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LV Dyssynchrony Is Helpful in Predicting Ventricular Arrhythmia in Ischemic Cardiomyopathy After Cardiac

Shih-Chuan Tsai1, Yu-Cheng Chang, Kuo-Feng Chiang

  • 1From the Department of Nuclear Medicine (S-CT, W-YL) and Cadiovascular Center (Y-CC, K-FC, J-LH), Taichung Veterans General Hospital; Department of Medical Imaging and Radiological Sciences (S-CT, G-UH), Central Taiwan University of Science and Technology; Department of Nuclear Medicine (G-UH), Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Medical Imaging and Radiological Sciences, China Medical University, Taichung, Taiwan (G-UH, C-HK); Department of Medicine, School of Medicine, Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan (J-LH); and Department of Radiology and Imaging Sciences (JC), Emory University School of Medicine, Atlanta, GA.

Medicine
|February 18, 2016
PubMed

Insights

Left ventricular (LV) dyssynchrony and myocardial scar, assessed by myocardial perfusion SPECT (MPS), predict ventricular arrhythmia in ischemic cardiomyopathy patients receiving cardiac resynchronization therapy (CRT). LV dyssynchrony via bandwidth is a strong predictor.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Electrophysiology

Background:

  • Larger myocardial scar burdens increase ventricular arrhythmia risk in coronary artery disease.
  • Left ventricular (LV) dyssynchrony correlates with sudden cardiac death risk in heart failure patients.

Purpose of the Study:

  • To evaluate LV dyssynchrony and myocardial scar using myocardial perfusion SPECT (MPS) for predicting ventricular arrhythmia in ischemic cardiomyopathy.
  • To identify independent predictors of ventricular arrhythmia in patients undergoing cardiac resynchronization therapy (CRT).

Main Methods:

  • Twenty-two patients with ischemic cardiomyopathy received MPS post-CRT.
  • Quantitative parameters including LV dyssynchrony (phase SD, bandwidth), LVEF, and scar percentage were analyzed.
  • Ventricular arrhythmias (VT/VF) were recorded by CRT devices; logistic regression and ROC analysis identified predictors.

Main Results:

  • Nine patients (41%) developed VT/VF.
  • VT/VF patients showed significantly lower LVEF, larger scar, phase SD, and bandwidth (P < 0.05).
  • LV bandwidth (>139°) and LVEF (<36%) were independent predictors; bandwidth demonstrated higher predictive accuracy (AUC 0.83).

Conclusions:

  • LV dyssynchrony, particularly bandwidth assessed by MPS, is valuable for predicting ventricular arrhythmia in ischemic cardiomyopathy post-CRT.
  • Patients with LV bandwidth >139° may benefit from further consideration for defibrillator implantation.

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