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Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: a study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

LV mechanical dyssynchrony (LVMD) is a risk marker in narrow QRS cardiomyopathy, but its association with treatment outcome is not well defined. We determined the incremental prognostic value of LVMD in ischemic cardiomyopathy, and assessed its interaction with scar, myocardium in jeopardy and subsequent revascularization.

Methods

Stress and rest 82Rb gated PET were performed in 486 consecutive patients (66 ± 11 years of age, 82 % men, LV ejection fraction 26 ± 6 %) with ischemic cardiomyopathy and QRS <120 ms. LVMD was determined as the standard deviation (SD) of the regional time to minimum volume on phase analysis of the gated PET scan. A propensity score was determined to adjust for nonrandomized referral after imaging to coronary artery bypass grafting (CABG). In a Cox proportional hazards model used to determine the association between measures of LVMD and survival time, CABG was included as a time-dependent covariate and the use of an implantable cardiac defibrillator (ICD) after imaging was modeled as a stratification factor.

Results

Over 1.9 ± 1.4 years, 96 patients (20 %) underwent CABG and 108 (22 %) died. LVMD was a predictor of mortality (HR 1.16. 95 % CI 1.03;1.30, per 10° increase in phase SD, p = 0.02) after adjusting for baseline covariates, prior ICD use, the use of postimaging CABG, and other imaging data. There was a significant interaction between phase SD and CABG. Nested Cox models showed that LVMD carried prognostic information incremental to clinical variables, ejection fraction and CABG.

Conclusion

LVMD is an independent predictor of all-cause mortality in ischemic cardiomyopathy, and may identify patients with a differential survival benefit from CABG versus medical therapy.

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Funding

The project was funded by the American Heart Association National Clinical Research Program 11CRP5180029.

Conflicts of interest

None.

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Authors and Affiliations

  1. Heart and Vascular, Imaging Institute, Cleveland, OH, USA

    Wael AlJaroudi, Rory Hachamovitch, Wael A. Jaber, Richard Brunken, Manuel D. Cerqueira & Thomas Marwick

  2. Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA

    M. Chadi Alraies

  3. Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, 9500 Euclid Avenue/J1-5, Cleveland, OH, 44195, USA

    Wael AlJaroudi

Authors
  1. Wael AlJaroudi
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  2. M. Chadi Alraies
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  3. Rory Hachamovitch
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  4. Wael A. Jaber
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  5. Richard Brunken
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  6. Manuel D. Cerqueira
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  7. Thomas Marwick
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Correspondence to Wael AlJaroudi.

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AlJaroudi, W., Alraies, M.C., Hachamovitch, R. et al. Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: a study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS. Eur J Nucl Med Mol Imaging 39, 1581–1591 (2012). https://doi.org/10.1007/s00259-012-2171-3

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  • DOI: https://doi.org/10.1007/s00259-012-2171-3

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