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Prognostic value of left ventricular mechanical dyssynchrony indices in long-standing type II diabetes mellitus with normal perfusion and left ventricular systolic functions on SPECT-MPI

  • Dharmender Malik
  • Bhagwant Rai Mittal
  • Ashwani Sood
  • Madan Parmar
  • Komalpreet Kaur
  • Ajay Bahl
Original Article

Abstract

Objective

To test whether phase analysis indices from SPECT-MPI for left ventricular mechanical dyssynchrony (LVMD) are predictors of major adverse cardiac events (MACEs) in long-standing diabetes mellitus (DM).

Methods

A total of 136 DM patients with normal perfusion and left ventricular systolic functions were followed up for about two years and divided into two groups according to the presence and the absence of MACEs.

Result

Thirteen (9.5%) patients experienced MACEs during follow-up. Patients experiencing MACEs showed significantly higher phase standard deviation (PSD) and wider phase bandwidth (PBW) than those who did not. Moreover, both PSD and PBW showed significant correlations (r = 0.25 and 0.27; P < 0.05) with duration of DM. Logistic regression analysis revealed significant associations of DM duration, microvascular complications, and LVMD indices for predicting MACEs. Kaplan–Meier event-free survival analysis revealed significantly higher rate of MACEs (Logrank = 10.02; P = 0.001) in patients with high PSD and wide PBW. An overall fit model consisting of high-PSD and wide-PBW group was improved with the addition of microvascular complications (χ2 = 15.9; P = 0.03) and further by addition of DM duration of ≥ 15 years (χ2 = 24.3; P = 0.007) as variables.

Conclusion

LVMD indices are novel prognostic markers in diabetic patients with normal perfusion and left ventricular systolic functions and their increases in magnitudes with DM-duration and in the presence of microvascular complications.

Keywords

Diabetes mellitus SPECT-MPI phase analysis phase standard deviation phase bandwidth LVMD indices 

Abbreviations

DM

Diabetes mellitus

LVMD

Left ventricular mechanical dyssynchrony

MACEs

Major adverse cardiac events

PSD

Phase standard deviation

PBW

Phase bandwidth

CAD

Coronary artery disease

DCM

Diabetic cardiomyopathy

TDI

Tissue doppler imaging

LVEF

Left ventricle ejection fraction

SPECT-MPI

Single-photon emission computed tomography myocardial perfusion imaging

CRT

Cardiac resynchronization therapy

LVD

Left ventricular dyssynchrony

Notes

Disclosures

There is no potential conflict of interest to disclose.

Supplementary material

12350_2018_1436_MOESM1_ESM.pptx (944 kb)
Supplementary material 1 (PPTX 830 kb)

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Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  • Dharmender Malik
    • 1
  • Bhagwant Rai Mittal
    • 1
  • Ashwani Sood
    • 1
  • Madan Parmar
    • 1
  • Komalpreet Kaur
    • 1
  • Ajay Bahl
    • 2
  1. 1.Nuclear MedicinePost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  2. 2.CardiologyPost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

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