Key result
LV mechanical dyssynchrony on gated SPECT MPI predicts ~5% higher adverse event risk in HF.
Why the study?
Phase analysis using gated SPECT MPI has shown promise in predicting outcomes in heart failure, but recent comprehensive reviews were lacking.
Does left ventricular mechanical dyssynchrony assessed by gated SPECT MPI predict adverse clinical events in patients with heart failure?
Systematic Review (n=2,004)
Does left ventricular mechanical dyssynchrony assessed by gated SPECT MPI predict adverse clinical events in patients with heart failure?
Effect estimate: HR 1.05 (95% CI 1.01, 1.08)
p-value: p=0.007
Phase analysis by gated SPECT MPI, particularly phase standard deviation, provides significant prognostic value for predicting adverse clinical events in patients with heart failure.
Gated SPECT MPI phase analysis aids HF risk stratification; confirms PSD as a prognostic marker in meta-analysis.
BACKGROUND: Heart failure (HF) significantly impacts quality of life and healthcare systems worldwide. Assessing left ventricular mechanical dyssynchrony (LVMD) is crucial for understanding cardiac function and optimizing treatments like cardiac resynchronization therapy (CRT). Phase analysis using gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has shown promise in predicting outcomes, yet recent comprehensive reviews are lacking. OBJECTIVE: To systematically assess the prognostic value of phase analysis by gated SPECT MPI in the HF population through a systematic review. METHODS: We conducted a systematic review by collecting studies from databases including PubMed, CINAHL, and Web of Science. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Systematic reviews were conducted using Review Manager Software 5.4 and STATA 16.0. RESULTS: A total of 2004 patients from seven studies were included in our review and analysis. The systematic review indicated that patients with predetermined clinical events had higher PSD [MD = 6.45, 95% CI (5.83, 7.07), p < 0.00001] and PBW [MD = 7.91, 95% CI (5.64, 10.19), p < 0.00001]. The diagnosis of LVMD determined by PSD [HR = 1.05, 95% CI (1.01, 1.08), p = 0.007] was a strong predictor of endpoint events compared to PBW [HR = 1.95, 95% CI (0.48, 7.89), p = 0.35]. CONCLUSIONS: The analysis demonstrated that phase information obtained from gated SPECT MPI is of significant prognostic value in patients with heart dysfunction. It effectively enhances clinical risk models, providing reliable guidance for patient treatment.
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Chen et al. (2024) conducted a systematic review in Heart failure (n=2,004). Phase analysis by gated SPECT MPI (Phase standard deviation [PSD] and Phase bandwidth [PBW]) vs. Patients without left ventricular mechanical dyssynchrony was evaluated on Endpoint events (adverse cardiac outcomes) (HR 1.05, 95% CI 1.01, 1.08, p=0.007). Left ventricular mechanical dyssynchrony determined by phase standard deviation using gated SPECT MPI was a strong predictor of endpoint events in heart failure patients (HR 1.05).
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