Author + information
- Received January 25, 2017
- Revision received April 8, 2017
- Accepted April 20, 2017
- Published online February 5, 2018.
- Brett W. Sperry, MDa,
- Balaji K. Tamarappoo, MD, PhDa,
- Jorge D. Oldan, MDb,
- Omair Javed, MDa,
- Daniel A. Culver, DOc,
- Richard Brunken, MDd,
- Manuel D. Cerqueira, MDd and
- Rory Hachamovitch, MD, MSca,∗ ()
- aDepartment of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- bDepartment of Radiology, University of North Carolina, Chapel Hill, North Carolina
- cDepartment of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
- dDepartment of Nuclear Medicine, Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Rory Hachamovitch, Cardiovascular Medicine J1-5, Cleveland Clinic, Euclid Avenue, Cleveland, Ohio 44195.
Objectives This study sought to evaluate the incremental value of quantifying the extent and severity of myocardial perfusion and 18F-labeled fluorodeoxyglucose (FDG) abnormalities in predicting adverse outcomes among patients with suspicion for cardiac sarcoidosis (CS).
Background Positron emission tomography (PET) with FDG is a key component of the noninvasive assessment of patients with suspected CS. However, the optimal method for image interpretation has not been defined.
Methods A retrospective analysis was performed of 203 patients who underwent perfusion and FDG-PET imaging to evaluate for CS. Imaging findings were scored by conventional 3-category methods (normal perfusion and metabolism, abnormal perfusion or metabolism, abnormal perfusion and metabolism) and by summed scores using the 17-segment model to represent extent and severity of disease. Heterogeneity of metabolism was quantified using the coefficient of variation (SD divided by the mean) of FDG uptake. Multivariable Cox models were developed to assess associations between imaging findings and adverse events (death, heart transplant, or ventricular arrhythmia requiring defibrillation).
Results The indication for FDG-PET was ventricular arrhythmia in 69 (34%), heart block in 16 (8%), cardiomyopathy in 54 (27%), and other indications in 64 (32%). There were 63 patients who developed adverse events over a mean follow-up of 1.8 years. After robust adjustment, only the summed score in segments with a perfusion–metabolism mismatch and the coefficient of variation were important prognostically (p = 0.029 and p = 0.041, respectively).
Conclusions Quantitative measures of extent and severity of perfusion–metabolism mismatch and coefficient of variation of FDG uptake provide an incremental prognostic advantage in patients undergoing FDG-PET for CS. These results support the use of a more detailed analysis of imaging findings, as is conventional in coronary artery disease.
Dr. Tamarappoo is currently affiliated with the Department of Cardiovascular Medicine, Cedars-Sinai Heart Institute, Los Angeles, California.
Dr. Culver has received clinical trial support from Mallinkrodt; and has received consultant fees from Gilead. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Sperry, Tamarappoo, and Oldan contributed equally to this work.
- Received January 25, 2017.
- Revision received April 8, 2017.
- Accepted April 20, 2017.
- 2018 American College of Cardiology Foundation
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