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Impact of left ventricular dyssynchrony by phase analysis on cardiovascular outcomes in patients with end-stage renal disease

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Cardiovascular disease is the leading cause of mortality in patients with end-stage renal disease (ESRD). While left ventricular (LV) perfusion pattern and ejection fraction (EF) are important determinant of outcome, the prognostic importance of LV dyssynchrony, which can also be assessed by gated SPECT myocardial perfusion imaging (MPI), has not been well studied in this population.

Methods and Results

The indices of LV mechanical dyssynchrony were measured by automated analysis of gated SPECT MPI in patients with ESRD who were evaluated for transplantation at our institution (2001-2004) and who had coronary angiography within 6 months of the evaluation. All-cause mortality data were prospectively collected and verified against the social security death index database. The study population consisted of 144 ESRD patients aged 53 ± 9 years. 35% were women and 63% had diabetes mellitus. The LVEF was 48 ± 12%. They were followed-up for 41 ± 28 months during which time 55 (38%) died prior to renal transplantation. An abnormal QRS duration was not predictive of worse outcomes (log-rank P = .9). The median phase bandwidth (BW) was 62° (inter-quartile range 47-98°) and standard deviation (SD) was 23° (inter-quartile range 15-35°). Patients with a BW above the median had worse survival (log-rank P = .017) and there was a trend toward worse survival in those with a SD above the median (log-rank P = .096). A 2-year mortality was higher in those with BW ≥ 62° in the entire cohort, and in the subsets of patients with normal LVEF (log-rank P = .001), coronary artery disease by angiography, increased LV mass index, QRS <110 ms, and perfusion defect size <20% of the LV.

Conclusions

LV mechanical dyssynchrony by phase analysis is a predictor of mortality in patients with ESRD. It may have a role in risk-stratifying patients and should be incorporated in future studies using gated MPI.

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Acknowledgment

The authors have indicated that they have no financial conflicts of interest.

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Authors and Affiliations

  1. Division of Cardiovascular Diseases, University of Alabama at Birmingham, 318 LHRB, 1900 University Blvd., Birmingham, AL, 35294-0006, USA

    Wael AlJaroudi MD, Himanshu Aggarwal MD, Rajesh Venkataraman MD, Jaekyeong Heo MD, FACC, Ami E. Iskandrian MD, MACC & Fadi G. Hage MD

  2. Division of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Fadi G. Hage MD

Authors
  1. Wael AlJaroudi MD
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  2. Himanshu Aggarwal MD
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  3. Rajesh Venkataraman MD
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  4. Jaekyeong Heo MD, FACC
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  5. Ami E. Iskandrian MD, MACC
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  6. Fadi G. Hage MD
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Correspondence to Wael AlJaroudi MD.

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AlJaroudi, W., Aggarwal, H., Venkataraman, R. et al. Impact of left ventricular dyssynchrony by phase analysis on cardiovascular outcomes in patients with end-stage renal disease. J. Nucl. Cardiol. 17, 1058–1064 (2010). https://doi.org/10.1007/s12350-010-9271-x

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  • DOI: https://doi.org/10.1007/s12350-010-9271-x

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