心肌炎症和纤维化的特定部位与心脏结节病中事件发生风险较高相关。
Specific locations of myocardial inflammation and fibrosis are associated with higher risk of events in cardiac sarcoidosis.
作者信息
Devesa Ana, Robson Philip M, Cangut Busra, Vazirani Ravi, Vergani Vittoria, LaRocca Gina, Romero-Daza Angelica M, Liao Steve, Azoulay Lévi-Dan, Pyzik Renata, Fayad Rima A, Jacobi Adam, Abgral Ronan, Morgenthau Adam S, Miller Marc A, Fayad Zahi A, Trivieri Maria Giovanna
机构信息
BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
出版信息
Heart Rhythm. 2025 Jun;22(6):1606-1614. doi: 10.1016/j.hrthm.2024.09.011. Epub 2024 Sep 10.
BACKGROUND
F-Fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/magnetic resonance (MR) can identify inflammation and fibrosis, which are high-risk features in cardiac sarcoidosis.
OBJECTIVE
The purpose of this study was to evaluate whether the involvement of certain myocardial segments is associated with higher risk compared to others.
METHODS
One hundred twenty-four patients with suspected clinical sarcoidosis underwent F-FDG-PET/MR. Late gadolinium enhancement (LGE) and focal F-FDG uptake were evaluated globally and in the 16 myocardial segments. Presence of LGE was defined when the percentage of LGE exceeded 5.7% globally (relative to myocardial volume) and in each myocardial segment. Patients were followed up for 5.5 years. Events were defined as ventricular arrhythmia (VA) (including sustained ventricular tachycardia, ventricular fibrillation, and appropriate implantable cardioverter-defibrillator discharge), heart failure hospitalization, or all-cause death.
RESULTS
Mean age was 57.1 ± 8.9 years, and 39.5% were female. Twenty-two patients (17.6%) had an event during follow-up, and 9 (7.2%) presented with VA. LGE and F-FDG uptake were more frequent in patients with than without events (36.4% vs 7.8%, P = .001). Presence of LGE and F-FDG in the basal anterior segment were independent predictors for events after adjustment for left ventricular ejection fraction and relative enhanced volume (LGE: odds ratio [1.2-92.4], P = .034;F-FDG: odds ratio 5.5 [1.1-27.5], P = .038). LGE presence in basal to mid-anterior, mid-anteroseptal, and basal to mid-inferoseptal segments was an independent predictor of VA. Presence of F-FDG in basal to mid-anterior, mid-inferoseptal and mid-inferior segments was an independent predictor of VA.
CONCLUSION
Involvement of specific myocardial segments, particularly basal to mid-anterior and mid-septal segments, is associated with higher rates of events in patients with suspected cardiac sarcoidosis.
背景
氟脱氧葡萄糖（F-FDG）正电子发射断层扫描（PET）/磁共振成像（MR）能够识别炎症和纤维化，这些是心脏结节病的高危特征。
目的
本研究旨在评估某些心肌节段受累是否比其他节段具有更高的风险。
方法
124例疑似临床结节病患者接受了F-FDG-PET/MR检查。对晚期钆增强（LGE）和局灶性F-FDG摄取进行整体及16个心肌节段的评估。当整体（相对于心肌体积）及每个心肌节段的LGE百分比超过5.7%时定义为存在LGE。对患者进行了5.5年的随访。事件定义为室性心律失常（VA）（包括持续性室性心动过速、心室颤动和合适的植入式心脏复律除颤器放电）、心力衰竭住院或全因死亡。
结果
平均年龄为57.1±8.9岁，女性占39.5%。22例患者（17.6%）在随访期间发生事件，9例（7.2%）出现VA。发生事件的患者中LGE和F-FDG摄取比未发生事件的患者更常见（36.4%对7.8%，P=.001）。在调整左心室射血分数和相对增强体积后，基底前节段存在LGE和F-FDG是事件的独立预测因素（LGE：比值比[1.2 - 92.4]，P=.034；F-FDG：比值比5.5[1.1 - 27.5]，P=.038）。基底至中前、中前间隔和基底至中下间隔节段存在LGE是VA的独立预测因素。基底至中前、中下间隔和中下节段存在F-FDG是VA的独立预测因素。
结论
特定心肌节段受累，尤其是基底至中前节段和中间隔节段，与疑似心脏结节病患者的更高事件发生率相关。
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