Prognostic value of left-ventricular systolic and diastolic dyssynchrony measured from gated SPECT MPI in patients with dilated cardiomyopathy

Abstract

Background

Left-ventricular systolic dyssynchrony (LVSD) has been an important prognostic factor in the patients with dilated cardiomyopathy (DCM). However, the association between the LV diastolic dyssynchrony (LVDD) and clinical outcome is not well established. This study aims to evaluate the prognostic values of both systolic and diastolic dyssynchrony in patients with DCM.

Methods

Fifty-two patients with DCM were enrolled and divided into two groups according to cardiac deaths from the follow-up data. The phase-analysis technique was applied on resting gated short-axis SPECT MPI images to measure LV systolic and diastolic dyssynchrony, including phase standard deviation (PSD), phase histogram bandwidth (PBW), and phase entropy (PE). Variables with P < 0.10 in the univariate analysis were included in the multivariate cox analysis.

Results

During the follow-up period (2.9 ± 1.7 years), 18 (34.6%) cardiac deaths were observed. Compared with survivors, patients with cardiac death had lower LVEF (P = 0.011), and more severe LV systolic and diastolic dyssynchrony. The univariate cox regression analysis showed that hypertension, NT-proBNP, LVEF, systolic PSD, systolic PE, and diastolic PBW were statistically significantly associated with cardiac death. The multivariate cox regression analysis showed that systolic PE and diastolic PE were independent predictive factors for cardiac death. Furthermore, the receiver operating characteristic (ROC) analysis, when applied into the combination of systolic PE and diastolic PE for predicting cardiac death, had an area under curve (AUC) of 0.766, a sensitivity of 0.765, and a specificity of 0.722.

Conclusions

Both the LVSD and LVDD parameters from SPECT MPI have important prognostic values for DCM patients. Both systolic PE and diastolic PE are independent prognostic factors for cardiac death.

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Abbreviations

DCM:

Dilated cardiomyopathy

LVEF:

Left-ventricular ejection fraction

NYHA:

New York Heart Association

BMI:

Body mass index

ECG:

Electrocardiogram

SPECT:

Single photon emission computed tomography

PSD:

Phase standard deviation

PBW:

Phase histogram bandwidth

PE:

Phase entropy

ROC:

Receiver operating characteristic

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Acknowledgement

This research was supported by a grant from the American Heart Association (Project Number: 17AIREA33700016, PI: Weihua Zhou), and a New Faculty startup grant from the University of Southern Mississippi (Project Number: DE01791, PI: Weihua Zhou).

Disclosures

Dr. Garcia receives royalties from the sales of Emory Cardiac Toolbox. The terms of this arrangement have been reviewed and approved by the Emory University in accordance with its conflicts of interest practice. None of the other authors have any relevant conflicts of interest.

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Correspondence to Dianfu Li MD, PhD or Weihua Zhou PhD.

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Wang, C., Tang, H., Zhu, F. et al. Prognostic value of left-ventricular systolic and diastolic dyssynchrony measured from gated SPECT MPI in patients with dilated cardiomyopathy. J. Nucl. Cardiol. 27, 1582–1591 (2020). https://doi.org/10.1007/s12350-018-01468-z

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Keywords

  • Dilated cardiomyopathy
  • Single photon emission computed tomography
  • Phase analysis
  • Left-ventricular mechanical dyssynchrony