Skip to main content
SpringerLink
Log in

Prognostic value of left ventricular mechanical dyssynchrony by phase analysis in patients with non-ischemic cardiomyopathy with ejection fraction 35-50% and QRS < 150 ms

  • Original Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Left ventricular mechanical dyssynchrony (LVMD) by phase analysis of gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a useful tool for predicting response to cardiac resynchronization therapy and has prognostic value. While most of the studies were done on patients with ischemic cardiomyopathy or those with LV ejection fraction (EF) < 35%, there are little data on the prognostic value of LVMD in patients with non-ischemic cardiomyopathy (NICM), particularly those with mildly decreased systolic function and narrow or intermediate QRS duration.

Methods and Results

From the stress SPECT-MPI database at Cleveland Clinic, we identified 324 consecutive patients (mean age 62 ± 13 years, 62% male, 36% diabetics) with NICM, LVEF 35-50% (median [Q1,Q3] 45 [41,49]), and QRS < 150 ms (13% with QRS 120-149 ms). LVMD was determined from gated stress images and expressed as phase standard deviation (SD) and histogram BW (% R-R cycle). For easier graphical illustration, patients were divided into tertiles of LVMD. All-cause death was the primary endpoint and determined using the Social Security Death Index. Cox proportional hazard model was performed to determine the independent predictive value of LVMD, and next Cox models for incremental value. After a mean follow-up time of 1,689 days, 86 (26.5%) of patients died. These patients were older, had more diabetes, more use of diuretics, with wider QRS duration, and with a trend for higher phase SD and BW. After adjusting for age, hypertension, diabetes, aspirin, beta-blockers, diuretics, QRS, and EF, phase SD was an independent predictor of all-cause mortality with hazard ratio [95% CI] 1.97 [1.06,3.66] for the highest tertile, and added incremental prognostic value (P = .025). Similar findings were obtained using histogram BW.

Conclusion

In patients with NICM, EF 35-50%, and QRS < 150 ms, increased LVMD on peak stress SPECT was an independent predictor of all-cause mortality. The utility and applicability of such findings in clinical practice need further evaluation in larger and prospective studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Chen J, Garcia EV, Folks RD, Cooke CD, Faber TL, Tauxe EL, et al. Onset of left ventricular mechanical contraction as determined by phase analysis of ECG-gated myocardial perfusion SPECT imaging: Development of a diagnostic tool for assessment of cardiac mechanical dyssynchrony. J Nucl Cardiol 2005;12:687-95.

    Article  PubMed  Google Scholar 

  2. Lin X, Xu H, Zhao X, Folks RD, Garcia EV, Soman P, et al. Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies. J Nucl Cardiol 2010;17:811-6.

    Article  PubMed Central  PubMed  Google Scholar 

  3. AlJaroudi W, Jaber WA, Grimm RA, Marwick T, Cerqueira MD. Alternative methods for the assessment of mechanical dyssynchrony using phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. Int J Cardiovasc Imaging 2012;28:1385-94.

    Article  PubMed  Google Scholar 

  4. AlJaroudi W, Alraies MC, Hachamovitch R, Jaber WA, Brunken R, Cerqueira MD, 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 2012;39:1581-91.

    Article  PubMed  Google Scholar 

  5. AlJaroudi W, Alraies MC, Menon V, Brunken RC, Cerqueira MD, Jaber WA. Predictors and incremental prognostic value of left ventricular mechanical dyssynchrony response during stress-gated positron emission tomography in patients with ischemic cardiomyopathy. J Nucl Cardiol 2012;19:958-69.

    Article  PubMed  Google Scholar 

  6. Aljaroudi WA, Hage FG, Hermann D, Doppalapudi H, Venkataraman R, Heo J, et al. Relation of left-ventricular dyssynchrony by phase analysis of gated SPECT images and cardiovascular events in patients with implantable cardiac defibrillators. J Nucl Cardiol 2010;17:398-404.

    Article  PubMed  Google Scholar 

  7. Boogers MM, Van Kriekinge SD, Henneman MM, Ypenburg C, Van Bommel RJ, Boersma E, et al. Quantitative gated SPECT-derived phase analysis on gated myocardial perfusion SPECT detects left ventricular dyssynchrony and predicts response to cardiac resynchronization therapy. J Nucl Med 2009;50:718-25.

    Article  PubMed  Google Scholar 

  8. Atchley AE, Trimble MA, Samad Z, Shaw LK, Pagnanelli R, Chen J, et al. Use of phase analysis of gated SPECT perfusion imaging to quantify dyssynchrony in patients with mild-to-moderate left ventricular dysfunction. J Nucl Cardiol 2009;16:888-94.

    Article  PubMed Central  PubMed  Google Scholar 

  9. AlJaroudi W, Jaber WA, Cerqueira MD. Effect of tracer dose on left ventricular mechanical dyssynchrony indices by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2012;19:63-72.

    Article  PubMed  Google Scholar 

  10. Hansen CL, Goldstein RA, Akinboboye OO, Berman DS, Botvinick EH, Churchwell KB, et al. Myocardial perfusion and function: Single photon emission computed tomography. J Nucl Cardiol 2007;14:e39-60.

    Article  PubMed  Google Scholar 

  11. Aljaroudi W, Alraies MC, Brunken R, Cerquiera M, Jaber WA. Paradoxical septal motion from prior coronary artery bypass graft surgery does not impact left ventricular mechanical dyssynchrony by gated myocardial perfusion imaging. J Nucl Cardiol 2012;19:1190-7.

    Article  PubMed  Google Scholar 

  12. Lauer MS, Blackstone EH, Young JB, Topol EJ. Cause of death in clinical research: Time for a reassessment? J Am Coll Cardiol 1999;34:618-20.

    Article  CAS  PubMed  Google Scholar 

  13. Aljaroudi W, Koneru J, Heo J, Iskandrian AE. Impact of ischemia on left ventricular dyssynchrony by phase analysis of gated single photon emission computed tomography myocardial perfusion imaging. J Nucl Cardiol 2011;18:36-42.

    Article  PubMed  Google Scholar 

  14. Samad Z, Atchley AE, Trimble MA, Sun JL, Shaw LK, Pagnanelli R, et al. Prevalence and predictors of mechanical dyssynchrony as defined by phase analysis in patients with left ventricular dysfunction undergoing gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2011;18:24-30.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Russo AM, Stainback RF, Bailey SR, Epstein AE, Heidenreich PA, Jessup M, et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: A report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2013;61:1318-68.

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

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

    Adam S. Goldberg MD, M. Chadi Alraies MD, Manuel D. Cerqueira MD, Wael A. Jaber MD & Wael A. AlJaroudi MD, FACC

  2. Division of Cardiovascular Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107-2020, Lebanon

    Wael A. AlJaroudi MD, FACC

Authors
  1. Adam S. Goldberg MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Chadi Alraies MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Manuel D. Cerqueira MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wael A. Jaber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wael A. AlJaroudi MD, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wael A. AlJaroudi MD, FACC.

Additional information

Funding: None.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Goldberg, A.S., Alraies, M.C., Cerqueira, M.D. et al. Prognostic value of left ventricular mechanical dyssynchrony by phase analysis in patients with non-ischemic cardiomyopathy with ejection fraction 35-50% and QRS < 150 ms. J. Nucl. Cardiol. 21, 57–66 (2014). https://doi.org/10.1007/s12350-013-9787-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-013-9787-y

Keywords

Search

Navigation