Author + information
- Received February 9, 2018
- Revision received May 21, 2018
- Accepted May 24, 2018
- Published online July 1, 2019.
- Marat Fudim, MDa,b,∗ (, )@FudimMarat,
- Mouhammad Fathallah, MDa,
- Linda K. Shaw, MSa,
- Peter R. Liu, MDa,
- Olga James, MDc,
- Zainab Samad, MD, MHSa@ZainabASamad,
- Jonathan P. Piccini, MD, MHSa,b@JonPicciniSr,
- Paul L. Hess, MD, MHSd and
- Salvador Borges-Neto, MDc
- aDepartment of Medicine and Division of Cardiology, Duke University, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cDepartment of Radiology and Division of Nuclear Medicine, Duke University, Durham, North Carolina
- dVA Eastern Colorado and Health Care System, Denver, Colorado
- ↵∗Address for correspondence:
Dr. Marat Fudim, Duke Clinical Research Institute, Duke University Medical Center, 2301 Erwin Road, Durham, North Carolina 27710.
Objectives The goal of this study was to examine whether diastolic dyssynchrony, measured by using gated single-photon emission computed tomography (GSPECT) myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD), is independently associated with adverse outcomes.
Background Systolic left ventricular dyssynchrony is known to be associated with worse clinical outcome in patients with CAD.
Methods This study included patients who presented to Duke University for GSPECT MPI between 2003 and 2009. Patients had at least 1 major epicardial obstruction ≥50%. Dyssynchrony was assessed by using Emory Cardiac Toolbox software and compared with a control population without CAD. Abnormal degree of diastolic/systolic dyssynchrony was defined as values above 2 SDs above mean of mechanical dyssynchrony parameters. Using Cox proportional hazards modeling, the adjusted association between dyssynchrony and outcomes, including all-cause and cardiovascular death, was assessed.
Results Among 1,310 patients with a median age of 64 years (interquartile range: 55 to 72 years), 69.7% were male and 2.6% had left bundle branch block. Overall, 241 (18.4%) and 238 (18.2%) patients had significant systolic and diastolic mechanical dyssynchrony, respectively, and 211 (16.1%) had both. After a median follow-up of 7.1 years, 543 deaths occurred. At 5 years, the mortality estimate was 21.2% among patients with a normal degree of diastolic left ventricular mechanical dyssynchrony (LVMD) and 41.7% among those with an abnormal degree of LVMD (p < 0.001). When added to clinical comorbidities, electrical dyssynchrony, and systolic LVMD, diastolic dyssynchrony was incrementally associated with cardiovascular mortality (global chi-square statistic of 211.9 vs. 222.8; 2 degrees of freedom; p = 0.004). In a model that also includes left ventricular ejection fraction, the addition of diastolic dyssynchrony to systolic dyssynchrony maintained an incremental prognostic benefit (global chi-square statistic of 234.8 vs. 241.8; p = 0.030). Adjustment for baseline ischemia and scar burden did not change this relationship.
Conclusions Systolic and diastolic left ventricular dyssynchrony, as measured by using GSPECT MPI, were associated with adverse outcomes. Moreover, diastolic dyssynchrony appears to provide incremental predictive value to clinical history, electrical dyssynchrony, and left ventricular function.
Dr. Fudim is on the advisory board for GE Healthcare; and has received grant support from an American Heart Association grant (17MCPRP33460225) and a National Institutes of Health T32 grant (5T32HL007101). Dr. Borges-Neto has received research grant support from GE Healthcare. Dr. Piccini has received funding for clinical research from ARCA biopharma, Boston Scientific, Gilead, Janssen Pharmaceuticals, ResMed, Spectranetics, and St. Jude Medical; and serves as a consultant to Allergan, Amgen, GlaxoSmithKline, Johnson & Johnson, Medtronic, and Spectranetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 9, 2018.
- Revision received May 21, 2018.
- Accepted May 24, 2018.
- 2019 American College of Cardiology Foundation
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