Prognostic Value of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology in Patients with Known or Suspected Stable Coronary Artery Disease with Preserved Left Ventricular Ejection Fraction

Hatta, Takumi; Yoda, Shunichi; Hayase, Misa; Monno, Koyuru; Hori, Yusuke; Fujito, Hidesato; Suzuki, Yasuyuki; Matsumoto, Naoya; Okumura, Yasuo

doi:10.1536/ihj.20-008

Cited by 9 publications

(10 citation statements)

References 29 publications

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“…The LVEF was shown to be the most powerful predictor for abnormal phase bandwidth, and its optimal cut-off value was 47% (sensitivity 73% and specificity 98%) ( 22 ). We also reported that the onset of LV mechanical dyssynchrony was associated with the occurrence of ischemic MCEs and related to post-ischemic stunning caused by a ≥5% reduction in the LVEF during stress in patients with known or suspected stable CAD and a preserved LVEF ( 12 ). Those findings suggest that a normalized LVEF after revascularization leads to improvement in LV mechanical dyssynchrony and ultimately a good prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…The study subjects were 332 patients who ( 1 ) underwent rest 201 Tl and stress 99m Tc-tetrofosmin ECG-gated SPECT myocardial perfusion imaging (MPI) ( 2 , 5 , 12 - 15 ) at Nihon University Itabashi Hospital between January 2010 and November 2016 ( 2 ), had significant stenosis and ≥75% narrowing of the coronary arterial diameter according to the American Heart Association classification detected by coronary angiography (CAG) performed after confirmation of ≥5% ischemia by the SPECT, and ( 2 ) subsequently received revascularization.…”

Section: Methodsmentioning

confidence: 99%

“…The procedure of rest 201 Tl and stress 99m Tc-tetrofosmin ECG-gated SPECT MPI was performed according to a previously reported protocol (2,5,(12)(13)(14)(15). All patients received an intravenous (i.v.)…”

Section: Ecg-gated Spect Mpimentioning

confidence: 99%

“…We reported that the LV mechanical dyssynchrony index stress phase bandwidth was a predictor independent of the ischemic volume evaluated with SPECT. This index was shown to be useful for stratifying the risk of MCEs in patients with known or suspected stable CAD who had a preserved LV ejection fraction (LVEF) and were indicated for optimal medical therapy ( 12 ). Based on those findings, we hypothesized that the stress phase bandwidth could also predict the prognosis in patients with CAD who underwent revascularization.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Ecg-gated Spect Mpimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Left ventricular (LV) asynchrony is associated with severe heart failure, and cardiac resynchronization therapy (CRT) has proven to be an effective treatment (1)(2)(3)(4). However, according to current guidelines, nearly 30% of patients with heart failure have not received good treatment results for CRT (5).…”

Section: Introductionmentioning

confidence: 99%

The feasibility of 18F-FDG gated positron emission tomography (PET) for left ventricular dyssynchrony assessment in comparison with 99mTc-MIBI gated single-photon emission computed tomography (SPECT) among patients with prior myocardial infarction

Yao¹,

Wei²,

Wang³

2022

Quant Imaging Med Surg

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Background: Phase analysis by 99m Tc-MIBI gated single-photon emission computed tomography (GSPECT) has been considered to be an adequate method in the validation of left ventricular (LV) dyssynchrony. Compared with GSPECT, prior myocardial infarction patients with myocardial perfusion defects but myocardial viability usually show preserved uptake of 18 F-FDG, and extensive myocardium is detected by 18 F-FDG gated positron emission tomography (GPET). Thus, theoretically, it should be more accurate. The aim of this study was to investigate the feasibility of GPET for LV dyssynchrony assessment in comparison with GSPECT among infarction patients.Methods: A total of 146 patients with infarction underwent 2 consecutive days of GSPECT and GPET examinations. Quantitative gated SPECT-derived LV phase analysis was applied to GPET and GSPECT data to assess the presence of LV dyssynchrony via histogram bandwidth (BW) and phase standard deviation (SD). The correlation and agreement of BW and SD between GSPECT and GPET were examined. Factors (i.e., total perfusion defect, scar and mismatch) related to the discrepancies of LV dyssynchrony (i.e., BW and SD) in GPET and GSPECT were assessed by univariate and multivariate regression analysis.Results: A moderate correlation between GPET and GSPECT was found in the measurements of BW (r=0.554) and SD (r=0.537). Bland-Altman analysis revealed that GPET overestimated both BW and SD (20.5° and 9.5°, respectively). In addition, the BW and SD measured by GPET were still overestimated after subgroup analysis. Between GPET and GSPECT, multivariate regression analysis revealed that total perfusion defects were related to the difference in BW measurement (P<0.001), and mismatch was associated with the difference in SD measurement (P<0.01). Conclusions:In patients with infarction, GPET moderately correlated with GSPECT in assessing LV dyssynchrony. GPET overestimated both BW and SD, so these analyses should not be interchangeable in individual patients.

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Construction of a web‐based dynamic nomogram for predicting the prognosis in acute heart failure

Gao

Guo

et al. 2023

ESC Heart Failure

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Aims The early identification and appropriate management may provide clinically meaningful and substained benefits in patients with acute heart failure (AHF). This study aimed to develop an integrative nomogram with myocardial perfusion imaging (MPI) for predicting the risk of all‐cause mortality in AHF patients. Methods and results Prospective study of 147 patients with AHF who received gated MPI (59.0 [47.5, 68.0] years; 78.2% males) were enrolled and followed for the primary endpoint of all‐cause mortality. We analysed the demographic information, laboratory tests, electrocardiogram, and transthoracic echocardiogram by the least absolute shrinkage and selection operator (LASSO) regression for selection of key features. A multivariate stepwise Cox analysis was performed to identify independent risk factors and construct a nomogram. The predictive values of the constructed model were compared by Kaplan–Meier curve, area under the curves (AUCs), calibration plots, continuous net reclassification improvement, integrated discrimination improvement, and decision curve analysis. The 1, 3, and 5 year cumulative rates of death were 10%, 22%, and 29%, respectively. Diastolic blood pressure [hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.93–0.99; P = 0.017], valvular heart disease (HR 3.05, 95% CI 1.36–6.83; P = 0.007), cardiac resynchronization therapy (HR 0.37, 95% CI 0.17–0.82; P = 0.014), N‐terminal pro‐B‐type natriuretic peptide (per 100 pg/mL; HR 1.02, 95% CI 1.01–1.03; P < 0.001), and rest scar burden (HR 1.03, 95% CI 1.01–1.06; P = 0.008) were independent risk factors for patients with AHF. The cross‐validated AUCs (95% CI) of nomogram constructed by diastolic blood pressure, valvular heart disease, cardiac resynchronization therapy, N‐terminal pro‐B‐type natriuretic peptide, and rest scar burden were 0.88 (0.73–1.00), 0.83 (0.70–0.97), and 0.79 (0.62–0.95) at 1, 3, and 5 years, respectively. Continuous net reclassification improvement and integrated discrimination improvement were also observed, and the decision curve analysis identified the greater net benefit of the nomogram across a wide range of threshold probabilities (0–100% at 1 and 3 years; 0–61% and 62–100% at 5 years) compared with dismissing the included factors or using either factor alone. Conclusions A predictive nomogram for the risk of all‐cause mortality in patients with AHF was developed and validated in this study. The nomogram incorporated the rest scar burden by MPI is highly predictive, and may help to better stratify clinical risk and guide treatment decisions in patients with AHF.

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Prognostic Value of Left Ventricular Dyssynchrony Assessed with Nuclear Cardiology in Patients with Known or Suspected Stable Coronary Artery Disease with Preserved Left Ventricular Ejection Fraction

Cited by 9 publications

References 29 publications

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

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

The feasibility of 18F-FDG gated positron emission tomography (PET) for left ventricular dyssynchrony assessment in comparison with 99mTc-MIBI gated single-photon emission computed tomography (SPECT) among patients with prior myocardial infarction

Construction of a web‐based dynamic nomogram for predicting the prognosis in acute heart failure

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