Pulmonary perfusion and NYHA classification improve after cardiac resynchronization therapy
Mariam Al-Mashat1, Rasmus Borgquist2, Marcus Carlsson1
1Clinical Physiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Entrégatan 7, 22185, Lund, Sweden.
Summary
Ventilation/perfusion single-photon emission computed tomography (V/P SPECT) perfusion gradients show promise for assessing cardiac resynchronization therapy (CRT) response in heart failure (HF) patients, correlating better with symptom improvement than echocardiography.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Cardiac resynchronization therapy (CRT) evaluation commonly uses New York Heart Association (NYHA) classification and echocardiography, but these methods have limitations.
- Perfusion gradients from ventilation/perfusion single-photon emission computed tomography (V/P SPECT) correlate with left-heart filling pressures and are validated against invasive methods.
- Assessing CRT response in heart failure (HF) patients requires reliable diagnostic tools.
Purpose of the Study:
- To determine if changes in V/P SPECT perfusion gradients correlate with improved HF symptoms after CRT.
- To evaluate the association between perfusion gradients and established diagnostic methods for CRT follow-up.
- To compare the efficacy of V/P SPECT perfusion gradients versus echocardiography in assessing CRT response.
Main Methods:
- Nineteen HF patients underwent V/P SPECT, echocardiography, NYHA classification, and Minnesota Living with Heart Failure (MLWHF) quality-of-life scoring before and after CRT.
- Changes in V/P SPECT perfusion gradients and echocardiographic left ventricular end-systolic volume (LVESV) were analyzed.
- Correlation between these measures and NYHA classification and MLWHF scores was assessed.
Main Results:
- CRT improved V/P SPECT perfusion gradients, which were associated with improved NYHA classification (P = .0456).
- Improvements in echocardiographic LVESV did not correlate with NYHA classification improvements.
- A higher proportion of patients improved based on perfusion gradients (68%) compared to LVESV (37%) after CRT.
Conclusions:
- Perfusion gradients from V/P SPECT offer a promising, quantitative, and user-independent surrogate for assessing left-sided filling pressure in CRT response evaluation.
- V/P SPECT may provide a more sensitive measure of CRT effectiveness than traditional echocardiographic parameters.
- This technique aids in the follow-up of heart failure patients undergoing CRT.
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