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15.03.2016 | Original Article | Ausgabe 4/2017

Journal of Nuclear Cardiology 4/2017

Impact of cardiac reverse remodeling after cardiac resynchronization therapy assessed by myocardial perfusion imaging on ventricular arrhythmia

Zeitschrift:
Journal of Nuclear Cardiology > Ausgabe 4/2017
Autoren:
MD Kuo-Feng Chiang, MD Guang-Uei Hung, MD Shih-Chung Tsai, MD Chien-Ming Cheng, MD Yu-Cheng Chang, MD Wan-Yu Lin, MD, PhD Yu-Cheng Hsieh, MD, PhD Tsu-Juey Wu, MD Shih-Ann Chen, MD, PhD Jin-Long Huang, MD Ying-Chieh Liao, PhD Ji Chen
Wichtige Hinweise
See related editorial, doi:10.​1007/​s12350-016-0474-7.
Kuo-Feng Chiang and Guang-Uei Hung have equal contributions to this work.

Abstract

Background

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).

Methods and Results

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.

Conclusions

The characteristics of cardiac reverse remodeling after CRT as assessed by MPI are associated with the prevalence of ventricular arrhythmia.

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