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Background <p>Non-response to cardiac resynchronization therapy (CRT) is an important issue in the treatment of heart failure with reduced ejection fraction (HFrEF) and non-left bundle branch block (LBBB). Electrocardiogram-gated myocardial perfusion single-photon emission computed tomography imaging (G-MPI SPECT) is typically used to assess left ventricular (LV) dyssynchrony. This study aimed to determine whether G-MPI parameters are associated with non-responsiveness to CRT.</p> Methods <p>Between January 2021 and December 2022, 128 patients underwent CRT, of whom 73 with preoperative evaluation using G-MPI were selected. Forty-three patients with non-LBBB (21 and 22 CRT responders and non-responders, respectively) and 30 patients with LBBB were analyzed.</p> Results <p>Among patients with non-LBBB, CRT responders and non-responders exhibited no significant differences in baseline characteristics, except for the LV dimension. A receiver operating characteristic curve analysis identified 108° and 27.7° as the optimal cutoff values for the bandwidth and phase standard deviation (SD), respectively, to predict non-responsiveness to CRT (area under the curve [AUC] = 0.762; 95% confidence interval [CI] 0.601–0.923 and AUC = 0.742; 95% CI 0.576–0.909, respectively). A multivariate analysis revealed that a cutoff bandwidth of ≥ 108° and phase SD of ≥ 27.7° are independent predictors of non-responsiveness to CRT in patients with non-LBBB (hazard ratio 5.65; 95% CI 1.53–20.9; <i>P</i> = 0.009). In contrast, there were no significant associations between G-MPI parameters and non-responsiveness to CRT in patients with LBBB.</p> Conclusions <p>Preoperative G-MPI might be associated with non-responsiveness to CRT in patients with non-LBBB, indicating that identifying potential non-responders can improve patient management.</p> Graphical Abstract <p></p>

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Identifying non-responders to cardiac resynchronization therapy in the non-left bundle branch block

  • 期刊论文

  • 发表日期：

    2025年1月3日

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  • Toshihiro Nakamura,
  • Kohei Ishibashi,
  • Nobuhiko Useda,
  • Satoshi Oka,
  • Yuichiro Miyazaki,
  • Akinori Wakamiya,
  • Kenzaburo Nakajima,
  • Tsukasa Kamakura,
  • Mitsuru Wada,
  • Yuko Inoue,
  • Koji Miyamoto,
  • Satoshi Nagase,
  • Takeshi Aiba,
  • Kengo Kusano

摘要

Background

Non-response to cardiac resynchronization therapy (CRT) is an important issue in the treatment of heart failure with reduced ejection fraction (HFrEF) and non-left bundle branch block (LBBB). Electrocardiogram-gated myocardial perfusion single-photon emission computed tomography imaging (G-MPI SPECT) is typically used to assess left ventricular (LV) dyssynchrony. This study aimed to determine whether G-MPI parameters are associated with non-responsiveness to CRT.

Methods

Between January 2021 and December 2022, 128 patients underwent CRT, of whom 73 with preoperative evaluation using G-MPI were selected. Forty-three patients with non-LBBB (21 and 22 CRT responders and non-responders, respectively) and 30 patients with LBBB were analyzed.

Results

Among patients with non-LBBB, CRT responders and non-responders exhibited no significant differences in baseline characteristics, except for the LV dimension. A receiver operating characteristic curve analysis identified 108° and 27.7° as the optimal cutoff values for the bandwidth and phase standard deviation (SD), respectively, to predict non-responsiveness to CRT (area under the curve [AUC] = 0.762; 95% confidence interval [CI] 0.601–0.923 and AUC = 0.742; 95% CI 0.576–0.909, respectively). A multivariate analysis revealed that a cutoff bandwidth of ≥ 108° and phase SD of ≥ 27.7° are independent predictors of non-responsiveness to CRT in patients with non-LBBB (hazard ratio 5.65; 95% CI 1.53–20.9; P = 0.009). In contrast, there were no significant associations between G-MPI parameters and non-responsiveness to CRT in patients with LBBB.

Conclusions

Preoperative G-MPI might be associated with non-responsiveness to CRT in patients with non-LBBB, indicating that identifying potential non-responders can improve patient management.

Graphical Abstract