Jiang Zhongwei, Bu Ju, Zhao Zhongqiang, Li Chunxiang, Li Dianfu, Chen Qiushi, Qin Huiyuan, Wang Cheng
Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Cardiology, Jiangsu Provincial People's Hospital Chongqing Hospital (Qijiang District People's Hospital), Chongqing, China., Jiangsu, China.
Pacing Clin Electrophysiol. 2025 May 20. doi: 10.1111/pace.15200.
Texture analysis (TA) is a powerful tool for extracting quantitative information, assessing myocardial heterogeneity, evaluating therapeutic efficacy, and predicting outcomes in heart disease. This study investigated whether TA based on gated single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) can enhance the prediction of response to cardiac resynchronization therapy (CRT).
A total of 165 patients who underwent gated SPECT MPI and received CRT were enrolled in the study. Quantitative analysis of SPECT imaging generated 1225 TA features. Phase analysis of resting gated short-axis SPECT myocardial perfusion images was utilized to assess left ventricular (LV) systolic and diastolic mechanical dyssynchrony (LVMD), including phase standard deviation (PSD), phase bandwidth (PBW), and entropy. Patients were categorized into CRT response and non-response groups based on a ≥5% improvement in LV ejection fraction (LVEF) measured by echocardiography at the 6-month follow-up. Variables with a p-value <0.05 in the univariate logistic regression analysis were incorporated into a backward stepwise multivariate logistic regression model for further analysis.
During follow-up, 60.0% (99 of 165 patients) demonstrated a response to CRT. Univariate logistic regression analysis revealed that CRT response was significantly associated with N-terminal pro-brain natriuretic peptide (NT-proBNP), non-sustained ventricular tachycardia (NS-VT), LV end-diastolic diameter (LVEDD), LV end-systolic diameter (LVESD), scar burden, systolic and diastolic PSD, PBW, entropy, and 51 TA parameters. In the backward stepwise multivariate regression analysis, inverse difference moment normalized (IDMN), NS-VT, NT-proBNP, diastolic PSD, and LVEDD emerged as independent predictors of CRT response.
TA based on gated SPECT MPI provides independent prognostic predictor for CRT response in medically treated Heart failure patients.
纹理分析（TA）是一种强大的工具，可用于提取定量信息、评估心肌异质性、评估治疗效果以及预测心脏病的预后。本研究调查了基于门控单光子发射计算机断层扫描心肌灌注成像（SPECT MPI）的TA是否能增强对心脏再同步治疗（CRT）反应的预测。
共有165例行门控SPECT MPI并接受CRT的患者纳入本研究。SPECT成像的定量分析产生了1225个TA特征。利用静息门控短轴SPECT心肌灌注图像的相位分析来评估左心室（LV）收缩期和舒张期机械不同步（LVMD），包括相位标准差（PSD）、相位带宽（PBW）和熵。根据6个月随访时超声心动图测量的左心室射血分数（LVEF）提高≥5%，将患者分为CRT反应组和无反应组。单因素逻辑回归分析中p值<0.05的变量被纳入向后逐步多因素逻辑回归模型进行进一步分析。
随访期间，60.0%（165例患者中的99例）对CRT有反应。单因素逻辑回归分析显示，CRT反应与N末端脑钠肽前体（NT-proBNP）、非持续性室性心动过速（NS-VT）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、瘢痕负荷、收缩期和舒张期PSD、PBW、熵以及51个TA参数显著相关。在向后逐步多因素回归分析中，反差异矩归一化（IDMN）、NS-VT、NT-proBNP、舒张期PSD和LVEDD成为CRT反应的独立预测因素。
基于门控SPECT MPI的TA为药物治疗的心力衰竭患者CRT反应提供了独立的预后预测因素。
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