Roderick Tung1, Brenton Bauer1, Heinrich Schelbert2, Joseph P Lynch3, Martin Auerbach2, Pawan Gupta2, Christiaan Schiepers2, Samantha Chan1, Julie Ferris1, Martin Barrio2, Olujimi Ajijola2, Jason Bradfield1, Kalyanam Shivkumar4. 1. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California. 2. UCLA Department of Nuclear Medicine, Department of Molecular and Medical Pharmacology, Los Angeles, California. 3. UCLA Department of Medicine, Division of Pulmonary, and Critical Care Medicine, Los Angeles, California. 4. UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California; UCLA Department of Medicine, Division of Pulmonary, and Critical Care Medicine, Los Angeles, California. Electronic address: kshivkumar@mednet.ucla.edu.
Abstract
BACKGROUND: The incidence of myocardial inflammation in patients with unexplained cardiomyopathy referred for ventricular arrhythmias (VAs) is unknown. OBJECTIVE: The purpose of this study was to report fasting positron emission tomographic (PET) scan findings in consecutive patients referred with unexplained cardiomyopathy and VA. METHODS: Fluorine-18 fluoro-2-deoxyglucose (18-FDG) PET/computed tomographic (CT) scans with a >16-hour fasting protocol were prospectively ordered for patients referred for VA and unexplained cardiomyopathy (ejection fraction <55%). Patients with focal myocardial FDG uptake were labeled as arrhythmogenic inflammatory cardiomyopathy (AIC) and classified into 4 groups based on the presence of lymph node uptake (AIC+) and perfusion abnormalities (early vs late stage). RESULTS: Over a 3-year period, 103 PET scans were performed, with 49% (AIC+ 17, AIC 33) exhibiting focal FDG uptake. Mean patient age was 52 ± 12 years (ejection fraction 36% ± 16%). Patients with AIC were more likely to have a history of pacemaker (32% vs 6%, P = .002) compared to those with normal PET. When biopsy was performed, histologic diagnosis revealed nongranulomatous inflammation in 6 patients and sarcoidosis in 18 patients. Ninety percent of patients with AIC/AIC+ were prescribed immunosuppressive therapy, and 58% underwent ablation. Correlation between low voltage regions on electroanatomic mapping and FDG uptake was observed in 74%. Magnetic resonance imaging findings matched abnormal PET regions in only 40%. CONCLUSION: Nearly 50% of patients referred with unexplained cardiomyopathy and VA demonstrate ongoing focal myocardial inflammation on FDG PET. These data suggest that a significant proportion of patients labeled "idiopathic" may have occult AIC, which may benefit from early detection and immunosuppressive medical therapy. Published by Elsevier Inc.
BACKGROUND: The incidence of myocardial inflammation in patients with unexplained cardiomyopathy referred for ventricular arrhythmias (VAs) is unknown. OBJECTIVE: The purpose of this study was to report fasting positron emission tomographic (PET) scan findings in consecutive patients referred with unexplained cardiomyopathy and VA. METHODS:Fluorine-18 fluoro-2-deoxyglucose (18-FDG) PET/computed tomographic (CT) scans with a >16-hour fasting protocol were prospectively ordered for patients referred for VA and unexplained cardiomyopathy (ejection fraction <55%). Patients with focal myocardial FDG uptake were labeled as arrhythmogenic inflammatory cardiomyopathy (AIC) and classified into 4 groups based on the presence of lymph node uptake (AIC+) and perfusion abnormalities (early vs late stage). RESULTS: Over a 3-year period, 103 PET scans were performed, with 49% (AIC+ 17, AIC 33) exhibiting focal FDG uptake. Mean patient age was 52 ± 12 years (ejection fraction 36% ± 16%). Patients with AIC were more likely to have a history of pacemaker (32% vs 6%, P = .002) compared to those with normal PET. When biopsy was performed, histologic diagnosis revealed nongranulomatous inflammation in 6 patients and sarcoidosis in 18 patients. Ninety percent of patients with AIC/AIC+ were prescribed immunosuppressive therapy, and 58% underwent ablation. Correlation between low voltage regions on electroanatomic mapping and FDG uptake was observed in 74%. Magnetic resonance imaging findings matched abnormal PET regions in only 40%. CONCLUSION: Nearly 50% of patients referred with unexplained cardiomyopathy and VA demonstrate ongoing focal myocardial inflammation on FDG PET. These data suggest that a significant proportion of patients labeled "idiopathic" may have occult AIC, which may benefit from early detection and immunosuppressive medical therapy. Published by Elsevier Inc.
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