Myocardial ischemia and previous infarction contribute to left ventricular dyssynchrony in patients with coronary artery
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Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, KYS, Finland Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland Department of Cardiothoracic Surgery, Kuopio University Hospital, Kuopio, Finland Heart Center, Kuopio University Hospital, Kuopio, Finland
Received Dec 31, 2019; accepted Jul 14, 2020 doi:10.1007/s12350-020-02316-9
Aims. The aim of this study was to characterize determinants of left ventricular mechanical dyssynchrony (LVMD) in patients with coronary artery disease (CAD). Methods. Medical records and results of myocardial perfusion SPECT/CT studies were evaluated in 326 patients with previously diagnosed CAD. LVMD was assessed with the phase analysis of ECG-gated myocardial SPECT. Dyssynchrony was described with phase histogram bandwidth (PHBW), standard deviation (PHSD) or entropy (PHE) values above limit of the highest normal. Results. Prevalence of LVMD was 29% in CAD patients. Size of the infarction scar and ischemia extent correlated significantly with PHBW, PHSD and PHE (P < 0.001 for all). Independent predictors of LVMD were myocardial infarction scar (P = 0.004), ischemia extent (P = 0.003), and QRS duration (P = 0.003). Previous percutaneous coronary intervention and coronary artery bypass grafting did not independently predict dyssynchrony. Conclusions. Almost one-third of CAD patients had significant LVMD. Dyssynchrony was associated with earlier myocardial infarction and presence of myocardial ischemia. Previous percutaneous coronary intervention and coronary artery bypass grafting did not independently predict dyssynchrony. (J Nucl Cardiol 2020) Key Words: Heart failure Æ gated SPECT Æ dyssynchrony Æ CAD
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02316-9) contains supplementary material, which is available to authorized users. The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. Funding This study was financially supported by Finnish Cultural Foundation, Paavo Nurmi Foundation, The Finnish Medical Foundation, Finnish Foundation for Cardiovascular Research, Finnish Cardiac Society and Specified governments transfers to Kuopio University Hospital (5031349).
Reprint requests: Hanna Ha¨ma¨la¨inen, MD, Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, PO BOX 100Kuopio70029, KYS , Finland; [email protected] 1071-3581/$34.00 Copyright Ó 2020 The Author(s)
Ha¨ma¨la¨inen et al Myocardial ischemia and previous infarction contribute
Abbreviations CAD Coronary artery disease LVMD Left ventricular mechanical dyssynchrony PHBW Phase histogram bandwidth PHSD Phase histogram standard deviation PHE Phase histogram entropy PCI Percutaneous coronary intervention CABG Coronary artery bypass graft LV Left ventricle EF Ejection fraction SPECT
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