Correlation of left ventricular mechanical dyssynchrony in patients with chronic kidney disease using phase analysis of gated single photon emission computed tomography myocardial perfusion imaging
Authors: Tan L M , Magsombol E B , Pawhay C M 
Published: October 2022

Abstract

Background
Left ventricular mechanical dyssynchrony (LVMD) possesses deleterious effects that have been neglected in chronic kidney disease (CKD) as a cause of left ventricular dysfunction and further progression to heart failure, possibly contributing to sudden cardiac death in this population. Thus, cardiovascular risk assessment is essential in early stages of CKD as well as in the pre-transplant screening and this can be performed non-invasively by modalities including phase analysis Gated-SPECT myocardial perfusion imaging (MPI). This modality has emerged as a prognostic tool to predict mortality independent of MPI abnormalities as well as assessment of ventricular synchrony.

Purpose
The goal of this study is to evaluate the relationship of left ventricular mechanical dyssynchrony using phase analysis G-SPECT and chronic kidney disease severity and its predictors.

Methods
We included 567 patients who underwent one day rest/stress (dipyridamole) 99mTc-sestamibi myocardial perfusion imaging with G-SPECT for the following indications for testing: detection of CAD among asymptomatic patients, risk assessment during pre-operative evaluation for kidney transplantation and evaluation for noncardiac surgery without active cardiac conditions between January 2017 to January 2021. Data was collected including gender, age, risk factors resting heart rate and baseline blood pressure. Gated SPECT-MPI was performed according to the protocol rest followed by stress images (dipyridamole) 99mTc-sestamibi. The rest and stress phase analysis (histogram bandwidth, standard deviation of phase and entropy) parameters were compared between the five stages of chronic kidney disease. Data of the stress-rest difference in dyssynchrony was analyzed using McNemar's test; crude odds ratios and adjusted odds or multivariate analysis were done.

Results
Advanced CKD (Stage 4–5) shows statistically significant correlation with the Histogram bandwidth (HBW) both at stress (p=0.008) and rest (p=0.018), and stress entropy (p=0.007). As for the other stages, LVMD is present with similar results seen with the phase parameters HBW and PSD, the entropy values at rest than at stress for Stages I to IV (p&lt;0.05). On further analysis, abnormal perfusion showed to be an independent predictor of left ventricular mechanical dyssynchrony across all arms. Other associated factors includes advanced CKD (stages 4–5), male sex, BMI ≥30 kg/m2, blood pressure and resting heart rate were significantly associated with increased odds of dyssynchrony across stress and rest tests. Overall, the full models were statistically significant, with R-squared ranging from 14.96% to 30.11% (p&lt;0.001).

Conclusion
This study showed that CKD patients have left ventricular mechanical dyssynchrony on gated-SPECT MPI. Hence, it can be used as an alternative for early assessment and guide decision making for the treatment of patients with CKD to prevent further cardiovascular complication.

Funding Acknowledgement
Type of funding sources: None.