TY - JOUR
T1 - Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization
T2 - A study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS
AU - AlJaroudi, Wael
AU - Alraies, M. Chadi
AU - Hachamovitch, Rory
AU - Jaber, Wael A.
AU - Brunken, Richard
AU - Cerqueira, Manuel D.
AU - Marwick, Thomas
N1 - Funding Information:
Funding The project was funded by the American Heart Association National Clinical Research Program 11CRP5180029.
PY - 2012/10
Y1 - 2012/10
N2 - Purpose LV mechanical dyssynchrony (LVMD) is a risk marker in narrow QRS cardiomyopathy, but its association with treatment outcome is not well defined. We determined the incremental prognostic value of LVMD in ischemic cardiomyopathy, and assessed its interaction with scar, myocardium in jeopardy and subsequent revascularization. Methods Stress and rest 82Rb gated PET were performed in 486 consecutive patients (66±11 years of age, 82 % men, LVejection fraction 26±6 %) with ischemic cardiomyopathy and QRS <120 ms. LVMD was determined as the standard deviation (SD) of the regional time to minimum volume on phase analysis of the gated PET scan. A propensity score was determined to adjust for nonrandomized referral after imaging to coronary artery bypass grafting (CABG). In a Cox proportional hazards model used to determine the association between measures of LVMD and survival time, CABG was included as a time-dependent covariate and the use of an implantable cardiac defibrillator (ICD) after imaging was modeled as a stratification factor. Results Over 1.9±1.4 years, 96 patients (20 %) underwent CABG and 108 (22 %) died. LVMD was a predictor of mortality (HR 1.16. 95 % CI 1.03;1.30, per 10° increase in phase SD, p00.02) after adjusting for baseline covariates, prior ICD use, the use of postimaging CABG, and other imaging data. There was a significant interaction between phase SD and CABG. Nested Cox models showed that LVMD carried prognostic information incremental to clinical variables, ejection fraction and CABG. Conclusion LVMD is an independent predictor of all-cause mortality in ischemic cardiomyopathy, and may identify patients with a differential survival benefit from CABG versus medical therapy.
AB - Purpose LV mechanical dyssynchrony (LVMD) is a risk marker in narrow QRS cardiomyopathy, but its association with treatment outcome is not well defined. We determined the incremental prognostic value of LVMD in ischemic cardiomyopathy, and assessed its interaction with scar, myocardium in jeopardy and subsequent revascularization. Methods Stress and rest 82Rb gated PET were performed in 486 consecutive patients (66±11 years of age, 82 % men, LVejection fraction 26±6 %) with ischemic cardiomyopathy and QRS <120 ms. LVMD was determined as the standard deviation (SD) of the regional time to minimum volume on phase analysis of the gated PET scan. A propensity score was determined to adjust for nonrandomized referral after imaging to coronary artery bypass grafting (CABG). In a Cox proportional hazards model used to determine the association between measures of LVMD and survival time, CABG was included as a time-dependent covariate and the use of an implantable cardiac defibrillator (ICD) after imaging was modeled as a stratification factor. Results Over 1.9±1.4 years, 96 patients (20 %) underwent CABG and 108 (22 %) died. LVMD was a predictor of mortality (HR 1.16. 95 % CI 1.03;1.30, per 10° increase in phase SD, p00.02) after adjusting for baseline covariates, prior ICD use, the use of postimaging CABG, and other imaging data. There was a significant interaction between phase SD and CABG. Nested Cox models showed that LVMD carried prognostic information incremental to clinical variables, ejection fraction and CABG. Conclusion LVMD is an independent predictor of all-cause mortality in ischemic cardiomyopathy, and may identify patients with a differential survival benefit from CABG versus medical therapy.
KW - Coronary artery bypass grafting
KW - Ischemic cardiomyopathy
KW - Mechanical dyssynchrony
KW - Narrow QRS
KW - Outcomes
KW - Positron emission tomography
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U2 - 10.1007/s00259-012-2171-3
DO - 10.1007/s00259-012-2171-3
M3 - Article
C2 - 22699531
AN - SCOPUS:84868232038
SN - 1619-7070
VL - 39
SP - 1581
EP - 1591
JO - European Journal of Nuclear Medicine and Molecular Imaging
JF - European Journal of Nuclear Medicine and Molecular Imaging
IS - 10
ER -