- 作者：Ron Blankstein ; Michael Osborne ; Masanao Naya ; Alfonso Waller ; Chun K. Kim ; Venkatesh L. Murthy ; Pedram Kazemian ; Raymond Y. Kwong ; Michifumi Tokuda ; Hicham Skali ; Robert Padera ; Jon Hainer ; William G. Stevenson ; Sharmila Dorbala ; Marcelo F. Di Carli
- 关键词：FDG ; PET ; prognosis ; sarcoidosis ; VT
- 刊名：Journal of the American College of Cardiology
- 出版年：4 February, 2014
- 年：2014
- 卷：63
- 期：4
- 页码：329-336
- 全文大小：1144 K
ss="h4">Objectives
This study sought to relate imaging findings on positron emission tomography (PET) to adverse cardiac events in patients referred for evaluation of known or suspected cardiac sarcoidosis.ss="h4">Background
Although cardiac PET is commonly used to evaluate patients with suspected cardiac sarcoidosis, the relationship between PET findings and clinical outcomes has not been reported.
ss="h4">Methods
We studied 118 consecutive patients with no history of coronary artery disease, who were referred for PET, using [<sup>18sup>F]fluorodeoxyglucose (FDG) to assess for inflammation and rubidium-82 to evaluate for perfusion defects (PD), following a high-fat/low-carbohydrate diet to suppress normal myocardial glucose uptake. Blind readings of PET data categorized cardiac findings as normal, positive PD or FDG, positive PD and FDG. Images were also used to identify whether findings of extra-cardiac sarcoidosis were present. Adverse events (AE)鈥攄eath or sustained ventricular tachycardia (VT)鈥攚ere ascertained by electronic medical records, defibrillator interrogation, patient questionnaires, and telephone interviews.
ss="h4">Results
Among the 118 patients (age 52 卤 11 years; 57% males; mean ejection fraction: 47 卤 16%), 47 (40%) had normal and 71聽(60%) had abnormal cardiac PET findings. Over a median follow-up of 1.5 years, there were 31 (26%) adverse events (27聽VT and 8 deaths). Cardiac PET findings were predictive of AE, and the presence of both a PD and abnormal FDG (29% of patients) was associated with hazard ratio of 3.9 (p聽< 0.01) and remained significant after adjusting for left ventricular ejection fraction (LVEF) and clinical criteria. Extra-cardiac FDG uptake (26% of patients) was not associated with AE.
ss="h4">Conclusions
The presence of focal PD and FDG uptake on cardiac PET identifies patients at higher risk of death or VT. These findings offer prognostic value beyond Japanese Ministry of Health and Welfare clinical criteria, the presence of extra-cardiac sarcoidosis and LVEF.