title: Perfusion and metabolic scintigraphy with (123)I-BMIPP in prognosis of cardiac resynchronization therapy in patients with dilated cardiomyopathy.
abstract: OBJECTIVE
  The objective of the study was to investigate the left ventricular (LV) myocardial perfusion and metabolism in patients with idiopathic dilated cardiomyopathy (DCM) and to identify the scintigraphic predictors of the efficacy of cardiac resynchronization therapy (CRT).
  
  
  METHODS
  The study comprised 63 patients with DCM and severe heart failure (NYHA class III-IV). Before CRT, all patients received gamma-scintigraphy with (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) and with (123)I-β-methyl-iodophenyl pentadecanoic acid ((123)I-BMIPP) for evaluation of myocardial perfusion and metabolism, respectively. Before and after 6 months of CRT, all patients underwent echocardiography study to assess cardiac hemodynamics.
  
  
  RESULTS
  After 6 months of CRT, patients were divided into two groups: group 1 comprised responders in whom LV end systolic volume (LVESV) decreased by ≥15 % (n = 39); group 2 comprised non-responders in whom LVESV decreased by <15 % (n = 24). Before CRT, LV pumping function did not significantly differ between groups. Significant differences were found in the following preoperative scintigraphic parameters: myocardial perfusion defect size [7.4 % (5.9; 13.2) % and 11.8 (8.8; 16.2) %, p < 0.05] and metabolic defect size [7.4 (4.4; 14.7) % and 8.8 (8.8; 17.6) %, p < 0.05]. Metabolic scintigraphy showed greater diagnostic efficacy in determining the indications for CRT compared with perfusion scintigraphy [areas under the ROC curves (AUC) of 0.722 and 0.612, respectively]. The best metabolic defect size threshold value of 7.35 % predicted CRT efficacy with the sensitivity and specificity rates of 77.8 and 66.7 %, respectively.
  
  
  CONCLUSIONS
  Data of metabolic scintigraphy may be useful for the integrated prediction of CRT efficacy.
authors.affiliation: Department of Nuclear Medicine, Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Kievskaya str., 111a, 634012, Tomsk, Russian Federation. konstzav@gmail.com.|National Research Tomsk Polytechnic University, Lenina Avenue, 30, 634050, Tomsk, Russian Federation. konstzav@gmail.com.
authors.forename: Konstantin V
authors.initials: KV
authors.lastname: Zavadovsky
authors.affiliation: Department of Nuclear Medicine, Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Kievskaya str., 111a, 634012, Tomsk, Russian Federation.|National Research Tomsk Polytechnic University, Lenina Avenue, 30, 634050, Tomsk, Russian Federation.
authors.forename: Marina O
authors.initials: MO
authors.lastname: Gulya
authors.affiliation: Department of Nuclear Medicine, Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Kievskaya str., 111a, 634012, Tomsk, Russian Federation.|National Research Tomsk Polytechnic University, Lenina Avenue, 30, 634050, Tomsk, Russian Federation.
authors.forename: Yuri B
authors.initials: YB
authors.lastname: Lishmanov
authors.affiliation: Department of Nuclear Medicine, Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Kievskaya str., 111a, 634012, Tomsk, Russian Federation.|Department of Surgical Treatment of Arrhythmias, Federal State Budgetary Scientific Institution, Research Institute for Cardiology, Kievskaya str., 111a, 634012, Tomsk, Russian Federation.
authors.forename: Denis I
authors.initials: DI
authors.lastname: Lebedev
mesh_terms: D058406:Cardiac Resynchronization Therapy; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D005227:Fatty Acids; D005260:Female; D006801:Humans; D007462:Iodobenzenes; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000378:metabolism
chemical_list: D005227:Fatty Acids; D007462:Iodobenzenes; C049338:iodofiltic acid
keywords: Cardiac resynchronization therapy; Dilated cardiomyopathy; Myocardial scintigraphy