Left ventricular end-systolic contractile entropy can predict cardiac prognosis in patients with complete left bundle
Masato Shimizu1, Munehiro Iiya2, Hiroyuki Fujii2
1Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura-higashi, Kanazawa-ku, Yokohama, 236-0037, Japan. mst-smz@my.email.ne.jp.
Insights
Left ventricular end-systolic contractile entropy is a strong predictor of poor cardiac prognosis in patients with complete left bundle branch block (CLBBB). This finding may offer a more valuable prognostic tool than existing SPECT parameters.
Area of Science:
- Cardiology
- Medical Imaging
- Prognostics
Background:
- Complete left bundle branch block (CLBBB) is associated with left ventricular (LV) dyssynchrony and poor cardiac outcomes.
- The prognostic significance of LV end-systolic contractile entropy in CLBBB patients remains unclear.
Purpose of the Study:
- To investigate the prognostic value of LV end-systolic contractile entropy measured by SPECT in patients with CLBBB.
Main Methods:
- 115 patients with CLBBB underwent ECG-gated 201TlCl-SPECT.
- 102 patients were retrospectively analyzed for major cardiac events over a median of 671 days.
- Multivariate Cox regression and Random Forest analysis were used to identify predictors of cardiac events.
Main Results:
- LV end-systolic contractile entropy ≥ 79% and estimated glomerular filtration rate (eGFR) ≤ 39.35 mL/min were independent predictors of major cardiac events.
- Entropy and eGFR showed higher feature importance in Random Forest analysis.
- Patients with both high entropy and low eGFR had the worst cardiac prognosis.
Conclusions:
- LV end-systolic contractile entropy is a valuable predictor of poor cardiac prognosis in CLBBB patients.
- This entropy measure may be superior to other SPECT parameters for risk stratification in this population.
Background:
Several patients with complete left bundle branch block (CLBBB) show left ventricular (LV) dyssynchrony and poor cardiac prognosis. However, the prognostic value of LV end-systolic contractile entropy which was measured by single-photon emission computer tomography (SPECT) has not been elucidated in patients with CLBBB.
Methods And Results:
We recruited consecutive 115 sinus-rhythm patients with CLBBB who underwent ECG-gated 201TlCl-SPECT. After 30 days of observation, finally 102 patients (75.2 ± 9.5 years, 62 male) were enrolled and observed retrospectively for a median of 671 days. Twenty-five patients fell into major cardiac events. Multivariate Cox regression analysis showed estimated glomerular filtration rate (eGFR) ≤ 39.35 mL/min and entropy ≥ 79% were significant and independent predictors for major cardiac events (hazard ratio: 4.256 and 7.587, P value = 0.006 and < 0.001, respectively). Machine learning (Random Forest method) revealed eGFR and entropy had higher feature importance than other predictors (0.140 and 0.138, respectively). Kaplan-Meyer curve analysis demonstrated that the group with entropy ≥ 79% and eGFR ≤ 39.36 mL/min had the worst cardiac prognosis (Logrank: P = 0.002).
Conclusions:
Left ventricular end-systolic contractile entropy predicts poor cardiac prognosis in patients with CLBBB, which may be more valuable than the other parameters of SPECT.
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