Dyssynchrony as a marker of adverse prognosis among patients with coronary artery disease and heart failure
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Cook County Health, Chicago, IL Rush Medical College, Chicago, IL
Received Oct 20, 2019; accepted Oct 21, 2019 doi:10.1007/s12350-019-01945-z
See related article, https://doi.org/10.10 07/s12350-019-01843-4. Left ventricular dyssynchrony (LVD) is referred to disorganized ventricular contractility and has been extensively studied among patient with heart failure (HF) and low left ventricular ejection fraction (EF). While some degree of disorganized contractility exists in normal ventricles, presence of LVD is defined by limits not seen in normal patients. While most reports have focused on the assessment of systolic LVD and its diagnostic and prognostic attributes among patients with heart failure, there are emerging data on the value of assessing diastolic LVD by phase analysis of gated single photon emission tomography (GSPECT).1-3 Simply put, while phase analysis of gated SPECT determines the time (phase) of onset of myocardial contraction for calculation of systolic phase indices, the time of onset of mechanical relaxation is used for calculation of diastolic phase indices.2 Similar to systolic LVD, phase standard deviation (PSD) and phase histogram bandwidth (HBW) are used as indices to describe the presence and severity of diastolic LVD. In this issue of the Journal of Nuclear Cardiology, Fudim et al. report both systolic and diastolic indices of LVD as predictors of mortality among patients with CAD and HF.4 The authors conducted a retrospective study of patients who underwent a GSPECT between 2003 and 2009, and who also had at least 50% stenosis
Reprint requests: Saurabh Malhotra, MD, MPH, FASNC, Cook County Health, Chicago, IL; [email protected] and [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2019 American Society of Nuclear Cardiology.
in one major epicardial vessel. Data on 1294 patients were evaluated of whom a quarter had a history of HF, as clinically determined by their respective physicians and providers. Both systolic and diastolic LVD parameters were assessed by phase analysis of GSPECT, with the application of the following LVD cut-offs, derived from a control population: systolic PSD = 46.9°, systolic HBW = 134°, diastolic PSD = 51.3°, and diastolic HBW = 155.8°. Patients with CAD and HF had a greater prevalence of both systolic (up to 31% vs up to 15%) and diastolic LVD (up to 29% vs up to 15%), when compared to those with CAD alone. Over a median follow-up of 6.7 years, there were 537 deaths, and as expected, patients with CAD and HF had a worse survival than those with CAD alone. History of HF and LVD indices (both systolic and diastolic) were independent predictors of all-cause mortality and cardiovascular mortality, after adjusting for clinically significant variables. The prognostic value of systolic and diastolic indices of LVD for all-cause and cardiovascular mortality did not significantly differ by the presence of HF among these patients with CAD. This report is an extension of a previously published observational analysis from the same cohor
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