Author + information
- Tariel Atabekov,
- Svetlana Sazonova,
- Roman Batalov,
- Michail Khlynin and
- Sergey Popov
Identify the relation between ventricular tachycardia occurrence and sympathetic innervation and myocardial perfusion disorders in patients with coronary artery diseases and ICD and identify potential predictors of ventricular tachycardia in these patients.
Sixteen patients aged 48 to 82 years, mean age 64,4 ± 8,3 years, with coronary artery disease and myocardial infarction, I-III functional class (FC) of angina pectoris and I-III FC of chronic heart failure (CHF) by NYHA classification were included to research. Ejection fraction (EF) of the left ventricle was 46,1 ± 12,1%. All patients with ICD implantation indications before the manipulation underwent single-photon emission computed tomography (SPECT) with thallium-199 (perfusion defects detecting) and iodine-123-metaiodobenzylguanidine (123I-MIBG) (cardiac sympathetic innervation assessment). After ICD implantation, all patients received an appropriate antiarrhythmic therapy. The following parameters were assessed after 3 months: the incidence of ventricular tachycardia (VT), FC of angina pectoris, FC of CHF and left ventricular EF. Patients were divided into two groups by the presence of VT episodes. The first group included 12 (75%) patients with registered VT. The second group consisted of 4 (25%) patients without VT.
The first group consisted of 2 patients with I FC of angina pectoris, II - 6 patients, III - 4 patients. II FC of CHF diagnosed in 11 patients, III – 1 patient. The second group consisted of 1 patient with I FC of angina pectoris, II - 2 patients, III - 1 patient. I FC of CHF diagnosed in 1 patient, II - 2 patients, III – 1 patient. In first group left ventricle perfusion defect was 26,7 ± 12,7%, in second group - 7,7±5,2% (p<0,0002). In first group defect of 123I-MIBG accumulation was 40,0 ± 14,5%, in second group - 8,5±7,2% (p<0,0001). Left ventricular EF in the first group was 42,0 ± 9,6%, in second group - 58,5±12,7% (p<0,001). Preliminary results showed that II and III FC of angina pectoris and CHF, left ventricle EF decrease less than 42%, myocardial perfusion defect more than 26.7% and MIBG defect accumulating more than 40.0% in first group patients, are potential predictors of VT comparing with second group.
These preliminary results showed that disorders of the sympathetic innervation and myocardial perfusion estimated by SPECT with 123I-MIBG and thallium-199, as well as the FC of angina pectoris and CHF and left ventricular systolic function decrease, influence on the incidence of VT in patients with coronary artery disease and implanted ICD.