Prognostic value of left-ventricular systolic and diastolic dyssynchrony measured from gated SPECT MPI in patients with dilated cardiomyopathy

Abstract

Background. Left-ventricular systolic dyssynchrony (LVSD) has been an important prognostic factor in the patients with dilated cardiomyopathy (DCM). However, the association between the LV diastolic dyssynchrony (LVDD) and clinical outcome is not well established. This study aims to evaluate the prognostic values of both systolic and diastolic dyssynchrony in patients with DCM. Methods. Fifty-two patients with DCM were enrolled and divided into two groups according to cardiac deaths from the follow-up data. The phase-analysis technique was applied on resting gated short-axis SPECT MPI images to measure LV systolic and diastolic dyssynchrony, including phase standard deviation (PSD), phase histogram bandwidth (PBW), and phase entropy (PE). Variables with P < 0.10 in the univariate analysis were included in the multivariate cox analysis. Results. During the follow-up period (2.9 ± 1.7 years), 18 (34.6%) cardiac deaths were observed. Compared with survivors, patients with cardiac death had lower LVEF (P = 0.011), and more severe LV systolic and diastolic dyssynchrony. The univariate cox regression analysis showed that hypertension, NT-proBNP, LVEF, systolic PSD, systolic PE, and diastolic PBW were statistically significantly associated with cardiac death. The multivariate cox regression analysis showed that systolic PE and diastolic PE were independent predictive factors for cardiac death. Furthermore, the receiver operating characteristic (ROC) analysis, when applied into the combination of systolic PE and diastolic PE for predicting cardiac death, had an area under curve (AUC) of 0.766, a sensitivity of 0.765, and a specificity of 0.722. Conclusions. Both the LVSD and LVDD parameters from SPECT MPI have important prognostic values for DCM patients. Both systolic PE and diastolic PE are independent prognostic factors for cardiac death.

Prognostic value of summed motion score assessed by gated SPECT myocardial perfusion imaging in patients with dilated cardiomyopathy

“…In the follow-up of the 81 DCM patients for 44 (25, 54) months, we found that the AUC of the ROC curve of SMS was relatively stable around 0.80 at all timepoints, suggesting that SMS is relatively stable in predicting cardiac death. It is well known that the LV global functional parameter LVEF is an important predictor of cardiac death in patients with DCM ( 2 , 17 ). The global and regional functions are closely related and the correlation between global systolic wall motion score measured by echocardiography (echocardiographic wall motion score index, WSMI) and LVEF obtained by radionuclide ventriculography is high ( r = 0.72) ( 40 , 41 ).…”

“…Follow-up data were obtained through phone contact with patients or their relatives, and other information of patients were obtained from the records of the hospitalized case system. The endpoint was cardiac death, including cardiac arrest or death from circulatory failure occurring within the first hour or refractory chronic heart failure ( 17 ). The mean follow-up period was 44 (25, 54) months.…”

Taking a deeper dive into MPI: There’s more there than meets the eye

“…Diastolic dyssynchrony was present without systolic dyssynchrony in 21/ 78 patients in the study but when systolic dyssynchrony was present, diastolic dyssynchrony was always present. In the current issue of the Journal, Wang et al 10 compare the prognostic significance of systolic and diastolic PSD, PBW, and phase entropy in patients with idiopathic dilated cardiomyopathy (CAD, valvular disease, alcoholic or inflammatory disease, or any identifiable systemic illness excluded). They acquired 8-frame SPECT MPI data and processed the data using Emory ERToolbox software.…”

Mechanical dyssynchrony & CRT: Is it time for guideline updates?

“…21 The review paper nicely summarized the recent papers on diastolic LVMD which seems to be complimentary to systolic LVMD, have prognostic value and are likely to play an important role in fine tuning patient selection for CRT. 19,22,23 It seems things are getting bit more complex with several parameters from gated SPECT and LVMD impacting CRT response, not forgetting clinical parameters (Figure 1). While each of these parameters have shown in a paper or other its ability to discriminate CRT responder, there is still no single parameter or cutoff value that has high enough diagnostic accuracy and provides robust clinical decision to proceed or amend guidelines.…”

“…)23 E and F are reproduced with permission from Tao et al(Figure 2)18 G and H are reproduced with permission from Wang et al(Figure 8)17 .…”