Out-of-hospital sudden coronary death: rest and exercise radionuclide left ventricular function in survivors.

One hundred fifty-four survivors of out-of-hospital ventricular fibrillation (VF) with coronary artery disease underwent radionuclide ventriculography an average of 4.2 months after VF. All patients were studied at rest, and 91 of these patients were also studied during supine bicycle exercise. Clinical histories and 24-hour ambulatory electrocardiograms were also assessed, and patients were followed for an average of 3.1 years after ventriculography. The mean left ventricular (LV) ejection fraction (EF) at rest was 40 +/- 16%; in 34% of patients, it was 30% or less; in 37%, 31 to 50%; and in 29%, more than 50%. Regional LV wall motion was normal in 18%. The most severe segmental abnormality was hypokinesia in 22%, akinesia in 45% and dyskinesia in 14%. Wall motion abnormalities were usually located at the apex. During exercise, only 3% of patients (3 of 91) had a normal increase in EF of more than 5%, and the mean EF decreased from 42 to 38%. New exercise-induced wall motion abnormalities occurred in 30%. During the follow-up period, 54 patients died (35%): 48 from cardiac causes and 42 from unexpected and sudden causes. Predictors of death included EF at rest, presence of akinesia or dyskinesia on the ventriculogram at rest, the number of abnormal LV segments, history of congestive heart failure, history of acute myocardial infarction, absence of acute myocardial infarction at the time of VF and the presence of ventricular arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)