Noninvasive diagnostic technique in ventricular tachyarrhythmias assessment in patients with coronary artery disease
Abstract
Background. Sudden cardiac death (SCD) remains the leading cause of death. Ventricular tachyarrhythmias (VTA) are the main cause of SCD. The incidence of VTA and SCD in coronary artery disease (CAD) patients still is a hot spot in cardiology. The implantable cardioverter-defibrillator (ICD) is the main method of SCD prevention. However, only 15–25% patients after ICD implantation have VTA events. So, it’s necessary to find out new predictors of VTA.
Аim. To investigate the possibility of using heart rate variability (HRV) individual parameters analysis, left ventricle systolic function assessment, perfusion scintigraphy of myocardium and cardiac single-photon emission computer tomography (SPECT) with 123I-methaiodobenzylguanidine (123I-MIBG) in the evaluation of the VTA development in patients with CAD and high risk of SCD.
Mаterial and methods. 51 patients (male – 41, female – 10, average age 65,4±6,9 years) with CAD and myocardial infarction were examined. Patients were divided into 2 groups according to the ICD implantation indications (primary and secondary SCD prevention). Before ICD implantation, patients underwent echocardiography, HRV individual parameters analysis, perfusion scintigraphy of myocardium with 99mТс-methoxy-isobutyl-isonitrile (99mТс-MIBI) and cardiac SPECT with123I-MIBG. All patients were treated with antiarrhythmic therapy (beta-blockers and amiodarone). During 6-month follow-up VTA events were documented in each group.
Results. The 1st group consisted of 21 (41,1%) patients with primary prevention (male – 19, female – 2, age 63,2±7,7 years). 18 (85,7%) patients had VTA events. 1 or more VTA events was documented in these patients, average number of VTA was 1,5±0,6 (minimal – 1, maximal – 3), VTA duration – 7,0±3,9 s. 3 (16,6%) patients had successful ventricular antitachypacing, 15 (84,4%) had non-sustained VTA. 3 (14,3%) patient from this group don’t have VTA events. The 2nd group consisted of 30 (58,9%) patients with secondary prevention (male – 22, female – 8, age 66,9±8,6 years). 19 (63,3%) patients have VTA events. 1 or more VTA events were documented in these patients, average number of VTA was 1,42±0,96 (minimal – 1, maximal – 4), VTA duration – 11,1±4,7 s. 1 (5,2%) patient had successful ICD (shock) therapy, 9 (47,4%) patients had successful ventricular antitachypacing, 9 (84,4%) had nonsustained VTA. 11 (14,3%) patients from this group didn’t have VTA events within 6 months.
In the 1st group the differences between patients with and without VTA before ICD implantation were statistically significant in terms of: average NN interval – 900,2±131,1 vs 1267,0± 6,9 ms (p=0,001), standard deviation of NN interval – 88,4±21,6 vs 138,0±24,2 ms (p=0,001), low frequency – 794,6±295,0 vs 1348,6±382,2 ms (p=0,03), average accumulation defect index of 123I-MIBG on early (SSe%) [29,55±14,97 vs 11,33±6,35% (p=0,006)] and delayed (SSd%) scintigrams [36,77±14,72 vs 18,66±4,04% (p=0,03)] and accumulation defect of 99mТс-MIBI – 19,16±12,34 vs 6,01±3,61% (p=0,01), respectively. In the 2nd group the differences between patients with and without VTA before ICD implantation were statistically significant in terms of: left ventricle ejec- tion fraction – 50,6±9,2 vs 64,1±7,9% (p=0,0006), low frequency – 719,4±437,8 vs 1385,1±889,9 ms (p=0,01), total frequency – 1910,6±882,1 vs 2830,8±1208,6 ms (p=0,04), average SSe of 123I-MIBG [31,68±17,71 vs 7,36±2,24% (p=0,0002)] and SSd [33,05±18,08 vs 9,36±3,93% (p=0,0001)] and accumulation defect of 99mТс-MIBI – 24,57±15,82 vs 7,48±7,01% (p=0,001), respectively.
Conclusion. HRV assessment, as well as radionuclide assessment of perfusion and cardiac sympathetic innervation assessment can be used for identification of patients with the highest SCD risk. Individual results of these diagnostic methods can be an additional diagnostic marker of SCD in patients with CAD.
Keywords:ventricular tachyarrhyth- mias, sudden cardiac death, implantable cardioverter- defibrillator, heart rate variability, left ventricle ejection fraction, perfusion scintigraphy of myocardium, 99mТс-methoxy-isobutyl- isonitrile, single-photon emission computer tomog- raphy, 123I-methaiodoben- zylguanidine
Clin Experiment Surg. Petrovsky J. 2018; 6 (3): 50–63.
doi: 10.24411/2308-1198-2018-13005. Received: 20.04.2018. Accepted: 10.08.2018.
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