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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 11/2008

01-11-2008 | Original Article

Cardiac sympathetic nerve abnormality predicts ventricular tachyarrhythmic events in patients without conventional risk of sudden death

Authors: Yasushi Akutsu, Kyouichi Kaneko, Yusuke Kodama, Hui-Ling Li, Mitsuharu Kawamura, Taku Asano, Kaoru Tanno, Akira Shinozuka, Takehiko Gokan, Youichi Kobayashi

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 11/2008

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Abstract

Purpose

Patients with structural heart disease, severe left ventricular dysfunction, or history of cardiac arrest are at increased risk of sudden cardiac death. However, a useful marker for predicting sudden cardiac death is not clarified in low-risk patients without those conventional risks. We hypothesized that cardiac sympathetic nerve system (SNS) abnormality would be associated with ventricular tachyarrhythmic events in low-risk patients with ventricular tachycardia (VT).

Methods

Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy was performed in 50 patients (mean±standard deviation, age 54 ± 16 years, 52% males) with VT who did not have structural heart disease, severe left ventricular dysfunction, or history of cardiac arrest, and SNS activity was assessed from heart/mediastinal (H/M) ratio on delayed images.

Results

Over 11 years of follow-up, three patients had sudden deaths (6%) and nine patients had sustained ventricular tachyarrhythmic events (18%). SNS abnormality, defined as H/M ratio <2.8, was predictive of sudden death or ventricular tachyarrhythmic events (45% in nine of 20 patients with SNS abnormality vs 16.7% in three of 30 patients without SNS abnormality, p = 0.005). After adjustment for potential confounding variables including slight left ventricular dysfunction, SNS abnormality remained independently predictive of ventricular tachyarrhythmic events with a hazard ratio of 5.3 (95% confidence interval = 1.4 to 20.8, p = 0.016).

Conclusion

SNS abnormality is a readily available and powerful predictor of recurrent ventricular tachyarrhythmic events in patients with VT who did not have conventional risk of sudden cardiac death. 123I-MIBG scintigraphy can provide prognostic information of VT patients without conventional risk.
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Metadata
Title
Cardiac sympathetic nerve abnormality predicts ventricular tachyarrhythmic events in patients without conventional risk of sudden death
Authors
Yasushi Akutsu
Kyouichi Kaneko
Yusuke Kodama
Hui-Ling Li
Mitsuharu Kawamura
Taku Asano
Kaoru Tanno
Akira Shinozuka
Takehiko Gokan
Youichi Kobayashi
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 11/2008
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-008-0879-x

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