Abstract
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Objectives The aim of this study was to investigate the prognostic value of left ventricular dyssynchrony (LV) assessed by rest gated myocardial perfusion imaging (MPI) in medically treated patients with dilated cardiomyopathy (DCM).
Methods Forty-eight consecutive hospitalized DCM patients were recruited [1, 2]. All patients underwent rest gated SPECT MPI. Phase analysis of gated SPECT was conducted to identify LV dyssynchrony [3-5]. These patients were retrospectively followed up and cardiac death was considered as the only endpoint. Univariate and multivariate Cox proportional hazards regression analysis were performed to identify the independent predictors of cardiac death. Kaplan-Meier cumulative survival analysis with stratification was performed, and survival curves were compared by Log-rank test.
Results The mean age was 47.5 ± 15.8 years (range, 15 - 76 y) and 85.4 % were men. The mean LV ejection fraction (LVEF) was 22.2 ± 7.7 %. During the follow-up period (22.7 ± 5.1 months), 12 (25.0 %) cardiac deaths occurred. Compared to survivors, patients with cardiac death had lower body mass index (BMI, P = 0.010), higher percent of prolonged QRS duration (QRSD, P = 0.043) and severe LV dyssynchrony (P = 0.002). Multivariate Cox analysis demonstrated that severe LV dyssynchrony (hazard ratio = 9.607, 95 % confidential interval, 95 % CI 2.064 - 44.713, P = 0.004) and BMI (hazard ratio = 0.851, 95 % CI 0.732 - 0.989, P = 0.036) were predictive of cardiac death.
Conclusions Left ventricular dyssynchrony assessed by phase analysis of gated SPECT and BMI are predictive of cardiac death in medically treated DCM patients.