Cardiac Resynchronization Therapy for Heart Failure

Gottlieb, Stephen S.; Fisher, Michael L.

doi:10.1056/nejm200211283472216

Cited by 40 publications

(2 citation statements)

References 18 publications

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“…33–40 CRT is recommended in HF patients with New York Heart Association (NYHA) class III-IV symptoms refractory to medical therapy, LVEF ≤ 35%, and sinus rhythm with QRS ≥ 120 ms. 41 However, when chosen for CRT based on these conventional criteria, according to clinical endpoints up to one third of the patients did not show response to CRT, 36,37 and according to echocardiographic endpoints even higher non-response rates have been reported. 42–45 Thus, there is considerable interest in optimizing patient selection for this expensive therapy.…”

Section: Evolving Clinical Applications Of Phase Analysismentioning

confidence: 99%

SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony

Chen

Garcia

Bax

et al. 2011

Journal of Nuclear Cardiology

112

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Phase analysis of gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is an evolving technique for measuring LV mechanical dyssynchrony. Since its inception in 2005, it has undergone considerable technical development and clinical evaluation. This article reviews the background, the technical and clinical characteristics, and evolving clinical applications of phase analysis of gated SPECT MPI in patients requiring cardiac resynchronization therapy or implantable cardioverter defibrillator therapy and in assessing LV diastolic dyssynchrony.

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Section: Evolving Clinical Applications Of Phase Analysismentioning

confidence: 99%

SPECT myocardial perfusion imaging for the assessment of left ventricular mechanical dyssynchrony

Chen

Garcia

Bax

et al. 2011

Journal of Nuclear Cardiology

112

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“…The American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines recommend CRT in patients with end-stage drug-refractory HF of New York Heart Association (NYHA) class III or IV severity, depressed left ventricular ejection fraction (LVEF; ≤ 35%), prolonged QRS duration (≥ 120 ms), and sinus rhythm as a class I indication with level of evidence A [11]. However, using these conventional criteria for selecting patients for CRT, 20% to 40% of patients fail to respond to CRT [6, 7, 12-15]. It was suggested that electrical dyssynchrony represented by prolonged QRS intervals is not necessarily related to mechanical dyssynchrony, which may explain why 20% to 40% of the patients in the above trials did not respond to CRT [16-18].…”

Section: Introductionmentioning

confidence: 99%

The Use of Nuclear Imaging for Cardiac Resynchronization Therapy

et al. 2010

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Cardiac resynchronization therapy (CRT) has shown benefits in patients with end-stage heart failure, depressed left ventricular (LV) ejection fraction (≤ 35%), and prolonged QRS duration (≥ 120 ms). However, based on the conventional criteria, 20% to 40% of patients fail to respond to CRT. Studies have focused on important parameters for predicting CRT response, such as LV dyssynchrony, scar burden, LV lead position, and site of latest activation. Phase analysis allows nuclear cardiology modalities, such as gated blood-pool imaging and gated myocardial perfusion single photon emission computed tomography (GMPS), to assess LV dyssynchrony. Most importantly, GMPS with phase analysis has the potential of assessing LV dyssynchrony, scar burden, and site of late activation from a single acquisition, so that this technique may provide a one-stop shop for predicting CRT response. This article provides a summary on the role of nuclear cardiology in selecting patients for CRT, with emphasis on GMPS with phase analysis.

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