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Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: a study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS

Citation

AlJaroudi, W and Chadi Alraies, M and Hachamovitch, R and Jaber, WA and Brunken, R and Cerqueira, MD and Marwick, T, Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: a study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS, European Journal of Nuclear Medicine and Molecular Imaging, 39, (10) pp. 1581-1591. ISSN 1619-7070 (2012) [Refereed Article]

Copyright Statement

Copyright 2012 Springer-Verlag

DOI: doi:10.1007/s00259-012-2171-3

Abstract

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, LV ejection 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, p = 0.02) 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.

Item Details

Item Type:Refereed Article
Keywords:ischemic cardiomyopathy, narrow QRS, mechanical dyssynchrony, positron emission tomography, outcomes, coronary artery bypass grafting
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, T (Professor Tom Marwick)
ID Code:91169
Year Published:2012
Web of Science® Times Cited:19
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-05-09
Last Modified:2014-12-17
Downloads:0

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