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23.03.2022 | Original Article

Prognostic value of the normalization of left ventricular mechanical dyssynchrony after revascularization in patients with coronary artery disease

verfasst von: Hidesato Fujito, Shunichi Yoda, Takumi Hatta, Masatsugu Miyagawa, Yudai Tanaka, Katsunori Fukumoto, Yasuyuki Suzuki, Naoya Matsumoto, Yasuo Okumura

Erschienen in: Heart and Vessels | Ausgabe 8/2022

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Abstract

There are no reports indicating a prognostic difference based on normalization of left ventricular (LV) mechanical dyssynchrony after revascularization in patients with coronary artery disease (CAD). We retrospectively investigated 596 patients who underwent rest ²⁰¹Tl and stress ^99mTc-tetrofosmin electrocardiogram-gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging. All patients had significant stenosis with ≥ 75% narrowing of the coronary arterial diameter detected by coronary angiography performed after confirmation of ≥ 5% ischemia by the SPECT. Patients underwent revascularization and thereafter were re-evaluated by the SPECT during a chronic phase, and followed-up to confirm their prognosis for ≥ 1 year. The composite endpoint was the onset of major cardiac events (MCEs) consisting of cardiac death, non-fatal myocardial infarction (MI), unstable angina pectoris (UAP), and severe heart failure requiring hospitalization. The stress phase bandwidth (SPBW) was calculated by phase analysis with the Heart Risk View-F software and its normal upper limit was set to 38°. During the follow-up, 64 patients experienced MCEs: Cardiac death (n = 11), non-fatal MI (n = 5), UAP (n = 26), and severe heart failure (n = 22). The results of the multivariate analysis showed the ∆summed difference score %, ∆stress LV ejection fraction, and stress SPBW after revascularization to be independent predictors of MCEs. Additionally, the results of the multivariate logistic regression analysis showed the summed rest score%, summed difference score%, stress LV ejection fraction, and perfusion defects in the left circumflex artery region before revascularization to be independent predictors for normalized SPBW after revascularization. The prognosis of patients who normalized SPBW after revascularization was similar to that of patients with a normal SPBW before revascularization, while patients who did not normalize after revascularization had the worst prognosis. In conclusion, normalization of LV dyssynchrony after revascularization assessed with nuclear cardiology may help predict future MCEs and thus a useful indicator for predicting improved prognosis in patients with CAD.

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Titel: Prognostic value of the normalization of left ventricular mechanical dyssynchrony after revascularization in patients with coronary artery disease
verfasst von: Hidesato Fujito
Shunichi Yoda
Takumi Hatta
Masatsugu Miyagawa
Yudai Tanaka
Katsunori Fukumoto
Yasuyuki Suzuki
Naoya Matsumoto
Yasuo Okumura
Publikationsdatum: 23.03.2022
Verlag: Springer Japan
Erschienen in: Heart and Vessels / Ausgabe 8/2022
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-022-02045-8

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Prognostic value of the normalization of left ventricular mechanical dyssynchrony after revascularization in patients with coronary artery disease

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