左室舒张不同步在扩张型心肌病患者中预后价值

目的：评估扩张型心肌病（Dilated cardiomyopathy，DCM）患者左心室收缩不同步（Left-ventricular systolic dyssynchrony，LVSD）和舒张不同步（Left-ventricular diastolic dyssynchrony，LVDD）的预后价值。方法：纳入2009年9月至2019年8月南京医科大学第一附属医院心脏科住院的74例DCM患者，将相位分析技术应用于静息门控核素心肌显像（SPECT MPI）图像，并测量左室收缩和舒张不同步，包括相位标准偏差（Phase standard deviation，PSD）、相位直方图带宽（Phase histogram bandwidth，PBW）和相位熵（Phase entropy，PE）。根据随访结果将患者分为心源性死亡组和存活组，Cox回归分析确定主要心脏不良事件的预测因子和独立危险因素。单变量分析中p <0.10的变量纳入多元Cox分析进一步确定主要心脏不良事件的独立危险因素。结果：在随访期间观察到29例（39.2％）心源性死亡。与存活组相比，心源性死亡组的左室射血分数（left ventricular ejection fraction, LVEF）更低（p = 0.011），左室收缩期和舒张期不同步更差（p<0.01）。单因素Cox回归分析显示，高血压、NT-proBNP、LVEF、左室疤痕、收缩期PSD、收缩期PBW、收缩期PE、舒张期PSD、舒张期PBW和舒张期PE与心源性死亡有统计学意义。多元Cox回归分析表明，收缩期PE和舒张期PE是心源性死亡的独立危险因素。结论：核素测定的LVSD和LVDD参数对于DCM有重要的预后价值。收缩期PE和舒张期PE均是DCM患者死亡的独立预测因素。

Prognostic value of left-ventricular diastolic dyssynchrony in patients with dilated cardiomyopathy

Objective: This study aims to evaluate the prognostic value of both Left-ventricular systolic and diastolic dyssynchrony in patients with dilated cardiomyopathy (DCM). Methods: Seventy-four patients with DCM from the First Affiliated Hospital of Nanjing Medical University were enrolled. The phase analysis technique was applied on resting gated short-axis SPECT MPI images to measure left ventricular systolic dyssynchrony(LVSD) and left ventricular diastolic dyssynchrony(LVDD), including phase standard deviation(PSD), phase histogram bandwidth(PBW) and phase entropy(PE). Patients were divided into cardiac death group and survivor group according to the follow-up data. The cox regression analysis was applied to determine independent predictors of major adverse cardiac events. Variables with p <0.10 in the univariate analysis were included in the multivariate cox analysis to determine independent predictors of major adverse cardiac events. Results: During the follow-up period, 29(39.2%) cardiac deaths were observed. Compared to survivor group, patients with cardiac death had lower left ventricular ejection fraction (LVEF)(p =0.011), and more severe LVSD and LVDD. The univariate cox regression analysis showed that hypertension, NT-proBNP, left scar burden, LVEF, systolic PSD, systolic PE, diastolic PSD, diastolic PBW and diastolic PE were statistically significantly associated with cardiac death. The multivariate cox regression analysis showed that systolic PE and diastolic PE were independent predictive risk factors for cardiac death. Conclusion: Both the LVSD and LVDD parameters from SPECT MPI have important prognostic values for DCM patients. Both systolic PE and diastolic PE are independent prognostic factors for cardiac death.