A novel method combining gated SPECT and vectorcardiography to guide left ventricular lead placement to improve response to cardiac resynchronization therapy: A Proof of Concept study

Hongjin Si; Zhuo He; Saurabh Malhotra; Xinwei Zhang; Fengwei Zou; Siyuan Xue; Zhiyong Qian; Yao Wang; Xiaofeng Hou; Weihua Zhou; Jiangang Zou

doi:10.1016/j.nuclcard.2024.101867

A novel method combining gated SPECT and vectorcardiography to guide left ventricular lead placement to improve response to cardiac resynchronization therapy: A Proof of Concept study

J Nucl Cardiol. 2024 Apr 30:101867. doi: 10.1016/j.nuclcard.2024.101867. Online ahead of print.

Authors

Hongjin Si¹, Zhuo He², Saurabh Malhotra³, Xinwei Zhang⁴, Fengwei Zou⁵, Siyuan Xue⁴, Zhiyong Qian⁴, Yao Wang⁴, Xiaofeng Hou⁴, Weihua Zhou⁶, Jiangang Zou⁷

Affiliations

¹ Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Cardiology, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China.
² Department of Applied Computing, Michigan Technological University, Houghton, MI.
³ Division of Cardiology, Cook County Health and Hospitals System, Chicago, IL, USA; Division of Cardiology, Rush Medical College, Chicago, IL, USA.
⁴ Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
⁵ Department of Cardiology, Montefiore Medical Center, 111 E 210th St, Bronx, NY, 10467, USA.
⁶ Department of Applied Computing, Michigan Technological University, Houghton, MI; Center for Biocomputing and Digital Health, Institute of Computing and Cybersystems, and Health Research Institute, Michigan Technological University, Houghton, MI, USA. Electronic address: whzhou@mtu.edu.
⁷ Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address: jgzou@njmu.edu.cn.

PMID: 38697386
DOI: 10.1016/j.nuclcard.2024.101867

Abstract

Background: The segment of the latest mechanical contraction (LMC) does not always overlap with the site of the latest electrical activation (LEA). By integrating both mechanical and electrical dyssynchrony, this proof-of-concept study aimed to propose a new method for recommending left ventricular (LV) lead placements, with the goal of enhancing response to cardiac resynchronization therapy (CRT).

Methods: The LMC segment was determined by single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) phase analysis. The LEA site was detected by vectorcardiogram. The recommended segments for LV lead placement were as follows: (1) the LMC viable segments that overlapped with the LEA site;(2) the LMC viable segments adjacent to the LEA site;(3) If no segment met either of the above, the LV lateral wall was recommended. The response was defined as ≥15% reduction in left ventricular end-systolic volume (LVESV) 6-months after CRT. Patients with LV lead located in the recommended site were assigned to the recommended group, and those located in the non-recommended site were assigned to the non-recommended group.

Results: The cohort comprised of 76 patients, including 54 (71.1%) in the recommended group and 22 (28.9%) in the non-recommended group. Among the recommended group, 74.1% of the patients responded to CRT, while 36.4% in the non-recommended group were responders (p=.002). Compared to pacing at the non-recommended segments, pacing at the recommended segments showed an independent association with an increased response by univariate and multivariable analysis (odds ratio 5.00, 95% confidence interval 1.73-14.44, p=.003; odds ratio 7.33, 95% confidence interval 1.53-35.14, p=.013). Kaplan-Meier curves showed that pacing at the recommended LV lead position demonstrated a better long-term prognosis.

Conclusions: Our findings indicate that pacing at the recommended segments, by integrating of mechanical and electrical dyssynchrony, is significantly associated with an improved CRT response and better long-term prognosis.

Keywords: Cardiac resynchronization therapy; SPECT MPI; electrical activation; mechanical contraction; vectorcardiogram.