title: Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic value of additional evaluation of left ventricular mechanical dyssynchrony (LVMD) by gated myocardial perfusion single-photon emission computed tomography (GMPS) in patients with acute myocardial infarction (MI) and multivessel disease.
  
  
  METHODS
  One hundred and nine acute MI patients with >50 % stenosis in at least one non-culprit artery who underwent GMPS within 2 weeks were enrolled. All patients underwent successful revascularization of the culprit arteries. Those with previous MI, atrial fibrillation, or frequent ventricular premature complexes, cardiac devices, significant patient motion, or procedure-related events were excluded. Phase standard deviation (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. Patients were followed up for a median of 26 months after index MI, for composite major adverse cardiac events (MACE), which consisted with all-cause death, unplanned hospitalization due to heart failure and severe ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation). Independent predictors of MACE were evaluated.
  
  
  RESULTS
  MACE occurred in 22 patients (20 %). Stress PSD (53.3 ± 17.3° vs. 35.3 ± 18.9°; p <0.001), stress PBW (147.6 ± 54.6° vs. 96.8 ± 59.2°; p = 0.001) and resting PBW (126.8 ± 37.5° vs. 96.6 ± 48.9°; p = 0.001) were significantly higher in patients with MACE compared to those without. Multivariate analysis revealed that stress PSD ≥45.5° and stress PBW ≥126.0° were predictive of MACE, as well as suboptimal non-culprit artery revascularization (SNR) and renin-angiotensin system (RAS) blockade medication. Higher stress PSD and stress PBW were associated with poorer prognosis both in patients with and without SNR, and those with RAS blockade medication, but not in those without RAS blockade medication.
  
  
  CONCLUSIONS
  LVMD measured by GMPS showed added prognostic value in acute MI with multivessel disease. GMPS could serve as a comprehensive evaluation imaging tool in patients with acute MI and multivessel disease.
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Sang-Geon
authors.initials: SG
authors.lastname: Cho
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, South Korea, 58128.
authors.forename: Zeenat
authors.initials: Z
authors.lastname: Jabin
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Ki Seong
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Jahae
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, South Korea, 58128.
authors.forename: Sae-Ryung
authors.initials: SR
authors.lastname: Kang
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, South Korea, 58128.
authors.forename: Seong Young
authors.initials: SY
authors.lastname: Kwon
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, South Korea, 58128.
authors.forename: Geum-Cheol
authors.initials: GC
authors.lastname: Jeong
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, South Korea, 58128.
authors.forename: Minchul
authors.initials: M
authors.lastname: Song
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Jong Sang
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Jae Yeong
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Hyun Kuk
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hospital, Gwang-ju, Republic of Korea.
authors.forename: Ho-Chun
authors.initials: HC
authors.lastname: Song
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, South Korea, 58128.
authors.forename: Jung-Joon
authors.initials: JJ
authors.lastname: Min
authors.affiliation: Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, South Korea, 58128. hsbom@jnu.ac.kr.
authors.forename: Hee-Seung
authors.initials: HS
authors.lastname: Bom
mesh_terms: D015984:Causality; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality*; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015996:Survival Rate; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Acute myocardial infarction; Gated myocardial perfusion single photon emission computed tomography; Left ventricular mechanical dyssynchrony; Multivessel disease