Kovacs Boldizsar, Gllareva Valon, Ruschitzka Frank, Duru Firat, Kaufmann Philipp A, Buechel Ronny R, Benz Dominik C, Saguner Ardan M
Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Eur Heart J Cardiovasc Imaging. 2024 Dec 31;26(1):30-37. doi: 10.1093/ehjci/jeae232.
Known predictors of major arrhythmic events (MAEs) in patients with ischaemic cardiomyopathy (ICM) include previous MAE and left ventricular ejection fraction (LVEF) ≤ 35%. Myocardial scars detected by perfusion imaging in ICM have been linked to MAE, but the prognostic significance of hibernating myocardium (HM) is unclear. The objective was to predict MAEs from combined 13N-ammonia (NH3) and 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in ICM.
Consecutive patients with ICM undergoing combined NH3- and FDG-PET/CT were included. HM was quantified in relation to total left ventricular myocardium (i.e. ≥7% is large). The primary outcome was MAEs [sudden cardiac death, implantable cardioverter defibrillator (ICD) therapy, and sustained ventricular tachycardia/fibrillation].Among 254 patients, median baseline LVEF was 35% [interquartile range (IQR) 28-45] and 10% had an ICD. PET/CT identified ischaemia in 94 (37%), scar in 229 (90%), and HM in 195 (77%) patients. Over a median follow-up of 5.4 (IQR 2.2-9.5) years, MAE occurred in 34 patients (13%). Large HM was associated with a lower incidence of MAE (hazard ratio 0.31, 95% confidence interval 0.1-0.8, P = 0.001). After multivariate adjustment for history of MAE, LVEF ≤35%, and scar ≥10%, large HM remained significantly associated with a lower incidence of MAE (P = 0.016). LVEF improved over time among patients with large HM (P = 0.006) but did not change in those without (P = 0.610) or small HM (P = 0.240).
HM conveys a lower risk of MAE in patients with ICM. This may be explained by an increase in LVEF when a large extent of HM is present.
缺血性心肌病（ICM）患者主要心律失常事件（MAE）的已知预测因素包括既往MAE和左心室射血分数（LVEF）≤35%。通过灌注成像在ICM中检测到的心肌瘢痕与MAE有关，但冬眠心肌（HM）的预后意义尚不清楚。目的是通过13N-氨（NH3）和18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）联合检查预测ICM患者的MAE。
纳入连续接受NH3和FDG-PET/CT联合检查的ICM患者。HM相对于左心室总心肌进行定量（即≥7%为大面积）。主要结局是MAE[心源性猝死、植入式心律转复除颤器（ICD）治疗以及持续性室性心动过速/心室颤动]。在254例患者中，基线LVEF中位数为35%[四分位间距（IQR）28 - 45]，10%的患者植入了ICD。PET/CT检查发现94例（37%）患者存在缺血，229例（90%）患者存在瘢痕，195例（77%）患者存在HM。在中位随访5.4（IQR 2.2 - 9.5）年期间，34例患者（13%）发生了MAE。大面积HM与较低的MAE发生率相关（风险比0.31，95%置信区间0.1 - 0.8，P = 0.001）。在对MAE病史、LVEF≤35%和瘢痕≥10%进行多变量调整后，大面积HM仍与较低的MAE发生率显著相关（P = 0.016）。大面积HM患者的LVEF随时间改善（P = 0.006），但无HM或小面积HM患者的LVEF无变化（P = 0.61）或小面积HM患者（P = 0.24）。
HM在ICM患者中MAE风险较低。这可能是由于存在大面积HM时LVEF增加所致。
