Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization Therapy
Abstract Background: Approximately 20 to 40% of patients with heart failure do not respond to cardiac resynchronization therapy (CRT). To improve patient selection, phase analysis by myocardial perfusion scintigraphy (GSPECT) was developed. Objectives: To evaluate the clinical and scintigraphic response of patients with heart failure (HF) submitted to CRT using GSPECT. Method: This was an interventional study that included consecutive patients assessed by GSPECT four weeks prior to CRT implantation and six months after it for comparison. These patients also answered the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The categorical variables were compared using Fisher's exact test and chi-square test, whereas Student's t-test was used for numerical variables. The level of statistical significance was set at 5%. The scintigraphic variables analyzed were left ventricular ejection fraction, end-systolic volume, end-diastolic volume, left ventricular mass, standard deviation and bandwidth, as well as QRS duration and the Minnesota Quality of Life Questionnaire score. The presence of mechanical dyssynchrony was defined as standard deviation > 43º. Results: Nine patients were included in the study. After the cardiac resynchronization therapy, there was a significant improvement (p < 0.05) in the end-systolic volume (206 ± 80 mL vs. 158 ± 108 mL), QRS (180 ± 18 ms vs. 120 ± 9 ms), left ventricular mass (248 ± 65 g vs. 193 ± 52 g) and Minnesota Quality of Life Questionnaire score (63 ± 16 vs. 34 ± 20). All patients with scintigraphic criteria of mechanical dyssynchrony showed clinical improvement. Two patients had only electrical dyssynchrony and did not achieve significant clinical improvement, although they showed QRS duration reduction. Conclusion: GSPECT was able to differentiate patients with isolated electrical dyssynchrony from those with associated mechanical dyssynchrony, through the intraventricular dyssynchrony parameters. The cardiac resynchronization therapy is associated with the improvement of both mechanical and electrical dyssynchrony. Pre-implantation GSPECT showed that patients with associated electrical and mechanical dyssynchrony had a better response to cardiac resynchronization therapy than those with isolated electrical dyssynchrony.
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Sociedade Brasileira de Cardiologia
2018
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oai:scielo:S2359-564720180003002642018-05-29Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization TherapyWiefels,Christiane CigagnaNascimento,Erivelton Alessandro doAlves,Christiane RodriguesRibeiro,Fernanda BaptistaFernandes,Fernando de AmorimRibeiro,Mario LuizMesquita,Claudio Tinoco Heart Failure Cardiac Resynchronization Therapy Myocardial Perfusion Imaging / scintigraphy Stroke Volume Artery Coronary Disease / physiopathology Myocardial Infarction Abstract Background: Approximately 20 to 40% of patients with heart failure do not respond to cardiac resynchronization therapy (CRT). To improve patient selection, phase analysis by myocardial perfusion scintigraphy (GSPECT) was developed. Objectives: To evaluate the clinical and scintigraphic response of patients with heart failure (HF) submitted to CRT using GSPECT. Method: This was an interventional study that included consecutive patients assessed by GSPECT four weeks prior to CRT implantation and six months after it for comparison. These patients also answered the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The categorical variables were compared using Fisher's exact test and chi-square test, whereas Student's t-test was used for numerical variables. The level of statistical significance was set at 5%. The scintigraphic variables analyzed were left ventricular ejection fraction, end-systolic volume, end-diastolic volume, left ventricular mass, standard deviation and bandwidth, as well as QRS duration and the Minnesota Quality of Life Questionnaire score. The presence of mechanical dyssynchrony was defined as standard deviation > 43º. Results: Nine patients were included in the study. After the cardiac resynchronization therapy, there was a significant improvement (p < 0.05) in the end-systolic volume (206 ± 80 mL vs. 158 ± 108 mL), QRS (180 ± 18 ms vs. 120 ± 9 ms), left ventricular mass (248 ± 65 g vs. 193 ± 52 g) and Minnesota Quality of Life Questionnaire score (63 ± 16 vs. 34 ± 20). All patients with scintigraphic criteria of mechanical dyssynchrony showed clinical improvement. Two patients had only electrical dyssynchrony and did not achieve significant clinical improvement, although they showed QRS duration reduction. Conclusion: GSPECT was able to differentiate patients with isolated electrical dyssynchrony from those with associated mechanical dyssynchrony, through the intraventricular dyssynchrony parameters. The cardiac resynchronization therapy is associated with the improvement of both mechanical and electrical dyssynchrony. Pre-implantation GSPECT showed that patients with associated electrical and mechanical dyssynchrony had a better response to cardiac resynchronization therapy than those with isolated electrical dyssynchrony.info:eu-repo/semantics/openAccessSociedade Brasileira de CardiologiaInternational Journal of Cardiovascular Sciences v.31 n.3 20182018-05-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000300264en10.5935/2359-4802.20180022 |
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Wiefels,Christiane Cigagna Nascimento,Erivelton Alessandro do Alves,Christiane Rodrigues Ribeiro,Fernanda Baptista Fernandes,Fernando de Amorim Ribeiro,Mario Luiz Mesquita,Claudio Tinoco |
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Wiefels,Christiane Cigagna Nascimento,Erivelton Alessandro do Alves,Christiane Rodrigues Ribeiro,Fernanda Baptista Fernandes,Fernando de Amorim Ribeiro,Mario Luiz Mesquita,Claudio Tinoco Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization Therapy |
author_facet |
Wiefels,Christiane Cigagna Nascimento,Erivelton Alessandro do Alves,Christiane Rodrigues Ribeiro,Fernanda Baptista Fernandes,Fernando de Amorim Ribeiro,Mario Luiz Mesquita,Claudio Tinoco |
author_sort |
Wiefels,Christiane Cigagna |
title |
Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization Therapy |
title_short |
Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization Therapy |
title_full |
Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization Therapy |
title_fullStr |
Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization Therapy |
title_full_unstemmed |
Use of GATED-SPECT for Ventricular Desynchronization Evaluation in Patients with Heart Failure Submitted to Cardiac Resynchronization Therapy |
title_sort |
use of gated-spect for ventricular desynchronization evaluation in patients with heart failure submitted to cardiac resynchronization therapy |
description |
Abstract Background: Approximately 20 to 40% of patients with heart failure do not respond to cardiac resynchronization therapy (CRT). To improve patient selection, phase analysis by myocardial perfusion scintigraphy (GSPECT) was developed. Objectives: To evaluate the clinical and scintigraphic response of patients with heart failure (HF) submitted to CRT using GSPECT. Method: This was an interventional study that included consecutive patients assessed by GSPECT four weeks prior to CRT implantation and six months after it for comparison. These patients also answered the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The categorical variables were compared using Fisher's exact test and chi-square test, whereas Student's t-test was used for numerical variables. The level of statistical significance was set at 5%. The scintigraphic variables analyzed were left ventricular ejection fraction, end-systolic volume, end-diastolic volume, left ventricular mass, standard deviation and bandwidth, as well as QRS duration and the Minnesota Quality of Life Questionnaire score. The presence of mechanical dyssynchrony was defined as standard deviation > 43º. Results: Nine patients were included in the study. After the cardiac resynchronization therapy, there was a significant improvement (p < 0.05) in the end-systolic volume (206 ± 80 mL vs. 158 ± 108 mL), QRS (180 ± 18 ms vs. 120 ± 9 ms), left ventricular mass (248 ± 65 g vs. 193 ± 52 g) and Minnesota Quality of Life Questionnaire score (63 ± 16 vs. 34 ± 20). All patients with scintigraphic criteria of mechanical dyssynchrony showed clinical improvement. Two patients had only electrical dyssynchrony and did not achieve significant clinical improvement, although they showed QRS duration reduction. Conclusion: GSPECT was able to differentiate patients with isolated electrical dyssynchrony from those with associated mechanical dyssynchrony, through the intraventricular dyssynchrony parameters. The cardiac resynchronization therapy is associated with the improvement of both mechanical and electrical dyssynchrony. Pre-implantation GSPECT showed that patients with associated electrical and mechanical dyssynchrony had a better response to cardiac resynchronization therapy than those with isolated electrical dyssynchrony. |
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Sociedade Brasileira de Cardiologia |
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2018 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472018000300264 |
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