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Published on: December 11, 2017
Extent of viability to predict response to cardiac resynchronization therapy in ischemic heart failure patients
Claudia Ypenburg1, Martin J Schalij, Gabe B Bleeker
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Assessing myocardial viability using 18F-FDG SPECT can predict response to cardiac resynchronization therapy (CRT). A higher extent of viability, specifically 11 or more viable segments, indicates a greater likelihood of positive outcomes in patients with ischemic heart failure.
Area of Science:
- Cardiology
- Nuclear Medicine
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) response varies significantly.
- Myocardial viability may be a key factor influencing CRT outcomes.
Purpose of the Study:
- To determine if the extent of myocardial viability predicts response to CRT.
- To evaluate the predictive value of myocardial viability for CRT efficacy after 6 months.
Main Methods:
- Included 61 patients with advanced heart failure, LVEF < 35%, QRS duration > 120 ms, and coronary artery disease.
- Assessed myocardial viability using 18F-FDG SPECT prior to CRT implantation.
- Evaluated clinical and echocardiographic parameters at baseline and 6-month follow-up.
Main Results:
- Myocardial viability correlated with increased left ventricular ejection fraction post-CRT.
- Responders had significantly more viable segments (12 ± 3) than non-responders (7 ± 3).
- An extent of ≥11 viable segments predicted CRT response with 74% sensitivity and 87% specificity.
Conclusions:
- Myocardial viability is directly linked to CRT response in ischemic heart failure.
- The extent of viability, particularly ≥11 segments, can predict CRT response.
- Evaluating myocardial viability should be considered in CRT patient selection.
Unlabelled:
The response to cardiac resynchronization therapy (CRT) varies significantly among individuals. Preliminary data suggest that the presence of myocardial viability may be important for response to CRT. The aim of this study was to evaluate whether the extent of viability could predict response to CRT after 6 mo.
Methods:
Sixty-one consecutive patients with advanced heart failure, left ventricular ejection fraction < 35%, QRS duration > 120 ms, and chronic coronary artery disease were included. To determine the extent of viability all patients underwent nuclear imaging with 18F-FDG SPECT before implantation. Clinical and echocardiographic parameters were assessed at baseline and after 6 mo of follow-up.
Results:
The presence of myocardial viability was directly related to an increase in left ventricular ejection fraction after 6 mo of CRT. Furthermore, the extent of viability in responders (n = 38) was significantly larger compared with that of nonresponders (n = 23; 12 +/- 3 vs. 7 +/- 3 viable segments, P < 0.01). Moreover, the optimal cutoff value to predict clinical response to CRT was identified at an extent of 11 viable segments or more (in a 17-segment model), yielding a sensitivity of 74% and a specificity of 87%.
Conclusion:
The presence of myocardial viability is directly related to response to CRT in patients with ischemic heart failure. Interestingly, using a cutoff level of 11 viable segments or more, the extent of viability could be used to predict response. Therefore, evaluation for myocardial viability may be considered in the selection process for CRT.
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