Author + information
- Marat Fudim,
- Peter R. Liu,
- Linda Shaw,
- Paul Hess,
- Olga James and
- Salvador Borges-Neto
Background: Systolic left ventricular dyssynchrony measured by gated single photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) is associated with worse outcomes. Novel analytical algorithms now allow for evaluation of diastolic left ventricular dyssynchrony. Our aim was to examine if diastolic dyssynchrony has independent and incremental prognostic value in patients with coronary artery disease (CAD).
Methods: We included patients who presented to Duke University for GSPECT MPI between July 1993 and May 1999 in normal sinus rhythm. Patients had at least one major epicardial CAD. Diastolic dyssynchrony variables were computed using Emory Toolbox software. We performed unadjusted Cox proportional hazard modeling for diastolic dyssynchrony variables with all-cause mortality as primary outcome. Adjusted modeling included electrical dyssynchrony (QRS duration), diastolic and systolic dyssynchrony parameters.
Results: Total of 1153 patients were enrolled. Of them 69% were male and 73% Caucasian. Chronic congestive heart failure was present in 24% of cases. After median follow-up of 4.2 years, 309 deaths occurred. Diastolic phase bandwidth, a measure of left ventricular dyssynchrony, had the strongest association with all-cause mortality in the unadjusted model (LR Chi-square 52.2; p<0.0001) even when compared with systolic dyssynchrony parameters. Other markers of diastolic dyssynchrony such as phase standard deviation (LR Chi-square 46.6; p<0.0001) and skewness were also significantly associated with all-cause mortality risk (LR Chi-square 31.4; p<0.0001). This association persisted after adjustment for QRS and systolic dyssynchrony, diastolic phase bandwidth was significant (p= 0.04) with a global LR Chi-square increment of 4.2.
Conclusions: This is the first study to evaluate the prognostic value of diastolic mechanical dyssynchrony, as measured by GSPECT MPI on mortality. In our study of a CAD population, diastolic dyssynchrony had a stronger association with all-cause mortality than systolic dyssynchrony. After adjustment for electrical and systolic dyssynchrony, diastolic dyssynchrony remained an incremental predictor of mortality
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Nuclear Cardiology: Prognosis
Abstract Category: 30. Non Invasive Imaging: Nuclear
Presentation Number: 1159-208
- 2017 American College of Cardiology Foundation