RT Journal Article
SR Electronic
T1 The long-term prognostic value of left ventricular dyssynchrony assessed by 99mTc-MIBI gated SPECT in patients with left ventricular aneurysm
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1679
OP 1679
VO 57
IS supplement 2
A1 Zhao, Min
A1 Yang, Yijian
A1 Wang, Weixue
A1 Wei, Hongxing
A1 Wang, Huaiquan
A1 Li, Xiang
A1 Hacker, Marcus
A1 Zhang, Xiaoli
YR 2016
UL http://jnm.snmjournals.org/content/57/supplement_2/1679.abstract
AB 1679Objectives The aim of this study was to investigate the prognostic value of left ventricular mechanical dyssynchrony (LVMD) assessed by gated SPECT myocardial perfusion imaging (GMPI) in patients with left ventricular aneurysm (LVA).Methods Ninety-two consecutive LVA patients determined by echo/MRI (78 male, 57 ± 10 years) who underwent 99mTc-MIBI rest GMPI were followed-up for 57 ± 16 months. Left ventricular functional parameters were evaluated by QGS software, and EDV (mL), ESV (mL) and ejection fraction (EF, %) were obtained. Further, left ventricular mechanical synchrony was analyzed by phase analysis, and parameters of BW (°), entropy (%) and SD (°) were obtained. LVMD were considered if BW 蠅 90° or Entropy 蠅 62%. Cardiac death (CD) and heart failure (HF) were defined as cardiac event during follow-up, and served as the endpoint.Results A total of 11 (12%) patients suffered from CD and 16 (17%) patients occurred HF. Annual cardiac mortality rate in patients treated by medical therapy (n=38) had a trend to be higher than patients treated by revascularization (n= 54), but no significant difference (3.88% vs. 1.56%, χ2 = 2.880, P = 0.090). Then, patients were divided into 3 groups according to LVEF and BW. Group 1 (n = 34, 37%): EF>25%, LVMD-; Group 2 (n = 29, 31.5%): EF>25%, LVMD+; Group 3 (n = 29, 31.5%): EF≤25%, LVMD+. Among patients with EF≤25%, all had LVMD. No cardiac death was observed in group 1, no matter treated by medical therapy or revascularization, annual cardiac mortality rate (0%) was significantly lower than that in groups 2 (2.91%, χ2 =5.00, P = 0.025) and 3 (5.08% , χ2 =9.15, P = 0.002). The annual cardiac event rate was lowest in group 1 (3.1%), which had a trend to be lower than that in group 2 (6.53%, χ2 =2.88, P = 0.090) and significantly lower than that in group 3 (9.44%, χ2 =7.07, P = 0.008). In addition, combination LVMD and treatment strategy, patients were divided into 4 subgroups. Cardiac survival (χ2 =13.55, P = 0.004) and cardiac event-free survival (χ2 =10.20, P = 0.017) had significant difference among 4 subgroups. In patients with LVMD, compared with medical therapy, annual cardiac mortality rate was significantly reduced by revascularization (2.41% vs. 6.41%, χ2 =3.94, P = 0.047) while annual cardiac event rate has a trend to be reduced (6.62% vs. 10.1%, χ2 = 2.191, P = 0.139). Univariate Cox analysis demonstrated that EF, BW and Entropy were independent predictors for CD (all P < 0.05) and cardiac event (all P < 0.05). After adjusted by age and sex, EF (HR 0.928, 95% CI: 0.869-0.992, P = 0.028) was the only independent predictor for CD and BW (HR 1.011, 95% CI: 1.004-1.019, P = 0.002) was the only independent predictor for cardiac event by multivariate Cox analysis.Conclusions Patients with LVMD determined by GMPI were at higher risk for cardiac death and cardiac event, whereas revascularization could improve the long-term outcomes. However, patients without LVMD had long-term cardiac survival.