Viability Test in Prediction of Response to Cardiac Resynchronization Therapy.
Isidora Grozdic Milojevic1,2, Nikola N Radovanovic2,3, Jelena Petrovic1,2
1Center for Nuclear Medicine and PET, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Journal of Clinical Medicine
|August 14, 2025
Summary
Nuclear imaging parameters, specifically myocardial scar size, effectively predict cardiac resynchronization therapy (CRT) response and survival in ischemic heart failure patients. A scar burden under 19.5% indicates suitability for CRT and better outcomes.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Ischemic heart failure (HF) patients often require cardiac resynchronization therapy (CRT).
- Predicting CRT response and long-term outcomes in these patients remains challenging.
- Myocardial scar burden and distribution may influence CRT efficacy.
Purpose of the Study:
- To evaluate myocardial scar burden and distribution using SPECT MPI.
- To assess the predictive value of SPECT MPI parameters for CRT response.
- To determine the relationship between scar characteristics and long-term survival in ischemic HF patients undergoing CRT.
Main Methods:
- Prospective inclusion of 71 ischemic HF patients indicated for CRT.
- Pre-CRT SPECT MPI for myocardial scar assessment.
- Echocardiography before and 6 months after CRT implantation.
- 5-year telephone follow-up for survival assessment.
Main Results:
- SPECT MPI showed significant myocardial scar burden (44.53 ± 20.94%) and high summed rest scores (SRS).
- 35% of patients were CRT responders at 6 months.
- Lower SRS and smaller myocardial scar size (<19.5%) were significant predictors of CRT response (AUC 0.853).
Conclusions:
- SPECT MPI parameters, particularly myocardial scar size, are valuable predictors of CRT response.
- A myocardial scar size <19.5% is associated with better CRT response and improved cardiovascular survival.
- SPECT MPI can aid in patient selection for CRT in ischemic HF.
