Prediction of Outcome of Patients With Life-Threatening Ventricular Arrhythmias Treated With Automatic Implantable Cardioverter-Defibrillators Using SPECT Perfusion Imaging

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Abstract
Background In the present study, we examined the predictors of outcome of 103 patients with coronary artery disease and left ventricular dysfunction who had life-threatening ventricular arrhythmias and were treated with implantable cardioverter-defibrillators with the use of single-photon emission computed tomography (SPECT). Methods and Results During a mean follow-up of 29 months, there were 29 cardiac deaths. In comparison with patients who died, survivors had less diabetes mellitus (45% versus 19%, P <.007), higher left ventricular ejection fraction (23±9% versus 27±11%, P =.04), and fewer perfusion defects as determined with stress SPECT (15±5 versus 12±5, P <.004). Most of the perfusion defects were fixed, indicative of scarring; the extent of reversible defects did not differ (2±3 in survivors and 3±4 in nonsurvivors). Multivariate Cox survival analysis identified the number of fixed defects as the only independent predictor of death (χ 2 =10, P =.002). There were six deaths among 42 patients (14%) with P =.005). The 4-year survival was better in patients with 2 =8, P =.005). Conclusions The myocardial perfusion pattern is an important determinant of outcome in patients with life-threatening ventricular arrhythmias who are treated with a implantable cardioverter-defibrillator. The extent of scarring separates patients into high- and low-risk groups with a 2.7-fold difference in death rate.

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