Stępień-Wroniecka Agnieszka, Dziewięcka Ewa, Graczyk Katarzyna, Holcman Katarzyna, Winiarczyk Mateusz, Przytuła Natalia, Kostkiewicz Magdalena, Podolec Piotr, Rubiś Paweł
Doctoral School of Medical and Health Sciences, Jagiellonian University Medical College, Krakow, Poland .
Department of Cardiac and Vascular Diseases, St.John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland and .
Nucl Med Commun. 2025 Apr 1;46(4):285-303. doi: 10.1097/MNM.0000000000001955. Epub 2025 Jan 24.
Cardiac resynchronization therapy (CRT) is an intervention for heart failure patients with reduced ejection fraction who exhibit specific electrocardiographic indicators of electrical dyssynchrony. However, electrical dyssynchrony does not universally correspond to left ventricular mechanical dyssynchrony (LVMD). Gated single-photon emission computed tomography (SPECT) myocardial perfusion allows for the assessment of LVMD, yet its role in the CRT selection process remains debated.
We conducted a systematic literature review to critically evaluate the evidence for the prediction and prognostic utility of SPECT for LVMD in assessing LVMD among CRT candidates. The review adhered to PRISMA 2020 Statement criteria and included articles from PubMed, Embase, and Cochrane databases. The quality of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation framework.
From an initial pool of 1055 records, 33 met the inclusion criteria and provided original data on the predictive value of myocardial perfusion SPECT for LVMD. Most of them measured LVMD according to established recommendations, focusing on phase histogram bandwidth (HBW) and phase histogram standard deviation (PSD). Out of 2066 patients from 27 studies, 62% ( n = 1214) were qualified as CRT responders. Five studies reported SPECT-based cutoffs for predicting CRT response (HBW ranging 55°-152° and for PSD 20°-54°). Only five studies assessed the prognostic implications of baseline SPECT-measured LVMD, indicating that elevated baseline HBW and PSD values are associated with poorer outcomes.
The objective and reproducible measurement of LVMD provided by SPECT underscores its potential as a valuable tool. Such assessment seems to be emerging as a promising adjunctive technique with potential to enhance CRT outcomes.
心脏再同步治疗（CRT）是针对射血分数降低且表现出特定电不同步心电图指标的心力衰竭患者的一种干预措施。然而，电不同步并不普遍对应于左心室机械不同步（LVMD）。门控单光子发射计算机断层扫描（SPECT）心肌灌注可用于评估LVMD，但其在CRT选择过程中的作用仍存在争议。
我们进行了一项系统的文献综述，以严格评估SPECT预测LVMD以及在评估CRT候选者LVMD方面的预后效用的证据。该综述遵循PRISMA 2020声明标准，纳入了来自PubMed、Embase和Cochrane数据库的文章。使用推荐分级、评估、制定和评价框架对证据质量进行评估。
从最初的1055条记录中，33条符合纳入标准，并提供了关于心肌灌注SPECT对LVMD预测价值的原始数据。其中大多数根据既定建议测量LVMD，重点关注相位直方图带宽（HBW）和相位直方图标准差（PSD）。在27项研究的2066例患者中，62%（n = 1214）被判定为CRT反应者。五项研究报告了基于SPECT的预测CRT反应的临界值（HBW范围为55°-152°，PSD为20°-54°）。只有五项研究评估了基线SPECT测量的LVMD的预后意义，表明基线HBW和PSD值升高与较差的预后相关。
SPECT对LVMD进行的客观且可重复的测量突出了其作为一种有价值工具的潜力。这种评估似乎正在成为一种有前景的辅助技术，有可能改善CRT的治疗效果。
