NEUROTROPIC MYOCARDIAL SCINTIGRAPHY IN THE EVALUATION OF SUDDEN CARDIAC DEATH PROGNOSIS IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

Abstract

Objective . To explore the features of cardiac sympathetic activity impairments using neurotropic scintigraphy and singlephoton emission tomography (SPECT) in patients with hypertrophic cardiomyopathy (HCM), including the context of the risk of sudden cardiac death (SCD). Material and methods. 36 patients with HCM, II–IV NYHA CHF grade, underwent cardiac neurotropic scintigraphy and SPECT with 123I-MIBG. 30 patients also underwent cardiac perfusion SPECT with 99mTc-MIBI, standard quantitative parameters of global and local left ventricular sympathetic activity and perfusion impairments were obtained. After 5 years of follow-up, the analysis of the dependence of the frequency of SCD in patients with HCM on the values of the above parameters was performed. Results. All parameters of perfusion and neurotropic myocardial SPECT were significantly different in patients with HCM compared with the control group (p 4) in the main group was detected in 32% of cases, while it had a diffuse character and had no connection with certain coronary artery regions. The volume of regional innervation defects (SMSe) in HCM patients significantly exceeded the total volume of perfusion defects (SSS, p 14 predicted the occurrence of SCD with sensitivity of 87.5% and specificity of 57.1%. The risk of five-year mortality from SCD was significantly higher when SMSe >14 (p=0.024). Conclusion. Neurotropic SPECT in patients with HCM is able to identify a group of patients at high risk of sudden cardiac death.