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. 2025 Aug;40(8):677-687.
doi: 10.1007/s00380-024-02504-4. Epub 2025 Feb 28.

Prognostic value of stress phase entropy for predicting major cardiac events in patients with known or suspected stable coronary artery disease

Katsunori Fukumoto  1 , Shunichi Yoda  2 , Yudai Tanaka  1 , Takumi Hatta  1 , Yasuyuki Suzuki  1 , Naoya Matsumoto  1 , Yasuo Okumura  1
Affiliations

Prognostic value of stress phase entropy for predicting major cardiac events in patients with known or suspected stable coronary artery disease

Katsunori Fukumoto et al. Heart Vessels. 2025 Aug.

Abstract

There are no large-scale reports on the prediction of major cardiac events (MCEs) and risk stratification using phase entropy, a measure of left ventricular (LV) dyssynchrony, in Japanese patients with known or suspected coronary artery disease (CAD). We retrospectively investigated 5541 patients with known or suspected CAD who underwent rest 201Tl and stress 99mTc-tetrofosmin electrocardiogram (ECG)-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) and followed them for three years to confirm their prognosis. We excluded patients undergoing revascularization within 3 months before and after the SPECT and those with non-sinus rhythm. The composite endpoint was the onset of MCEs, consisting of cardiac death, non-fatal myocardial infarction (MI), and severe heart failure requiring hospitalization. Poststress phase standard deviation (SD), bandwidth, and entropy were calculated by phase analysis using Heart Risk View-F software. During follow-up, 401 patients experienced MCEs: cardiac death (n = 98), non-fatal MI (n = 76), and severe heart failure (n = 227). Multivariate analysis showed that age, diabetes, estimated glomerular filtration rate (eGFR), stress LV ejection fraction (EF), and stress phase entropy were independent predictors of MCEs. Kaplan-Meier analysis showed significant risk stratification between each group in the stress phase entropy quartile. The global chi-squared value predicting MCE onset was significantly improved in the model with summed stress score and LVEF plus entropy but was comparable in the model with added bandwidth or phase SD. Stress phase entropy was a strong predictor of MCEs in Japanese patients with CAD (known or suspected) and was considered the most useful left ventricular dyssynchrony index to improve risk stratification over prediction by perfusion and LVEF assessment alone.

Keywords: Gated single-photon emission computed tomography; Left ventricular mechanical dyssynchrony; Phase entropy; Prognosis; Risk stratification.

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare that they have no conflicts of interest.

References

    1. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA (1998) Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: differential stratification for risk of cardiac death and myocardial infarction. Circulation 97:535–543 - PubMed
    1. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 107:2900–2907 - PubMed
    1. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, Weintraub WS, O’Rourke RA, Dada M, Spertus JA, Chaitman BR, Friedman J, Slomka P, Heller GV, Germano G, Gosselin G, Berger P, Kostuk WJ, Schwartz RG, Knudtson M, Veledar E, Bates ER, McCallister B, Teo KK, Boden WE, Investigators COURAGE (2008) Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial nuclear substudy. Circulation 117:1283–1291 - PubMed
    1. Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, Van Train KF, Berman DS (1995) Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 36:2138–2147 - PubMed
    1. Sharir T, Germano G, Kavanagh PB, Lai S, Cohen I, Lewin HC, Friedman JD, Zellweger MJ, Berman DS (1999) Incremental prognostic value of post-stress left ventricular ejection fraction and volume by gated myocardial perfusion single photon emission computed tomography. Circulation 100:1035–1042 - PubMed

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