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Mechanical contraction to guide CRT left-ventricular lead placement instead of electrical activation in myocardial infarction with left ventricular dysfunction: An experimental study based on non-invasive gated myocardial perfusion imaging and invasive electroanatomic mapping

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Whether the region of the latest electrical activation (LEA) corresponds with the segment of the latest mechanical contraction (LMC) in ischemic cardiomyopathy (ICM) is uncertain. We aimed to investigate the relationship between the left-ventricular (LV) viable segments with LEA and with LMC after myocardial infarction (MI) and analyze the acute hemodynamic responses (dP/dtmax) after cardiac resynchronization therapy (CRT) pacing at different LV sites.

Methods and results

Bama suckling pigs (n = 6) were subjected to create MI models. Both gated myocardial perfusion imaging (GMPI) and electroanatomic mapping (EAM) were performed successfully before MI and 4 weeks after MI. LMC was assessed by phase analysis of GMPI, while LEA was evaluated by EAM. The dP/dtmax was measured before CRT and when the CRT LV electrode was implanted in viable segments of LMC, viable segments of lateral wall and scar, respectively. The viable segments of LEA were consistent with the sites of LMC for five in six cases. The dP/dtmax increased significantly compared with that before CRT when the CRT LV electrode was implanted in viable segments of LMC (1103.33 ± 195.76 vs 717.83 ± 80.74 mmHg·s−1, P = .001), which was also significantly higher than in viable segments of lateral wall (751.17 ± 105.62 mmHg·s−1, P = .000) and scar (679.50 ± 60.87 mmHg·s−1, P = .001).

Conclusions

Non-invasive GMPI may be a better option than invasive EAM for guiding LV electrode implantation for CRT in ICM.

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Abbreviations

ICM:

Ischemic cardiomyopathy

CRT:

Cardiac resynchronization therapy

LV:

Left ventricular

LVMD:

Left ventricular mechanical dyssynchrony

EAM:

Electroanatomical mapping

LEA:

Latest electrical activation

GMPI:

Gated myocardial perfusion imaging

LVED:

Left ventricular electrical dyssynchrony

MI:

Myocardial infarction

SPECT:

Single photon emission computed tomography

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Acknowledgments

The project was supported by the National Natural Science Foundation of China (81471690, PI: Yuetao Wang), Youth Science Fund Project of National Natural Science Foundation of China (81701737, PI: Jianfeng Wang; 81701734, PI: Xiaoliang Shao), Jiangsu Province Science and Technology Program-Project of Standardized Diagnosis and Treatment of Key Diseases (BE2015635, PI: Yuetao Wang), and Key Project of Changzhou Municipal Health Bureau (ZD201409, PI: Xiaosong Wang). It was also supported by a Grant from the American Heart Association (17AIREA33700016, PI: Weihua Zhou).

Disclosures

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China

    Jianfeng Wang MD, Yuetao Wang MD, Xiaoliang Shao MD, Feifei Zhang MD, Wei Yang MD, Wenchong Xin MD & Xiaosong Wang MD

  2. Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100000, China

    Minfu Yang MD

  3. Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China

    Shan Shao MD & Ling Yang MD

  4. Department of Nuclear Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China

    Yi Tian MD

  5. Department of Anesthesiology, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China

    Shengdeng Fan MD

  6. School of Computing, University of Southern Mississippi, Long Beach, MS, 39560, USA

    Haipeng Tang MS & Weihua Zhou PhD

  7. Department of Echocardiogram, The Third Affiliated Hospital of Soochow University, Changzhou, 213003, China

    Min Xu MD

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  1. Jianfeng Wang MD
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Correspondence to Yuetao Wang MD.

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Wang, J., Wang, Y., Yang, M. et al. Mechanical contraction to guide CRT left-ventricular lead placement instead of electrical activation in myocardial infarction with left ventricular dysfunction: An experimental study based on non-invasive gated myocardial perfusion imaging and invasive electroanatomic mapping. J. Nucl. Cardiol. 27, 419–430 (2020). https://doi.org/10.1007/s12350-019-01710-2

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