Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Eur J Nucl Med Mol Imaging. 2011 Feb;38(2):230-8. doi: 10.1007/s00259-010-1621-z. Epub 2010 Oct 17.
The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT).
The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of ≥15% in LVESV.
Enrolled in the study were 90 patients (72% men, 67±10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p<0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables.
Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements.
本研究旨在评估门控心肌灌注 SPECT（GMPS）测定的机械激活最晚部位、左心室（LV）导线位置与心脏再同步治疗（CRT）反应之间的关系。
入选患者为目前拟行 CRT 的晚期心力衰竭患者。植入前进行 2 维超声心动图和 GMPS 检查。超声心动图用于评估 LV 收缩末期容积（LVESV）、LV 舒张末期容积（LVEDV）和 LV 射血分数（LVEF）。通过 GMPS 相位分析评估机械激活最晚部位，并与透视下 LV 导线位置相关联。CRT 后 6 个月重复行超声心动图检查。CRT 反应定义为 LVESV 降低≥15%。
共入选 90 例（72%为男性，平均年龄 67±10 岁）晚期心力衰竭患者。52 例（58%）患者 LV 导线位于机械激活最晚部位（一致），38 例（42%）患者 LV 导线位于机械激活最晚部位以外（不一致）。LV 导线位置一致的患者 CRT 反应明显更常见（79%比 26%，p<0.01）。6 个月后，LV 导线位置一致的患者 LVEF、LVESV 和 LVEDV 明显改善（p<0.05），而 LV 导线位置不一致的患者这些变量无明显改善。
LV 导线位置一致的患者 LV 容积和 LV 收缩功能明显改善，而 LV 导线位置不一致的患者无明显改善。
