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Myocardial denervation coincides with scar heterogeneity in ischemic cardiomyopathy: A PET and CMR study

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Mismatch between myocardial innervation and perfusion assessed with positron emission tomography (PET) is a potential risk marker for ventricular arrhythmias in patients with ischemic cardiomyopathy. This mismatch zone originates from residual viable myocardium that has sustained ischemic nerve injury. Heterogenic scar size assessed with late gadolinium-enhanced (LGE) cardiac magnetic resonance imaging (CMR) is also a risk marker of ventricular arrhythmias. These two imaging parameters may represent identical morphological tissue features. The current study explored the relation between innervation-perfusion mismatch and heterogenic scar size.

Methods

Twenty-eight patients (26 males, age 67 ± 8 years) with ischemic cardiomyopathy and a left ventricular ejection fraction below 35%, eligible for ICD implantation were included. All patients underwent both [11C]-hydroxyephedrine and [15O]-water PET studies to assess myocardial sympathetic innervation and perfusion. LGE CMR was conducted to assess total myocardial scar size, scar core size, and heterogenic scar size.

Results

Perfusion defect size was 16.6 ± 9.9% and innervation defect size was 33.7 ± 10.8%, which resulted in an innervation-perfusion mismatch of 17.6 ± 8.9%. Total scar size, scar core size, and heterogenic scar size were 21.2 ± 8.6%, 14.7 ± 6.6%, and 6.5 ± 2.9%, respectively. No relation between scar core size and perfusion deficit size was observed (r = 0.18, P = .36). Total scar size was correlated with the innervation defect size (r = 0.52, P = .004) and the heterogenic scar zone displayed a significant correlation with the innervation-perfusion mismatch area (r = 0.67, P < .001).

Conclusions

Denerved residual viable myocardium in ischemic cardiomyopathy as observed with innervation-perfusion PET is related to the heterogenic scar zone as assessed with LGE CMR.

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Abbreviations

CMR:

Cardiac magnetic resonance imaging

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

HED:

Hydroxyephedrine

ICD:

Implantable cardioverter defibrillator

LGE:

Late gadolinium enhancement

MBF:

Myocardial blood flow

PET:

Positron emission tomography

ROI:

Region of interest

TAC:

Time-activity curve

VOI:

Volume of interest

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Disclosure

None of the authors have any potential conflict of interest in the contents of the manuscript.

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Authors and Affiliations

  1. Department of Cardiology and Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands

    Stefan de Haan MD, Mischa T. Rijnierse MD, Albert C. van Rossum MD, PhD, Cornelis P. Allaart MD, PhD & Paul Knaapen MD, PhD

  2. Department of Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, The Netherlands

    Hendrik J. Harms PhD, Adriaan A. Lammertsma PhD, Marc C. Huisman PhD & Albert D. Windhorst PhD

  3. Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Hein J. Verberne MD, PhD

Authors
  1. Stefan de Haan MD
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  2. Mischa T. Rijnierse MD
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  3. Hendrik J. Harms PhD
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  4. Hein J. Verberne MD, PhD
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  8. Albert C. van Rossum MD, PhD
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  10. Paul Knaapen MD, PhD
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Correspondence to Paul Knaapen MD, PhD.

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de Haan, S., Rijnierse, M.T., Harms, H.J. et al. Myocardial denervation coincides with scar heterogeneity in ischemic cardiomyopathy: A PET and CMR study. J. Nucl. Cardiol. 23, 1480–1488 (2016). https://doi.org/10.1007/s12350-015-0316-z

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  • DOI: https://doi.org/10.1007/s12350-015-0316-z

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