Key result
Left ventricular mechanical dyssynchrony was present in 28% of end-stage renal disease patients with normal SPECT-MPI, and its extent significantly correlated with LV myocardial volume (P<0.001).
Why the study?
Hypertension, diabetes, renal diseases, and dyslipidemia may affect phase parameters though their impact is not well understood, prompting evaluation of LVMD incidence in ESRD patients with normal gated SPECT-MPI and normal QRS duration.
Observational (n=129)
Left ventricular mechanical dyssynchrony is present in over a quarter of ESRD patients despite normal QRS duration and normal SPECT-MPI, correlating with increased LV myocardial volume.
LVMD in 28% of ESRD patients with normal MPI warrants interpretive caution; leaves open prospective validation before clinical adoption.
Phase analysis using gated single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) is a relatively new tool for the assessment of ventricular synchrony. Hypertension, diabetes, renal diseases, and dyslipidemia may affect the phase parameters though their impact is not well understood. The present study aimed to evaluate the incidence of the left ventricular mechanical dyssynchrony (LVMD) in end-stage renal disease (ESRD) patients with normal gated SPECT-MPI and QRS duration (<120 ms) on electrocardiogram. Data of 129 patients (86 males) referred for gated SPECT-MPI for their pretransplant evaluation with normal gated stress SPECT-MPI (SSS <3 and ejection fraction ≥50%) were included in the study analysis. Documented clinical history along with confounding factors such as hypertension, dyslipidemia, smoking, and alcoholism were evaluated. Left ventricle functional (end-diastolic, end-systolic, and LV myocardial volume) and phase parameters (phase standard deviation [PSD], phase bandwidth [PBW] and entropy) were calculated using the QPS-QGS program. LVMD was noted in 36 (28%) of ESRD patients with normal QRS duration and gated SPECT-MPI. The mean attenuated corrected LV myocardial volume, ejection fraction, mean PSD, and PBW values were 84.3 ± 38.1 ml, 65.3 ± 13.5%, 9.8° ± 3.9°, and 61.4° ± 24.7°, respectively. The LV myocardial volume shows statistically significant correlation with the phase parameters (r = 0.31–0.47; P < 0.001). LVMD is present in a significant number of ESRD patients, and its extent is more with increase in LV myocardial volume. It may have an additional role in risk-stratification for cardiovascular disease in ESRD patients.
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Malik et al. (2019) conducted an observational in End-stage renal disease (n=129). End-stage renal disease was evaluated on Incidence of left ventricular mechanical dyssynchrony (LVMD) (r = 0.31-0.47, p=< 0.001). Left ventricular mechanical dyssynchrony was present in 28% of end-stage renal disease patients with normal SPECT-MPI, and its extent significantly correlated with LV myocardial volume (P<0.001).
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