Takahashi Naoto, Sato Naoki, Takagi Koji, Omote Toshiya, Kikuchi Arifumi, Hanaoka Daisuke, Yamamoto Eisei, Ishikawa Masahiro, Amitani Kenichi, Kumita Shinichiro, Shimizu Wataru
Department of Internal Medicine and Cardiology, Nippon Medical School, Musashikosugi Hospital, Kanagawa, Japan.
Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan.
J Cardiol Cases. 2014 Dec 24;11(4):101-104. doi: 10.1016/j.jccase.2014.11.006. eCollection 2015 Apr.
Gated Tc-99m sestamibi myocardial perfusion single-photon emission computed tomography (GMPS) with phase analysis provides information on myocardial perfusion, left ventricular (LV) function, and LV dyssynchrony. We present a case of isolated left ventricular noncompaction (IVNC) cardiomyopathy in which GMPS with phase analysis proved to be beneficial and reliable to monitor the long-term response to cardiac resynchronization therapy with defibrillator (CRT-D). The patient was an 84-year-old man with shortness of breath on minimal exertion (New York Heart Association class III) who had severe drug-refractory heart failure with hypotension and ventricular tachycardia. He was diagnosed with IVNC using echocardiography. At baseline, GMPS with phase analysis revealed a reduced ejection fraction (EF, 21%), large perfusion defects in the inferior and inferolateral walls, and severe LV dyssynchrony [histogram bandwidth (HBW) 120°]. Combination therapy with CRT-D and a titrated beta-blocker was initiated to induce LV reverse remodeling and reduce LV dyssynchrony. Two years after CRT-D implantation, GMPS with phase analysis showed marked improvement in LV function and LV dyssynchrony (EF 28%, HBW 36°). This case demonstrates that GMPS with phase analysis is an important and useful modality to evaluate LV function and LV dyssynchrony in IVNC patients undergoing CRT-D. < We experienced a rare case of heart failure with isolated left ventricular noncompaction (IVNC) treated with cardiac resynchronization therapy with defibrillator (CRT-D). We demonstrate that gated Tc-99m myocardial perfusion SPECT (GMPS) with phase analysis can simultaneously evaluate myocardial perfusion and left ventricular dyssynchrony to assess the indication and efficacy of CRT-D. This case demonstrates that GMPS with phase analysis is useful to monitor IVNC patients before and after CRT-D.>.
门控锝-99m 甲氧基异丁基异腈心肌灌注单光子发射计算机断层扫描（GMPS）结合相位分析可提供心肌灌注、左心室（LV）功能和左心室不同步性的信息。我们报告一例孤立性左心室心肌致密化不全（IVNC）心肌病病例，其中 GMPS 结合相位分析被证明对监测心脏再同步化治疗除颤器（CRT-D）的长期反应有益且可靠。该患者为一名 84 岁男性，轻微活动即出现气短（纽约心脏协会 III 级），患有严重的药物难治性心力衰竭，伴有低血压和室性心动过速。通过超声心动图诊断为 IVNC。基线时，GMPS 结合相位分析显示射血分数（EF）降低（21%），下壁和下侧壁存在大的灌注缺损，以及严重的左心室不同步性[直方图带宽（HBW）120°]。启动 CRT-D 与滴定的β受体阻滞剂联合治疗以诱导左心室逆向重构并减少左心室不同步性。CRT-D 植入两年后，GMPS 结合相位分析显示左心室功能和左心室不同步性有显著改善（EF 28%，HBW 36°）。该病例表明，GMPS 结合相位分析是评估接受 CRT-D 治疗的 IVNC 患者左心室功能和左心室不同步性的重要且有用的方法。<我们经历了一例罕见的孤立性左心室心肌致密化不全（IVNC）心力衰竭病例，采用心脏再同步化治疗除颤器（CRT-D）进行治疗。我们证明，门控锝-99m 心肌灌注 SPECT（GMPS）结合相位分析可同时评估心肌灌注和左心室不同步性，以评估 CRT-D 的适应证和疗效。该病例表明，GMPS 结合相位分析有助于监测 CRT-D 治疗前后的 IVNC 患者。>
