BACKGROUND: Risk stratification for ventricular arrhythmias (VAs) is important to refine selection criteria for primary prevention implantable cardioverter defibrillator therapy. Impaired hyperemic myocardial blood flow (MBF) is associated with increased mortality rate in ischemic and nonischemic cardiomyopathy, which may be attributed to electric instability inducing VAs. The aim of this pilot study was to assess whether hyperemic MBF impairment may be related with VA inducibility in patients with ischemic cardiomyopathy. METHODS AND RESULTS: Thirty patients with ischemic cardiomyopathy referred for primary prevention implantable cardioverter defibrillator implantation were prospectively included (26 men; 65±8 years old; left ventricular ejection fraction, 29±6%). [15O]H2O positron-emission tomography was performed to quantify resting MBF, hyperemic MBF, and coronary flow reserve. Left ventricular dimensions, function, and scar burden were assessed with cardiovascular magnetic resonance imaging. An electrophysiological study was performed to test VA inducibility. Positive electrophysiological study patients (n=12) showed reduced hyperemic MBF (1.25±0.30 versus 1.66±0.38 mL·min(-1)·g(-1); P<0.01) and coronary flow reserve (1.59±0.49 versus 2.12±0.48; P<0.01) compared with electrophysiological study negative patients (n=18). In electrophysiological study positive patients, the number of scar segments>75% transmurality was higher (P<0.05), although scar size and border zone did not differ. Receiver-operating characteristic curve analysis indicated that impaired hyperemic MBF (area under the curve, 0.84; 95% confidence intervals [0.69-0.99]) and coronary flow reserve (area under the curve, 0.77; 95% confidence intervals [0.57-0.96]) were associated with VA inducibility. CONCLUSIONS: In this pilot study, impaired hyperemic MBF and coronary flow reserve were associated with VA inducibility in patients with ischemic cardiomyopathy. These results are hypothesis generating for a potential role of quantitative positron-emission tomography perfusion imaging in risk stratification for VAs.
BACKGROUND: Risk stratification for ventricular arrhythmias (VAs) is important to refine selection criteria for primary prevention implantable cardioverter defibrillator therapy. Impaired hyperemic myocardial blood flow (MBF) is associated with increased mortality rate in ischemic and nonischemic cardiomyopathy, which may be attributed to electric instability inducing VAs. The aim of this pilot study was to assess whether hyperemic MBF impairment may be related with VA inducibility in patients with ischemic cardiomyopathy. METHODS AND RESULTS: Thirty patients with ischemic cardiomyopathy referred for primary prevention implantable cardioverter defibrillator implantation were prospectively included (26 men; 65±8 years old; left ventricular ejection fraction, 29±6%). [15O]H2O positron-emission tomography was performed to quantify resting MBF, hyperemic MBF, and coronary flow reserve. Left ventricular dimensions, function, and scar burden were assessed with cardiovascular magnetic resonance imaging. An electrophysiological study was performed to test VA inducibility. Positive electrophysiological study patients (n=12) showed reduced hyperemic MBF (1.25±0.30 versus 1.66±0.38 mL·min(-1)·g(-1); P<0.01) and coronary flow reserve (1.59±0.49 versus 2.12±0.48; P<0.01) compared with electrophysiological study negative patients (n=18). In electrophysiological study positive patients, the number of scar segments>75% transmurality was higher (P<0.05), although scar size and border zone did not differ. Receiver-operating characteristic curve analysis indicated that impaired hyperemic MBF (area under the curve, 0.84; 95% confidence intervals [0.69-0.99]) and coronary flow reserve (area under the curve, 0.77; 95% confidence intervals [0.57-0.96]) were associated with VA inducibility. CONCLUSIONS: In this pilot study, impaired hyperemic MBF and coronary flow reserve were associated with VA inducibility in patients with ischemic cardiomyopathy. These results are hypothesis generating for a potential role of quantitative positron-emission tomography perfusion imaging in risk stratification for VAs.
Authors: Stefan de Haan; Mischa T Rijnierse; Hendrik J Harms; Hein J Verberne; Adriaan A Lammertsma; Marc C Huisman; Albert D Windhorst; Albert C van Rossum; Cornelis P Allaart; Paul Knaapen Journal: J Nucl Cardiol Date: 2015-11-09 Impact factor: 5.952
Authors: Ankur Gupta; Meagan Harrington; Christine M Albert; Navkaranbir S Bajaj; Jon Hainer; Victoria Morgan; Courtney F Bibbo; Paco E Bravo; Michael T Osborne; Sharmila Dorbala; Ron Blankstein; Viviany R Taqueti; Deepak L Bhatt; William G Stevenson; Marcelo F Di Carli Journal: JACC Clin Electrophysiol Date: 2018-07-25
Authors: Michael Ghannam; Hong Jun Yun; Edward P Ficaro; Hamid Ghanbari; John J Lazarus; Matthew Konerman; Ravi V Shah; Richard Weinberg; James R Corbett; Hakan Oral; Venkatesh L Murthy Journal: J Nucl Cardiol Date: 2018-09-06 Impact factor: 5.952
Authors: Michael Ghannam; Krasimira Mikhova; Hong Jun Yun; John J Lazarus; Matthew Konerman; Ashraf Saleh; Richard L Weinberg; Ryan Cunnane; Ravi V Shah; Keri M Hiller; Edward P Ficaro; James R Corbett; Venkatesh L Murthy Journal: J Nucl Cardiol Date: 2017-07-07 Impact factor: 5.952
Authors: Maulik D Majmudar; Venkatesh L Murthy; Ravi V Shah; Swathy Kolli; Negareh Mousavi; Courtney R Foster; Jon Hainer; Ron Blankstein; Sharmila Dorbala; Arkadiusz Sitek; Lynne W Stevenson; Mandeep R Mehra; Marcelo F Di Carli Journal: Eur Heart J Cardiovasc Imaging Date: 2015-02-25 Impact factor: 6.875