Grozdic Milojevic Isidora, Radovanovic Nikola N, Petrovic Jelena, Sobic-Saranovic Dragana, Artiko Vera
Center for Nuclear Medicine and PET, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Faculty of Medicine, University Belgrade, 11000 Belgrade, Serbia.
J Clin Med. 2025 Jul 29;14(15):5341. doi: 10.3390/jcm14155341.
: This study aimed to evaluate myocardial scar burden and distribution, as well as other nuclear imaging parameters, in predicting cardiac resynchronization therapy (CRT) responses and long-term outcomes in patients selected for CRT with ischemic HF etiology. : Seventy-one patients were prospectively included. They all had NYHA class II/III despite optimal medical therapy, LVEF ≤ 35%, wide QRS complexes, and ischemic HF etiology. All were indicated for de novo CRT implantation and underwent a SPECT MPI viability test prior to CRT implantation. Two-dimensional echocardiography was performed one day before CRT implantation and 6 months after the intervention. The follow-up examination was conducted six months after the CRT implantation and, after 5 years, patients underwent a telephone follow-up to assess survival. : Most patients (85%) were male, with an average age of 66.26 ± 9.25 yrs. SPECT MPI revealed large myocardial scars (44.53 ± 20.94%) with high summed rest scores (SRSs) of 25.02 ± 11.29 and low EFs of 26.67 ± 7.71%. At the 6-month follow-up, after the CRT implantation, the NYHA class significantly changed and 35% of the patients were classified as CRT responders. The only difference between responders and non-responders was in the SRS and myocardial scar size ( < 0.001). A scar size of 19.5% was an optimal cutoff for the prediction of CRT response (AUC 0.853, Sn 85% and 1-sp 94%). : SPECT MPI parameters are valuable in predicting responses and long-term survival in patients with CRT. Patients with myocardial scars of less than 19.5% may be suited to CRT and experience better cardiovascular survival.
本研究旨在评估心肌瘢痕负荷及分布，以及其他核成像参数，以预测缺血性心力衰竭病因且入选心脏再同步治疗（CRT）的患者的CRT反应及长期预后。前瞻性纳入71例患者。尽管接受了最佳药物治疗，但他们均为纽约心脏协会（NYHA）心功能II/III级，左心室射血分数（LVEF）≤35%，QRS波群增宽，且为缺血性心力衰竭病因。所有患者均适合首次CRT植入，并在CRT植入前接受了单光子发射计算机断层扫描心肌灌注显像（SPECT MPI）存活测试。在CRT植入前一天和干预后6个月进行二维超声心动图检查。在CRT植入后6个月进行随访检查，5年后，患者接受电话随访以评估生存率。大多数患者（85%）为男性，平均年龄为66.26±9.25岁。SPECT MPI显示存在大面积心肌瘢痕（44.53±20.94%），静息总分（SRS）较高，为25.02±11.29，EF较低，为26.67±7.71%。在CRT植入后的6个月随访中，NYHA心功能分级显著改变，35%的患者被归类为CRT反应者。反应者与无反应者之间的唯一差异在于SRS和心肌瘢痕大小（<0.001）。瘢痕大小为19.5%是预测CRT反应的最佳截断值（曲线下面积[AUC]为0.853，敏感度[Sn]为85%，1-特异度[1-sp]为94%）。SPECT MPI参数在预测CRT患者的反应及长期生存方面具有重要价值。心肌瘢痕小于19.5%的患者可能适合CRT，并具有更好的心血管生存率。
