Baseline myocardial perfusion predicts response to cardiac resynchronization therapy: a prospective observational study.
OBJECTIVE
We prospectively determined whether preimplant myocardial perfusion imaging (MPI) predicts outcome with biventricular pacing (BiVP).


METHODS
Single-photon emission computed tomography (SPECT) MPI, left ventricular (LV) volumes, ejection fraction (EF), 6-min hall walk (6MW) were assessed at baseline and at 4 months in 19 patients with ischemic cardiomyopathy undergoing BiVP. Clinical and hemodynamic responses were correlated with MPI.


RESULTS
Lower global myocardial scar burden predicted hemodynamic response to BiVP, while higher burden was associated with poor response. Clinical improvement with BiVP occurred in 12 (63%) of the patients. Clinical BiVP responders had lower rest/stress MPI score difference. There was a close negative correlation between MPI reversibility and increased 6MW distance.


CONCLUSIONS
Baseline MPI is associated with clinical and hemodynamic response to BiVP: greater myocardial scar burden is predictive of poor hemodynamic response, while higher ischemic burden is predictive of poor clinical response. There is a differential response to BiVP by clinical and hemodynamic criteria.
Orlov
Michael V
MV
Caritas St. Elizabeth's Medical Center, 736 Cambridge Street, Boston, MA, 02135, USA, mvorlov@gmail.com
Maysky
Michael
M
Akrivakis
Spyridon T
ST
Ujhelyi
Michael R
MR
Hoffmeister
Peter
P
Shukla
Gunjan
G
McAllister
Susan
S
Kotler
Gregory
G
Almasry
Ibrahim
I
Chaudhry
G Muqtada
GM
Haffajee
Charles I
CI
D000368:Aged; D002304:Cardiac Pacing, Artificial; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life; D019275:Radiopharmaceuticals; D018709:Statistics, Nonparametric; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi