NUCLEAR IMAGING TECHNIQUES IN THE PREDICTION OF EFFICIENCY OF CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH DILATED CARDIOMYOPATHY

Objective. To determine new predictors of an efficiency of cardiac resynchronization therapy (CRT) using nuclear imaging techniques. Design and methods. 75 patients with dilated cardiomyopathy and chronic heart failure were included in the study. Myocardial perfusion imaging with 99mТс-MIBI was performed in all patients before CRT. For assessment of myocardial metabolism 63 patients were referred to cardiac scintigraphy with 123I-BMIPP before CRT and 12 patients underwent positron emission tomography with 18F-FDG twice (before and 6 months after CRT). Echocardiography was carried out before and 6 months after CRT for estimate left ventricular (LV) function. Results. Based on the reduction of end systolic LV volume > 15% 6 months after CRT all patients were divided into two groups: responders (n = 39) and nonresponders (n = 24). ROC curve analysis showed the highest predictive values for the following parameters: the size of metabolic defect (sensitivity - 77,8 %, specificity - 66,7 %, the optimal cut off value - 7,35 %), the calculated value of the end systolic LV volume (sensitivity - 87,5 %, specificity - 100 %, the optimal cut off value - 34,02), and the septal-to-lateral ratio according to the 18F-FDG-PET results (sensitivity - 100 %, specificity - 80 %, the optimal cut off value - 0,67). Conclusion. The data of cardiac scintigraphy and positron emission tomography are useful to predict an efficiency of cardiac resynchronization therapy.

дилатационная кардиомиопатия, сцинтиграфия миокарда, позитронная эмиссионная томография сердца, кардиоресинхронизирующая терапия, dilated cardiomyopathy, myocardial scintigraphy, cardiac positron emission tomography, cardiac resynchronization therapy

1. Manolio T., Baughman K., Rodeheffer R. et al. Prevalence and etiology of idiopathic dilated cardiomyopathy (summary of a National Heart, Lung, and Blood Institute workshop) // Am. J. Cardiol. - 1992. - Vol. 69. - P. 1458-1466.

2. Abraham W.T., Hayes D.L. Cardiac resynchronization therapy for heart failure // Circulation. - 2003. - Vol. 108. - P. 2596-2603.

3. Bax J.J., Abraham T., Barold S.S. et al. Cardiac Resynchronization Therapy // JACC. - 2005. - Vol. 46, № 12. - P. 2168-2182.

4. Соколов А.А., Марцинкевич Г.И. Электромеханический асинхронизм сердца и сердечная недостаточность // Кардиология. - 2005. - Т. 45, № 5. - C. 85-91.

5. Попов С.В., Савенкова Г.М., Антонченко И.В. и др. Эффекты кардиоресинхронизирующей терапии в лечении застойной сердечной недостаточности // Сибирский медицинский журнал (г. Томск). - 2010. - Т. 25, № 2-1. - C. 25-33.

6. Anagnostopoulos C.D., Cokkinos D.V. Prediction of left ventricular remodeling by radionuclide imaging. - Eur. J. Nucl. Med. Mol. Imaging. - 2011. - Vol. 38, № 6. - P. 1120-1123.

7. Anagnostopoulos C.D., Cokkinos D.V. Prediction of left ventricular remodeling by radionuclide imaging. - Eur. J. Nucl. Med. Mol. Imaging. - 2011.-Vol. 38, № 6. - P. 1120-1123.

8. Рыжкова Д.В., Тютин Л.А., Мостова М.И. и др. Позитронная эмиссионная томография сердца в дифференциальной диагностике кардиомегалии ишемической и некоронарогенной природы. - Артериальная гипертензия. - 2009. - Т. 15, № 2. - C. 227-232.

9. Anagnostopoulos C.D., Cokkinos D.V. Prediction of left ventricular remodeling by radionuclide imaging. - Eur. J. Nucl. Med. Mol. Imaging. - 2011.-Vol. 38, № 6. - P. 1120-1123.

10. Birnie D., Kemp de R.A., Tang A.S. et al. Reduced septal glucose metabolism predicts response to cardiac resynchronization therapy. - J. Nucl. Cardiol. - 2012. - Vol. 19, № 1. - P. 73-83.

11. Anagnostopoulos C.D., Cokkinos D.V. Prediction of left ventricular remodeling by radionuclide imaging. - Eur. J. Nucl. Med. Mol. Imaging. - 2011. - Vol. 38, № 6. - P. 1120-1123.

12. Lishmanov Y., Minin S., Efimova I. et al. The possible role ofnuclear imaging in assessment of the cardiac resynchronization therapy effectiveness in patients with moderate heart failure // Ann. Nucl. Med. - 2013. - Vol. 27, № 4. - P. 378-385.

13. Anagnostopoulos C.D., Cokkinos D.V. Prediction of left ventricular remodeling by radionuclide imaging. - Eur. J. Nucl. Med. Mol. Imaging. - 2011.-Vol. 38, № 6. - P. 1120-1123.

14. Hesse B., Tägil K., Cuocolo A. et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology // Eur. J. Nucl. Med. Mol. Imaging. - 2005. - July. - Vol. 32, № 7. - P. 855-897.

15. Bax J.J., Visser F.C., Poldermans D. et al. Safety and feasibility of cardiac FDG SPECT following oral аdministration of Acipimox, a nicotinic acid derivative: comparison of image quality with hyperinsulinemic euglycemic clamping in nondiabetic patients // J. Nucl. Cardiol. - 2002. - Vol. 9. - P. 587-593.

16. Chung E.S., Leon A.R., Tavazzi L. et al. Results of the Predictors of Response to CRT (PROSPECT) trial // Circulation. - 2008. - Vol. 117, № 20. - P. 2608-2616.

17. Tanaka H., Nesser H.J., Buck T. Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the Speckle Tracking and Resynchronization(STAR) study // Eur. Heart. J. - 2010. - Vol. 31. - P. 1690-1700.

18. Lehner S., Uebleis C., Schüßler F. et al. The amount of viable and dyssynchronous myocardium is associated with response to cardiac resynchronization therapy: initial clinical results using multiparametric ECG-gated [18F]FDG PET // Eur. J. Nucl. Med. Mol. Imaging. - 2013. - Vol. 40, № 12. - P. 1876-1883.

19. Nowak B., Sinha A.M., Schaefer W.M. et al. Cardiac resynchronization therapy homogenizes myocardial glucose metabolism and perfusion in dilated cardiomyopathy and left bundle branch block // J. Am. Coll. Cardiol. - 2003. - Vol. 41. - P. 1523-1528.

20. Doenst N., Goodwin G.W., Cedars A.M. et al. Load-induced canges in vivo alter substrate fluxes and insulin responsiveness of rat heart in vitro // Metabolism. - 2001. - Vol. 50. - P. 1083-1090.