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The Significance of Cardiac Sympathetic Nervous System Abnormality in the Long-Term Prognosis of Patients with a History of Ventricular Tachyarrhythmia

¹ Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan; and ² Department of Radiology, Showa University School of Medicine, Tokyo, Japan

View larger version (103K): [in this window] [in a new window]   FIGURE 1.  Typical cardiac 123I-MIBG scintigraphy in patients with normal SNS (A) and abnormal SNS (B). (A) A 39-y-old woman with VF who had shown normal SNS activity with H/M ratio of 3.5 did not afterward have tachyarrhythmic event. (B) A 34-y-old man with VF who had shown abnormal SNS activity with lower H/M ratio of 1.81 then had recurrent tachyarrhythmic event. Ovals indicate region of interest on cardiac area.

View larger version (10K): [in this window] [in a new window]   FIGURE 2.  Receiver-operator characteristic curve comparing sensitivity and specificity of H/M ratio for predicting sudden cardiac death or ventricular tachyarrhythmic events. Optimal thresholds for prediction of H/M ratio were 2.78 (sensitivity of 0.75 and specificity of 0.645, P = 0.001).

View larger version (11K): [in this window] [in a new window]   FIGURE 3.  Kaplan–Meier survival curves of sudden cardiac death or ventricular tachyarrhythmic event-free survival according to cardiac SNS abnormality (H/M ratio < 2.8). Over 11 y of follow-up, SNS abnormality was predictive of sudden cardiac death or ventricular arrhythmic events.

View larger version (10K): [in this window] [in a new window]   FIGURE 4.  Kaplan–Meier survival curves of sudden cardiac death or ventricular tachyarrhythmic event-free survival according to left ventricular dysfunction (LVEF < 50%). Left ventricular dysfunction was predictive of sudden cardiac death or ventricular arrhythmic events.

View larger version (14K): [in this window] [in a new window]   FIGURE 5.  Relationship between cardiac SNS abnormality and left ventricular function in patients with history of ventricular arrhythmia. Closed circle indicates sudden cardiac death or ventricular tachyarrhythmic events, and open circle indicates no events during follow-up. Patients with both SNS abnormality (H/M ratio < 2.8) and left ventricular dysfunction (LVEF < 50%) were more likely to have ventricular tachyarrhythmic events than were other patients (9/12 patients [75%] vs. 15/74 patients [20.3%]).