Gendre Rémy, Lairez O, Mondoly P, Duparc A, Carrié D, Galinier M, Berry I, Cognet T
Department of Cardiology, Toulouse University Hospital, Toulouse, France.
Department of Nuclear Medicine, Toulouse University Hospital, Toulouse, France.
Ann Nucl Med. 2017 Apr;31(3):218-226. doi: 10.1007/s12149-017-1148-5. Epub 2017 Feb 14.
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in chronic systolic heart failure. About 20% of implanted patients are considered as "non-responders". This study aimed to evaluate gated myocardial perfusion single-photon emission computed tomography (GMPS) phase parameters as compared to echocardiography in the assessment of predictors for response to CRT before and after CRT activation.
Forty-two patients were prospectively included during 15 months. A single injection of Tc-tetrofosmin was used to acquire GMPS phase pre- and post-CRT activation. Indicators of positive CRT response were improvement of functional status and 15% reduction in left ventricular end-systolic volume at 3 months.
Phase parameters at baseline were similar in the two groups with no influence of perfusion data. Phase parameters after CRT activation were significantly improved in the responders' group (Δ Bandwidth -19° ± 24° vs. 13° ± 31°, p = 0.001; Δ SD -20° ± 30° vs. 26° ± 46°, p = 0.001; Δ Entropy -11 ± 12 vs. 2 ± 6%, p = 0.001). Feasibility and reproducibility were higher for GMPS.
Acute phase modifications after CRT activation may predict response to CRT immediately after implantation, but not at baseline, even when adjusted to perfusion data.
心脏再同步治疗（CRT）可降低慢性收缩性心力衰竭的发病率和死亡率。约20%的植入患者被视为“无反应者”。本研究旨在评估门控心肌灌注单光子发射计算机断层扫描（GMPS）相位参数与超声心动图相比，在评估CRT激活前后CRT反应预测因素中的作用。
在15个月内前瞻性纳入42例患者。单次注射锝-替曲膦用于获取CRT激活前后的GMPS相位图像。CRT阳性反应的指标为功能状态改善以及3个月时左心室收缩末期容积减少15%。
两组基线时的相位参数相似，灌注数据无影响。CRT激活后，反应者组的相位参数显著改善（带宽变化量-19°±24°对13°±31°，p = 0.001；标准差变化量-20°±30°对26°±46°，p = 0.001；熵变化量-11±12对2±6%；p = 0.001）。GMPS的可行性和可重复性更高。
CRT激活后的急性期改变可能在植入后立即预测CRT反应，但在基线时不能，即使调整了灌注数据也是如此。
