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Abstract：
It had not been reported that myocardial scar shown on gated myocardial perfusion SPECT (GMPS) might reduce after cardiac resynchronization therapy (CRT). In this study, we aim to investigate the clinical impact and characteristic of scar reduction (SR) after CRT.
Sixty-one heart failure patients following standard indication for CRT received twice GMPS as pre- and post-CRT evaluations. The patients with an absolute reduction of scar ≥ 10% after CRT were classified as the SR group while the rest were classified as the non-SR group. The SR group (N = 22, 36%) showed more improvement on LV function (∆LVEF: 18.1 ± 12.4 vs 9.4 ± 9.9 %, P = 0.007, ∆ESV: - 91.6 ± 52.6 vs - 38.1 ± 46.5 mL, P < 0.001) and dyssynchrony (ΔPSD: - 26.19 ± 18.42 vs - 5.8 ± 23.0°, P < 0.001, Δ BW: - 128.7 ± 82.8 vs - 25.2 ± 109.0°, P < 0.001) than non-SR group (N = 39, 64%). Multivariate logistic regression analysis showed baseline QRSd (95% CI 1.019-1.100, P = 0.006) and pre-CRT Reduced Wall Thickening (RWT) (95% CI 1.016-1.173, P = 0.028) were independent predictors for the development of SR.
More than one third of patients showed SR after CRT who had more post-CRT improvement on LV function and dyssynchrony than those without SR. Wider QRSd and higher RWT before CRT were related to the development of SR after CRT.
Sixty-one heart failure patients following standard indication for CRT received twice GMPS as pre- and post-CRT evaluations. The patients with an absolute reduction of scar ≥ 10% after CRT were classified as the SR group while the rest were classified as the non-SR group. The SR group (N = 22, 36%) showed more improvement on LV function (∆LVEF: 18.1 ± 12.4 vs 9.4 ± 9.9 %, P = 0.007, ∆ESV: - 91.6 ± 52.6 vs - 38.1 ± 46.5 mL, P < 0.001) and dyssynchrony (ΔPSD: - 26.19 ± 18.42 vs - 5.8 ± 23.0°, P < 0.001, Δ BW: - 128.7 ± 82.8 vs - 25.2 ± 109.0°, P < 0.001) than non-SR group (N = 39, 64%). Multivariate logistic regression analysis showed baseline QRSd (95% CI 1.019-1.100, P = 0.006) and pre-CRT Reduced Wall Thickening (RWT) (95% CI 1.016-1.173, P = 0.028) were independent predictors for the development of SR.
More than one third of patients showed SR after CRT who had more post-CRT improvement on LV function and dyssynchrony than those without SR. Wider QRSd and higher RWT before CRT were related to the development of SR after CRT.
摘要：
背景：在心脏再同步治疗（CRT）后，门控心肌灌注SPECT（GMPS）显示的心肌瘢痕可能会减轻。在这项研究中,我们的目的是探讨CRT后瘢痕缩小（SR）的临床影响和特点。
结果：61名符合CRT标准适应症的心力衰竭患者接受两次GMPS作为CRT前后评估。CRT后疤痕绝对减少≥10％的患者被归类为SR组，其余患者被归类为非SR组。SR组（N=22，36％）显示出更多的LV功能改善（ΔLVEF：18.1±12.4vs9.4±9.9％，P=0.007,ΔESV:-91.6±52.6vs-38.1±46.5mL,P<0.001）和不同步（ΔPSD：-26.19±18.42vs-5.8±23.0°，P<0.001，ΔBW：-128.7±82.8vs-25.2±109.0°，P<0.001)高于非SR组(N=39,64%)。多因素logistic回归分析显示，基线QRSd（95％CI1.019-1.100，P=0.006）和CRT前减少壁增厚（RWT）（95％CI1.016-1.173，P=0.028）是SR发展的独立预测因素。
结论：超过三分之一的患者在CRT后表现出SR，与没有SR的患者相比，CRT后的LV功能和不同步改善更多。CRT前较宽的QRSd和较高的RWT与CRT后SR的发展有关。
结果：61名符合CRT标准适应症的心力衰竭患者接受两次GMPS作为CRT前后评估。CRT后疤痕绝对减少≥10％的患者被归类为SR组，其余患者被归类为非SR组。SR组（N=22，36％）显示出更多的LV功能改善（ΔLVEF：18.1±12.4vs9.4±9.9％，P=0.007,ΔESV:-91.6±52.6vs-38.1±46.5mL,P<0.001）和不同步（ΔPSD：-26.19±18.42vs-5.8±23.0°，P<0.001，ΔBW：-128.7±82.8vs-25.2±109.0°，P<0.001)高于非SR组(N=39,64%)。多因素logistic回归分析显示，基线QRSd（95％CI1.019-1.100，P=0.006）和CRT前减少壁增厚（RWT）（95％CI1.016-1.173，P=0.028）是SR发展的独立预测因素。
结论：超过三分之一的患者在CRT后表现出SR，与没有SR的患者相比，CRT后的LV功能和不同步改善更多。CRT前较宽的QRSd和较高的RWT与CRT后SR的发展有关。
