Medical Radiology and Radiation Safety. 2026. Vol. 71. № 4

DOI:10.33266/1024-6177-2026-71-4-127-132

A.I. Mishkina, T.A. Atabekov, S.I. Sazonova, V.V. Saushkin, R.E. Batalov, S.V. Popov, K.V. Zavadovsky

PROGNOSTIC VALUE OF SCINTIGRAPHIC INDICES OF LEFT VENTRICLE MYOCARDIAL PERFUSION AND CONTRACTILITY FOR PATIENT SELECTION FOR CARDIAC RESYNCHRONIZATION THERAPY

Cardiology Research Institute, Tomsk National Research Medical Centre, Tomsk, Russia

Contact person: A.I. Mishkina, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

ABSTRACT

Purpose: To assess the significance of regional scintigraphic markers of left ventricular (LV) perfusion and contractility within the target vein region for predicting a positive response one year after cardiac resynchronization therapy (CRT).

Material and methods: The study included 44 chronic heart failure patients with II and III functional class (NYHA), referred for CRT according to current guidelines. The median age was 61 years (60, 63), and 28 (64%) were male. Prior to CRT, all patients underwent gated myocardial perfusion scintigraphy (MPS) to assess myocardial perfusion and LV contractility (evaluated using scintigraphic indices of wall motion, wall thickening, and mechanical dyssynchrony). Cardiac computed tomography with contrast was also performed to assess coronary venous anatomy and for target vein selection. Global and regional scintigraphic parameters of LV perfusion and contractility were assessed before CRT. One year after CRT, all patients underwent echocardiography to evaluate treatment efficacy. The echocardiographic response was defined as a reduction in LV end-systolic volume by ≥15% and/or an increase LV ejection fraction by ≥5%.

Results: At the one-year follow-up, a positive response to CRT was observed in 35 (79 %) patients. Comparison of regional scintigraphic indices in the area of the LV lead position revealed that responders had significantly higher indices of wall motion (p=0.01) and wall thickening (p=0.04). Multivariate logistic regression analysis showed that regional LV wall motion at the LV lead position, assessed by gated MPS, was an independent predictor of a positive response to CRT one year after the intervention. ROC analysis established a threshold value for this parameter (regional wall motion index >3.8 mm) for predicting a positive response one year after CRT.

Conclusion: Preoperative scintigraphic assessment of the LV lead position region may be useful for patient selection for CRT. A regional LV systolic wall motion value greater than 3.8 mm can be used as a prognostic marker for a positive response to CRT.

Keywords:  cardiac resynchronization therapy, myocardial perfusion scintigraphy, left ventricular systolic wall motion, mechanical dyssynchrony, regional analysis

For citation:  Mishkina AI, Atabekov TA, Sazonova SI, Saushkin VV, Batalov RE, Popov SV, Zavadovsky KV. Prognostic Value of Scintigraphic Indices of Left Ventricle Myocardial Perfusion and Contractility for Patient Selection for Cardiac Resynchronization Therapy. Medical Radiology and Radiation Safety. 2026;71(4):127–132. DOI:10.33266/1024-6177-2026-71-4-127-132

References

1. 2021 ESC Guidelines for Pacing and Cardiac Resynchronization Therapy. Rossiyskiy Kardiologicheskiy Zhurnal = Russian Journal of Cardiology. 2022;27;7:5159 (In Russ.). Doi: 10.15829/1560-4071-2022-5159.

2. Tokavanich N., Mongkonsritragoon W., Sattawatthamrong S., Techasatian W., Siranart N., Prasitlumkum N., Navaravong L., Chokesuwattanaskul R. Outcomes of Cardiac Resynchronization Therapy in Congenital Heart Disease: a Meta-Analysis and Systematic Review. J Cardiovasc Electrophysiol. 2024;35;2:249–257. Doi: 10.1111/jce.16144. PMID: 38065836.

3. Allen LaPointe N.M., Ali-Ahmed F., Dalgaard F., Kosinski A.S., Sanders Schmidler G., Al-Khatib S.M. Cardiac Resynchronization Therapy Outcomes with Left Ventricular Lead Concordant with Latest Mechanical Activation: a Meta-Analysis. Pacing Clin Electrophysiol. 2022;45;8:930-939. Doi: 10.1111/pace.14549. PMID: 35687711.

4. Butter C., Georgi C., Stockburger M. Optimal CRT Implantation-where and how to Place the Left-Ventricular Lead? Curr Heart Fail Rep. 2021;18;5:329-344. Doi: 10.1007/S11897-021-00528-9. PMID: 34495452.

5. Gach-Kuniewicz B., Goncerz G., Ali D., Kacprzyk M., Zarzecki M., Loukas M., Walocha J., Mizia E. Variations of Coronary Sinus Tributaries among Patients Undergoing Cardiac Resynchronisation Therapy. Folia Morphol (Warsz). 2023;82;2:282-290. Doi: 10.5603/FM.a2022.0044. PMID: 35607878.

6. Mamedova A.I., Prikhod’ko N.A., Lyubimtseva T.A., Kozlenok A.V., Lebedev D.S. Mechanical Dyssynchrony in Patients with Chronic Heart Failure with Left Bundle Branch Block. Sibirskiy Zhurnal Klinicheskoy i Eksperimental’noy Meditsiny = The Siberian Journal of Clinical and Experimental Medicine. 2024;39;3:72-79 (In Russ.).  Doi: 10.29001/2073-8552-2024-39-3-72-79.

7. Bertini M., Mele D., Malagù M., Fiorencis A., Toselli T., Casadei F., Cannizzaro T., Fragale C., Fucili A., Campagnolo E., Benea G., Ferrari R. Cardiac Resynchronization Therapy Guided by Multimodality Cardiac Imaging. Eur J Heart Fail. 2016;18;11:1375-1382. Doi: 10.1002/ejhf.605. PMID: 27406979.

8. Saba S., Marek J., Schwartzman D., Jain S., Adelstein E., White P., Oyenuga O.A., Onishi T., Soman P., Gorcsan J. 3rd.  Echocardiography-Guided Left Ventricular Lead Placement for Cardiac Resynchronization Therapy: Results of the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region Trial. Circ Heart Fail. 2013;6:427-434. Doi: 10.1161/CIRCHEARTFAILURE.112.000078. PMID: 23476053.

9. Khan F.Z., Virdee M.S., Palmer C.R., Pugh P.J., O’Halloran D., Elsik M., Read P.A., Begley D., Fynn S.P., Dutka D.P. Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy: the Target Study: a Randomized, Controlled Trial. J Am Coll Cardiol. 2012;59:1509-1518. Doi: 10.1016/j.jacc.2011.12.030. PMID: 22405632.

10. Sommer A., Kronborg M.B., Nørgaard B.L., Poulsen S.H., Bouchelouche K., Böttcher M., Jensen H.K., Jensen J.M., Kristensen J., Gerdes C., Mortensen P.T., Nielsen J.C. Multimodality Imaging-Guided left Ventricular Lead Placement in Cardiac Resynchronization Therapy: a Randomized Controlled Trial. Eur J Heart Fail. 2016;18;11:1365-1374. Doi: 10.1002/ejhf.530. PMID: 27087019.

11. Fyenbo D.B., Bjerre H.L., Frausing M.H.J.P., Stephansen C., Sommer A., Borgquist R., Bakos Z., Glikson M., Milman A., Beinart R., Kockova R., Sedlacek K., Wichterle D., Saba S., Jain S., Shalaby A., Kronborg M.B., Nielsen J.C. Targeted Left Ventricular Lead Positioning to the Site of Latest Activation in Cardiac Resynchronization Therapy: a Systematic Review and Meta-Analysis. Europace. 2023;25;9:euad267. Doi: 10.1093/europace/euad267. PMID: 37695316.

12. Mansour N., Nekolla S.G., Reyes E., Angelidis G., Georgoulias P., Anagnostopoulos C., Bravo P., Bruno I., Flotats A., Fuentes-Ocampo F., Sciagrà R., Keng F., Kessler L., Papathanasiou M., Soman P., Rischpler C. Multi-Center Study of Inter-Rater Reproducibility, Image Quality, and Diagnostic Accuracy of CZT Versus Conventional SPECT Myocardial Perfusion Imaging. J Nucl Cardiol. 2023;30;2:528-539. Doi: 10.1007/s12350-022-03054-w. PMID: 35799039.

13. Stiles M.K., Fauchier L., Morillo C.A., Wilkoff B.L. ESC Scientific Document Group. 2019 HRS/EHRA/APHRS/LAHRS Focused Update to 2015 Expert Consensus Statement on Optimal Implantable Cardioverter-Defibrillator Programming and Testing. Europace. 2019;21;9:1442-1443. Doi: 10.1093/europace/euz065. PMID: 31090914.

14. Gulya M.O., Lishmanov Yu.B., Zavadovskiy K.V., Lebedev D.I. The State of Fatty Acid Metabolism in the Left Ventricular Myocardium and the Prognosis of the Effectiveness of Cardiac Resynchronization Therapy in Patients with Dilated Cardiomyopathy. Rossiyskiy Kardiologicheskiy Zhurnal = Russian Journal of Cardiology. 2014;19;1:61-67 (In Russ.). Doi: 10.15829/1560-4071-2014-9-61-67 

15. Wang J., Wang Y., Yang M., Shao S., Tian Y., Shao X., Fan S., Zhang F., Yang W., Xin W., Tang H., Xu M., Yang L., Wang X., Zhou W. 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. 2020;27;2:419-430. Doi: 10.1007/s12350-019-01710-2. PMID: 30972718. 

16. Sedova K.A., van Dam P.M., Blahova M., Necasova L., Kautzner J. Localization of the Ventricular Pacing site from BSPM and Standard 12-lead ECG: a Comparison Study. Sci Rep. 2023;13;1:9618. Doi: 10.1038/s41598-023-36768-z. PMID: 37316547.

17. Mishkina A.I., Atabekov T.A., Sazonova S.I., Batalov R.Ye., Popov S.V., Zavadovskiy K.V. Optimization of Left Ventricular Electrode Implantation Based on a Combination of Myocardial Perfusion Scintigraphy and X-Ray Computed Tomography Data. Digital Diagnostics. 2025;6;2:229-238 (In Russ.). Doi: 10.17816/DD635333.

18. Zavadovskiy K.V., Saushkin V.V., Varlamova Yu.V., Mishkina A.I., Shipulin V.V., Le-bedev D.I., Popov S.V. Mechanical Dyssynchrony in the Prognosis of Response to Resynchronization Therapy in Patients with Dilated Cardiomyopathy. Kardiologiya = Cardiology. 2021;61;7:14-21 (In Russ.). Doi: 10.18087/cardio.2021.7.n1420. PMID: 34397337. 

19. Peix A., Karthikeyan G., Massardo T., Kalaivani M., Patel C., Pabon L.M., Jiménez-Heffernan A., Alexanderson E., Butt S., Kumar A., Marin V., Mesquita C.T., Morozova O., Paez D., Garcia E.V. Value of Intraventricular Dyssynchrony Assessment by Gated-SPECT Myocardial Perfusion Imaging in the Management of Heart Failure Patients Undergoing Cardiac Resynchronization Therapy (VISION-CRT). J Nucl Cardiol. 2021;28;1:55-64. Doi: 10.1007/s12350-018-01589-5. PMID: 30684258.

20. Mishkina A.I., Atabekov T.A., Shipulin V.V., Batalov R.Ye., Sazonova S.I., Popov S.V., Zavadovskiy K.V.  The Role of Radionuclide Assessment of Global and Regional Mechanical Dyssynchrony of the Heart in Assessing the Prognosis of Cardiac Resynchronization Therapy in Patients with Chronic Heart Failure. Rossiyskiy Kardiologicheskiy Zhurnal = Russian Journal of Cardiology. 2023;28;8:5497 (In Russ.). Doi: 10.15829/1560-4071-2023-5497.

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Conflict of interest.The authors declare no conflict of interest.

Financing.   The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.03.2026. Accepted for publication: 25.04.2026.