Regional Myocardial Sympathetic Denervation Predicts the Risk of Sudden Cardiac Arrest in Ischemic Cardiomyopathy
| Autor: | Michael E. Cain, Michael S. Haka, John M. Canty, Brendan M. Heavey, Andrew J. Luisi, Suzanne Michalek, Munawwar Sajjad, Sunil Baldwa, Terry Mashtare, James A. Fallavollita, Anne B. Curtis, Thomas R. Cimato, Alan D. Hutson, Robert A. deKemp |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty positron emission tomography Time Factors medicine.medical_treatment Myocardial Ischemia myocardial viability Ventricular tachycardia Ventricular Function Left Article 11C-meta-hydroxyephedrine sudden cardiac arrest Internal medicine medicine Humans Prospective Studies Sympathectomy Aged Ejection fraction Ischemic cardiomyopathy business.industry Incidence Sudden cardiac arrest medicine.disease United States sympathetic denervation Primary Prevention Survival Rate Death Sudden Cardiac Treatment Outcome medicine.anatomical_structure Ventricle Positron-Emission Tomography Anesthesia Ventricular fibrillation cardiovascular system Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business Perfusion Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 63:141-149 |
| ISSN: | 0735-1097 |
| Popis: | ObjectivesThe PAREPET (Prediction of ARrhythmic Events with Positron Emission Tomography) study sought to test the hypothesis that quantifying inhomogeneity in myocardial sympathetic innervation could identify patients at highest risk for sudden cardiac arrest (SCA).BackgroundLeft ventricular ejection fraction (LVEF) is the only parameter identifying patients at risk of SCA who benefit from an implantable cardiac defibrillator (ICD).MethodsWe prospectively enrolled 204 subjects with ischemic cardiomyopathy (LVEF ≤35%) eligible for primary prevention ICDs. Positron emission tomography (PET) was used to quantify myocardial sympathetic denervation (11C-meta-hydroxyephedrine [11C-HED]), perfusion (13N-ammonia) and viability (insulin-stimulated 18F-2-deoxyglucose). The primary endpoint was SCA defined as arrhythmic death or ICD discharge for ventricular fibrillation or ventricular tachycardia >240 beats/min.ResultsAfter 4.1 years follow-up, cause-specific SCA was 16.2%. Infarct volume (22 ± 7% vs. 19 ± 9% of left ventricle [LV]) and LVEF (24 ± 8% vs. 28 ± 9%) were not predictors of SCA. In contrast, patients developing SCA had greater amounts of sympathetic denervation (33 ± 10% vs. 26 ± 11% of LV; p = 0.001) reflecting viable, denervated myocardium. The lower tertiles of sympathetic denervation had SCA rates of 1.2%/year and 2.2%/year, whereas the highest tertile had a rate of 6.7%/year. Multivariate predictors of SCA were PET sympathetic denervation, left ventricular end-diastolic volume index, creatinine, and no angiotensin inhibition. With optimized cut-points, the absence of all 4 risk factors identified low risk (44% of cohort; SCA |
| Databáze: | OpenAIRE |
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