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Improved risk-stratification in heart failure patients with mid-range to severe abnormalities of QRS duration and systolic function using mechanical dyssynchrony assessed by myocardial perfusion-gated SPECT

  • ORIGINAL ARTICLE
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

The use of left ventricular mechanical dyssynchrony (LVMD), which has been reported to be responsible for unfavorable outcomes, might improve conventional risk-stratification by clinical indices including QRS duration (QRSd) and systolic dysfunction in patients with heart failure (HF).

Methods and results

Following measurements of 12-lead QRSd and left ventricular ejection fraction (LVEF), three-dimensional (3-D) LVMD was evaluated as a standard deviation (phase SD) of regional mechanical systolic phase angles by gated myocardial perfusion imaging in 829 HF patients. Patients were followed up for a mean period of 37 months with a primary endpoint of lethal cardiac events (CEs). In an overall multivariate Cox proportional hazards model, phase SDs were identified as significant prognostic determinants independently. The patients were divided into 4 groups by combining with the cut-off values of LVEF (35% and 50%) and QRSd (130 ms and 150 ms). The groups with lower LVEF and prolonged QRSd more frequently had CEs than did the other groups. Patient groups with LVEF < 35% and with 35% ≦ LVEF < 50% were differentiated into low-risk and high-risk categories by using an optimal phase SD cut-off value of both QRSd thresholds.

Conclusions

3-D LVMD can risk-stratify HF patients with mid-range as well as severe abnormalities of QRSd and systolic dysfunction.

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Abbreviations

LVMD:

Left ventricular mechanical dyssynchrony

QRSd:

QRS duration

HF:

Heart failure

NYHA:

New York Heart Association

LVEF:

Left ventricular ejection fraction

CRT:

Cardiac resynchronization therapy

ICD:

Implantable cardioverter defibrillator

Hb:

Hemoglobin

BNP:

Brain natriuretic peptide

eGFR:

Estimated glomerular filtration rate

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Acknowledgements

The authors sincerely thank the staff of Nuclear Medicine Laboratory, Teine-Ki**nkai Hospital (Sapporo), Hokkaido, Japan for their clinical services and their technical assistance.

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Authors and Affiliations

  1. Department of Cardiology, Teine Ki**kai Hospital, Sapporo, Hokkaido, Japan

    Takahiro Doi MD, PhD, Takahiro Noto MD, Tomohiro Mita MD, PhD & Satoshi Yuda MD, PhD

  2. Department of Cardiology, Hakodate Goryokaku Hospital, Hakodate, Japan

    Tomoaki Nakata MD, PhD

  3. Department of Cardiology, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan

    Akiyoshi Hashimoto MD, PhD

Authors
  1. Takahiro Doi MD, PhD
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  2. Tomoaki Nakata MD, PhD
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  3. Takahiro Noto MD
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  4. Tomohiro Mita MD, PhD
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  5. Satoshi Yuda MD, PhD
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  6. Akiyoshi Hashimoto MD, PhD
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Correspondence to Takahiro Doi MD, PhD.

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Doi, T., Nakata, T., Noto, T. et al. Improved risk-stratification in heart failure patients with mid-range to severe abnormalities of QRS duration and systolic function using mechanical dyssynchrony assessed by myocardial perfusion-gated SPECT. J. Nucl. Cardiol. 29, 1611–1625 (2022). https://doi.org/10.1007/s12350-021-02554-5

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