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Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT.

Boogers MJ, Chen J, van Bommel RJ, Borleffs CJ, Dibbets-Schneider P, van der Hiel B, Al Younis I, Schalij MJ, van der Wall EE, Garcia EV, Bax JJ - Eur. J. Nucl. Med. Mol. Imaging (2010)

Bottom Line: CRT response was defined as a decrease of ≥15% in LVESV.After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables.Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. j.m.j.boogers@lumc.nl

ABSTRACT

Purpose: The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT).

Methods: The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of ≥15% in LVESV.

Results: Enrolled in the study were 90 patients (72% men, 67±10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p<0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables.

Conclusion: Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements.

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Area of latest mechanical activation as assessed by phase analysis of GMPS studies. a LV lead positioned at the area of latest activation (concordant LV lead position). The area of latest activation Is located in the lateral segment. The patient showed a significant improvement in LVESV (139 ml vs. 86 ml) and LVEF (32% vs. 44%) after 6 months of CRT. b LV lead positioned outside the area of latest activation (discordant LV lead position). The area of latest activation is located in the anterior segment, whereas the LV lead is positioned in the posterior segment. The patient showed no improvement in LVESV (124 ml vs. 153 ml) or LVEF (27% vs. 22%) after 6 months of CRT
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Fig2: Area of latest mechanical activation as assessed by phase analysis of GMPS studies. a LV lead positioned at the area of latest activation (concordant LV lead position). The area of latest activation Is located in the lateral segment. The patient showed a significant improvement in LVESV (139 ml vs. 86 ml) and LVEF (32% vs. 44%) after 6 months of CRT. b LV lead positioned outside the area of latest activation (discordant LV lead position). The area of latest activation is located in the anterior segment, whereas the LV lead is positioned in the posterior segment. The patient showed no improvement in LVESV (124 ml vs. 153 ml) or LVEF (27% vs. 22%) after 6 months of CRT

Mentions: The mean values of histogram bandwidth and phase SD were 139±77° and 41±21°. The region of latest mechanical activation as assessed with GMPS was located in the posterior (42.2%), lateral (23.3%), inferior (13.3%), anterior (15.6%), anteroseptal (3%) and septal (2.3%) regions. Furthermore, good agreement was found between GMPS and 2-D speckle tracking radial strain analysis for assessment of the site of latest mechanical activation (k = 0.79, total agreement of 86%). Good intraobserver (k = 0.96, total agreement of 93%) and interobserver (k = 0.92, total agreement of 87%) reproducibility of the phase analysis was observed for assessment of the site of latest mechanical activation. CRT device and LV lead implantation were successful in all patients without major complications. The LV pacing lead was positioned in the lateral (44.4% of patients), posterior (50.0% of patients) or anterior (5.6% of patients) regions. Good intraobserver (k = 0.82, total agreement of 90%) and interobserver (k = 0.76, total agreement of 87%) reproducibility for assessment of LV lead position on fluoroscopy was observed. LV lead position was concordant in 52 patients (58%) and discordant in 38 (42%), as shown in Table 2. No significant differences were observed in demographic, clinical or echocardiographic variables between patients with concordant or discordant LV lead position. In addition, no differences were found for histogram bandwidth and phase SD between the two groups. Patients with concordant and discordant LV lead positions showed no significant differences in perfusion defects located in the LV pacing region (13% vs. 26%, p = NS). Additionally, no differences were found between patients with concordant and discordant LV lead positions in the extent of myocardial perfusion defects (22.9±14.1% vs. 29.3±18.1%, p = NS). The extent of myocardial perfusion defects was significantly smaller in patients with a CRT response than in those without a CRT response (21.1±12.3% vs. 31.6±18.7%, p < 0.05). Furthermore, the percentage of CRT responders was significantly higher among patients with a concordant LV lead position than among those with a discordant LV lead position (79% vs. 26%, p < 0.01). Patient examples with a concordant and a discordant LV lead position are shown in Fig. 2. Of note, 11 patients with a concordant LV lead position showed no response to CRT after 6 months. Of these patients, seven showed severe perfusion defects at the region of LV pacing.Table 2


Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT.

Boogers MJ, Chen J, van Bommel RJ, Borleffs CJ, Dibbets-Schneider P, van der Hiel B, Al Younis I, Schalij MJ, van der Wall EE, Garcia EV, Bax JJ - Eur. J. Nucl. Med. Mol. Imaging (2010)

Area of latest mechanical activation as assessed by phase analysis of GMPS studies. a LV lead positioned at the area of latest activation (concordant LV lead position). The area of latest activation Is located in the lateral segment. The patient showed a significant improvement in LVESV (139 ml vs. 86 ml) and LVEF (32% vs. 44%) after 6 months of CRT. b LV lead positioned outside the area of latest activation (discordant LV lead position). The area of latest activation is located in the anterior segment, whereas the LV lead is positioned in the posterior segment. The patient showed no improvement in LVESV (124 ml vs. 153 ml) or LVEF (27% vs. 22%) after 6 months of CRT
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Fig2: Area of latest mechanical activation as assessed by phase analysis of GMPS studies. a LV lead positioned at the area of latest activation (concordant LV lead position). The area of latest activation Is located in the lateral segment. The patient showed a significant improvement in LVESV (139 ml vs. 86 ml) and LVEF (32% vs. 44%) after 6 months of CRT. b LV lead positioned outside the area of latest activation (discordant LV lead position). The area of latest activation is located in the anterior segment, whereas the LV lead is positioned in the posterior segment. The patient showed no improvement in LVESV (124 ml vs. 153 ml) or LVEF (27% vs. 22%) after 6 months of CRT
Mentions: The mean values of histogram bandwidth and phase SD were 139±77° and 41±21°. The region of latest mechanical activation as assessed with GMPS was located in the posterior (42.2%), lateral (23.3%), inferior (13.3%), anterior (15.6%), anteroseptal (3%) and septal (2.3%) regions. Furthermore, good agreement was found between GMPS and 2-D speckle tracking radial strain analysis for assessment of the site of latest mechanical activation (k = 0.79, total agreement of 86%). Good intraobserver (k = 0.96, total agreement of 93%) and interobserver (k = 0.92, total agreement of 87%) reproducibility of the phase analysis was observed for assessment of the site of latest mechanical activation. CRT device and LV lead implantation were successful in all patients without major complications. The LV pacing lead was positioned in the lateral (44.4% of patients), posterior (50.0% of patients) or anterior (5.6% of patients) regions. Good intraobserver (k = 0.82, total agreement of 90%) and interobserver (k = 0.76, total agreement of 87%) reproducibility for assessment of LV lead position on fluoroscopy was observed. LV lead position was concordant in 52 patients (58%) and discordant in 38 (42%), as shown in Table 2. No significant differences were observed in demographic, clinical or echocardiographic variables between patients with concordant or discordant LV lead position. In addition, no differences were found for histogram bandwidth and phase SD between the two groups. Patients with concordant and discordant LV lead positions showed no significant differences in perfusion defects located in the LV pacing region (13% vs. 26%, p = NS). Additionally, no differences were found between patients with concordant and discordant LV lead positions in the extent of myocardial perfusion defects (22.9±14.1% vs. 29.3±18.1%, p = NS). The extent of myocardial perfusion defects was significantly smaller in patients with a CRT response than in those without a CRT response (21.1±12.3% vs. 31.6±18.7%, p < 0.05). Furthermore, the percentage of CRT responders was significantly higher among patients with a concordant LV lead position than among those with a discordant LV lead position (79% vs. 26%, p < 0.01). Patient examples with a concordant and a discordant LV lead position are shown in Fig. 2. Of note, 11 patients with a concordant LV lead position showed no response to CRT after 6 months. Of these patients, seven showed severe perfusion defects at the region of LV pacing.Table 2

Bottom Line: CRT response was defined as a decrease of ≥15% in LVESV.After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables.Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. j.m.j.boogers@lumc.nl

ABSTRACT

Purpose: The aim of the current study was to evaluate the relationship between the site of latest mechanical activation as assessed with gated myocardial perfusion SPECT (GMPS), left ventricular (LV) lead position and response to cardiac resynchronization therapy (CRT).

Methods: The patient population consisted of consecutive patients with advanced heart failure in whom CRT was currently indicated. Before implantation, 2-D echocardiography and GMPS were performed. The echocardiography was performed to assess LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF). The site of latest mechanical activation was assessed by phase analysis of GMPS studies and related to LV lead position on fluoroscopy. Echocardiography was repeated after 6 months of CRT. CRT response was defined as a decrease of ≥15% in LVESV.

Results: Enrolled in the study were 90 patients (72% men, 67±10 years) with advanced heart failure. In 52 patients (58%), the LV lead was positioned at the site of latest mechanical activation (concordant), and in 38 patients (42%) the LV lead was positioned outside the site of latest mechanical activation (discordant). CRT response was significantly more often documented in patients with a concordant LV lead position than in patients with a discordant LV lead position (79% vs. 26%, p<0.01). After 6 months, patients with a concordant LV lead position showed significant improvement in LVEF, LVESV and LVEDV (p<0.05), whereas patients with a discordant LV lead position showed no significant improvement in these variables.

Conclusion: Patients with a concordant LV lead position showed significant improvement in LV volumes and LV systolic function, whereas patients with a discordant LV lead position showed no significant improvements.

Show MeSH
Related in: MedlinePlus