Prognostic Significance of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology for the Prediction of Major Cardiac Events after Revascularization

Abstract

Objective This retrospective study was aimed at determining whether or not stress phase bandwidth (SPBW), a left ventricular (LV) mechanical dyssynchrony index, predicts major cardiac events (MCEs) and stratifies the risk of those in patients with coronary artery disease (CAD) who undergo revascularization. Methods Patients were followed up to confirm the prognosis for at least one year. The SPBW was calculated by a phase analysis using the Heart Risk View-F software program. The composite endpoint was the onset of MCEs, consisting of cardiac death, non-fatal myocardial infarction, unstable angina pectoris, and severe heart failure requiring hospitalization. Patients The study subjects were 332 patients with CAD who underwent coronary angiography and revascularization after confirming " 5% ischemia detected by rest 201 Tl and stress 99m Tc-tetrofosmin electrocardiogram-gated single-photon emission computed tomography myocardial perfusion imaging. Results During the follow-up, 35 patients experienced MCEs of cardiac death (n=5), non-fatal myocardial infarction (n=3), unstable angina pectoris (n=11), and severe heart failure requiring hospitalization (n=16). A receiver operating characteristics analysis indicated that the optimal cut-off value of the SPBW was 52°for predicting MCEs, and the MCE rate was significantly higher in the patients with an SPBW >52°than in those with an SPBW ! 52°. Results of the multivariate analysis showed the SPBW and estimated glomerular filtration rate to be independent predictors for MCEs. In addition, the cut-off value of the SPBW significantly stratified the risk of MCEs according to the results of the Kaplan-Meier analysis. Conclusion Evaluating the SPBW before revascularization may help predict future MCEs in patients with CAD who intended to undergo treatment.

The relationship between mechanical dyssynchrony of the left ventricular myocardium and the degree of coronary artery occlusion in patients with coronary artery disease

“…Важливим є прогностичне значення ДМ у хворих з ХКС та ХСН. Було показано, що нормалізація дисинхронії ЛШ після реваскуляризації може допомогти передбачити майбутні великі серцево-судинні події і, отже, бути корисним показником для прогнозування поліпшення прогнозу у пацієнтів з ХКС [13,14]. Також було показано, що ДМ є предиктором подій в короткому періоді спостереження у хворих після аортокоронарного шунтування [15].…”

Normal and Range Value Evaluations Using Heart Risk View-Function Based on the Japanese Society of Nuclear Medicine Working Group Database

“…The Japanese assessment of cardiac events and survival study by gated SPECT (J-ACCESS) and a number of clinical studies using HRV-F software have been conducted and exhibited that the LV function and phase parameters were helpful for the diagnosis of coronary artery disease, prognostic risk stratification, and determination of subsequent treatments (8)(9)(10). However, few studies have reported the mean and range of normal values for HRV-F were to compare software differences (5,7).…”