| Objective:1.To explore the prognostic value of left ventricular dyssynchrony of phase analysis detected by gated myocardial perfusion imaging in patients with coronary artery chronic total occlusion.2.To explore the relationship between the left ventricular dyssynchrony parameters of phase analysis detected by gated myocardial perfusion imaging and the clinical biochemical indexes of coronary artery chronic total occlusion.3.To analyze the levels of plasma brain natriuretic peptide(BNP)in patients with coronary artery chronic total occlusion,and investigate the influence of high BNP levels on the risk of major adverse cardiovascular events(MACE)in patients with chronic total occlusion,and evaluate the ability of BNP to predict the occurrence of events.Methods:A total of 349 patients who underwent coronary angiography and were diagnosed with coronary artery chronic total occlusion in Anzhen Hospital from January 2015 to August 2019 were included,and these patients underwent gated resting myocardial perfusion and 18F-FDG myocardial metabolism imaging.All patients were followed up by telephone,with a median follow-up time of 2 years.Standard gating tomography images were obtained through a post-processing workstation.The left ventricular function was analyzed by Cedars QGS software,and the left ventricular end diastolic volume(EDV),left ventricular end systolic volume(ESV)and left ventricular ejection fraction(LVEF)were obtained;The left ventricular synchronization parameters including phase histogram width(PBW),phase standard deviation(PSD),phase entropy(PE)can be obtained by the phase analysis(PA).Left ventricular synchronization parameters(PBW,PSD and PE)and cardiac function parameters in different groups of CTO patients were analyzed and compared.Cox proportional risk regression was used to evaluate the predictive value of PBW,PSD and PE.In addition,in order to explore the influencing factors of left ventricular dyssynchrony parameters of phase analysis,We analyzed the relationship between left ventricular dyssynchrony parameters and clinical biochemical indexes by Pearson correlation.The results showed that plasma BNP level was significantly correlated with left ventricular dyssynchrony parameters.Therefore,we continued to investigate the predictive value of BNP levels on the risk of MACE in patients with CTO by Cox proportional risk regression in 214 patients with plasma BNP levels measured after admission.Receiver operating curve(ROC)was used to evaluate the predictive ability of BNP for the risk of all-cause mortality.The Kaplan-Meier survival curve was used for survival analysis of CTO patients.Results:1.Among the 349 patients who underwent phase analysis of gated myocardial perfusion and myocardial metabolism,there were significant differences in EDV,ESV and LVEF between the event group and the non-event group.EDV and ESV were larger and LVEF was smaller in the event group.The left ventricular asynchrony parameters of phase analysis obtained by gating myocardial perfusion and myocardial metabolism showed moderate intensity correlation.The correlation coefficients of PBW,PSD,and PE obtained by the two methods were 0.75,0.56,and 0.74,showing statistical difference(P < 0.05).2.Left ventricular dyssynchrony parameters of phase analysis in gated myocardial perfusion imaging has the predictive value on the risk of MACE in coronary CTO patients.The risk of MACE increased by 1.523 times for each additional unit of PBW[HR: 1.523,95%CI(1.239-1.872),P < 0.001].Each unit increase in PSD,the risk of MACE increased by 1.419-fold [HR: 1.419,95%CI(1.165-1.728),P=0.001];Each unit increase in PE,the risk of MACE increased by 2.038-fold [HR: 2.038,95%CI(1.413-2.940),P < 0.001].Separate analysis of each outcome events showed that PBW,PSD,and PE were better predictors of all-cause death and heart failure.For all-cause death,the risk of all-cause death increased 1.765 times per unit increasing in PBW [HR:1.765,95%CI(1.286-2.422),P < 0.001].Each additional unit of PSD increased,the risk of all-cause death increasing by 1.419-fold [HR: 1.419,95%CI(1.174-1.569),P=0.002].For heart failure,each additional unit of PBW increased the risk of heart failure increasing by 2.291-fold [HR: 2.291,95%CI(1.371-3.828),P=0.002].The risk of heart failure increased by 2.106 times for each additional unit of PBW [HR: 2.106,95%CI(1.305-3.398),P=0.002].The risk of heart failure increased by 1.221 times for every unit of PE [HR: 1.221,95%CI(1.085-1.374),P < 0.001].3.Correlation analysis of left ventricular dyssynchrony parameters and clinical biochemical parameters showed that PBW was correlated with BNP,D-Dimer,low density lipoprotein cholesterol and potassium ion level,and the correlation coefficients were 0.309,0.234,0.154,0.153,respectively.PSD was correlated with BNP,D-Dimer,low density lipoprotein cholesterol and potassium ion level,and the correlation coefficients were 0.305,0.243,0.176 and 0.250 respectively.PE was correlated with BNP,D-Dimer,triglyceride,total cholesterol and low density lipoprotein cholesterol,and the correlation coefficients were 0.360,0.161,0.188,0.238 and 0.278 respectively,showing statistical difference(P < 0.05).BNP,D-Dimer and low density lipoprotein cholesterol were significantly correlated with PBW,PSD and PE.And the correlation coefficient with BNP was the largest.4.Further analysis of the difference between the event group and the non-event group in patients with chronic total occlusion showed that BNP concentration was significantly higher in the event group than in the non-event group(P < 0.01),especially in patients with all-cause death.The higher the BNP concentration was,the greater the risk of MACE [HR(95%CI)=2.334(1.521-3.579),P < 0.01].After adjusting for gender,age,BMI and other factors,BNP still had predictive value for the risk of MACE [HR(95%CI)=1.862(1.097-3.160),P=0.021].Analysis of all-cause mortality alone showed that the risk of all-cause mortality increased 3.491 times for each unit increase in BNP [HR(95%CI)=3.491(1.874-6.503),P < 0.01].After adjusting for the above factors,BNP still had predictive value for the risk of all-cause death [HR(95%CI)=2.146(1.015-4.534),P=0.046].ROC curve analysis showed that the area under the curve for BNP level to predict all-cause mortality was 0.713,the sensitivity was 73.5%,and the specificity was62.2%.Conclusion:1.Left ventricular dyssynchrony parameters of phase analysis detected by gated myocardial perfusion and myocardial metabolism imaging showed a moderate correlation.2.Phase histogram bandwidth,phase standard deviation and phase entropy are the influencing factors for the risk of major adverse cardiovascular events,especially for heart failure and all-cause death in coronary chronic total occlusion.3.The left ventricular dyssynchrony parameters,PBW,SD and PE were significantly positively correlated with BNP,D-Dimer and low density lipoprotein cholesterol,and the correlation coefficient with BNP was the largest.4.Brain natriuretic peptide is an independent risk factor for cardiovascular events in patients with coronary chronic total occlusion,especially for all-cause death.When BNP levels were ≥287.98pg/ml,the risk of all-cause death was significantly increased. |
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