Prognostic Value of Radionuclide Angiography in Patients With Right Ventricular Arrhythmias

Abstract

Background-The prognosis of patients with right ventricular (RV) arrhythmias remains uncertain. This study prospectively evaluated the prognostic value of RV and left ventricular (LV) involvement assessed by radionuclide angiography (RNA) as predictors for sudden death. Methods and Results-Patients (nϭ188) with severe arrhythmias originating from the RV were followed up for a mean of 45Ϯ34 months. Data on clinical presentation, resting and stress ECG, signal-averaged ECG, 24-hour Holter monitoring, and programmed stimulation were collected along with RNA. Patients were classified as group I (nϭ82) with normal RNA or group II (nϭ106) with an abnormal RV suggestive of arrhythmogenic RV cardiomyopathy, classified as diffuse or localized disease, with or without associated LV abnormalities. During follow-up, 14 patients died suddenly, all in group II. None of the clinical and electrical data were predictive of death. An abnormal RNA study was a highly predictive factor for death (PϽ0.005), as well as the presence of LV abnormalities (PϽ0.01). Conclusions-The present study confirms that arrhythmogenic RV cardiomyopathy is a severe disease with a high risk for cardiac death. Evidence of RV abnormalities in patients presenting with RV arrhythmias is highly predictive for sudden death, as is its association with LV involvement.

The Value of Radionuclide Assessment of Mechanical Dyssynchrony in Patients With Cardiac Diseases

“…В многоцентровом исследовании, посвященном вопросам прогностической оценки результатов равновесной радионуклидной томовентрикулографии у пациентов с правожелудочковыми аритмиями, было показано, что наличие зон диссинхронии в миокарде желудочков является независимым прогностическим фактором внезапной сердечной смерти и синкопальных состояний [59]. При этом другие инструментальные (ЭКГ, Холтеровское мониторирование) и клинические (выраженность симптомов нарушения ритма сердца, частота эпизодов желудочковой тахиаритмии и др.)…”

Scintigraphic spectrum of a patient population with suspected arrhythmogenic right ventricular dysplasia

“…It has been reported that very small structural or functional abnormalities of the RV can be related to ARVD [17][18][19][20] even in the absence of RV dilatation or RVEF alteration. Based on a topographical analysis of the RV kinetics for a small and localized dyskinetic area, mainly in the 3D tomographic approach, such cases will completely be missed by our method based on global ventricular data.…”

“…The multiplicity of reasons for suspecting ARVD leads to the necessity of a non invasive screening method, and radionuclide gated ventriculography (RNV) has excellent features to be a good candidate as a screening method: ability of precise measurement of both left and right ejection fractions, simultaneous biventricular imaging for ventricular volumes and regional wall motion appreciation, assessment of inter-and intraventricular synchronism through phase analysis [13][14][15][16][17][18][19][20].…”

A new perspective for phase analysis of radionuclide angiocardiography

“…RNA RV phase analysis was the only variable able to predict death and the addition of an LV abnormality significantly increased the risk. 5 Mechanical dyssynchrony is not equivalent to electrical dyssynchrony even if both often concur. Indeed, the latter is defined by an asynchronous electrical activation illustrated by a prolonged QRS duration ([ 120 ms) and studies have shown that mechanical dyssynchrony could exist in more than a third of patients with normal QRS duration.…”