A Left Ventricular Mechanical Dyssynchrony-Based Nomogram for Predicting Major Adverse Cardiac Events Risk in Patients With Ischemia and No Obstructive Coronary Artery Disease

Zhang, Han; Shi, Kuangyu; Fei, Mengyu; Fan, Xin; Liu, Lu; Xu, Chong; Qin, Shanshan; Zhang, Jiajia; Wang, Junpeng; Lv, Zhongwei; Che, Wenliang; Yu, Fei

doi:10.3389/fcvm.2022.827231

Cited by 5 publications

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References 34 publications

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“…Similar results were reported by Mannarino et al [ 27 ], wherein the analysis of regional perfusion abnormalities on CZT SPECT was predictive of MACEs in a large population of patients with suspected CAD. Furthermore, our previous study demonstrated that the left ventricular mechanical dyssynchrony (LVMD) evaluated by the CZT SPECT phase analysis technique allows for better risk stratification of INOCA patients [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of CZT SPECT myocardial blood flow (MBF) quantification in patients with ischemia and no obstructive coronary artery disease (INOCA): a pilot study

Zhang

Caobelli

Che

et al. 2023

Eur J Nucl Med Mol Imaging

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Background Despite the demonstrated adverse outcome, it is difficult to early identify the risks for patients with ischemia and no obstructive coronary artery disease (INOCA). We aimed to explore the prognostic potential of CZT SPECT in INOCA patients. Methods The study population consisted of a retrospective cohort of 118 INOCA patients, all of whom underwent CZT SPECT imaging and invasive coronary angiography (ICA). Dynamic data were reconstructed, and MBF was quantified using net retention model. Major adverse cardiovascular events (MACEs) were defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, heart failure, late coronary revascularization, or hospitalization for unstable angina. Results During a median follow-up of 15 months (interquartile range (IQR) 11–20), 19 (16.1%) MACEs occurred; both stress myocardial blood flow (sMBF) ($$p<0.001$$ p < 0.001 ) and coronary flow reserve (CFR) ($$p<0.001$$ p < 0.001 ) were significantly lower in the MACE group. Optimal thresholds of sMBF<3.16 and CFR<2.52 were extracted from the ROC curves, and both impaired sMBF (HR: 15.08; 95% CI 2.95–77.07; $$p=0.001$$ p = 0.001 ) and CFR (HR: 6.51; 95% CI 1.43–29.65; $$p=0.01$$ p = 0.01 ) were identified as prognostic factors for MACEs. Only sMBF<3.16 (HR: 11.20; 95% CI 2.04–61.41; $$p=0.005$$ p = 0.005 ) remained a robust predictor when sMBF and CFR were integrated considered. Compared with CFR, sMBF provides better prognostic model discrimination and reclassification ability (C-index improvement = 0.06, $$p=0.02$$ p = 0.02 ; net reclassification improvement (NRI) = 0.19; integrated discrimination improvement (IDI) = 0.10). Conclusion The preliminary results demonstrated that quantitative analysis on CZT SPECT provides prognostic value for INOCA patients, which may allow the stratification for early prevention and intervention.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of CZT SPECT myocardial blood flow (MBF) quantification in patients with ischemia and no obstructive coronary artery disease (INOCA): a pilot study

Zhang

Caobelli

Che

et al. 2023

Eur J Nucl Med Mol Imaging

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“…Також було показано, що ДМ є предиктором подій в короткому періоді спостереження у хворих після аортокоронарного шунтування [15]. Крім того, аналіз Каплана -Майєра виявив значно вищу частоту великих несприятливих серцево-судинних подій у пацієнтів з необструктивною коронарною хворобою серця та ДМ порівняно з хворими без дисинхронії [16].…”

Section: вступunclassified

The relationship between mechanical dyssynchrony of the left ventricular myocardium and the degree of coronary artery occlusion in patients with coronary artery disease

Bilchenko,

Mehtieva,

Bilchenko

2023

ЕМ

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Background. The prevalence of chronic heart failure in the world is increasing; however, it is stabilizing in developed countries. One of the reasons for this stabilization is an improvement of acute coronary syndrome treatment and revascularization. Revascularization in patients with chronic coronary syndromes without signs of the left ventricular dysfunction is less effective. One of the promising methods for assessing left ventricular dysfunction is the detection of electrical and mechanical dyssynchrony of the myocardium (DM). However, mechanical dyssynchrony of the myocardium has not been sufficiently studied in patients with coronary artery (CA) disease. The purpose was to assess the relationship between mechanical myocardial dyssynchrony and the degree of coronary artery occlusion in patients with coronary artery disease who underwent revascularization. Materials and methods. One hundred and thirty-four patients with coronary artery disease (35 with myocardial infarction and 99 with chronic coronary syndromes) who underwent coronary angiography and revascularization of coronary arteries were included in the study. According to the results of coronary angiography, patients were divided into 3 groups: 12 had unchanged CA (group 1), 17 had atherosclerotic lesions of CA without signs of occlusion (group 2), and 105 patients were with CA occlusion. Among those with CA occlusion, 10 people had an occlusion of less than 50 %, 26 patients had occlusion from 50 to 80 %, 36 had more than 80 %, and 33 patients had complete occlusion of at least one coronary artery. In all patients, parameters of mechanical DM were determined by ultrasound method. Results. In the first group, 3 patients (25 %) had mechanical DM, in the second — 4 patients (23.5 %), in the group with coronary artery occlusion, 42 patients (40 %) had mechanical DM. In the group with complete CA occlusion, mechanical DM was detected in 18 (53 %) cases. Septal to posterior wall motion delay (SPWMD) did not differ significantly in the comparison groups; however, it increased significantly to 64.8 ± 43.2 ms in patients with complete CA occlusion compared with 40.8 ± 13.1 ms in the group with unchanged CA (p < 0.05). SPWMD had a significant correlation with the degree of CA occlusion (r = 0.254, p = 0.009). The interventricular mechanical delay increased significantly, to 61.3 ± 40.5 ms compared with 33.4 ± 3.4 ms in patients with unchanged CA (p < 0.05). Left ventricular filling time was significantly shorter in the group with complete CA occlusion compared to the patients with incomplete CA occlusion and those with unchanged CA (47.3 ± 10.4 ms vs. 54.2 ± 5.7 ms, respectively; p < 0.05). Left ventricular ejection time was not significantly different between comparison groups, but correlated significantly with the degree of CA occlusion (r = 0.241, p = 0.013). The early ventricular time deceleration, the time from the beginning of the QRS complex to the beginning of the peak systolic velocity did not differ significantly. The time to the peak systolic velocity was significantly longer in the group with complete CA occlusion (32.6 ± 8.5 ms), and had a significant correlation with the degree of CA occlusion (r = 0.26, p = 0.007). Conclusions. A third of patients with chronic coronary syndrome included in the study had DM. In the group with complete CA occlusion, the frequency of DM detection increased significantly and was diagnosed in half of cases. In patients with complete CA occlusion, DM manifested itself in a significant SPWMD, an increase in the period of pre-ejection into the aorta and, as a result, a significant increase in the interventricular mechanical delay. An increase in the time to peak systolic velocity was also found in the group of patients with complete CA occlusion. DM associated with left ventricular diastolic dysfunction was detected in a group of patients with complete CA occlusion and manifested itself in a reduced left ventricular filling time.

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Prognostic value of left ventricular mechanical dyssynchrony indices derived from gated myocardial perfusion SPECT in coronary artery disease: a systematic review and meta-analysis

Lee,

Han,

Ryu

et al. 2024

Ann Nucl Med

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A Left Ventricular Mechanical Dyssynchrony-Based Nomogram for Predicting Major Adverse Cardiac Events Risk in Patients With Ischemia and No Obstructive Coronary Artery Disease

Cited by 5 publications

References 34 publications

The prognostic value of CZT SPECT myocardial blood flow (MBF) quantification in patients with ischemia and no obstructive coronary artery disease (INOCA): a pilot study

The prognostic value of CZT SPECT myocardial blood flow (MBF) quantification in patients with ischemia and no obstructive coronary artery disease (INOCA): a pilot study

The relationship between mechanical dyssynchrony of the left ventricular myocardium and the degree of coronary artery occlusion in patients with coronary artery disease

Prognostic value of left ventricular mechanical dyssynchrony indices derived from gated myocardial perfusion SPECT in coronary artery disease: a systematic review and meta-analysis

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