Prognostic value of combined assessment of cardiac autonomic system activity in appropriate cardioverter-defibrillator therapy prediction

Abstract

Abstract Objective. This prospective study aimed to determine the prognostic value of the combined assessment of cardiac autonomic nervous system (CANS) activity in appropriate implanted cardioverter-defibrillator (ICD) therapy predicting in patients (pts) with coronary artery disease (CAD) during mid-term follow-up period after ICD implantation. Methods. We enrolled 45 pts with CAD and ICD implantation indications. Before ICD implantation CANS was assessed by using myocardium scintigraphy with iodine-123-metaiodobenzylguanidine (I-123-MIBG), heart rate variability (HRV) and erythrocyte membranes β-adrenoreactivity (EMA). Patients were grouped based on the presence of appropriate ICD therapy according to the device interrogation data during 30.0 months [28.0; 52.0] follow-up period. Results. The 1st group included 15 (33.3%) pts with appropriate ICD therapy, the 2nd group – 30 (66.7%) pts without appropriate ICD therapy. There were significant differences between groups in cardiac I-123-MIBG (p < 0.001), HRV (p < 0.05) and EMA (p < 0.001) indicators. In multivariate logistic regression summed I-123-MIBG score late (SSd) (odds ratio [OR] 1.5109; 95% confidence interval [CI] 1.0767–2.1203; p = 0.017), I-123-MIBG washout rate (WR) (OR 0.5810; 95% CI 0.3666–0.9207; p = 0.02) and standard deviation of average NN intervals (SDANN) (OR 1.1686; 95% CI 1.0140–1.3468; p = 0.03) were independent predictors of appropriate ICD therapy. Predictive model with using of indicators (SSd, WR and SDANN) combination showed that prognostic coefficient increase > 0.25 was associated with appropriate ICD therapy (AUC 0.982; p < 0.001). Conclusion. Combined CANS activity assessment is useful in prediction of appropriate ICD therapy in pts with CAD during mid-term follow-up period after ICD implantation.