Usefulness of scintigraphy to predict electrical storms in severe idiopathic dilated cardiomyopathy

• Published in: Annals of nuclear medicine 2013-06, Vol.27 (5), p.407-415
• Main Authors: Takigawa, Masateru, Kiso, Keisuke, Noda, Takashi, Kurita, Takashi, Yamada, Yuko, Okamura, Hideo, Satomi, Kazuhiro, Suyama, Kazuhiro, Aihara, Naohiko, Nanasato, Mamoru, Hirayama, Haruo, Kamakura, Shiro, Shimizu, Wataru, Ishida, Yoshio
• Format: Article
• Language: English
• Subjects: Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - therapy; Humans; Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Perfusion Imaging - methods; Myocardial Stunning - diagnostic imaging; Myocardial Stunning - etiology; Myocardial Stunning - prevention & control; Nuclear Medicine; Original Article; Radiology; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tachycardia, Ventricular - diagnostic imaging; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - prevention & control; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon - methods; Treatment Outcome; Ventricular Fibrillation - diagnostic imaging; Ventricular Fibrillation - etiology; Ventricular Fibrillation - prevention & control
• ISSN: 0914-7187; 1864-6433
• DOI: 10.1007/s12149-013-0699-3

Background Although several predictors of an electrical storm (ES) are indicated in patients with idiopathic dilated cardiomyopathy (IDCM), whether the severity of the myocardial tissue damage (SMTD) evaluated by myocardial perfusion SPECT (MPS) has an association with an ES remains unclear. The purpose of this study was to elucidate the clinical significance of SMTD for the prediction of ES in IDCM patients with an ICD. Methods Thirty-seven (27 men, mean age 58 ± 15 years) IDCM patients receiving ICD implantations for secondary prevention with preoperative MPS were enrolled in this study. The medical history, physical and laboratory findings, electrocardiograms, echocardiograms and MPS findings were evaluated. The SMTD was assessed by the summed scores of 17 segments using a 4-point system (0, normal ~3, severe defect). Results During a mean follow-up of 43.9 ± 30.7 months, an ES developed in 12/37 (32.4 %) patients. The SMTD score predicted an ES with a 92 % sensitivity and 56 % specificity, at a cut-off score of 10. In addition, a multivariate analysis showed that the SMTD score remained an independent predictor of an ES (HR 1.09/score 1 increase, 95 % CI 1.01–1.19, p  = 0.02). The SMTD score was significantly associated with three indices of late potentials on the signal-averaged electrocardiograms, and was significantly higher in patients with positive late potentials ( p  = 0.0006). Conclusion SMTD score assessed by MPS has a strong correlation to the late potentials and higher SMTD score may increase the risk of ES among patients with IDCM and an ICD.