Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Int J Cardiol. 2019 May 15;283:171-177. doi: 10.1016/j.ijcard.2018.10.106. Epub 2018 Oct 31.
Direct evidence of inflammatory activity in the atria of patients with atrial fibrillation (AF) is scarce. We assessed the capability of positron-emission tomography/computed tomography (PET/CT) to diagnose AF based on fluorodeoxyglucose (FDG) uptake in the atrial wall.
Among 8233 patients who underwent FDG-PET/CT as work-up for malignancies, we identified 180 consecutive patients with AF (2.2%). Of those, we selected 137 patients who had fasted >12 h before FDG injection for inclusion in the experimental group (88 men and 49 women; age: 72.7 ± 8.9 years). Controls were 62 age- and sex-matched patients without AF. For visual analysis, we used a 4-point grading system. For quantitative analysis, we used the maximum standard uptake value (SUVmax) in the left (LA) and right atrial (RA) myocardium and the target-to-background ratio (TBR) of SUVmax to blood pool activity. The sensitivity, specificity, and positive-predictive value for detecting AF visually were 54.0%, 95.2%, and 96.1%, respectively; for quantitative analysis, the respective values were 65.7%, 75.8%, and 85.7%. Multivariable analysis of 11 clinical and imaging variables showed significant associations with RA SUVmax (odds ratio [OR]: 14.353, P = 0.026) and LA volume (OR: 1.371, P = 0.0001). The RA TBR was greater in cases with persistent AF than in those with paroxysmal AF (P < 0.0001). Pathological investigation of 4 autopsy hearts confirmed infiltration of extravascular macrophages and lymphocytes in the regions with FDG uptake.
Higher atrial FDG uptake was associated with AF. PET/CT could be a useful tool for detecting local inflammation in the atria with AF.
在患有心房颤动（AF）的患者的心房中，炎症活动的直接证据很少。我们评估了正电子发射断层扫描/计算机断层扫描（PET/CT）基于心房壁中氟脱氧葡萄糖（FDG）摄取来诊断 AF 的能力。
在 8233 名接受 FDG-PET/CT 检查以恶性肿瘤为基础的患者中，我们确定了 180 名连续患有 AF（2.2%）的患者。在这些患者中，我们选择了 137 名在 FDG 注射前禁食超过 12 小时的患者纳入实验组（88 名男性和 49 名女性；年龄：72.7±8.9 岁）。对照组为 62 名年龄和性别匹配且无 AF 的患者。对于视觉分析，我们使用了 4 分分级系统。对于定量分析，我们使用左心房（LA）和右心房（RA）心肌中的最大标准摄取值（SUVmax）和 SUVmax 与血池活性的靶标与背景比（TBR）。视觉检测 AF 的敏感性、特异性和阳性预测值分别为 54.0%、95.2%和 96.1%；定量分析的相应值分别为 65.7%、75.8%和 85.7%。对 11 个临床和影像学变量的多变量分析显示，与 RA SUVmax（优势比[OR]：14.353，P=0.026）和 LA 容积（OR：1.371，P=0.0001）有显著关联。持续性 AF 病例的 RA TBR 大于阵发性 AF 病例（P<0.0001）。对 4 例尸检心脏的病理研究证实，在 FDG 摄取区域有血管外巨噬细胞和淋巴细胞浸润。
心房 FDG 摄取较高与 AF 有关。PET/CT 可能是一种有用的工具，可用于检测 AF 心房中的局部炎症。
