Related Experiment Videos
Out-of-hospital sudden coronary death: rest and exercise radionuclide left ventricular function in survivors
Insights
Survivors of ventricular fibrillation (VF) with coronary artery disease often have impaired left ventricular (LV) function and poor exercise tolerance. These factors predict mortality, highlighting the need for risk stratification after VF events.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Electrophysiology
Background:
- Out-of-hospital ventricular fibrillation (VF) survivors with coronary artery disease represent a high-risk population.
- Assessing left ventricular (LV) function and wall motion is crucial for prognostication after VF.
- Understanding exercise hemodynamics can further refine risk stratification in these patients.
Purpose of the Study:
- To evaluate resting and exercise left ventricular (LV) function and wall motion in survivors of out-of-hospital ventricular fibrillation (VF).
- To identify predictors of mortality in this patient cohort.
- To assess the prognostic value of radionuclide ventriculography and clinical factors.
Main Methods:
- One hundred fifty-four survivors of out-of-hospital VF with coronary artery disease underwent radionuclide ventriculography at rest and exercise.
- Clinical histories and 24-hour ambulatory electrocardiograms were obtained.
- Patients were followed for an average of 3.1 years to determine mortality.
Main Results:
- Mean resting left ventricular (LV) ejection fraction (EF) was 40%, with 34% having EF ≤30%.
- Regional LV wall motion abnormalities were common, with 45% exhibiting akinesia and 14% dyskinesia.
- Exercise resulted in decreased mean EF and new wall motion abnormalities in 30% of patients. Mortality was 35% during follow-up, with predictors including resting EF, akinesia/dyskinesia, and history of heart failure.
Conclusions:
- Survivors of out-of-hospital VF with coronary artery disease frequently have significant LV dysfunction and abnormal wall motion.
- Impaired resting LV function, specific wall motion abnormalities, and clinical factors are associated with increased mortality.
- Radionuclide ventriculography provides valuable prognostic information in this high-risk population.
Abstract:
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)