Clinical usefulness of gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography with phase analysis for the management of patients with isolated ventricular noncompaction

Naoto Takahashi; Naoki Sato; Koji Takagi; Toshiya Omote; Arifumi Kikuchi; Daisuke Hanaoka; Eisei Yamamoto; Masahiro Ishikawa; Kenichi Amitani; Shinichiro Kumita; Wataru Shimizu

doi:10.1016/j.jccase.2014.11.006

Clinical usefulness of gated technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography with phase analysis for the management of patients with isolated ventricular noncompaction

J Cardiol Cases. 2014 Dec 24;11(4):101-104. doi: 10.1016/j.jccase.2014.11.006. eCollection 2015 Apr.

Affiliations

¹ Department of Internal Medicine and Cardiology, Nippon Medical School, Musashikosugi Hospital, Kanagawa, Japan.
² Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan.
³ Department of Cardiovascular Medicine, Nippon Medical School Hospital, Tokyo, Japan.

Abstract

Gated Tc-99m sestamibi myocardial perfusion single-photon emission computed tomography (GMPS) with phase analysis provides information on myocardial perfusion, left ventricular (LV) function, and LV dyssynchrony. We present a case of isolated left ventricular noncompaction (IVNC) cardiomyopathy in which GMPS with phase analysis proved to be beneficial and reliable to monitor the long-term response to cardiac resynchronization therapy with defibrillator (CRT-D). The patient was an 84-year-old man with shortness of breath on minimal exertion (New York Heart Association class III) who had severe drug-refractory heart failure with hypotension and ventricular tachycardia. He was diagnosed with IVNC using echocardiography. At baseline, GMPS with phase analysis revealed a reduced ejection fraction (EF, 21%), large perfusion defects in the inferior and inferolateral walls, and severe LV dyssynchrony [histogram bandwidth (HBW) 120°]. Combination therapy with CRT-D and a titrated beta-blocker was initiated to induce LV reverse remodeling and reduce LV dyssynchrony. Two years after CRT-D implantation, GMPS with phase analysis showed marked improvement in LV function and LV dyssynchrony (EF 28%, HBW 36°). This case demonstrates that GMPS with phase analysis is an important and useful modality to evaluate LV function and LV dyssynchrony in IVNC patients undergoing CRT-D. <Learning objective: We experienced a rare case of heart failure with isolated left ventricular noncompaction (IVNC) treated with cardiac resynchronization therapy with defibrillator (CRT-D). We demonstrate that gated Tc-99m myocardial perfusion SPECT (GMPS) with phase analysis can simultaneously evaluate myocardial perfusion and left ventricular dyssynchrony to assess the indication and efficacy of CRT-D. This case demonstrates that GMPS with phase analysis is useful to monitor IVNC patients before and after CRT-D.>.

Keywords: Cardiac resynchronization therapy; Gated Tc-99m sestamibi myocardial perfusion single-photon emission computed tomography; Isolated ventricular noncompaction; Left ventricular dyssynchrony; Phase analysis.