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Chiang KF, Hung GU, Tsai SC, Cheng CM, Chang YC, Lin WY, Hsieh YC, Wu TJ, Chen SA, Huang JL, Liao YC, Chen J. Impact of cardiac reverse remodeling after cardiac resynchronization therapy assessed by myocardial perfusion imaging on ventricular arrhythmia. J Nucl Cardiol 2017; 24:1282-1288. [PMID: 26979308 DOI: 10.1007/s12350-016-0447-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) has been a useful treatment of heart failure, patients with CRT are still in risk of sudden cardiac death due to ventricular arrhythmia. The aim of this study was to investigate the impact of cardiac reverse remodeling after CRT on the prevalence of ventricular tachycardia or fibrillation (VT/VF). METHODS AND RESULTS Forty-one heart failure patients (26 men, age 66 ± 10 years), who were implanted with CRT for at least 12 months, were enrolled. All patients received myocardial perfusion imaging (MPI) under CRT pacing to evaluate left ventricle (LV) function, dyssynchrony, and scar. VT/VF episodes during the follow-up period after MPI were recorded by the CRT devices. Sixteen patients (N = 16/41, 39%) were found to have VT/VF. Multivariate Cox regression analysis and receiver operating characteristic curve analysis showed that five risk factors were significant predictors of VT/VF, including increased left ventricle ejection fraction (LVEF) by ≤7% after CRT, low LVEF after CRT (≤30%), change of intrinsic QRS duration (iQRSd) by ≤7 ms, wide iQRSd after CRT (≥121 ms), and high systolic dyssynchrony after CRT (phase standard deviation ≥45.6°). For those patients with all of the 5 risk factors, 85.7% or more developed VT/VF. CONCLUSIONS The characteristics of cardiac reverse remodeling after CRT as assessed by MPI are associated with the prevalence of ventricular arrhythmia.
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Affiliation(s)
- Kuo-Feng Chiang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Shih-Chung Tsai
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chien-Ming Cheng
- Division of Cardiology, Department of Medicine, Department of Health of Executive Yuan, Fong Yuan Hospital, Taichung, Taiwan
| | - Yu-Cheng Chang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
| | - Wan-Yu Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsu-Juey Wu
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Ann Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Divisions of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ying-Chieh Liao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Division of Cardiology, Department of Medicine, Buddhist Tzu-Chi General Hospital, Taichung Branch, 6688, Fung Hing Rd Sect 1, Tanzi District, Taichung, 427, Taiwan.
| | - Ji Chen
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
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Cheng CM, Su CS, Chou P, Liao YC, Wang CY, Zhang JR, Hsieh YC, Wu TJ, Chen YW, Weng CJ, Chang KH, Zhou W, Hung GU, Huang JL, Nakajima K. Prediction of Both Electrical and Mechanical Reverse Remodeling on Acute Electrocardiogram Changes After Cardiac Resynchronization Therapy. Circ J 2017; 81:1322-1328. [PMID: 28442644 DOI: 10.1253/circj.cj-16-1181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The development of both electrical reverse remodeling and mechanical reverse remodeling (ERR+MRR) after cardiac resynchronization therapy (CRT) implantation could reduce the incidence of lethal arrhythmia, hence the prediction of ERR+MRR is clinically important.Methods and Results:Eighty-three patients (54 male; 67±12 years old) with CRT >6 months were enrolled. ERR was defined as baseline intrinsic QRS duration (iQRSd) shortening ≥10 ms in lead II on ECG after CRT, and MRR as improvement in LVEF ≥25% on echocardiography after CRT. Acute ECG changes were measured by comparing the pre-implant and immediate post-implant ECG. Ventricular arrhythmia episodes, including ventricular tachycardia and ventricular fibrillation, detected by the implanted device were recorded. Patients were classified as ERR only (n=12), MRR only (n=23), ERR+MRR (n=26), or non-responder (ERR- & MRR-, n=22). On multivariate regression analysis, difference between baseline intrinsic QRS and paced QRS duration (∆QRSd) >35 ms was a significant predictor of ERR+MRR (sensitivity, 68%; specificity, 64%; AUC, 0.7; P=0.003), and paced QTc >443 ms was a negative predictor of ERR+MRR (sensitivity, 78%; specificity, 60%; AUC, 0.7; P=0.002). On Cox proportional hazard modeling, ERR+MRR may reduce risk of ventricular arrhythma around 70% compared with non-responder (HR, 0.29; 95% CI: 0.13-0.65). CONCLUSIONS Acute ECG changes after CRT were useful predictors of ERR+MRR. ERR+MRR was also a protective factor for ventricular arrhythmia.
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Affiliation(s)
- Chien-Ming Cheng
- Division of Cardiology, Department of Medicine, Feng Yuan Hospital, Department of Health of the Executive Yuan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Chieh-Shou Su
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Ying-Chieh Liao
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Chi-Yen Wang
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Jian-Rong Zhang
- Department of Cardiology, Tungs' Taichung MetroHarbor Hospital
| | - Yu-Cheng Hsieh
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Tsu-Juey Wu
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
| | - Yu-Wei Chen
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Chi-Jen Weng
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Keng-Hao Chang
- Cardiovascular Center, Taichung Veterans General Hospital
| | - Weihua Zhou
- School of Computing, University of Southern Mississippi
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital
| | - Jin-Long Huang
- Institute of Clinical Medicine and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University.,Cardiovascular Center, Taichung Veterans General Hospital
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