title: Impact of cardiac reverse remodeling after cardiac resynchronization therapy assessed by myocardial perfusion imaging on ventricular arrhythmia.
abstract: Although cardiac resynchronization therapy (CRT) has been a useful treatment of heart failure, patients with CRT are still in risk of sudden cardiac death due to ventricular arrhythmia. The aim of this study was to investigate the impact of cardiac reverse remodeling after CRT on the prevalence of ventricular tachycardia or fibrillation (VT/VF).
  
  
  
  Forty-one heart failure patients (26 men, age 66 ± 10 years), who were implanted with CRT for at least 12 months, were enrolled. All patients received myocardial perfusion imaging (MPI) under CRT pacing to evaluate left ventricle (LV) function, dyssynchrony, and scar. VT/VF episodes during the follow-up period after MPI were recorded by the CRT devices. Sixteen patients (N = 16/41, 39%) were found to have VT/VF. Multivariate Cox regression analysis and receiver operating characteristic curve analysis showed that five risk factors were significant predictors of VT/VF, including increased left ventricle ejection fraction (LVEF) by ≤7% after CRT, low LVEF after CRT (≤30%), change of intrinsic QRS duration (iQRSd) by ≤7 ms, wide iQRSd after CRT (≥121 ms), and high systolic dyssynchrony after CRT (phase standard deviation ≥45.6°). For those patients with all of the 5 risk factors, 85.7% or more developed VT/VF.
  
  
  
  The characteristics of cardiac reverse remodeling after CRT as assessed by MPI are associated with the prevalence of ventricular arrhythmia.
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
authors.forename: Kuo-Feng
authors.initials: KF
authors.lastname: Chiang
authors.affiliation: Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.|Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan.
authors.forename: Guang-Uei
authors.initials: GU
authors.lastname: Hung
authors.affiliation: Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Tsai
authors.affiliation: Division of Cardiology, Department of Medicine, Department of Health of Executive Yuan, Fong Yuan Hospital, Taichung, Taiwan.
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Cheng
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Wan-Yu
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Yu-Cheng
authors.initials: YC
authors.lastname: Hsieh
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tsu-Juey
authors.initials: TJ
authors.lastname: Wu
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Divisions of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan.
authors.forename: Shih-Ann
authors.initials: SA
authors.lastname: Chen
authors.affiliation: Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan. golden@vghtc.gov.tw.|School of Medicine, National Yang-Ming University, Taipei, Taiwan. golden@vghtc.gov.tw.
authors.forename: Jin-Long
authors.initials: JL
authors.lastname: Huang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan. starr0813@gmail.com.|Division of Cardiology, Department of Medicine, Buddhist Tzu-Chi General Hospital, Taichung Branch, 6688, Fung Hing Rd Sect 1, Tanzi District, Taichung, 427, Taiwan. starr0813@gmail.com.
authors.forename: Ying-Chieh
authors.initials: YC
authors.lastname: Liao
authors.affiliation: Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
authors.forename: Ji
authors.initials: J
authors.lastname: Chen
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
keywords: Heart failure; cardiac resynchronization therapy; phase analysis; reverse remodeling