Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Prognostic value of left ventricular dyssynchrony evaluated by gated myocardial perfusion imaging in patients with chronic kidney disease and normal perfusion defect scores Hiroaki Mori, MD,a Satoshi Isobe, MD, PhD,a Susumu Suzuki, MD, PhD,a Kazumasa Unno, MD, PhD,a Ryota Morimoto, MD,a Naoaki Kano, MD,a Takahiro Okumura,MD, PhD,a Yoshinari Yasuda, MD, PhD,c Katsuhiko Kato,MD, PhD,d Toyoaki Murohara, MD, PhDa aDepartment of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan bDepartment of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan cDivision of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan dDepartment of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND 1- The left ventricular (LV) dyssynchrony in addition to myocardial perfusion abnormality has recently been assessed simultaneously by electrocardiographically gated myocardial perfusion SPECT (GMPS) 2- Some chronic kidney disease (CKD) patients without significant perfusion defects and obviously previous heart diseases experience major adverse cardiac events (MACEs). 3- Phase standard deviation (PSD) and bandwidth (BW) are new parameters of LV contractile dispersion. 4- The prognostic value of these dyssynchrony parameters in CKD patients showing normal perfusion defect scores is unclear. Copyright American Society of Nuclear Cardiology

METHODS Study type:(Select all that apply) Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type:(Select all that apply) Retrospective/cohort in a single center. Study subjects: 167 CKD patients showing normal perfusion defect scores on ECG-gated myocardial 201Tl perfusion SPECT. Study endpoints: Primary end points: sudden cardiac death, fatal arrhythmias, and acute coronary syndrome required coronary revascularization. Secondary end point: prognostic implications of LV dyssynchrony indices. Study variables: PSD and BW derived from ECG-gated myocardial 201Tl perfusion SPECT. Copyright American Society of Nuclear Cardiology

RESULTS Low PSD- and Narrow BW-group High PSD- and Wide BW-group Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Low PSD- and Narrow BW-group High PSD- and Wide BW-group Event free rate P = 0.002 Mean follow-up periods: 560 days Follow-up periods (days) Fig. 1. Kaplan-Meier event-free survival analysis Major cardiac event rate was significantly higher in the high phase standard deviation (PSD) and wide-bandwidth (BW) group than in the low-PSD and narrow-BW group (P = 0.002). Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Table 3. Binary logistic regression analysis for the cardiac event Variable Univariate Multivariate Odds Ratio 95% CI P value Age 0.99 0.92-1.06 0.92 BMI 0.88 0.72-1.07 0.20 eGFR 0.97 0.94-1.00 0.15 Hemoglobin 0.95 0.68-1.34 0.80 C-reactive protein 0.43-2.30 LDL-cholesterol 1.00 0.98-1.02 HbA1c 1.22 0.45-3.26 0.68 SSS 0.52-1.73 0.87 EDV 1.03 1.00-1.05 0.01 1.02 0.03 EF 0.93 0.86-1.01 0.11   TID ratio 1.63 0.12-224.54 0.84 PSD 1.35 1.08-1.69 0.007 1.33 1.05-1.69 Variables with a p value ≤ 0.01 were included in the multivariate analysis. CI = confidence interval; BMI = body mass index; eGFR = estimated glomerular filtration rate; LDL = low-density lipoprotein; HbA1c = glycosylated hemoglobin concentration; SSS = Summed stress score; EDV = End-diastolic volume; EF = Ejection fraction; TID = transient ischemic dilatation; PSD = Phase standard deviation EDV, EF and PSD are calculated in the stress phase. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS 1- The LV dyssynchrony indices noninvasively calculated by GMPS may be novel prognostic predictors in CKD patients presenting normal perfusion defect scores on myocardial SPECT. 2- However, this is a single center and retrospective study with a limited number of CKD patients so that larger prospective studies will be needed to confirm the prognostic implications. Copyright American Society of Nuclear Cardiology