title: The prognostic value of mechanical left ventricular dyssynchrony defined by phase analysis from gated single-photon emission computed tomography myocardial perfusion imaging among patients with coronary heart disease.
abstract: The prognostic value of left ventricular dyssynchrony measured by gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) and its relationship to electrical dyssynchrony measured by QRS duration are incompletely understood. The aim of this study was therefore to examine the independent and incremental prognostic value of dyssynchrony in yet the largest group of patients with coronary artery disease (CAD).
  
  
  
  Patients presenting for GSPECT- MPI between July 1993 and May 1999 in normal sinus rhythm were identified from the Duke Nuclear Cardiology Databank and the Duke Databank for Cardiovascular Disease (N = 1244). After a median of 4.2 years, 336 deaths occurred. At 8 years, the Kaplan-Meier estimates of the probability of death were 34.0% among patients with a phase bandwidth <100° and 56.8% among those with a bandwidth ≥100°. After adjustment for standard clinical variables, QRS dyssynchrony was independently associated with death (Hazard Ratio (HR), per 10°: 1.092, 95% Confidence Interval (CI) 1.048,1.139, P < .0001). Phase bandwidth was similarly associated with death after clinical adjustment (HR per 10°: 1.056, 95% CI 1.041,1.072, P < .0001). In clinically adjusted models examining QRS duration in addition to phase bandwidth, phase bandwidth had a stronger association with mortality. After accounting for left ventricular ejection fraction (LVEF), neither QRS duration nor phase bandwidth were statistically significant. Among patients with EF >35%, QRS duration and phase bandwidth together provided value above that provided by LVEF alone (P = 0.0181). When examining cardiovascular death, results were consistent with all-cause death.
  
  
  
  Among patients with CAD, mechanical left ventricular dyssynchrony measured by GSPECT MPI has a stronger relationship with outcomes than electrical dyssynchrony measured by QRS duration. After adjustment for baseline characteristics and LVEF, neither mechanical nor electrical dyssynchrony is independently associated with all-cause death or cardiac death. Among patients with EF >35%, mechanical and electrical dyssynchrony together provided prognostic value above that afforded by LVEF.
authors.affiliation: VA Eastern Colorado and Health Care System, Denver, CO, USA.|Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hess
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.affiliation: Division of Cardiology, Duke Department of Medicine, DUMC, Box 3929, Durham, NC, 27710, USA.
authors.forename: Marat
authors.initials: M
authors.lastname: Fudim
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Ami E
authors.initials: AE
authors.lastname: Iskandrian
authors.affiliation: Division of Cardiology, Duke Department of Medicine, DUMC, Box 3929, Durham, NC, 27710, USA. salvador.borgesneto@dm.duke.edu.|Division of Nuclear Medicine, Duke Department of Radiology, Durham, NC, USA. salvador.borgesneto@dm.duke.edu.
authors.forename: Salvador
authors.initials: S
authors.lastname: Borges-Neto
mesh_terms: D000368:Aged; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography / Q000379:methods* / Q000706:statistics & numerical data; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods* / Q000706:statistics & numerical data; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Single-photon emission computed tomography; dyssynchrony; ejection fraction; myocardial perfusion imaging; outcome; phase analysis
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