A novel approach to the selection of an appropriate pacing position for optimal cardiac resynchronization therapy using CT coronary venography and myocardial perfusion imaging: FIVE STaR method (fusion image using CT coronary venography and perfusion SPECT applied for cardiac resynchronization therapy)

Abstract

Background. Nearly one-third of patients with advanced heart failure (HF) do not benefit from cardiac resynchronization therapy (CRT). We developed a novel approach for optimizing CRT via a simultaneous assessment of the myocardial viability and an appropriate lead position using a fusion technique with CT coronary venography and myocardial perfusion imaging. Methods and Results. The myocardial viability and coronary venous anatomy were evaluated by resting Tc-99m-tetrofosmin myocardial perfusion imaging (MPI) and contrast CT venography, respectively. Using fusion images reconstructed by MPI and CT coronary venography, the pacing site and lead length were determined for appropriate CRT device implantations in 4 HF patients. The efficacy of this method was estimated by the symptomatic and echocardiographic functional parameters. In all patients, fusion images using MPI and CT coronary venograms were successfully reconstructed without any misregistration and contributed to an effective CRT. Before the surgery, this method enabled the operators to precisely identify the optimal indwelling site, which exhibited myocardial viability and had a lead length necessary for an appropriate device implantation. Conclusions. The fusion image technique using myocardial perfusion imaging and CT coronary venography is clinically feasible and promising for CRT optimization and enhancing the patient safety in patients with advanced HF.

Synergistic prognostication of left ventricular hypertrophy and three‐dimensional mechanical dyssynchrony in heart failure

“…Myocardial perfusion abnormality can be evaluated as an aetiology of myocardial injury and LVMD. This is also practically very important for selecting an appropriate pacing site for effective CRT in terms of identification of the regional viable myocardium . The results of this…”

Mechanical Dyssynchrony for Prediction of the Cardiac Resynchronization Therapy Response in Patients with Dilated Cardiomyopathy

“…Оценка прогностической значимости показателей МД ЛЖ, определенных по данным ЭКГ-ПСМ, в прогнозе эффективности РТ у пациентов с ХСН неишемической этиологии. [21,25,[28][29][30].…”

Cardiovascular Imaging Applications in Clinical Management of Patients Treated with Cardiac Resynchronization Therapy

“…In the study by Girsky et al [33], a pre-procedural review of coronary venous anatomy, assessed by cardiovascular CT, was associated with decreased implantation times and the utilization of contrast, fluoroscopy, and guide catheters. In a recent pilot study [34], a combined imaging approach, based on the assessment of coronary venous anatomy, in contrast to CT venography and myocardial viability by myocardial perfusion imaging, showed promising results for the identification of the optimal LV pacing site. Despite these In a recent pilot study [34], a combined imaging approach, based on the assessment of coronary venous anatomy, in contrast to CT venography and myocardial viability by myocardial perfusion imaging, showed promising results for the identification of the optimal LV pacing site.…”

“…In a recent pilot study [34], a combined imaging approach, based on the assessment of coronary venous anatomy, in contrast to CT venography and myocardial viability by myocardial perfusion imaging, showed promising results for the identification of the optimal LV pacing site. Despite these In a recent pilot study [34], a combined imaging approach, based on the assessment of coronary venous anatomy, in contrast to CT venography and myocardial viability by myocardial perfusion imaging, showed promising results for the identification of the optimal LV pacing site. Despite these results, anatomic constraints may often require using less favourable coronary venous sites during CRT implantation, and this may be responsible for a portion of non-responders observed in clinical practice.…”