门控 SPECT 心肌灌注显像评估心室不同步在心力衰竭患者心脏再同步治疗管理中的价值（VISION-CRT）。
Value of intraventricular dyssynchrony assessment by gated-SPECT myocardial perfusion imaging in the management of heart failure patients undergoing cardiac resynchronization therapy (VISION-CRT).
机构信息
Nuclear Medicine Department, Institute of Cardiology, 17 No. 702, Vedado, CP 10 400, La Habana, Cuba.
All India Institute of Medical Sciences, New Delhi, India.
出版信息
J Nucl Cardiol. 2021 Feb;28(1):55-64. doi: 10.1007/s12350-018-01589-5. Epub 2019 Jan 25.
BACKGROUND
Placing the left ventricular (LV) lead in a viable segment with the latest mechanical activation (vSOLA) may be associated with optimal cardiac resynchronization therapy (CRT) response. We assessed the role of gated SPECT myocardial perfusion imaging (gSPECT MPI) in predicting clinical outcomes at 6 months in patients submitted to CRT.
METHODS
Ten centers from 8 countries enrolled 195 consecutive patients. All underwent gSPECT MPI before and 6 months after CRT. The procedure was performed as per current guidelines, the operators being unaware of gSPECT MPI results. Regional LV dyssynchrony (Phase SD) and vSOLA were automatically determined using a 17 segment model. The lead was considered on-target if placed in vSOLA. The primary outcome was improvement in ≥1 of the following: ≥1 NYHA class, left ventricular ejection fraction (LVEF) by ≥5%, reduction in end-systolic volume by ≥15%, and ≥5 points in Minnesota Living With Heart Failure Questionnaire (MLHFQ).
RESULTS
Sixteen patients died before the follow-up gSPECT MPI. The primary outcome occurred in 152 out of 179 (84.9%) cases. Mean change in LV phase standard deviation (PSD) at 6 months was 10.5°. Baseline dyssynchrony was not associated with the primary outcome. However, change in LV PSD from baseline was associated with the primary outcome (OR 1.04, 95% CI 1.01-1.07, P = .007). Change in LV PSD had an AUC of 0.78 (0.66-0.90) for the primary outcome. Improvement in LV PSD of 4° resulted in the highest positive likelihood ratio of 7.4 for a favorable outcome. In 23% of the patients, the CRT lead was placed in the vSOLA, and in 42% in either this segment or in a segment within 10° of it. On-target lead placement was not significantly associated with the primary outcome (OR 1.53, 95% CI 0.71-3.28).
CONCLUSION
LV dyssynchrony improvement by gSPECT MPI, but not on-target lead placement, predicts clinical outcomes in patients undergoing CRT.
背景
将左心室（LV）导线放置在具有最新机械激活（vSOLA）的存活节段中可能与最佳心脏再同步治疗（CRT）反应相关。我们评估了门控单光子发射计算机断层扫描心肌灌注成像（gSPECT MPI）在预测 CRT 后 6 个月患者临床结局中的作用。
方法
来自 8 个国家的 10 个中心纳入了 195 例连续患者。所有患者均在 CRT 前和 CRT 后 6 个月进行了 gSPECT MPI。该程序按照当前指南进行，操作者不知道 gSPECT MPI 结果。使用 17 节段模型自动确定局部 LV 不同步（相位 SD）和 vSOLA。如果导线放置在 vSOLA 中，则认为该导线在靶区。主要结局是以下至少一项的改善：至少 1 项 NYHA 分级、左心室射血分数（LVEF）提高≥5%、收缩末期容积减少≥15%以及明尼苏达州心力衰竭生活质量问卷（MLHFQ）增加≥5 分。
结果
在随访 gSPECT MPI 之前，有 16 例患者死亡。179 例患者中有 152 例（84.9%）发生主要结局。6 个月时 LV 相位标准差（PSD）的平均变化为 10.5°。基线不同步与主要结局无关。然而，LV PSD 从基线的变化与主要结局相关（OR 1.04，95%CI 1.01-1.07，P =.007）。LV PSD 的变化 AUC 为 0.78（0.66-0.90），用于预测主要结局。LV PSD 改善 4°可使有利结局的阳性似然比最高达到 7.4。在 23%的患者中，CRT 导线放置在 vSOLA 中，在 42%的患者中放置在该节段或其 10°内的节段。靶区导线放置与主要结局无显著相关性（OR 1.53，95%CI 0.71-3.28）。
结论
gSPECT MPI 评估的 LV 不同步改善，但不是靶区导线放置，可预测接受 CRT 的患者的临床结局。
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