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Left ventricular phase entropy: Novel prognostic predictor in patients with dilated cardiomyopathy and narrow QRS

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The prognostic impact and pathophysiology of global left ventricular mechanical dyssynchrony (LVMD), namely mechanical dyssynchrony of whole left ventricle, as assessed by phase analysis of electrocardiographically gated (ECG-gated) myocardial perfusion SPECT has not been clearly elucidated in patients with dilated cardiomyopathy (DCM) and narrow QRS complex (<120 ms).

Methods and Results

Forty-six patients with DCM underwent ECG-gated myocardial 99mTc-sestamibi perfusion SPECT and endomyocardial biopsy. LV phase entropy was automatically calculated using a phase analysis of ECG-gated myocardial perfusion SPECT. The patients were divided into two groups according to the median phase entropy value: low-phase entropy (<0.61) (N = 23: LE group) and high-phase entropy (≥0.61) (N = 23: HE group). In the Kaplan-Meier survival analysis, the event-free survival rate was significantly lower in the HE group (log-rank P = 0.015). Moreover, high-phase entropy was an independent predictor of adverse cardiac events (hazard ratio, 5.77%; 95% confidence interval, 1.02-108.32; P = 0.047). Interestingly, the mRNA expression levels of sarcoplasmic reticulum Ca2+-ATPase (SERCA2a) in endomyocardial biopsy specimens were significantly lower in the HE group (P = 0.015).

Conclusion

LV phase entropy, which may reflect impairment of Ca2+ handling caused by decreased SERCA2a mRNA levels, is a novel prognostic predictor in patients with DCM and narrow QRS complex.

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Abbreviations

BNP:

Brain natriuretic peptide

DCM:

Dilated cardiomyopathy

ECG:

Electrocardiogram

HF:

Heart failure

LV:

Left ventricular

LVMD:

Left ventricular mechanical dyssynchrony

NYHA:

New York Heart Association

RT-PCR:

Reverse-transcriptase polymerase chain reaction

SERCA2a:

Sarcoplasmic reticulum Ca2+-ATPase

SPECT:

Single-photon emission computed tomography

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Acknowledgements

This work was supported in part by Japanese Society for the Promotion of Science KAKENHI Grant No. 25860594 (TO).

Disclosures

N K. has nothing to declare. T.O. received lecture fees from Otsuka and research grants from Ono Yakuhin, Bayer, and Daiichi Sankyo. S.I. received lecture fee from FUJIFILM RI Farma. A.S. has nothing to declare. N.W. has nothing to declare. K. F. has nothing to declare. H. M. has nothing to declare. R.M. belongs to a development endowed by Chugai, Dainippon Sumitomo, Kowa, Kyowa Hakko Kirin, MSD, Nihon Medi-physics, and Nippon Boehringer Ingelheim. K.K. has nothing to declare. Y.B. received lecture fees and research grants from Asteras, AstraZeneca, Boehringer Ingelheim, MSD, Takeda, and Tanabe-Mitsubishi. T.M. received lecture fees and research grants from Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Otsuka, Teijin, Sanofi-aventis, Kowa, Dainippon Sumitomo, Novartis, MSD, Pfizer, Takeda, and Tanabe-Mitsubishi.

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Authors and Affiliations

  1. Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Naoaki Kano MD, Takahiro Okumura MD, PhD, Satoshi Isobe MD, PhD, Akinori Sawamura MD, Naoki Watanabe MD, Kenji Fukaya MD, Hiroaki Mori MD, Ryota Morimoto MD, Yasuko K. Bando MD, PhD & Toyoaki Murohara MD, PhD

  2. Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Katsuhiko Kato MD, PhD

  3. Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Ryota Morimoto MD

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  1. Naoaki Kano MD
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  2. Takahiro Okumura MD, PhD
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  3. Satoshi Isobe MD, PhD
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Correspondence to Takahiro Okumura MD, PhD.

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Kano, N., Okumura, T., Isobe, S. et al. Left ventricular phase entropy: Novel prognostic predictor in patients with dilated cardiomyopathy and narrow QRS. J. Nucl. Cardiol. 25, 1677–1687 (2018). https://doi.org/10.1007/s12350-017-0807-1

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