期刊
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
卷 63, 期 2, 页码 141-149出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2013.07.096
关键词
C-11-meta-hydroxyephedrine; myocardial viability; positron emission tomography; sudden cardiac arrest; sympathetic denervation
资金
- U.S. National Institute of Health Heart, Lung, and Blood Institute [HL-76252]
- Medtronic, Inc.
- St. Jude Medical
Objectives The 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). Background Left ventricular ejection fraction (LVEF) is the only parameter identifying patients at risk of SCA who benefit from an implantable cardiac defibrillator (ICD). Methods We 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 (C-11-meta-hydroxyephedrine [C-11-HED]), perfusion (N-13-ammonia) and viability (insulin-stimulated F-18-2-deoxyglucose). The primary endpoint was SCA defined as arrhythmic death or ICD discharge for ventricular fibrillation or ventricular tachycardia > 240 beats/min. Results After 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 < 1%/year); whereas >= 2 factors identified high risk (20% of cohort; SCA similar to 12%/year). Conclusions In ischemic cardiomyopathy, sympathetic denervation assessed using C-11-HED PET predicts cause-specific mortality from SCA independently of LVEF and infarct volume. This may provide an improved approach for the identification of patients most likely to benefit from an ICD. (Prediction of ARrhythmic Events With Positron Emission Tomography [PAREPET]; NCT01400334) (C) 2014 by the American College of Cardiology Foundation
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