Sincronia ventricular em portadores de miocardiopatia dilatada e indivíduos normais: avaliação através da ventriculografia radioisotópica

Brandão, Simone Cristina Soares; Giorgi, Maria Clementina Pinto; Miche, Rodrigo T de; Nishioka, Silvana; Lopes, Rafael Willain; Izaki, Marisa; Soares, José; Filho, Martino Martinelli; Meneghetti, José Cláudio

doi:10.1590/s0066-782x2007000500016

Cited by 4 publications

(1 citation statement)

References 33 publications

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“…A medicina nuclear tem mostrado seu valor no estudo de vários mecanismos implicados na fisiopatologia da IC [51][52][53][54][55][56] . Ela pode ser usada para estudar os efeitos da dissincronia sobre a perfusão miocárdica [57][58][59][60] • IC classe funcional III ou IV ambulatorial da NYHA;…”

Section: A Cintilografia Cardíaca Com Mibi-99m Tc E a Terapia De Ressunclassified

Efeitos da terapia de ressincronização cardíaca (TRC) sobre a perfusão miocárdica: correlações clínico-funcionais

Cristina¹,

Brandão²

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, p<0.001; ESV: 401 ± 154 mL vs. 220 ± 85 mL, p<0.001, G2 and G1, respectively). Myocardial 99m Tc-MIBI uptake was lower in G2 compared with G1 in the anterior wall (60 ± 10% vs. 67 ± 7%, p=0.049, at rest) and inferior wall (48 ± 10% vs. 59 ± 11%, at rest, and 47 ± 10% vs. 58 ± 9%, p=0.003, after adenosine stress). Summed stress score was significantly higher in G2 compared to G1 (14 ± 9 vs. 9 ± 4, G2 and G1, respectively, p=0.039). By multivariate analysis, EDV was the only independent predictor of LVEF increase posttherapy, p=0.01. By ROC curve, optimal EDV cutoff point was 315mL with 89% of sensitivity and 94% of specificity. Conclusions: CRT increased myocardial 99m Tc-MIBI uptake, improved HF functional class, and reduced QRS width independently of LV performance improvement. Post-CRT, LVEF increase occurred in hearts less dilated showing higher regional myocardial 99m Tc-MIBI uptake, mainly in the inferior wall. Descriptors: 1. Artificial pacemaker; 2. Heart failure; 3. Emission computed tomography; 4. Bundle-branch block; 5. Technetium 99mTc Sestamibi

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Section: A Cintilografia Cardíaca Com Mibi-99m Tc E a Terapia De Ressunclassified

Efeitos da terapia de ressincronização cardíaca (TRC) sobre a perfusão miocárdica: correlações clínico-funcionais

Cristina¹,

Brandão²

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Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function

Brandão

Nishioka

Giorgi

et al. 2009

Eur J Nucl Med Mol Imaging

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Purpose 99mTc-MIBI gated myocardial scintigraphy (GMS) evaluates myocyte integrity and perfusion, left ventricular (LV) dyssynchrony and function. Cardiac resynchronization therapy (CRT) may improve the clinical symptoms of heart failure (HF), but its benefits for LV function are less pronounced. We assessed whether changes in myocardial 99mTc-MIBI uptake after CRT are related to improvement in clinical symptoms, LV synchrony and performance, and whether GMS adds information for patient selection for CRT. Methods A group of 30 patients with severe HF were prospectively studied before and 3 months after CRT. Variables analysed were HF functional class, QRS duration, LV ejection fraction (LVEF) by echocardiography, myocardial 99mTc-MIBI uptake, LV end-diastolic volume (EDV) and end-systolic volume (ESV), phase analysis LV dyssynchrony indices, and regional motion by GMS. After CRT, patients were divided into two groups according to improvement in LVEF: group 1 (12 patients) with increase in LVEF of 5 or more points, and group 2 (18 patients) without a significant increase. Results After CRT, both groups showed a significant improvement in HF functional class, reduced QRS width and increased septal wall 99mTc-MIBI uptake. Only group 1 showed favourable changes in EDV, ESV, LV dyssynchrony indices, and regional motion. Before CRT, EDV, and ESV were lower in group 1 than in group 2. Anterior and inferior wall 99mTc-MIBI uptakes were higher in group 1 than in group 2 (p<0.05). EDV was the only independent predictor of an increase in LVEF (p=0.01). The optimal EDV cut-off point was 315 ml (sensitivity 89%, specificity 94%). Conclusion The evaluation of EDV by GMS added information on patient selection for CRT. After CRT, LVEF increase occurred in hearts less dilated and with more normal 99mTc-MIBI uptake.

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Bifocal Right Ventricular Resynchronization for the Failing Right Ventricle

Berruezo

Potter

Sitges

et al. 2011

Pacing Clinical Electrophis

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The present case illustrates that in patients with right ventricular (RV) failure and right bundle branch block it is possible to resynchronize the RV without further worsening RV or left ventricular (LV) pump function, even in cases with various degrees of atrioventricular block. The acute response to different pacing configurations was analyzed in terms of dP/dt variations. Bifocal RV pacing (His bundle plus RV outflow tract pacing) achieved the best acute results and was chosen for permanent pacing. This pacing configuration was associated to clinical and echocardiographic improvement.

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Sincronia ventricular em portadores de miocardiopatia dilatada e indivíduos normais: avaliação através da ventriculografia radioisotópica

Abstract: Results: vs G2 and G1 vs vsConclusion: The parameters analyzed discriminate the three groups of patients according to the ventricular synchrony but at a lower degree than patients with widened QRS.

Cited by 4 publications

References 33 publications

Efeitos da terapia de ressincronização cardíaca (TRC) sobre a perfusão miocárdica: correlações clínico-funcionais

Efeitos da terapia de ressincronização cardíaca (TRC) sobre a perfusão miocárdica: correlações clínico-funcionais

Cardiac resynchronization therapy evaluated by myocardial scintigraphy with 99mTc-MIBI: changes in left ventricular uptake, dyssynchrony, and function

Bifocal Right Ventricular Resynchronization for the Failing Right Ventricle

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