title: The prognostic value of left ventricular mechanical dyssynchrony using gated myocardial perfusion imaging in patients with end-stage renal disease.
abstract: BACKGROUND
  Prior studies show that left ventricular mechanical dyssynchrony (LVD), measured by gated SPECT myocardial perfusion imaging (MPI), identifies patients with end-stage renal disease (ESRD) at higher risk for all-cause mortality but these were in small number of patients. We sought to assess the interaction between LVD and LV perfusion pattern in risk-stratification of a large sample size of patients with ESRD.
  
  
  METHODS
  From the renal transplantation database maintained at the University of Alabama at Birmingham, we identified consecutive patients with ESRD who had gated SPECT MPI between 2003 and 2007. MPIs were reprocessed to derive LV ejection fraction (EF), perfusion defect size, and LVD [phase bandwidth (BW) and phase standard deviation (SD)]. The primary end-point was all-cause mortality, which was prospectively collected and verified against the social security death index database.
  
  
  RESULTS
  There were 828 patients aged 52.6 ± 0.36 years (45% were women and 60% had diabetes mellitus). The LVEF was 54.8 ± 0.4% and the perfusion pattern was abnormal in 334 patients (41%). During a follow-up period of 61 ± 0.9 months, 230 patients (28%) received renal transplants and 290 patients (35%) died. The phase BW (73.1 ± 2.6° vs 66.3 ± 1.8°, P = .02) and SD (25.2 ± 0.8° vs 23.4 ± 0.5°, P = .06) were greater in patients who died than those who survived indicating greater dyssynchrony. Patients with phase BW >56° or SD ≥21° (median values) had worse 5-year survival (64% vs 72%, and 66% vs 71%, log-rank P = .005 and P = .07, respectively). After adjusting for demographics, co-morbidities, LVEF, and perfusion pattern, phase BW was associated with worse outcome (hazard ratio 1.289 95% CI 1.010-1.644, P = .04).
  
  
  CONCLUSIONS
  LVD by phase analysis of gated SPECT MPI provides prognostic value in ESRD beyond myocardial perfusion and EF.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, 35294, USA, haggarwal@uabmc.edu.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Aggarwal
authors.forename: Wael A
authors.initials: WA
authors.lastname: AlJaroudi
authors.forename: Shikha
authors.initials: S
authors.lastname: Mehta
authors.forename: Roslyn
authors.initials: R
authors.lastname: Mannon
authors.forename: Jaekyeong
authors.initials: J
authors.lastname: Heo
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.forename: Fadi G
authors.initials: FG
authors.lastname: Hage
mesh_terms: D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D013318:Stroke Volume; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*