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Prognostic risk stratification based on left ventricular mechanical dyssynchrony in patients at low or intermediate

Masatsugu Miyagawa1, Shunichi Yoda2, Hidesato Fujito1

  • 1Department of Cardiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan.

Heart and Vessels
|August 12, 2022
PubMed

Insights

Stress phase bandwidth (SPBW), a left ventricular (LV) mechanical dyssynchrony index, improves risk stratification for patients with stable coronary artery disease (CAD). Abnormal SPBW identifies higher-risk individuals missed by traditional J-ACCESS risk models, enhancing prognostic prediction.

Area of Science:

  • Cardiology
  • Nuclear Cardiology
  • Cardiovascular Imaging

Background:

  • Prognostic prediction and risk stratification in stable coronary artery disease (CAD) are crucial for patient management.
  • Existing risk models, such as the J-ACCESS risk model, may not fully identify all individuals at risk, particularly in low-to-intermediate risk groups.
  • Left ventricular (LV) mechanical dyssynchrony, assessed by stress phase bandwidth (SPBW), has not been extensively studied for prognostic value in this population.

Purpose of the Study:

  • To investigate the prognostic value of SPBW in predicting major cardiac events (MCEs) in patients with known or suspected stable CAD at low or intermediate risk.
  • To evaluate if SPBW can improve risk stratification beyond the J-ACCESS risk model.
  • To assess the association of SPBW with MCEs, including cardiac death, non-fatal myocardial infarction, and severe heart failure.

Main Methods:

  • Retrospective analysis of 4,996 patients with known or suspected CAD undergoing rest 201Tl and stress 99mTc-tetrofosmin ECG-gated SPECT MPI.
  • Patients were risk-stratified using the J-ACCESS risk model into low (n=2,653) or intermediate (n=1,470) risk groups.
  • SPBW was calculated using phase analysis, with a normal upper limit set at 38°. Patients were followed for 3 years for MCEs.

Main Results:

  • Multivariate analysis identified age, eGFR, stress LV ejection fraction, and stress SPBW as independent predictors of MCEs.
  • The 3-year MCE rate was significantly higher in intermediate-risk (6.7%) versus low-risk (2.1%) patients (P < 0.0001).
  • Patients with abnormal SPBW (>38°) showed higher MCE rates (4.0% in low-risk, 9.2% in intermediate-risk), indicating improved risk stratification.

Conclusions:

  • LV mechanical dyssynchrony, assessed by SPBW using ECG-gated SPECT MPI, is a valuable tool for risk stratification in stable CAD patients.
  • SPBW can identify higher-risk patients within low- and intermediate-risk categories who might be missed by conventional risk assessment.
  • Incorporating SPBW assessment into routine practice may enhance prognostic prediction and guide clinical decision-making for CAD patients.

Keywords:
Gated single-photon emission computed tomographyLeft ventricular mechanical dyssynchronyPrognosisRisk stratification

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