Prognostic value of left ventricular mechanical dyssynchrony induced by exercise stress in patients with normal myocardi
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Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan Department of Cardiology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
Received Jul 5, 2020; accepted Sep 17, 2020 doi:10.1007/s12350-020-02389-6
Background. Left ventricular mechanical dyssynchrony (LVMD) induced by exercise stress was reported to be clinically useful in detecting multivessel coronary artery diseases. The aim of this study was to compare the prognostic value of LVMD induced by pharmacological stress with that induced by exercise stress. Methods. We retrospectively examined 918 consecutive patients who underwent exercise (N = 310) or pharmacological stress (N = 608) 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) with normal myocardial perfusion. LVMD was evaluated by phase analysis as the indices of phase bandwidth and phase standard deviation (PSD). Results. During the follow-up period (2.2 ± 1.9 years), 74 major cardiac events (MCEs) occurred (7 cases of cardiac death, 17 cases of heart failure, and 50 cases of coronary intervention). In global patients, the indices of LVMD on rest images were significantly greater in patients with MCEs (bandwidth (°): 51 ± 31 vs 37 ± 21, P = .001, PSD: 14 ± 9 vs 10 ± 6, P = .001). The exercise stress bandwidth was significantly higher in patients with MCEs (62 ± 37° vs 42 ± 21°, P = .026), as was the pharmacological stress bandwidth (57 ± 35° vs 43 ± 24°, P = .006). Multivariate analysis demonstrated the exercise stress bandwidth to be an independent predictor of MCEs (HR 1.017, CI 1.003 to 1.032, P = .019), but the pharmacological stress bandwidth had no influence on MCEs. Conclusions. LVMD induced by exercise stress was an independent predictor of MCEs in patients with normal perfusion SPECT, whereas that induced by pharmacological stress had no association with further events. (J Nucl Cardiol 2020)
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02389-6) 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 summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com. The authors have also provided an audio summary of the article, which is available to download as ESM, or to listen to via the JNC/ASNC Podcast. All editorial decisions for this article, including selection of reviewers and the final decision, were made by guest editor Saurabh Malhotra, MD, MPH.
Funding Not applicable. Reprint requests: Tomohiko Sakatani, MD, PhD, Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 HaruobiCho, Kamigyo-Ku, Kyoto 602-8026, Japan; [email protected] 1071-3581/$34.00 Copyright Ó 2020 American Society of Nuclear Cardiology.
Sakatani et al Clinical value of left ventricular mechanical dyssynchrony
Key Words: cardiac events
Journal of Nuclear Cardi
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