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Left ventricular dyssynchrony assessed by gated SPECT phase analysis is an independent predictor of death in patients with advanced coronary artery disease and reduced left ventricular function not undergoing cardiac resynchronization therapy

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Abstract

Purpose

Left ventricular (LV) mechanical dyssynchrony (LVMD) was assessed by gated single-photon emission CT myocardial perfusion imaging (MPI) as an independent predictor of death from any cause in patients with known coronary artery disease (CAD) and reduced LV function.

Methods

Between 2001 and 2010, 135 patients (64 ± 11 years of age, 84 % men) with known CAD, reduced LV ejection fraction (LVEF, 38 ± 15 %) and without an implanted cardiac resynchronization therapy device underwent gated MPI at rest. LV functional evaluation, which included phase analysis, was conducted to identify patients with LVMD. Kaplan-Meier survival curves were calculated for death of any cause during a mean follow-up of 2.0 ± 1.7 years. Uni- and multivariate Cox proportional hazards regression models were calculated to identify independent predictors of death from any cause.

Results

Of the 135 patients, 30 (22 %) died during follow-up (18 cardiac deaths and 12 deaths from other causes). Kaplan-Meier curves showed a significantly shorter survival time in the patients with severely reduced LVEF (<30 %, n = 45) or with LVMD (n = 81, log-rank test P <0.005). Cox models identified LVMD, LVEF <30 % and a total perfusion deficit at rest of ≥20 % as independent predictors of death from any cause. While patients with LVEF <30 % in conjunction with LVMD had similar survival times irrespective of whether they had early revascularization or medical therapy, those patients with LVEF ≥30% and LVMD who underwent revascularization had significantly longer survival.

Conclusion

In patients with known CAD and reduced LV function, dyssynchrony of the LV is an independent predictor of death from any cause.

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Acknowledgments

A substantial part of this work originated from the doctoral thesis of cand. med. Stefan Hellweger.

Conflicts of interest

Cedars-Sinai Medical Center receives royalties for the licensure of software used in the quantitative assessment of function, perfusion, and viability, a portion of which is distributed to some of the authors of this article.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Ludwig-Maximilian’s University, Marchioninistr. 15, 81377, Munich, Germany

    Christopher Uebleis, Stefan Hellweger, Sebastian Lehner, Alexander Haug, Peter Bartenstein, Paul Cumming & Marcus Hacker

  2. Institute of Medical Informatics, Biometry, and Epidemiology (IBE), Ludwig-Maximilian’s University, Munich, Germany

    Rüdiger Paul Laubender

  3. Medical Department I, Ludwig-Maximilian’s University, Munich, Germany

    Alexander Becker

  4. Medical Department Innenstadt, Ludwig-Maximilian’s University, Munich, Germany

    Hae-Young Sohn

  5. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Serge D. Van Kriekinge & Piotr J. Slomka

  6. David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Serge D. Van Kriekinge & Piotr J. Slomka

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  1. Christopher Uebleis
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  2. Stefan Hellweger
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  3. Rüdiger Paul Laubender
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  10. Serge D. Van Kriekinge
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  12. Marcus Hacker
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Correspondence to Marcus Hacker.

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Uebleis, C., Hellweger, S., Laubender, R.P. et al. Left ventricular dyssynchrony assessed by gated SPECT phase analysis is an independent predictor of death in patients with advanced coronary artery disease and reduced left ventricular function not undergoing cardiac resynchronization therapy. Eur J Nucl Med Mol Imaging 39, 1561–1569 (2012). https://doi.org/10.1007/s00259-012-2157-1

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  • DOI: https://doi.org/10.1007/s00259-012-2157-1

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