Nakamura Toshihiro, Ishibashi Kohei, Useda Nobuhiko, Oka Satoshi, Miyazaki Yuichiro, Wakamiya Akinori, Nakajima Kenzaburo, Kamakura Tsukasa, Wada Mitsuru, Inoue Yuko, Miyamoto Koji, Nagase Satoshi, Aiba Takeshi, Kusano Kengo
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
J Interv Card Electrophysiol. 2025 Jan 3. doi: 10.1007/s10840-024-01972-y.
Non-response to cardiac resynchronization therapy (CRT) is an important issue in the treatment of heart failure with reduced ejection fraction (HFrEF) and non-left bundle branch block (LBBB). Electrocardiogram-gated myocardial perfusion single-photon emission computed tomography imaging (G-MPI SPECT) is typically used to assess left ventricular (LV) dyssynchrony. This study aimed to determine whether G-MPI parameters are associated with non-responsiveness to CRT.
Between January 2021 and December 2022, 128 patients underwent CRT, of whom 73 with preoperative evaluation using G-MPI were selected. Forty-three patients with non-LBBB (21 and 22 CRT responders and non-responders, respectively) and 30 patients with LBBB were analyzed.
Among patients with non-LBBB, CRT responders and non-responders exhibited no significant differences in baseline characteristics, except for the LV dimension. A receiver operating characteristic curve analysis identified 108° and 27.7° as the optimal cutoff values for the bandwidth and phase standard deviation (SD), respectively, to predict non-responsiveness to CRT (area under the curve [AUC] = 0.762; 95% confidence interval [CI] 0.601-0.923 and AUC = 0.742; 95% CI 0.576-0.909, respectively). A multivariate analysis revealed that a cutoff bandwidth of ≥ 108° and phase SD of ≥ 27.7° are independent predictors of non-responsiveness to CRT in patients with non-LBBB (hazard ratio 5.65; 95% CI 1.53-20.9; P = 0.009). In contrast, there were no significant associations between G-MPI parameters and non-responsiveness to CRT in patients with LBBB.
Preoperative G-MPI might be associated with non-responsiveness to CRT in patients with non-LBBB, indicating that identifying potential non-responders can improve patient management.
在射血分数降低的心力衰竭（HFrEF）且非左束支传导阻滞（LBBB）的治疗中，心脏再同步治疗（CRT）无反应是一个重要问题。心电图门控心肌灌注单光子发射计算机断层扫描成像（G-MPI SPECT）通常用于评估左心室（LV）不同步。本研究旨在确定G-MPI参数是否与CRT无反应相关。
2021年1月至2022年12月期间，128例患者接受了CRT，其中73例术前使用G-MPI进行评估的患者被纳入。分析了43例非LBBB患者（分别有21例和22例CRT反应者和无反应者）和30例LBBB患者。
在非LBBB患者中，除左心室尺寸外，CRT反应者和无反应者在基线特征方面无显著差异。受试者工作特征曲线分析确定带宽为108°和相位标准差（SD）为27.7°分别为预测CRT无反应的最佳截断值（曲线下面积[AUC]分别为0.762；95%置信区间[CI] 0.601 - 0.923和AUC为0.742；95% CI 0.576 - 0.909）。多因素分析显示，对于非LBBB患者，截断带宽≥108°和相位SD≥27.7°是CRT无反应的独立预测因素（风险比5.65；95% CI 1.53 - 20.9；P = 0.009）。相比之下，LBBB患者中G-MPI参数与CRT无反应之间无显著关联。
术前G-MPI可能与非LBBB患者对CRT无反应相关，这表明识别潜在的无反应者可改善患者管理。
