The prognostic value of diastolic and systolic mechanical left ventricular dyssynchrony among patients with coronary art
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Division of Cardiology, Duke Department of Medicine, Durham, NC Duke Clinical Research Institute, Durham, NC Division of Nuclear Medicine, Duke Department of Radiology, Durham, NC VA Eastern Colorado and Health Care System, Denver, CO
Received Jun 15, 2019; accepted Jul 20, 2019 doi:10.1007/s12350-019-01843-4
Background. Prevalence and prognostic value of diastolic and systolic dyssynchrony in patients with coronary artery disease (CAD) 1 heart failure (HF) or CAD alone are not well understood. Methods. We included patients with gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) between 2003 and 2009. Patients had at least one major epicardial obstruction ‡ 50%. We assessed the association between dyssynchrony and outcomes, including all-cause and cardiovascular death. Results. Of the 1294 patients, HF was present in 25%. Median follow-up was 6.7 years (IQR 4.9-9.3) years with 537 recorded deaths. Patients with CAD 1 HF had a higher incidence of dyssynchrony than patients with CAD alone (diastolic BW 28.8% for the HF 1 CAD vs 14.7% for the CAD alone). Patients with CAD 1 HF had a lower survival than CAD alone at 10 years (33%; 95% CI 27-40 vs 59; 95% CI 55-62, P < 0.0001). With one exception, HF was found to have no statistically significant interaction with dyssynchrony measures in unadjusted and adjusted survival models. Conclusions. Patients with CAD 1 HF have a high prevalence of mechanical dyssynchrony as measured by GSPECT MPI, and a higher mortality than CAD alone. However, clinical outcomes associated with mechanical dyssynchrony did not differ in patients with and without HF. (J Nucl Cardiol 2019) Key Words: Heart failure Æ coronary artery disease Æ mechanical dyssynchrony Æ systolic Æ diastolic
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-019-01843-4) 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. Funding This analysis was supported by a Grant from GE Healthcare to S.B.
Reprint requests: Marat Fudim, MD, Division of Cardiology, Duke Department of Medicine, 2301 Erwin Road, Durham, NC 27710; [email protected] 1071-3581/$34.00 Copyright Ó 2019 American Society of Nuclear Cardiology.
Fudim et al. Diastolic dyssynchrony in heart failure
Abbreviations BW Phase bandwidth CAD Coronary artery disease GSPECT Gated single-photon emission computed tomography LV Left ventricular/ventricle MPI Myocardial perfusion imaging SD Standard deviation
Journal of Nuclear CardiologyÒ
METHODS Data Sources Data were collected from two single-center, observational registries of patients undergoing cardiovascular procedures and cardiac imaging: Duke Nuclear Cardiology Databank and Duke Databank for Cardiovascular Disease (DDCD). Longitudinal records were
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