Universidade Federal Fluminense - Serviço de Cardiologia, Hospital Universitário Antônio Pedro e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ - Brasil.
Instituto Estadual de Cardiologia Aloysio de Castro - Departamento de Arritmias Cardíacas, Rio de Janeiro, RJ - Brasil.
Arq Bras Cardiol. 2023 Mar;120(3):e20220077. doi: 10.36660/abc.20220077.
Cardiac resynchronization therapy (CRT) may benefit patients with advanced heart failure (HF). Abnormal eccentricity index by gated SPECT is related to structural and functional alterations of the left ventricle (LV).
The aim of this study is to evaluate the feasibility of LV lead implantation guided by phase analysis and its relationship to ventricular remodeling.
Eighteen patients with indication for CRT underwent myocardial scintigraphy for implant orientation, and eccentricity and ventricular shape parameters were evaluated. P < 0.05 was adopted as statistical significance.
At baseline, most patients were classified as NYHA 3 (n = 12). After CRT, 11 out of 18 patients were reclassified to a lower degree of functional limitation. In addition, patients' quality of life was improved post-CRT. Significant reductions were observed in QRS duration, PR interval, end-diastolic shape index, end-systolic shape index, stroke volume, and myocardial mass post-CRT. The CRT LV lead was positioned concordant, adjacent, and discordant in 11 (61.1%), 5 (27.8%), and 2 (11.1%) patients, respectively. End-systolic and end-diastolic eccentricity demonstrated reverse remodeling post-CRT.
LV lead implantation in CRT guided by gated SPECT scintigraphy is feasible. The placement of the electrode concordant or adjacent to the last segment to contract was a determinant of reverse remodeling.
心脏再同步治疗（CRT）可能使晚期心力衰竭（HF）患者受益。门控 SPECT 的异常偏心指数与左心室（LV）的结构和功能改变有关。
本研究旨在评估相位分析引导 LV 导联植入的可行性及其与心室重构的关系。
18 例有 CRT 适应证的患者接受心肌闪烁显像以确定植入方向，并评估偏心和心室形状参数。P<0.05 为统计学意义。
基线时，大多数患者被归类为 NYHA 3 级（n=12）。在 CRT 后，18 例中有 11 例重新分类为功能限制程度较低的患者。此外，患者的生活质量在 CRT 后得到改善。CRT 后 QRS 持续时间、PR 间隔、舒张末期形状指数、收缩末期形状指数、心搏量和心肌质量均显著降低。CRT 的 LV 导联分别在 11 例（61.1%）、5 例（27.8%）和 2 例（11.1%）患者中被定位为一致、邻近和不一致。CRT 后收缩末期和舒张末期偏心表现出反向重构。
门控 SPECT 闪烁显像引导的 CRT 中 LV 导联植入是可行的。电极的放置与最后收缩段一致或相邻是反向重构的决定因素。
