Capabilities of myocardial perfusion-metabolism scintigraphy for prediction of cardiac resynchronization therapy outcomes in patients with dilated cardiomyopathy

Aim: to evaluate myocardial perfusion and metabolism of the left ventricle (LV) in patients with dilated cardiomyopathy (DCMP) and to use these data for development of gamma-scintigraphic predictors of cardiac resynchronization therapy (CRT) efficacy. The study included DCMP patients (n=51) who received CRT. Before treatment, all patients underwent examination of the myocardial metabolism and perfusion by using ß-methyl-p-[123I] iodophenyl-pentadecanoic acid (¹²³I-BMIPP) and^99mTc-methoxyisobutylisonitrile, respectively. The 17-segment model of the LV myocardium was used to evaluate metabolic and perfusion deficits as well as perfusion-metabolism mismatch. After 6 months of CRT, patients whose end-systolic volume (ESV) decreased by 15% and more were qualified as “responders” whereas those with ESV decrease by less than 15% were considered “nonresponders”. Groups of “responders” (n=36) and “nonresponders” (n=15) significantly differed by the sizes of perfusion defects (8.70+2.94% vs. 13.73±1.92%, p<0.00005) and metabolic defects seen in the early images (7.97+4.39% vs. 13.23±3.32%, p<0.01). These results of perfusion-metabolic SPECT correlated with post-CRT LV ESV and post-CRT LV ejection fraction. Results of myocardial perfusion-metabolism scintigraphy with¹²³I-BMIPP may be used as additional diagnostic criteria for selection of patients for CRT and for prediction of efficacy of this interventional method of treatment in patients with DCMP.

дилатационная кардиомиопатия, метаболическая сцинтиграфия миокарда, кардиоресинхронизирующая терапия, прогноз, dilated cardiomyopathy, myocardial metabolism SPECT, cardiac resynchronization therapy, prognosis

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