Prognostic value of mechanical dyssynchrony in patients with heart failure: a systematic review.

Background: Heart failure (HF) significantly impacts quality of life and healthcare systems worldwide. Assessing left ventricular mechanical dyssynchrony (LVMD) is crucial for understanding cardiac function and optimizing treatments like cardiac resynchronization therapy (CRT). Phase analysis using gated single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has shown promise in predicting outcomes, yet recent comprehensive reviews are lacking.

Objective: To systematically assess the prognostic value of phase analysis by gated SPECT MPI in the HF population through a systematic review.

Methods: We conducted a systematic review by collecting studies from databases including PubMed, CINAHL, and Web of Science. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Systematic reviews were conducted using Review Manager Software 5.4 and STATA 16.0.

Results: A total of 2004 patients from seven studies were included in our review and analysis. The systematic review indicated that patients with predetermined clinical events had higher PSD [MD = 6.45, 95% CI (5.83, 7.07), p < 0.00001] and PBW [MD = 7.91, 95% CI (5.64, 10.19), p < 0.00001]. The diagnosis of LVMD determined by PSD [HR = 1.05, 95% CI (1.01, 1.08), p = 0.007] was a strong predictor of endpoint events compared to PBW [HR = 1.95, 95% CI (0.48, 7.89), p = 0.35].

Conclusions: The analysis demonstrated that phase information obtained from gated SPECT MPI is of significant prognostic value in patients with heart dysfunction. It effectively enhances clinical risk models, providing reliable guidance for patient treatment.