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Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The risk stratification of patients with ischemia and no obstructive coronary artery disease (INOCA) remains suboptimal. This study aims to establish a left ventricular mechanical dyssynchrony (LVMD)-based nomogram to improve the present situation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with suspected coronary artery disease (CAD) were retrospectively enrolled and divided into three groups: normal (stenosis &amp;lt;50%, without myocardial ischemia), INOCA (stenosis &amp;lt;50%, summed stress score &amp;gt;4, summed difference score \u22652), and obstructive CAD (stenosis \u226550%). LVMD was defined by ROC analysis. INOCA group were followed up for the occurrence of major adverse cardiac events (MACEs: cardiovascular death, non-fatal myocardial infarction, revascularization, stroke, heart failure, and hospitalization for unstable angina). Nomogram was established using multivariate Cox regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 334 patients (118 [35.3%] INOCA), LVMD parameters were significantly higher in INOCA group versus normal group but they did not differ between obstructive CAD groups. In INOCA group, 27 (22.9%) MACEs occurred during a 26-month median follow-up. Proportion of LVMD was significantly higher with MACEs under both stress (63.0% vs. 22.0%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001) and rest (51.9% vs. 20.9%, <jats:italic>P<\/jats:italic> = 0.002). Kaplan\u2013Meier analysis revealed significantly higher rate of MACEs (stress log-rank: <jats:italic>P<\/jats:italic> = 0.002; rest log-rank: <jats:italic>P<\/jats:italic> &amp;lt; 0.001) in LVMD patients. Multivariate Cox regression analysis showed that stress LVMD (HR: 3.82; 95% CI: 1.30\u201311.20; <jats:italic>P<\/jats:italic> = 0.015) was an independent predictor of MACEs. The internal bootstrap resampling approach indicates that the C-index of nomogram was 0.80 (95% CI: 0.71\u20130.89) and the AUC values for 1 and 3 years of risk prediction were 0.68 (95% CI: 0.46\u20130.89) and 0.84 (95% CI: 0.72\u20130.95), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LVMD-based nomogram might provide incremental prognostic value and improve the risk stratification in INOCA patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.827231","type":"journal-article","created":{"date-parts":[[2022,3,18]],"date-time":"2022-03-18T05:03:35Z","timestamp":1647579815000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["A Left Ventricular Mechanical Dyssynchrony-Based Nomogram for Predicting Major Adverse Cardiac Events Risk in Patients With Ischemia and No Obstructive Coronary Artery 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