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 SoodEmail author
  • Madan Parmar
  • Komalpreet Kaur
  • Ajay Bahl
Original Article



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).


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.


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.


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.


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



Diabetes mellitus


Left ventricular mechanical dyssynchrony


Major adverse cardiac events


Phase standard deviation


Phase bandwidth


Coronary artery disease


Diabetic cardiomyopathy


Tissue doppler imaging


Left ventricle ejection fraction


Single-photon emission computed tomography myocardial perfusion imaging


Cardiac resynchronization therapy


Left ventricular dyssynchrony



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
    Email author
  • 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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