Department of Cardiology, Teine Kijinkai Hospital, Sapporo, Hokkaido, Japan.
Department of Cardiology, Hakodate Goryokaku Hospital, Hakodate, Japan.
J Nucl Cardiol. 2022 Aug;29(4):1611-1625. doi: 10.1007/s12350-021-02554-5. Epub 2021 Feb 24.
The use of left ventricular mechanical dyssynchrony (LVMD), which has been reported to be responsible for unfavorable outcomes, might improve conventional risk-stratification by clinical indices including QRS duration (QRSd) and systolic dysfunction in patients with heart failure (HF).
Following measurements of 12-lead QRSd and left ventricular ejection fraction (LVEF), three-dimensional (3-D) LVMD was evaluated as a standard deviation (phase SD) of regional mechanical systolic phase angles by gated myocardial perfusion imaging in 829 HF patients. Patients were followed up for a mean period of 37 months with a primary endpoint of lethal cardiac events (CEs). In an overall multivariate Cox proportional hazards model, phase SDs were identified as significant prognostic determinants independently. The patients were divided into 4 groups by combining with the cut-off values of LVEF (35% and 50%) and QRSd (130 ms and 150 ms). The groups with lower LVEF and prolonged QRSd more frequently had CEs than did the other groups. Patient groups with LVEF < 35% and with 35% ≦ LVEF < 50% were differentiated into low-risk and high-risk categories by using an optimal phase SD cut-off value of both QRSd thresholds.
3-D LVMD can risk-stratify HF patients with mid-range as well as severe abnormalities of QRSd and systolic dysfunction.
左心室机械不同步（LVMD）的使用，据报道与不良预后有关，可能通过包括 QRS 时限（QRSd）和射血分数（LVEF）在内的临床指标改善传统的风险分层。
在测量 12 导联 QRSd 和左心室射血分数（LVEF）后，通过门控心肌灌注成像对 829 例心力衰竭（HF）患者的三维（3-D）LVMD 进行评估，作为区域机械收缩相位角度的标准偏差（相位 SD）。对患者进行了平均 37 个月的随访，主要终点为致死性心脏事件（CEs）。在整体多变量 Cox 比例风险模型中，相位 SDs 被确定为独立的显著预后决定因素。根据 LVEF（35%和 50%）和 QRSd（130ms 和 150ms）的截止值，将患者分为 4 组。与其他组相比，LVEF 较低和 QRSd 延长的组发生 CEs 的频率更高。通过使用两个 QRSd 阈值的最佳相位 SD 截止值，将 LVEF<35%和 35%≤LVEF<50%的患者组区分成低风险和高风险组。
3-D LVMD 可以对 QRSd 和收缩功能中度至严重异常的 HF 患者进行风险分层。
