Optimization of left ventricular lead implantation based on combined myocardial perfusion scintigraphy and computed tomography data

BACKGROUND: Successful cardiac resynchronization therapy in patients with chronic heart failure critically depends on the selection of the optimal implantation site for the left ventricular lead. A hybrid imaging approach combining cardiac venous computed tomography and myocardial perfusion scintigraphy may assist in identifying the target vein and improve procedural efficacy.

AIM: The work aimed to evaluate the feasibility of a multimodal imaging approach for optimizing left ventricular lead implantation in cardiac resynchronization therapy.

METHODS: It was a prospective, observational, single-center, non-randomized controlled study. Patients with chronic heart failure and indications for cardiac resynchronization therapy in accordance with current guidelines were enrolled. Prior to the procedure, the patients underwent computed tomography of the cardiac veins to visualize venous anatomy and myocardial perfusion scintigraphy to assess the extent of left ventricular perfusion impairment. The optimal site for left ventricular lead placement was identified using a three-dimensional reconstruction of the coronary sinus fused with myocardial perfusion scintigraphy data. To assess the effectiveness of the hybrid approach, a reference group was formed, in which cardiac resynchronization implantation was performed using the standard method, without preprocedural evaluation of coronary venous anatomy or myocardial scarring. Six months after cardiac resynchronization therapy, all patients underwent echocardiography to evaluate treatment effectiveness. Echocardiographic response was defined as a reduction in left ventricular end-systolic volume by ≥15% and/or an increase in ejection fraction by ≥5%.

RESULTS: The imaging group consisted of 40 patients with chronic heart failure, whereas the reference group included 30 patients with the same diagnosis. Six months after cardiac resynchronization therapy, a positive treatment response was observed in 33 patients (82%) in the imaging group, significantly higher than in the reference group (17 patients, 57%), p = 0.031. In the imaging group, the reduction in left ventricular end-systolic volume was statistically significant compared with the reference group and amounted to −52 [−71; −22.5] mL versus −21 [−64; −1] mL, respectively (p = 0.039). The increase in left ventricular ejection fraction was 7.5 [4.5; 15]% in the imaging group and 4.5 [0; 13]% in the reference group, with no statistically significant difference (p = 0.082).

CONCLUSION: The use of cardiovascular imaging methods, including cardiac venous computed tomography and myocardial perfusion scintigraphy, was associated with an increased proportion of responders to cardiac resynchronization therapy.