Division of Cardiovascular Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Department of Internal Medicine, University of Pittsburgh Medical Center at McKeesport, McKeesport, PA, USA.
J Nucl Cardiol. 2018 Apr;25(2):555-569. doi: 10.1007/s12350-017-1095-5. Epub 2017 Nov 6.
Left ventricular (LV) ejection fraction (EF) has poor predictive value for ventricular tachyarrhythmia (VT). Other parameters such as LV dyssynchrony (LVD), and LV scar burden have also been individually associated with VT, but the interplay of these factors in the genesis of VT has not been explored. This retrospective study sought to evaluate the relationship between LVD and imaging characteristics of the myocardial substrate in predicting VT.
We identified 183 patients (150 men; mean age: 64 ± 14 years and mean LVEF: 23% ± 7%), who received an implantable cardioverter defibrillator (ICD) for primary prevention and who underwent a gated single-photon emission computed tomography (GSPECT) myocardial perfusion scan prior to ICD implantation. LVD was determined by phase analysis of the GSPECT images. Occurrence of VTs was established through routine ICD interrogations and review of electronic medical records.
LVD was present in 136 (74%) patients. VT occurred in 48 (26%) patients. Ninety-eight percent of patient who experienced VT had LVD. Patients without LVD had a significantly better survival free of both sustained and non-sustained VT (HR, 95% CI 4.90, 2.12-11.20; P < 0.0001). The combination of LVD and myocardial scar occupying > 6% of LV myocardium accounted for 83% of all VT events.
LVD assessment by GSPECT is strongly associated with incident VT in patients with low LVEF. The combination of LVD and scar burden predicted the majority of VT events.
左心室（LV）射血分数（EF）对室性心动过速（VT）的预测价值有限。其他参数，如 LV 不同步（LVD）和 LV 瘢痕负荷，也与 VT 有单独关联，但这些因素在 VT 发生中的相互作用尚未得到探索。本回顾性研究旨在评估 LVD 与心肌底物成像特征之间的关系，以预测 VT。
我们确定了 183 名患者（150 名男性；平均年龄：64±14 岁，平均 LVEF：23%±7%），他们因原发性预防而接受植入式心脏复律除颤器（ICD）治疗，并在 ICD 植入前接受门控单光子发射计算机断层扫描（GSPECT）心肌灌注扫描。LVD 通过 GSPECT 图像的相位分析确定。VT 的发生通过常规 ICD 询问和电子病历审查确定。
136 名（74%）患者存在 LVD。48 名（26%）患者发生 VT。发生 VT 的患者中 98%存在 LVD。无 LVD 的患者在持续和非持续 VT 方面均无明显生存获益（HR，95%CI 4.90，2.12-11.20；P<0.0001）。LVD 和心肌瘢痕占 LV 心肌>6%的组合占所有 VT 事件的 83%。
GSPECT 评估的 LVD 与低 LVEF 患者的 VT 事件密切相关。LVD 和瘢痕负荷的组合预测了大多数 VT 事件。
