Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling

Nascimento, Erivelton Alessandro do; Fernandes, Fernando de Amorim; Mira, Pedro Augusto Carvalho; He, Zhuo; Zhou, Weihua; Mesquita, Claudio Tinoco

Erivelton Alessandro do Nascimento

Conception and design of the research

Acquisition of data and Critical revision of the manuscript for important intellectual content

Analysis and interpretation of the data

Statistical analysis

Writing of the manuscript

Universidade Federal Fluminense – Serviço de Cardiologia, Hospital Universitário Antônio Pedro e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brasil

Instituto Estadual de Cardiologia Aloysio de Castro – Departamento de Arritmias Cardíacas, Rio de Janeiro, RJ – Brazil

https://orcid.org/0000-0001-8260-6572

Fernando de Amorim Fernandes

Acquisition of data and Critical revision of the manuscript for important intellectual content

Analysis and interpretation of the data

Universidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brazil

Pedro Augusto Carvalho Mira

Statistical analysis

Universidade Federal Fluminense – Laboratório de Ciências do Exercício, Niterói, RJ – Brazil

https://orcid.org/0000-0003-1511-2681

Zhuo He

Analysis and interpretation of the data

Writing of the manuscript

Department of Applied Computing, Michigan Technological University, Houghton – MI – USA

Weihua Zhou

Analysis and interpretation of the data

Department of Applied Computing, Michigan Technological University, Houghton – MI – USA

Claudio Tinoco Mesquita

Conception and design of the research

Acquisition of data and Critical revision of the manuscript for important intellectual content

Analysis and interpretation of the data

Statistical analysis

Writing of the manuscript

Universidade Federal Fluminense – Departamento de Radiologia – Universidade Federal Fluminense e Pós-Graduação em Ciências Cardiovasculares, Niterói, RJ – Brazil

https://orcid.org/0000-0002-1466-9413

Mailing Address: Erivelton Alessandro do Nascimento • Universidade Federal Fluminense – Cardiologia – Rua Marques Paraná, 303. Postal Code 24220-900, Niterói, RJ – Brazil E-mail: hpcrates7@gmail.com, erivelton.nascimento@ebserh.gov.br

Potential conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures (5)
Tables (2)

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Figure 1
– Quality of life pre- and post-cardiac resynchronization therapy (CRT). a.u: absolute unit.

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Figure 2
– Box plot and individual data depicting comparisons between pre- and post-CRT (panels A and C) considering whether CRT left ventricle lead position was adjacent, concordant, or discordant (panels B and D). Box plot shows the median (horizontal line within the box), minimum, 25th – 75th percentiles, and maximum. CRT: cardiac resynchronization therapy, EDE: end-diastolic eccentricity, ESE: end-systolic eccentricity.

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Figure 3
– Patient who was 64 years old before CRT with heart failure of hypertensive origin and severe LV dysfunction. EF: 14%, EDE: 0.56, ESE: 0.59, ESSi: 0.81, EDSi: 0.83, LVESV: 175 ml, LV mass: 191 g. CRT: cardiac resynchronization therapy, EDE: end-diastolic eccentricity, EDSi: end-diastolic shape index, EF: ejection fraction, ESE: end-systolic eccentricity, ESSi: end-systolic shape index, LV: left ventricular, LVESV: left ventricular end-systolic volume.

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Figure 4
– Fluoroscopy during device implantation (CRT-ICD). The left image shows venography of the coronary sinus and its tributaries and polar map. The right image shows the final positioning of the shock electrodes (right ventricular), right atrium and left ventricle lead in concordant segment, positioned in the coronary sinus.

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Figure 5
– The patient shown in , after CRT showing super-response. EF: 57%, ESE: 0.84, EDE: 0.80, ESSi: 0.54 EDSi: 0.6, LVESV: 28 ml, LV mass: 90 g. CRT: cardiac resynchronization therapy, EDE: end-diastolic eccentricity, EDSi: end-diastolic shape index, EF: ejection fraction, ESE: end-systolic eccentricity, ESSi: end-systolic shape index, LV: left ventricular, LVESV: left ventricular end-systolic volume.

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Table 1
– Participants’ characteristics

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Table 2
– Electrocardiogram and SPECT variables

Variables	Patients (n = 18)
Age (years)	65 ± 7
Height (m)	1.36 ± 0.09
Weight (kg)	70.65 ± 16.45
Coronary artery disease. n (%)	8 (44.4)
Diabetes. n (%)	7 (38.9)
Race. n (%)
White	5 (27.8)
Black	9 (50.0)
Others	4 (22.2)

Variables	Pre-CRT	Post-CRT	p
QRS duration (ms)	194.83 ± 23.68	119.78 ± 11.65	< 0.001
PR interval (ms)	190.0 (167.5 – 210.0)	90.0 (90.0 – 100.0)	< 0.001
EDVi (ml/m²)	202.5 (175.0 – 281.75)	164.0 (110.0 – 277.0)	0.058
ESVi (ml/m²)	165.5 (124.0 – 209.25)	108.0 (61.5 – 242.75)	0.157
EDSi	0.87 ± 0.11	0.76 ± 0.14	0.001
ESSi	0.80 ± 0.08	0.71 ± 0.12	0.004
LVEF (%)	28.11 ± 5.93	40.94 ± 11.09	0.001
EDE	0.5 ± 0.1	0.6 ± 0.2	0.040
ESE	0.6 ± 0.1	0.7 ± 0.1	0.041
SV (ml)	66.50 (54.75 – 83.75)	51.00 (48.75 – 61.00)	0.002
PBW (degree)	58.5 (39.5 – 108.3)	68 (65 – 72.25)	0.777
PSD (degree)	23.5 (13.4 – 43.1)	21.1 (20.0 – 26.6)	0.372
SPECT phase peak	120.33 ± 34.25	118.22 ± 28.19	0.836
SPECT phase skewness	3.00 (2.86 – 3.37)	2.95 (2.33 – 3.45)	0.231
SPECT phase kurtosis	10.61 (8.05 – 14.42)	8.76 (5.83 – 17.50)	0.586
Myocardial mass (g)	207.5 (185.0 – 262.5)	143.5 (137.25 – 208.25)	0.004

[1] Mailing Address: Erivelton Alessandro do Nascimento • Universidade Federal Fluminense – Cardiologia – Rua Marques Paraná, 303. Postal Code 24220-900, Niterói, RJ – Brazil E-mail: hpcrates7@gmail.com, erivelton.nascimento@ebserh.gov.br

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Feasibility of Left Ventricle Lead Implantation in Cardiac Resynchronization Therapy Guided by Gated SPECT and Ventricular Remodeling

Abstract

Background

Objective

Methods

Results

Conclusions