The prognostic value of left ventricular mechanical dyssynchrony using gated myocardial perfusion imaging in patients with end-stage renal disease
The prognostic value of left ventricular mechanical dyssynchrony using gated myocardial perfusion imaging in patients with end-stage renal disease
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DOI：
10.1007/s12350-014-9886-4
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发表时间：
2014-08-01
影响因子：
2.4
通讯作者：
Hage, Fadi G.
中科院分区：
文献类型：
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作者：
Aggarwal, Himanshu;AlJaroudi, Wael A.;Hage, Fadi G.
先前的研究表明，通过门控SPECT心肌灌注成像（MPI）测量的左心室机械不同步（LVD）识别出终末期肾病（ESRD）患者的全因死亡风险较高，但这些患者数量较少。我们试图评估LVD和左室灌注模式之间的相互作用，在风险分层的大样本量的ESRD.From肾移植数据库维护的亚拉巴马大学伯明翰分校，我们确定了连续的患者与ESRD谁门控SPECT MPI在2003年和2007年之间。对MPI进行再处理，以得出LV射血分数（EF）、灌注缺损大小和LVD [相位带宽（BW）和相位标准差（SD）]。主要终点是全因死亡率，这是前瞻性收集和验证的社会保障死亡指数数据库。有828例患者年龄52.6 +/-A0.36岁（45%是女性，60%患有糖尿病）。LVEF为54.8 +/- A 0.4%，334例（41%）患者的灌注模式异常。在61 +/- A 0.9个月的随访期间，230例患者（28%）接受了肾移植，290例患者（35%）死亡。死亡患者的相位BW（73.1 +/- A 2.6A度vs 66.3 +/- A 1.8A度，P = 0.02）和SD（25.2 +/- A 0.8A度vs 23.4 +/- A 0.5A度，P = 0.06）大于存活患者，表明更大的不同步性。阶段BW > 56 A度或SD a千分之21 A度（中位数）的患者5年生存率较差（分别为64% vs 72%和66% vs 71%，对数秩P = 0.005和P = 0.07）。在调整人口统计学、合并症、LVEF和灌注模式后，BW阶段与更差的结局相关（风险比1.289 95% CI 1.010-1.644，P = 0.04）。门控SPECT MPI的LVD阶段分析提供了超越心肌灌注和EF的ESRD预后价值。
Prior studies show that left ventricular mechanical dyssynchrony (LVD), measured by gated SPECT myocardial perfusion imaging (MPI), identifies patients with end-stage renal disease (ESRD) at higher risk for all-cause mortality but these were in small number of patients. We sought to assess the interaction between LVD and LV perfusion pattern in risk-stratification of a large sample size of patients with ESRD.From the renal transplantation database maintained at the University of Alabama at Birmingham, we identified consecutive patients with ESRD who had gated SPECT MPI between 2003 and 2007. MPIs were reprocessed to derive LV ejection fraction (EF), perfusion defect size, and LVD [phase bandwidth (BW) and phase standard deviation (SD)]. The primary end-point was all-cause mortality, which was prospectively collected and verified against the social security death index database.There were 828 patients aged 52.6 +/- A 0.36 years (45% were women and 60% had diabetes mellitus). The LVEF was 54.8 +/- A 0.4% and the perfusion pattern was abnormal in 334 patients (41%). During a follow-up period of 61 +/- A 0.9 months, 230 patients (28%) received renal transplants and 290 patients (35%) died. The phase BW (73.1 +/- A 2.6A degrees vs 66.3 +/- A 1.8A degrees, P = .02) and SD (25.2 +/- A 0.8A degrees vs 23.4 +/- A 0.5A degrees, P = .06) were greater in patients who died than those who survived indicating greater dyssynchrony. Patients with phase BW > 56A degrees or SD a parts per thousand yen21A degrees (median values) had worse 5-year survival (64% vs 72%, and 66% vs 71%, log-rank P = .005 and P = .07, respectively). After adjusting for demographics, co-morbidities, LVEF, and perfusion pattern, phase BW was associated with worse outcome (hazard ratio 1.289 95% CI 1.010-1.644, P = .04).LVD by phase analysis of gated SPECT MPI provides prognostic value in ESRD beyond myocardial perfusion and EF.