Author + information
- Received September 25, 2019
- Revision received January 15, 2020
- Accepted January 24, 2020
- Published online June 17, 2020.
- Mischa T. Rijnierse, MD, PhDa,∗,
- Anne-Lotte C.J. van der Lingen, MDa,∗,
- Stefan de Haan, MD, PhDa,
- Marthe A.J. Becker, MDa,
- Hendrik J. Harms, PhDb,
- Marc C. Huisman, PhDb,
- Adriaan A. Lammertsma, PhDb,
- Peter M. van de Ven, PhDc,
- Albert C. van Rossum, MD, PhDa,
- Paul Knaapen, MD, PhDa and
- Cornelis P. Allaart, MD, PhDa,∗ ()
- aDepartment of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- bDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- cEpidemiology and Biostatistics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. C.P. Allaart, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
Objectives 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).
Background 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.
Methods 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. [15O]H2O and [11C]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.
Results 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.
Conclusions 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.
- cardiovascular cardiac magnetic resonance
- implantable cardioverter-defibrillator
- positron emission tomography
- ventricular arrhythmia
↵∗ Drs. Rijnierse and van der Lingen contributed equally to this work.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 25, 2019.
- Revision received January 15, 2020.
- Accepted January 24, 2020.
- 2020 American College of Cardiology Foundation
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