a valuable non-drug treatment for refractory symptomatic heart failure, severe left ventricular systolic dysfunction, and ventricular dyssynchrony in patients with inadequate response to optimal medical therapies (12). CRT has the potential to improve heart failure symptoms, reduce hospital admissions, and improve the survival and functional capacity. ...
Cardiac resynchronization therapy (CRT) for heart failure requires transvenous insertion of a left ventricular pacing lead through the coronary sinus. However, repeated intraoperative dislocations often occur. Therefore, we describe a novel technique that uses the loop technique to treat patients with repeated intraoperative dislocations during transvenous left ventricular lead implantation to stabilize the lead in its final position. In five patients with repeated intraoperative dislocation during transvenous left ventricular lead implantation, the loop technique was successfully used to stabilize the lead in its final position. The pacing and sensing parameters were satisfactory in all patients at implantation and 12 months post-operatively. Compared with the pre-operative values, the 12-month post-operative values for the left ventricular ejection fraction were significantly increased and the left ventricular end systolic dimension and left ventricular end diastolic dimension were significantly decreased (P < 0.05). The left ventricular ejection fraction of these 5 patients increased by more than 15%. CRT significantly improved the left ventricular structure and function of these 5 patients. During the 1-, 3-, 6-, and 12-month follow-ups, no left ventricular lead dislocations were observed. This loop technique is safe and effective and can be considered for repeated intraoperative dislocation during transvenous left ventricular lead implantation through the coronary sinus of a CRT device.
... GBPS is a widely used imaging technique for assessment of myocardial contractility. This approach has diagnostic and prognostic signi cance in patients with HF including those with arrhythmia (particularly in CRT candidates) [25], pulmonary embolism [26] and cardiotoxicity [17,20,27]. This method was validated on cardiac phantom [28] and showed good correlation with CMR [29] and TTE [25]. ...
... This approach has diagnostic and prognostic signi cance in patients with HF including those with arrhythmia (particularly in CRT candidates) [25], pulmonary embolism [26] and cardiotoxicity [17,20,27]. This method was validated on cardiac phantom [28] and showed good correlation with CMR [29] and TTE [25]. However, this approach is not widely used for assessment of CR because of the relatively long study duration and high radiation exposure [8]. ...
Purpose: The purpose of present study was to assess the feasibility of GBPS with low-dose dobutamine (LDD) stress test, performed on a SPECT camera equipped with Cadmium-Zinc-Telluride (CZT) solid state detectors in evaluation of patients with ischemic heart failure (HF).
Methods. A total of 52 patients with ischemic cardiomyopathy (ICM) and a control group of 10 patients without obstructive coronary artery lesion underwent GBPS and transthoracic echocardiography (TTE) at rest and during LDD stress test (5, 10, 15 µg/kg/min). The duration of each GBPS step was 5 minutes. Stress-induced changes (∆) in LV ejection fraction (LVEF), peak ejection rate, LV volumes and dyssynchrony (phase histogram standard deviation, phase histogram bandwidth and entropy) obtained with GBPS were estimated.
Results. All GBPS indices except end-diastolic volume showed significant dynamics during stress test in both groups. 17% of ICM patients, but none from control group, showed a decrease in EF during stress, accompanied by a significant increase in entropy. The inter-rater reproducibility was excellent for both rest and stress studies. There was a moderate correlation (r=0.5, p=0.01) between GBPS and TTE, with a mean difference value of -1.7 (95% confidence interval -9.8; 6.4; p=0.06) in ΔLVEF.
Conclusion. Low-dose dobutamine stress gated blood pool SPECT performed with high-efficiency CZT-SPECT cameras allow evaluation of stress-induced changes in LV contractility and dyssynchrony in patients with ischemic HF. The high sensitivity of the semiconductor detectors provides an opportunity to perform GBPS with lower acquisition time and a decrease in patient radiation exposure.
ClinicalTrials.gov identifier: NCT04508608 (August 7, 2020)
Purpose
The purpose of the present study was to evaluate the feasibility of gated blood pool single-photon emission computed tomography (GBPS) with low-dose dobutamine (LDD) stress test, performed on a single-photon emission computed tomography (SPECT) camera equipped with cadmium-zinc-telluride (CZT) solid-state detectors, in assessing of left ventricle (LV) contractile reserve in patients with ischemic cardiomyopathy (ICM).
Methods
A total of 52 patients (age 59 ± 7.2 years, 47 men and 5 women) with ICM and a control group of 10 patients without obstructive coronary artery lesion underwent GBPS and transthoracic echocardiography (TTE) at rest and during LDD stress test (5, 10, 15 µg/kg/min). The duration of each GBPS step was 5 min. Stress-induced changes in LV ejection fraction (ΔLVEF), peak ejection rate, LV volumes, and mechanical dyssynchrony (phase histogram standard deviation, phase histogram bandwidth and entropy) obtained with GBPS were estimated.
Results
All GBPS indices except end-diastolic volume showed significant dynamics during stress test in both groups. The majority of parameters in ICM patients showed significant changes at a dobutamine dose of 10 µg/kg/min as compared to the rest study. Seventeen percent of ICM patients, but none from the control group, showed a decrease in LVEF during stress, accompanied by a significant increase in entropy. The intra- and inter-observer reproducibility was excellent for both rest and stress studies. There was a moderate correlation (r = 0.5, p = 0.01) between GBPS and TTE, with a mean difference value of − 1.7 (95% confidence interval − 9.8; 6.4; p = 0.06) in ΔLVEF.
Conclusion
Low-dose dobutamine stress GBPS performed with high-efficiency CZT-SPECT cameras can be performed for evaluating stress-induced changes in LV contractility and dyssynchrony with lower acquisition time. A dobutamine dose of 10 µg/kg/min can potentially suffice to detect stress-induced changes in patients with ICM during GBPS.
Trial registration
ClinicalTrials.gov identifier: NCT04508608 (August 7, 2020).
