Department of Cardiology, AIG Hospitals, Hyderabad, India.
Department of Nuclear Medicine, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India.
JACC Cardiovasc Imaging. 2021 Oct;14(10):2008-2016. doi: 10.1016/j.jcmg.2020.11.016. Epub 2021 Jan 13.
This study identified predictors of clinical (CR) and echocardiographic response (ER) following immunosuppressive therapy (IST) in patients with cardiac sarcoidosis (CS).
IST has been the cornerstone of treatment for patients with CS and active myocardial inflammation. However, there are little data to explain the variable response to IST in CS.
Data of 96 consecutive patients with CS from the Granulomatous Myocarditis Registry were analyzed. All patients underwent a fluorodeoxy glucose positron emission tomography-computed tomography (FDG-PET-CT) before initiation of IST. Response was assessed after 4 to 6 months of therapy. CR was defined as an improvement in functional class (New York Heart Association functional class ≥I) and freedom from ventricular arrhythmias and heart failure hospitalizations. ER was defined as an improvement in left ventricular ejection fraction (LVEF) ≥10%. ER was assessed only in patients with a LVEF <50%. Complete responders had no residual myocardial FDG uptake and fulfilled both response criteria. Partial responders fulfilled only 1 response criteria or had residual FDG uptake. Nonresponders did not fulfill either CR or ER criteria. The uptake index (UI) was defined as the product of maximum standardized uptake value and the number of LV segments with abnormal uptake on FDG-PET-CT.
Among 91 patients included in the final analysis, 54.9%, 20.9%, and 24.2% of patients were classified as complete and partial responders and nonresponders, respectively. Cox regression analysis (all responders vs. nonresponders) identified the following as independent predictors of response following immunosuppression: LVEF >40% (hazard ratio: 1.61; 95% confidence interval: 1.06 to 7.69; p = 0.031) and myocardial UI >30 (hazard ratio: 1.28; 95% confidence interval: 1.05 to 6.12; p = 0.010). The final model had a good discriminative power (area under the curve [AUC]: 0.85) and predictive accuracy (sensitivity: 85.5%; specificity: 86.4%). Pre-treatment myocardial UI had a strong positive correlation with change in LVEF following immunosuppression.
Pre-treatment FDG myocardial uptake was a predictor of CR and ER response to immunosuppression in patients with CS.
本研究旨在确定心脏结节病（CS）患者接受免疫抑制治疗（IST）后临床（CR）和超声心动图（ER）反应的预测因素。
IST 一直是 CS 合并活动性心肌炎症患者的治疗基石。然而，CS 对 IST 反应的变异性的数据较少。
对来自肉芽肿性心肌炎注册中心的 96 例连续 CS 患者的数据进行分析。所有患者在开始 IST 前均行氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（FDG-PET-CT）。在治疗 4 至 6 个月后评估反应。CR 定义为心功能分级（纽约心脏协会心功能分级≥I）改善和无室性心律失常及心力衰竭住院。ER 定义为左心室射血分数（LVEF）改善≥10%。仅在 LVEF＜50%的患者中评估 ER。完全缓解者无残留心肌 FDG 摄取，且符合所有反应标准。部分缓解者仅符合 1 项反应标准或有残留 FDG 摄取。无反应者不符合 CR 或 ER 标准。摄取指数（UI）定义为最大标准化摄取值与 FDG-PET-CT 上异常摄取的 LV 节段数的乘积。
在最终分析的 91 例患者中，54.9%、20.9%和 24.2%的患者分别被归类为完全和部分缓解者和无反应者。Cox 回归分析（所有缓解者与无缓解者）确定了以下 IST 后反应的独立预测因素：LVEF＞40%（危险比：1.61；95%置信区间：1.06 至 7.69；p=0.031）和心肌 UI＞30（危险比：1.28；95%置信区间：1.05 至 6.12；p=0.010）。最终模型具有良好的判别能力（曲线下面积[AUC]：0.85）和预测准确性（敏感性：85.5%；特异性：86.4%）。治疗前心肌 UI 与 IST 后 LVEF 的变化呈强正相关。
治疗前 FDG 心肌摄取是 CS 患者对 IST 的 CR 和 ER 反应的预测因素。
