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Prognostic value of integrative analysis of electrical and mechanical dyssynchrony in patients with acute heart failure

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Left ventricular mechanical dyssynchrony has been shown to provide significant clinical values for chronic heart failure (HF) and cardiac resynchronization therapy (CRT). The purpose of this study was to evaluate whether electrical dyssynchrony combined with mechanical dyssynchrony has an incremental benefit over electrical dyssynchrony or mechanical dyssynchrony alone to predict clinical events in patients with acute heart failure (AHF).

Methods

Ninety-six AHF patients who received standard 12-lead ECG, gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), and echocardiography were enrolled. Thirty-two normal subjects were collected as the control group to get the normal database of mechanical dyssynchrony. The end point is the composite of all-cause death and heart transplantation. Electrical dyssynchrony was defined as QRS duration > 120 ms. Mechanical dyssynchrony was defined as > mean + 2 × SD phase standard deviation (PSD) or phase bandwidth (PBW) based on our normal database.

Results

During the follow-up of 28 ± 10 months, complete data were obtained in 92 patients. 26 (28.3%) Patients who reached the end point were classified into the event group. There were no significant differences in PSD or PBW between the event and non-event groups. However, PBW > 77.76° was independently associated with the end point in the univariate and multivariate analysis (hazard ratio 2.92, 95% confidence interval 1.00-8.47, P = .049; hazard ratio 3.89, 95% confidence interval 1.01-14.97, P = .048). The Kaplan-Meier curve with a log-rank test showed that the end point rate was significantly higher in the patients with PBW > 77.76° (log-rank P = .039). Moreover, the ROC curve analysis showed that the area under the curve (AUC) for predicting end point events by the integrative analysis of QRS > 120 ms and PBW > 77.76° was significantly improved compared to QRS duration > 120 ms (AUC: 0.75 vs 0.68, P = .001) or PBW > 77.76° (AUC: 0.75 vs 0.62, P = .049), respectively. The model of combined electrical and mechanical dyssynchrony yielded a further significantly improved risk prediction for adverse events in the global χ2.

Conclusions

The combination of QRS duration > 120 ms and PBW > 77.76° was an independent predictor of all-cause death and heart transplantation in AHF patients. The integrative analysis of electrical and mechanical dyssynchrony provides incremental prognostic value for clinical use.

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Abbreviations

AHF:

Acute heart failure

HF:

Heart failure

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

LVMD:

Left ventricular mechanical dyssynchrony

NYHA:

New York Heart Association

PBW:

Phase bandwidth

PSD:

Phase standard deviation

SPECT:

Single-photon emission computed tomography

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Acknowledgments

This study was funded by Grants from the Six Talents Peak Project of Jiangsu Province (Project Number 2014-WSN-008, PI: Yanli Zhou). It was also supported by a Grant from the American Heart Association (Project Number 17AIREA33700016, PI: Weihua Zhou) and a New Faculty Grant from Michigan Technological University Institute of Computing and Cybersystems (PI: Weihua Zhou).

Disclosures

None of the authors have any relevant conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road 300, Nanjing, 210029, China

    Yanli Zhou MD, PhD, Shengen Liao PhD, Li Zhang MD, Xu Zhu MD, Iokfai Cheang MD, Haifeng Zhang MD PhD, Wenming Yao MD PhD & Xinli Li MD PhD

  2. College of Computing, Michigan Technological University, Houghton, MI, USA

    Zhuo He BS & Weihua Zhou PhD

  3. School of Computer and Communication Engineering, Zhengzhou University of Light Industry, Zhengzhou, China

    Yanyun Liu MS

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  1. Yanli Zhou MD, PhD
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Correspondence to Yanli Zhou MD, PhD.

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Zhou, Y., He, Z., Liao, S. et al. Prognostic value of integrative analysis of electrical and mechanical dyssynchrony in patients with acute heart failure. J. Nucl. Cardiol. 28, 140–149 (2021). https://doi.org/10.1007/s12350-020-02429-1

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