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Valzania C, Bonfiglioli R, Fallani F, Martignani C, Ziacchi M, Diemberger I, Biffi M, Fanti S, Galiè N. Single-photon cardiac imaging in patients with cardiac implantable electrical devices. J Nucl Cardiol 2022; 29:633-641. [PMID: 33241474 DOI: 10.1007/s12350-020-02436-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/17/2020] [Indexed: 10/22/2022]
Abstract
Nuclear imaging techniques like single-photon emission computed tomography (SPECT) and radionuclide angiography have wide applications in patients receiving a cardiac implantable electrical device (CIED), who cannot usually undergo cardiac magnetic resonance. Our aim was to provide an update of single-photon imaging clinical applications, with a specific focus on CIED recipients. SPECT imaging is commonly used in CIED patients to assess myocardial perfusion, but it can also be used to evaluate myocardial viability, which is an important predictor of LV function improvement by cardiac resynchronization therapy (CRT). Radionuclide angiography has shown higher temporal resolution and reproducibility than SPECT in the evaluation of cardiac function and dyssynchrony. Left ventricular dyssynchrony as assessed by radionuclide angiography with phase analysis may be reliably used for CRT patient selection and evaluation of CRT response. SPECT imaging with meta-iodo-benzyl-guanidine allows for cardiac sympathetic innervation examination, which may be used for prognostic stratification of heart failure patients and prediction of ventricular tachyarrhythmias. Finally, promising results in CIED infection diagnosis have been shown by SPECT with radiolabeled autologous white blood cells.
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Affiliation(s)
- Cinzia Valzania
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy.
| | - Rachele Bonfiglioli
- Department of Nuclear Medicine, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Francesco Fallani
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Cristian Martignani
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Igor Diemberger
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
| | - Nazzareno Galiè
- Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S.Orsola, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy
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Valzania C, Massaro G, Spadotto A, Muraglia L, Frisoni J, Martignani C, Ziacchi M, Diemberger I, Fanti S, Boriani G, Biffi M, Galié N. Ten-year follow-up of cardiac resynchronization therapy patients with non-ischemic dilated cardiomyopathy assessed by radionuclide angiography: a single-center cohort study. J Interv Card Electrophysiol 2022; 64:723-731. [PMID: 35175490 DOI: 10.1007/s10840-022-01117-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Relatively few data are available on long-term survival and incidence of ventricular arrhythmias in cardiac resynchronization therapy (CRT) patients. We investigated long-term outcomes of CRT patients with non-ischemic dilated cardiomyopathy stratified as responders or non-responders according to radionuclide angiography. METHODS Fifty patients with non-ischemic dilated cardiomyopathy undergoing CRT were assessed by equilibrium Tc99 radionuclide angiography with bicycle exercise at baseline and after 3 months. Intra- and interventricular dyssynchrony were derived by Fourier phase analysis. Patient clinical outcome was assessed after 10 years. RESULTS At 3 months, 50% of patients were identified as CRT responders according to an increase in LV ejection fraction ≥ 5%. During a follow-up of 109 ± 48 months, 30% of patients died and 6% underwent heart transplantation. Age and history of paroxysmal atrial fibrillation were found to be predictors of all-cause mortality. CRT responders showed lower risk of death from cardiac causes than non-responders. At follow-up, 38% of patients presented at least one episode of sustained ventricular tachycardia, with a similar percentage between responders and non-responders. CONCLUSION At long-term follow-up, non-ischemic CRT recipients identified as responders by radionuclide angiography were found to be at lower risk of worsening heart failure death than non-responders. Long-term risk for sustained ventricular arrhythmia was similar between CRT responders and non-responders.
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Affiliation(s)
- Cinzia Valzania
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy.
| | - Giulia Massaro
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Alberto Spadotto
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Lorenzo Muraglia
- Department of Nuclear Medicine, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy
| | - Jessica Frisoni
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Cristian Martignani
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Igor Diemberger
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Polyclinic of Modena, Modena, Italy
| | - Mauro Biffi
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy
| | - Nazzareno Galié
- Department of Cardiology, IRCCS, Azienda Ospedaliero Universitaria Di Bologna, Policlinico Di S.Orsola, Via Massarenti 9, 40138, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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Valzania C, Biffi M, Bonfiglioli R, Fallani F, Martignani C, Diemberger I, Ziacchi M, Frisoni J, Tomasi L, Fanti S, Rapezzi C, Boriani G. Effects of cardiac resynchronization therapy on right ventricular function during rest and exercise, as assessed by radionuclide angiography, and on NT-proBNP levels. J Nucl Cardiol 2019; 26:123-132. [PMID: 28667454 DOI: 10.1007/s12350-017-0971-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
AIM We carried out this study to investigate mid-term effects of cardiac resynchronization therapy (CRT) on right ventricular (RV) function and neurohormonal response, expressed by N-terminal pro-brain natriuretic peptide (NT-proBNP), in heart failure patients stratified by baseline RV ejection fraction (RVEF). METHODS AND RESULTS Thirty-six patients with nonischemic dilated cardiomyopathy underwent technetium-99m radionuclide angiography with bicycle exercise immediately after CRT implantation (during spontaneous rhythm and after CRT activation) and 3 months later. Plasma NT proBNP was assessed before implantation and after 3 months. At baseline, RVEF was impaired (≤35%) in 14 patients, preserved (>35%) in 22. At 3 months, RVEF improved during rest and exercise (P = .02) in patients with impaired RV function, while remaining unchanged in patients with preserved RV function. Rest and exercise RV dyssynchrony decreased in both groups at follow-up (P < .05). A similar mid-term improvement in left ventricular (LV) function and NT-proBNP was observed in patients with impaired and preserved RVEF. In the former, the decrease in NT-proBNP correlated with the improvements both in LV and RV dyssynchrony and functions. CONCLUSION CRT may improve RV performance, during rest and exercise, and neurohormonal response in heart failure patients with nonischemic dilated cardiomyopathy and baseline RV dysfunction. RV dysfunction should not be considered per se a primary criterion for excluding candidacy to CRT.
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Affiliation(s)
- Cinzia Valzania
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
| | - Mauro Biffi
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Rachele Bonfiglioli
- Department of Nuclear Medicine, S.Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesco Fallani
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Cristian Martignani
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Igor Diemberger
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Matteo Ziacchi
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Jessica Frisoni
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Luciana Tomasi
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, S.Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Rapezzi
- Department of Cardiology, S.Orsola Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Boriani
- Division of Cardiology, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
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Albertí JFF, de Diego JJG, Delgado RV, Riera JC, Torres RA. [State of the art: new developments in cardiac imaging]. Rev Esp Cardiol 2012; 65 Suppl 1:24-34. [PMID: 22269837 DOI: 10.1016/j.recesp.2011.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 11/03/2011] [Indexed: 11/16/2022]
Abstract
Cardiac imaging continues to reveal new anatomical and functional insights into heart disease. In echocardiography, both transesophageal and transthoracic three-dimensional imaging have been fully developed and optimized, and the value of the techniques that have increased our understanding of cardiac mechanics and ventricular function is well established. At the same time, the healthcare industry has released new devices onto the market which, although they are easier to use, have limitations that restrict their use for routine assessment. Tomography's diagnostic and prognostic value in coronary artery disease continues to increase while radiation exposure becomes progressively lower. With cardiac magnetic resonance imaging, myocardial injury and recovery in ischemic heart disease and following acute coronary syndrome can be monitored in exquisite detail. The emergence of new combined tomographic and gamma camera techniques, exclusively developed for nuclear cardiology, have improved the quality of investigations and reduced radiation exposure. The hybrid or fusion images produced by combining different techniques, such as nuclear cardiology techniques and tomography, promise an exciting future.
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