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Updated: Aug 26, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Myocardial perfusion imaging using gated SPECT in heart failure patients undergoing cardiac resynchronization therapy
Roberto Sciagrà1, Marzia Giaccardi, Maria Cristina Porciani
1Nuclear Medicine, Department of Clinical Physiopathology, University of Florence, Viale Morgagni 85, 50134 Florence, Italy. r.sciagra@dfc.unifi.it
Insights
Perfusion gated SPECT can identify patients who will benefit from cardiac resynchronization therapy (CRT). Patients with severe perfusion defects showed clinical improvement but no significant change in left ventricular function after CRT.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Cardiac resynchronization therapy (CRT) is indicated for symptomatic heart failure patients with left bundle branch block despite optimal medical therapy.
- The impact of baseline perfusion patterns on CRT hemodynamic response requires further investigation.
Purpose of the Study:
- To evaluate the utility of perfusion gated SPECT for assessing candidates for CRT.
- To assess the role of perfusion gated SPECT in the follow-up of CRT patients.
Main Methods:
- Gated SPECT imaging was performed before and 3 months after CRT in 20 patients.
- Left ventricular ejection fraction (LVEF), volumes (LVEDVI, LVESVI), and wall motion score index (WMSI) were measured.
- Clinical outcomes, including New York Heart Association class and quality of life, were compared with imaging findings.
Main Results:
- Nineteen patients completed follow-up; 1 died.
- Patients were grouped by baseline perfusion defects (Group A) or absence thereof (Group B).
- Both groups showed clinical improvement; Group B demonstrated significant increases in LVEF and reductions in LV volumes, unlike Group A.
Conclusions:
- Perfusion gated SPECT is valuable for characterizing and monitoring CRT candidates.
- Patients with severe resting perfusion defects may experience clinical benefits but not significant improvements in LVEF or LV volumes post-CRT.
Unlabelled:
Cardiac resynchronization therapy (CRT) by biventricular pacing is indicated in patients with severe heart failure and left bundle branch block who remain symptomatic despite optimal medical therapy. The relationship between baseline resting perfusion pattern and hemodynamic response to CRT has not been fully investigated. We tested the usefulness of perfusion gated SPECT for baseline evaluation and follow-up of these patients.
Methods:
In 20 patients, we performed gated SPECT before CRT and at the 3-mo follow up. Left ventricular (LV) ejection fraction (EF), end-diastolic (ED) and end-systolic (ES) volume indexes (VI), and wall motion score index (WMSI) were measured and compared with clinical outcome.
Results:
One patient died before follow-up. The 19 remaining patients were classified into 1 of 2 groups according to the presence (group A) or absence (group B) of a significant severe perfusion defect at baseline before CRT. At the 3-mo follow-up, 6 of 10 group A and 8 of 9 group B patients had an improvement in New York Heart Association class. In both groups, quality of life, 6-min walking distance, and WMSI significantly improved. In group A, no significant change was registered in LVEF, LVEDVI, or LVESVI. In group B, LVEF increased from 23.1% +/- 8% to 27.1% +/- 11% (P < 0.03) and LVEDVI and LVESVI decreased from 159 +/- 70 mL to 135 +/- 68 mL (P < 0.02) and from 127 +/- 67 mL to 104 +/- 65 mL (P < 0.01), respectively.
Conclusion:
Perfusion gated SPECT appears useful to characterize and follow up candidates for CRT. Despite clinical improvement, patients with severe resting perfusion defects do not show significant improvement in LVEF or reduction in LV volumes.
