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Use of left ventricular pacing in heart failure: evaluation by gated blood pool imaging
C Le Rest1, O Couturier, A Turzo
1Department of Nuclear Medicine, University Hospital Cavale Blanche, Brest, France.
Insights
Left ventricular (LV) pacing improved heart failure symptoms by enhancing synchronization. A reduced interventricular phase shift was key to functional recovery in patients receiving LV pacing.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Heart failure management often requires complementary therapies.
- Left ventricular (LV) pacing is a potential therapeutic option for heart failure patients.
Purpose of the Study:
- To evaluate the impact of LV pacing on heart failure patients.
- To assess changes in cardiac synchronization and clinical outcomes post-LV pacing.
Main Methods:
- Investigated 17 heart failure patients (NYHA class III/IV) with LV pacers.
- Utilized equilibrium-gated blood pool studies for phase analysis before and after pacing.
- Monitored clinical improvement and changes in interventricular phase shift (delta(pi)).
Main Results:
- 12 out of 17 patients reported significant clinical improvement after LV pacing (mean NYHA class decreased from 3.7 to 2.6).
- LV pacing significantly decreased the interventricular phase shift (delta(pi)).
- LV ejection fraction remained unchanged.
Conclusions:
- LV pacing promotes interventricular and intraventricular synchronization in heart failure.
- A decrease in the interventricular phase shift is a critical predictor of functional recovery in paced heart failure patients.
Background:
Left ventricular (LV) pacing has been suggested to complement other forms of therapy in patients with heart failure.
Methods And Results:
We investigated 17 patients (15 men, 2 women, aged 68 +/- 6 years, 10 ischemic and 7 primary dilated cardiomyopathy) with heart failure (13 were in New York Heart Association class IV and 4 in class III). One month after LV pacer implantation, 12 patients reported clinical improvement (mean class 3.7 before pacing vs 2.6 with LV pacing; P = .001). We report the results of 3 equilibrium-gated blood pool studies performed in each patient, 1 before pacing and 2 after pacer implantation (1 with pacing on, and 1 after turning off the pacer). LV pacing did not modify LV ejection fraction. Phase analysis demonstrated a significant decrease of the interventricular phase shift (delta(pi)) with LV pacing (no pacing, delta(pi) = 8.99 degrees +/- 19.05 degrees; delta7n= -0.97 degrees +/- 27.85 degrees with LV pacing). Clinical improvement was observed in patients with an initial positive delta(pi) that decreased with pacing and/or an initial LV phase standard deviation >50 degrees that decreased with pacing.
Conclusion:
LV pacing induces interventricular and intraventricular synchronization. A decrease of the interventricular phase shift seems to be the most important predictor of functional recovery for paced patients with heart failure.