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. 2020 Oct;27(5):1582-1591.
doi: 10.1007/s12350-018-01468-z. Epub 2018 Nov 1.

Prognostic value of left-ventricular systolic and diastolic dyssynchrony measured from gated SPECT MPI in patients with dilated cardiomyopathy

Cheng Wang  1 , Haipeng Tang  2 , Fubao Zhu  3 , Zhixin Jiang  1 , Jianzhou Shi  1 , Yanli Zhou  1 , Ernest V Garcia  4 , Dianfu Li  5 , Weihua Zhou  6
Affiliations

Prognostic value of left-ventricular systolic and diastolic dyssynchrony measured from gated SPECT MPI in patients with dilated cardiomyopathy

Cheng Wang et al. J Nucl Cardiol. 2020 Oct.

Abstract

Background: Left-ventricular systolic dyssynchrony (LVSD) has been an important prognostic factor in the patients with dilated cardiomyopathy (DCM). However, the association between the LV diastolic dyssynchrony (LVDD) and clinical outcome is not well established. This study aims to evaluate the prognostic values of both systolic and diastolic dyssynchrony in patients with DCM.

Methods: Fifty-two patients with DCM were enrolled and divided into two groups according to cardiac deaths from the follow-up data. The phase-analysis technique was applied on resting gated short-axis SPECT MPI images to measure LV systolic and diastolic dyssynchrony, including phase standard deviation (PSD), phase histogram bandwidth (PBW), and phase entropy (PE). Variables with P < 0.10 in the univariate analysis were included in the multivariate cox analysis.

Results: During the follow-up period (2.9 ± 1.7 years), 18 (34.6%) cardiac deaths were observed. Compared with survivors, patients with cardiac death had lower LVEF (P = 0.011), and more severe LV systolic and diastolic dyssynchrony. The univariate cox regression analysis showed that hypertension, NT-proBNP, LVEF, systolic PSD, systolic PE, and diastolic PBW were statistically significantly associated with cardiac death. The multivariate cox regression analysis showed that systolic PE and diastolic PE were independent predictive factors for cardiac death. Furthermore, the receiver operating characteristic (ROC) analysis, when applied into the combination of systolic PE and diastolic PE for predicting cardiac death, had an area under curve (AUC) of 0.766, a sensitivity of 0.765, and a specificity of 0.722.

Conclusions: Both the LVSD and LVDD parameters from SPECT MPI have important prognostic values for DCM patients. Both systolic PE and diastolic PE are independent prognostic factors for cardiac death.

Keywords: Dilated cardiomyopathy; Left-ventricular mechanical dyssynchrony; Phase analysis; Single photon emission computed tomography.

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Conflict of interest statement

Disclosures

Dr. Garcia receives royalties from the sales of Emory Cardiac Toolbox. The terms of this arrangement have been reviewed and approved by the Emory University in accordance with its conflicts of interest practice. None of the other authors have any relevant conflicts of interest.

Figures

Figure 1.
Figure 1.
An example of a patient showing the systolic and diastolic phase polar maps and histograms. A and B are the systolic phase polar map and histogram, respectively. C and D are the diastolic phase polar map and histogram, respectively. The brighter regions mean greater phase values (phase bins).
Figure 2.
Figure 2.
The Bland–Altman difference plot between systolic PE and diastolic PE, with a mean absolute difference (bold continuous line) and 95% confidence interval of mean differences (dashed lines). PE phase entropy; SD standard deviation.
Figure 3.
Figure 3.
The Kaplan–Meier event-free survival curve.
See this image and copyright information in PMC

Comment in

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