Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
JACC Cardiovasc Imaging. 2020 Aug;13(8):1755-1766. doi: 10.1016/j.jcmg.2020.01.026. Epub 2020 Apr 15.
This study presents a head-to-head comparison of the value of cardiac magnetic resonance (CMR)-derived left-ventricular (LV) function and scar burden and positron emission tomography (PET)-derived perfusion and innervation in predicting ventricular arrhythmias (VAs).
Improved risk stratification of VA is important to identify patients who should benefit of prophylactic implantable cardioverter-defibrillator (ICD) implantation. Perfusion abnormalities, sympathetic denervation, and scar burden have all been linked to VA, although comparative studies are lacking.
Seventy-four patients with ischemic cardiomyopathy and left-ventricular ejection fraction (LVEF) ≤35%, referred for primary prevention ICD placement were enrolled prospectively. Late gadolinium-enhanced (LGE) CMR was performed to assess LV function and scar characteristics. [O]HO and [C]hydroxyephedrine positron emission tomography (PET) were performed to quantify resting and hyperemic myocardial blood flow (MBF), coronary flow reserve (CFR), and sympathetic innervation. During follow-up of 5.4 ± 1.9 years, the occurrence of sustained VA, appropriate ICD therapy, and mortality were evaluated.
In total, 20 (26%) patients experienced VA. CMR and PET parameters showed considerable overlap between patients with VA and patients without VA, caused by substantial heterogeneity within groups. Univariable analyses showed that lower LVEF (hazard ratio [HR]: 0.92; p = 0.03), higher left-ventricular end-diastolic volume index (LVEDVi) (HR 1.02; p < 0.01), and larger scar border zone (HR 1.11; p = 0.03) were related to VA. Scar core size, resting MBF, hyperemic MBF, perfusion defect size, innervation defect size, and the innervation-perfusion mismatch were not found to be associated with VA.
In patients with ischemic cardiomyopathy, lower LVEF, higher LVEDVi, and larger scar border zone were related to VA. PET-derived perfusion and sympathetic innervation, as well as CMR-derived scar core size were not associated with VA. These results suggest that improved prediction of VA by advanced imaging remains challenging for the individual patient.
本研究对头对头比较心脏磁共振（CMR）衍生的左心室（LV）功能和瘢痕负荷与正电子发射断层扫描（PET）衍生的灌注和神经支配在预测室性心律失常（VA）中的价值。
VA 的风险分层改善对于确定应受益于预防性植入式心脏复律除颤器（ICD）植入的患者很重要。尽管缺乏比较研究，但已经发现灌注异常、去交感神经支配和瘢痕负荷与 VA 有关。
前瞻性纳入 74 名缺血性心肌病和左心室射血分数（LVEF）≤35%的患者，这些患者被推荐接受原发性预防 ICD 放置。进行钆延迟增强（LGE）CMR 以评估 LV 功能和瘢痕特征。进行[O]HO 和[C]羟麻黄碱正电子发射断层扫描（PET）以量化静息和充血性心肌血流（MBF）、冠状血流储备（CFR）和交感神经支配。在 5.4±1.9 年的随访期间，评估持续性 VA、适当的 ICD 治疗和死亡率。
共有 20 名（26%）患者发生 VA。CMR 和 PET 参数在有 VA 和无 VA 的患者之间存在相当大的重叠，这是由于组内存在大量异质性。单变量分析表明，较低的 LVEF（风险比 [HR]：0.92；p=0.03）、较高的左心室舒张末期容积指数（LVEDVi）（HR 1.02；p<0.01）和较大的瘢痕边界区（HR 1.11；p=0.03）与 VA 相关。未发现瘢痕核心大小、静息 MBF、充血性 MBF、灌注缺陷大小、神经支配缺陷大小以及神经支配-灌注不匹配与 VA 相关。
在缺血性心肌病患者中，较低的 LVEF、较高的 LVEDVi 和较大的瘢痕边界区与 VA 相关。PET 衍生的灌注和交感神经支配以及 CMR 衍生的瘢痕核心大小与 VA 不相关。这些结果表明，通过先进的成像技术对 VA 进行更准确的预测对于个体患者仍然具有挑战性。
