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

Wael AlJaroudi, M Chadi Alraies, Rory Hachamovitch, Wael A. Jaber, Richard Brunken, Manuel D. Cerqueira, Thomas Marwick

Research output: Contribution to journalArticle

27 Citations (Scopus)

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, LVejection 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, p00.02) 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.

Original languageEnglish (US)
Pages (from-to)1581-1591
Number of pages11
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume39
Issue number10
DOIs
StatePublished - Oct 1 2012

Fingerprint

Coronary Artery Bypass
Positron-Emission Tomography
Survival
Cardiomyopathies
Implantable Defibrillators
Proportional Hazards Models
Propensity Score
Mortality
Cicatrix
Myocardium
Referral and Consultation

Keywords

  • Coronary artery bypass grafting
  • Ischemic cardiomyopathy
  • Mechanical dyssynchrony
  • Narrow QRS
  • Outcomes
  • Positron emission tomography

Cite this

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. / AlJaroudi, Wael; Alraies, M Chadi; Hachamovitch, Rory; Jaber, Wael A.; Brunken, Richard; Cerqueira, Manuel D.; Marwick, Thomas.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 39, No. 10, 01.10.2012, p. 1581-1591.

Research output: Contribution to journalArticle

AlJaroudi, Wael ; Alraies, M Chadi ; Hachamovitch, Rory ; Jaber, Wael A. ; Brunken, Richard ; Cerqueira, Manuel D. ; Marwick, Thomas. / 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. In: European Journal of Nuclear Medicine and Molecular Imaging. 2012 ; Vol. 39, No. 10. pp. 1581-1591.
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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, LVejection 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, p00.02) 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.",
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T1 - Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization

T2 - A study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS

AU - AlJaroudi, Wael

AU - Alraies, M Chadi

AU - Hachamovitch, Rory

AU - Jaber, Wael A.

AU - Brunken, Richard

AU - Cerqueira, Manuel D.

AU - Marwick, Thomas

PY - 2012/10/1

Y1 - 2012/10/1

N2 - 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, LVejection 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, p00.02) 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.

AB - 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, LVejection 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, p00.02) 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.

KW - Coronary artery bypass grafting

KW - Ischemic cardiomyopathy

KW - Mechanical dyssynchrony

KW - Narrow QRS

KW - Outcomes

KW - Positron emission tomography

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