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Sites of latest mechanical activation as assessed by SPECT myocardial perfusion imaging in ischemic and dilated cardiomyopathy patients with LBBB

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Objective

Sites of latest mechanical activation (SOLA) have been recognized as optimal left-ventricular (LV) lead positions for cardiac resynchronization therapy (CRT). This study was aimed to investigate SOLA in ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM) patients with left bundle branch block (LBBB).

Methods

Sixty-four consecutive LBBB patients (47 DCM, 17 ICM), who met the standard indications for CRT and underwent resting SPECT myocardial perfusion imaging (MPI), were selected. Phase analysis was used to assess LV dyssynchrony and SOLA. The Emory Cardiac Toolbox was used to measure perfusion defects. LV dyssynchrony and SOLA were compared between the DCM patients with wide (≥150 ms) and moderate (120-150 ms) QRS durations (QRSd). The relationship between SOLA and perfusion defects was analyzed in the ICM patients.

Results

The DCM patients with wide QRSd had significantly more LV dyssynchrony than those with moderate QRSd. Lateral SOLA were significantly more frequent in the DCM patients with wide QRSd than those with moderate QRSd (96 % vs. 62 %, p = 0.010). In the ICM patients, SOLA were either in the scar segments (82 %) or in the segments immediately adjacent to the scar segments (18 %), regardless of QRSd.

Conclusion

Lateral SOLA were more frequent in the DCM patients with wide QRSd than those with moderate QRSd. Such relationship was not observed in the ICM patients, where SOLA were associated with scar location rather than QRSd. These findings support the use of SPECT MPI to aid the selection of potential CRT responders and guide LV lead placement.

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Acknowledgment

This study was supported in part by a US NIH grant (1R01HL094438, PI: Ji Chen, PhD).

Conflicts of interest

Dr. Chen receives royalties from the sale of the Emory Cardiac Toolbox with SyncTool. The terms of this arrangement have been approved by Emory University in accordance with its conflict-of-interest practice.

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Authors and Affiliations

  1. Department of Cardiology, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, China

    Xianhe Lin

  2. Department of Nuclear Medicine, Anhui Medical University, 218 Jixi Road, Hefei, Anhui, 230022, China

    Huiqin Xu & Xuefeng Zhao

  3. Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, 30322, USA

    Ji Chen

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  1. Xianhe Lin
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Correspondence to Ji Chen.

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Lin, X., Xu, H., Zhao, X. et al. Sites of latest mechanical activation as assessed by SPECT myocardial perfusion imaging in ischemic and dilated cardiomyopathy patients with LBBB. Eur J Nucl Med Mol Imaging 41, 1232–1239 (2014). https://doi.org/10.1007/s00259-014-2718-6

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  • DOI: https://doi.org/10.1007/s00259-014-2718-6

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