Prediction of outcome of patients with life-threatening ventricular arrhythmias treated with automatic implantable cardioverter-defibrillators using SPECT perfusion imaging.
BACKGROUND
In the present study, we examined the predictors of outcome of 103 patients with coronary artery disease and left ventricular dysfunction who had life-threatening ventricular arrhythmias and were treated with implantable cardioverter-defibrillators with the use of single-photon emission computed tomography (SPECT).


RESULTS
During a mean follow-up of 29 months, there were 29 cardiac deaths. In comparison with patients who died, survivors had less diabetes mellitus (45% versus 19%, P < .007), higher left ventricular ejection fraction (23 +/- 9% versus 27 +/- 11%, P = .04), and fewer perfusion defects as determined with stress SPECT (15 +/- 5 versus 12 +/- 5, P < .004). Most of the perfusion defects were fixed, indicative of scarring; the extent of reversible defects did not differ (2 +/- 3 in survivors and 3 +/- 4 in nonsurvivors). Multivariate Cox survival analysis identified the number of fixed defects as the only independent predictor of death (chi 2 = 10, P = .002). There were six deaths among 42 patients (14%) with < 8 fixed defects compared with 23 deaths among 61 patients (38%) with > or = 8 defects (P = .005). The 4-year survival was better in patients with < 8 segmental fixed defects than in those with > or = 8 fixed defects (80% versus 36%) (chi 2 = 8, P = .005).


CONCLUSIONS
The myocardial perfusion pattern is an important determinant of outcome in patients with life-threatening ventricular arrhythmias who are treated with a implantable cardioverter-defibrillator. The extent of scarring separates patients into high- and low-risk groups with a 2.7-fold difference in death rate.
Gioia
G
G
Department of Medicine, MCP Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, PA 19102-1192, USA.
Bagheri
B
B
Gottlieb
C D
CD
Schwartzman
D S
DS
Callans
D J
DJ
Marchlinski
F E
FE
Heo
J
J
Iskandrian
A E
AE
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D016638:Critical Illness / Q000628:therapy*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D013318:Stroke Volume; D016019:Survival Analysis; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D016276:Ventricular Function; D016277:Ventricular Function, Left