The prognostic value of left ventricular diastolic dyssynchrony combined with myocardial perfusion, systolic dyssynchrony, and cardiovascular risk factors in patients with normal left ventricular ejection fraction.

Abstract

Objective: Major adverse cardiovascular events (MACE) still occur in the normal left ventricular ejection fraction (LVEF) patients with coronary artery disease (CAD). Currently, there are no studies related to the prognostic value of left ventricular diastolic dyssynchrony (LVDD) in combination with perfusion, systolic dyssynchrony, and cardiovascular risk factors in patients with normal LVEF. Therefore, we aimed to investigate the incremental prognostic value of LVDD in patients with normal LVEF and to establish a model to predict MACE.

Methods: This study included 239 suspected or known CAD patients with a normal LVEF who underwent gated single-photon emission computerized tomography myocardial perfusion imaging. Clinical data such as age, sex, and cardiovascular risk factors were collected. Myocardial perfusion, and left ventricular dyssynchrony parameters were assessed using QPS and Emory Toolbox software, respectively. The least absolute shrinkage and selection operator and multivariable Cox regression were used to select the variables.

Results: The subjects were followed up for a total of 73.2±16.4 months and MACE occurred in 28 patients. In multivariate Cox regression, rest diastolic bandwidth (BW) was closely related to MACE [hazard ratio (95% confidence interval), 10.78 (1.65-70.35); P=0.013]. The C-index of the model was increased from 0.748 to 0.783 by increasing the rest diastolic BW on the basis of summed difference score (SDS), stress systolic SD, age, hypertension, and chest pain (P<0.001). A final model for predicting MACE was constructed based on age, hypertension, chest pain, SDS, stress systolic SD, and rest diastolic BW. The C-index of the model was 0.783, and the area under the curves of the model predicting the occurrence of 3-year and 5-year MACE events were 0.766 and 0.827, respectively. The calibration curve showed a good calibration of the model.

Conclusion: LVDD is associated with MACE in patients with normal LVEF. In addition, based on SDS, stress systolic SD, age, hypertension, and chest pain, rest diastolic BW had an incremental predictive value for MACE.