Paul L Hess1,2, Linda K Shaw3, Marat Fudim4, Ami E Iskandrian5, Salvador Borges-Neto6,7. 1. VA Eastern Colorado and Health Care System, Denver, CO, USA. 2. Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA. 3. Duke Clinical Research Institute, Durham, NC, USA. 4. Division of Cardiology, Duke Department of Medicine, DUMC, Box 3929, Durham, NC, 27710, USA. 5. Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA. 6. Division of Cardiology, Duke Department of Medicine, DUMC, Box 3929, Durham, NC, 27710, USA. salvador.borgesneto@dm.duke.edu. 7. Division of Nuclear Medicine, Duke Department of Radiology, Durham, NC, USA. salvador.borgesneto@dm.duke.edu.
Abstract
BACKGROUND: The prognostic value of left ventricular dyssynchrony measured by gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) and its relationship to electrical dyssynchrony measured by QRS duration are incompletely understood. The aim of this study was therefore to examine the independent and incremental prognostic value of dyssynchrony in yet the largest group of patients with coronary artery disease (CAD). METHODS AND RESULTS: Patients presenting for GSPECT- MPI between July 1993 and May 1999 in normal sinus rhythm were identified from the Duke Nuclear Cardiology Databank and the Duke Databank for Cardiovascular Disease (N = 1244). After a median of 4.2 years, 336 deaths occurred. At 8 years, the Kaplan-Meier estimates of the probability of death were 34.0% among patients with a phase bandwidth <100° and 56.8% among those with a bandwidth ≥100°. After adjustment for standard clinical variables, QRS dyssynchrony was independently associated with death (Hazard Ratio (HR), per 10°: 1.092, 95% Confidence Interval (CI) 1.048,1.139, P < .0001). Phase bandwidth was similarly associated with death after clinical adjustment (HR per 10°: 1.056, 95% CI 1.041,1.072, P < .0001). In clinically adjusted models examining QRS duration in addition to phase bandwidth, phase bandwidth had a stronger association with mortality. After accounting for left ventricular ejection fraction (LVEF), neither QRS duration nor phase bandwidth were statistically significant. Among patients with EF >35%, QRS duration and phase bandwidth together provided value above that provided by LVEF alone (P = 0.0181). When examining cardiovascular death, results were consistent with all-cause death. CONCLUSIONS: Among patients with CAD, mechanical left ventricular dyssynchrony measured by GSPECT MPI has a stronger relationship with outcomes than electrical dyssynchrony measured by QRS duration. After adjustment for baseline characteristics and LVEF, neither mechanical nor electrical dyssynchrony is independently associated with all-cause death or cardiac death. Among patients with EF >35%, mechanical and electrical dyssynchrony together provided prognostic value above that afforded by LVEF.
BACKGROUND: The prognostic value of left ventricular dyssynchrony measured by gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) and its relationship to electrical dyssynchrony measured by QRS duration are incompletely understood. The aim of this study was therefore to examine the independent and incremental prognostic value of dyssynchrony in yet the largest group of patients with coronary artery disease (CAD). METHODS AND RESULTS:Patients presenting for GSPECT- MPI between July 1993 and May 1999 in normal sinus rhythm were identified from the Duke Nuclear Cardiology Databank and the Duke Databank for Cardiovascular Disease (N = 1244). After a median of 4.2 years, 336 deaths occurred. At 8 years, the Kaplan-Meier estimates of the probability of death were 34.0% among patients with a phase bandwidth <100° and 56.8% among those with a bandwidth ≥100°. After adjustment for standard clinical variables, QRS dyssynchrony was independently associated with death (Hazard Ratio (HR), per 10°: 1.092, 95% Confidence Interval (CI) 1.048,1.139, P < .0001). Phase bandwidth was similarly associated with death after clinical adjustment (HR per 10°: 1.056, 95% CI 1.041,1.072, P < .0001). In clinically adjusted models examining QRS duration in addition to phase bandwidth, phase bandwidth had a stronger association with mortality. After accounting for left ventricular ejection fraction (LVEF), neither QRS duration nor phase bandwidth were statistically significant. Among patients with EF >35%, QRS duration and phase bandwidth together provided value above that provided by LVEF alone (P = 0.0181). When examining cardiovascular death, results were consistent with all-cause death. CONCLUSIONS: Among patients with CAD, mechanical left ventricular dyssynchrony measured by GSPECT MPI has a stronger relationship with outcomes than electrical dyssynchrony measured by QRS duration. After adjustment for baseline characteristics and LVEF, neither mechanical nor electrical dyssynchrony is independently associated with all-cause death or cardiac death. Among patients with EF >35%, mechanical and electrical dyssynchrony together provided prognostic value above that afforded by LVEF.
Authors: William T Abraham; Westby G Fisher; Andrew L Smith; David B Delurgio; Angel R Leon; Evan Loh; Dusan Z Kocovic; Milton Packer; Alfredo L Clavell; David L Hayes; Myrvin Ellestad; Robin J Trupp; Jackie Underwood; Faith Pickering; Cindy Truex; Peggy McAtee; John Messenger Journal: N Engl J Med Date: 2002-06-13 Impact factor: 91.245
Authors: Salvador Borges-Neto; Robert A Pagnanelli; Linda K Shaw; Emily Honeycutt; Shuli C Shwartz; George L Adams; Ralph Edward Coleman Journal: J Nucl Cardiol Date: 2007-07 Impact factor: 5.952
Authors: Aju P Pazhenkottil; Ronny R Buechel; Lars Husmann; René N Nkoulou; Mathias Wolfrum; Jelena-Rima Ghadri; Janine Kummer; Bernhard A Herzog; Philipp A Kaufmann Journal: Heart Date: 2010-10-20 Impact factor: 5.994
Authors: Christopher Uebleis; Stefan Hellweger; Rüdiger Paul Laubender; Alexander Becker; Hae-Young Sohn; Sebastian Lehner; Alexander Haug; Peter Bartenstein; Paul Cumming; Serge D Van Kriekinge; Piotr J Slomka; Marcus Hacker Journal: Eur J Nucl Med Mol Imaging Date: 2012-07-03 Impact factor: 9.236
Authors: Adam S Goldberg; M Chadi Alraies; Manuel D Cerqueira; Wael A Jaber; Wael A Aljaroudi Journal: J Nucl Cardiol Date: 2013-10-04 Impact factor: 5.952
Authors: Saara Sillanmäki; Jukka A Lipponen; Mika P Tarvainen; Tiina Laitinen; Marja Hedman; Antti Hedman; Antti Kivelä; Hanna Hämäläinen; Tomi Laitinen Journal: J Nucl Cardiol Date: 2018-02-08 Impact factor: 5.952