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Relationship of non-invasive quantification of myocardial blood flow to arrhythmic events in patients with implantable cardiac defibrillators

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Ischemia contributes to arrhythmogenesis though its role is incompletely understood. Abnormal myocardial perfusion measured by PET imaging may predict ventricular arrhythmias (VAs) in a high-risk population.

Methods

Patients with implantable cardiac defibrillators who had undergone rubidium-82 cardiac PET imaging were identified. Patients were stratified by median MBF and MFR values for analysis. The Cox proportional hazards model was used to assess the impact of myocardial perfusion on survival free of VT independent of critical covariates.

Results

A total of 159 patients (124 (78%) males, median age 65.9 years, IQR [56.76-72.63]) were followed for 1.43 years IQR [0.83-2.21]. VA occurred in 29 patients (23.7%). After adjustment for ejection fraction, age, and sex, impaired stress MBF was associated with an increased risk of VA (adjusted HR per ml/min/g 1.52, 95% CI (1.01-2.31), P = 0.04). Summed rest and stress scores were not predictive of VA. Among patients with severe LV dysfunction, stress MBF remained an independent predictor of VA (adjusted HR per 1 ml/min/g HR 1.69, 95% CI (1.03-11.36), P = 0.03), while residual EF, summed rest, and summed stress scores were not (P > 0.05).

Conclusions

Impaired stress myocardial blood flow was associated with less survival free of ventricular arrhythmias.

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Abbreviations

EF:

Ejection fraction

ICD:

Implantable cardiac defibrillator

IQR:

Intra-quartile range

MACE:

Major adverse cardiac events

MBF:

Myocardial blood flow

PET:

Positron emission tomography

SCD:

Sudden cardiac death

SRS:

Summed rest score

SSS:

Summed stress score

VA:

Ventricular arrhythmia

References

  1. Myerburg RJ, Mitrani R, Interian A, Castellanos A. Interpretation of outcomes of antiarrhythmic clinical trials. Circulation 1998;97:1514-21.

    Article  CAS  PubMed  Google Scholar 

  2. Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006;114:e385-484.

    Article  PubMed  Google Scholar 

  3. Reichlin T, et al. Characterization and financial impact of implantable cardioverter-defibrillator patients without interventions 5 years after implantation. QJM 2011;104:849-57.

    Article  CAS  PubMed  Google Scholar 

  4. Myerburg RJ, Junttila MJ. Sudden cardiac death caused by coronary heart disease. Circulation 2012;125:1043-52.

    Article  PubMed  Google Scholar 

  5. Luqman N, Sung RJ, Wang C-L, Kuo C-T. Myocardial ischemia and ventricular fibrillation: pathophysiology and clinical implications. Int J Cardiol 2007;119:283-90.

    Article  PubMed  Google Scholar 

  6. Wilber DJ, Lynch JJ, Montgomery D, Lucchesi BR. Postinfarction sudden death: Significance of inducible ventricular tachycardia and infarct size in a conscious canine model. Am Heart J 1985;109:8-18.

    Article  CAS  PubMed  Google Scholar 

  7. Brugada J, Aguinaga L, Mont L, Betriu A, Mulet J, Sanz G. Coronary artery revascularization in patients with sustained ventricular arrhythmias in the chronic phase of a myocardial infarction: effects on the electrophysiologic substrate and outcome. J Am Coll Cardiol 2001;37:529-33.

    Article  CAS  PubMed  Google Scholar 

  8. Mondésert B, Khairy P, Schram G, Shohoudi A, Talajic M, Andrade JG, et al. Impact of revascularization in patients with sustained ventricular arrhythmias, prior myocardial infarction, and preserved left ventricular ejection fraction. Heart Rhythm Off J Heart Rhythm Soc 2016;13:1221-27.

    Article  Google Scholar 

  9. Tonino PAL, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, van’ t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009;360:213-24.

    Article  CAS  PubMed  Google Scholar 

  10. Murthy VL, Naya M, Foster CR, Hainer J, Gaber M, Di Carli G, et al. Improved cardiac risk assessment with noninvasive measures of coronary flow reserve. Circulation 2011;124:2215-24.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rijnierse MT, de Haan S, Harms HJ, Robbers LF, Wu L, Danad I, et al. Impaired hyperemic myocardial blood flow is associated with inducibility of ventricular arrhythmia in ischemic cardiomyopathy. Circ Cardiovasc Imaging 2014;7:20-30.

    Article  PubMed  Google Scholar 

  12. El Fakhri G, Kardan A, Sitek A, Dorbala S, Abi-Hatem N, Lahoud Y, et al. Reproducibility and accuracy of quantitative myocardial blood flow assessment with (82)Rb PET: comparison with (13)N-ammonia PET. J Nucl Med Off Publ Soc Nucl Med 2009;50:1062-71.

    Google Scholar 

  13. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 2002;18:539-42.

    PubMed  Google Scholar 

  14. El Fakhri G, Sitek A, Guérin B, Kijewski MF, Di Carli MF, Moore SC. Quantitative dynamic cardiac 82Rb PET using generalized factor and compartment analyses. J Nucl Med Off Publ Soc Nucl Med 2005;46:1264-71.

    Google Scholar 

  15. Sitek A, Gullberg GT, Huesman RH. Correction for ambiguous solutions in factor analysis using a penalized least squares objective. IEEE Trans Med Imaging 2002;21:216-25.

    Article  PubMed  Google Scholar 

  16. Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm Off J Heart Rhythm Soc 2014;11:e166-96.

    Article  Google Scholar 

  17. Epstein AE, DiMarco JP, Ellenbogen KA, Mark Estes I NA, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;51:e1-62.

    Article  PubMed  Google Scholar 

  18. Elhendy A, Sozzi FB, van Domburg RT, Bax JJ, Geleijnse ML, Roelandt JR. Relation among exercise-induced ventricular arrhythmias, myocardial ischemia, and viability late after acute myocardial infarction. Am J Cardiol 2000;86:723-29.

    Article  CAS  PubMed  Google Scholar 

  19. Fallavollita JA, Heavey BM, Luisi AJ, Michalek SM, Baldwa S, Mashtare TL, et al. Regional myocardial sympathetic denervation predicts the risk of sudden cardiac arrest in ischemic cardiomyopathy. J Am Coll Cardiol 2014;63:141-49.

    Article  PubMed  Google Scholar 

  20. Piccini JP, Horton JR, Shaw LK, Al-Khatib SM, Lee KL, Iskandrian AE, et al. Single-photon emission computed tomography myocardial perfusion defects are associated with an increased risk of all-cause death, cardiovascular death, and sudden cardiac death. Circ Cardiovasc Imaging 2008;1:180-88.

    Article  PubMed  Google Scholar 

  21. Nazarian S, Bluemke DA, Lardo AC, Zviman MM, Watkins SP, Dickfeld TL, et al. Magnetic resonance assessment of the substrate for inducible ventricular tachycardia in nonischemic cardiomyopathy. Circulation 2005;112:2821-25.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Roes SD, Borleffs CJW, van der Geest RJ, Westenberg JJM, Marsan NA, Kaandorp TAM, et al. Infarct tissue heterogeneity assessed with contrast-enhanced MRI predicts spontaneous ventricular arrhythmia in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillator. Circ Cardiovasc Imaging 2009;2:183-90.

    Article  PubMed  Google Scholar 

  23. Piccini JP, Starr AZ, Horton JR, Shaw LK, Lee KL, Al-Khatib SM, et al. Single-photon emission computed tomography myocardial perfusion imaging and the risk of sudden cardiac death in patients with coronary disease and left ventricular ejection fraction >35%. J Am Coll Cardiol 2010;56:206-14.

    Article  PubMed  Google Scholar 

  24. Yoshinaga K, Katoh C, Manabe O, Klein R, Naya M, Sakakibara M, et al. Incremental diagnostic value of regional myocardial blood flow quantification over relative perfusion imaging with generator-produced rubidium-82 PET. Circ J Off J Jpn Circ Soc 2011;75:2628-34.

    Google Scholar 

  25. Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR, Lerman A. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 2000;101:948-54.

    Article  CAS  PubMed  Google Scholar 

  26. McElwee SK, Velasco A, Doppalapudi H. Mechanisms of sudden cardiac death. J Nucl Cardiol Off Publ Am Soc Nucl Cardiol 2016;23:1368-79.

    Article  Google Scholar 

Download references

Disclosure

The following authors have no disclosures: Michael Ghannam, MD, Krasimira Mikhova, MD, Hong Jun Yun, MD, John J. Lazarus, MD, PhD, Matthew Konerman, MD, Ashraf Saleh, MD, Richard L. Weinberg, MD, Ryan Cunnane, MD, Ravi V. Shah, MD, Keri M. Hiller BS, CNMT, RT(N), and Venkatesh L. Murthy, MD, PhD. Edward P. Ficaro, PhD and James R. Corbett, MD have financial interest in INVIA Medical Imaging Solutions, which licenses the commercial software used for image processing. INVIA Medical Imaging did not provide direct support to this study.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, 1500 E. Medical Center Dr. SPC 5873, Ann Arbor, MI, 48109, USA

    Michael Ghannam MD, Hong Jun Yun MD, John J. Lazarus MD, PhD, Matthew Konerman MD, Richard L. Weinberg MD, Ryan Cunnane MD, James R. Corbett MD & Venkatesh L. Murthy MD, PhD

  2. Department of Medicine, University of Michigan, Ann Arbor, MI, USA

    Krasimira Mikhova MD & Ashraf Saleh MD

  3. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Ravi V. Shah MD

  4. INVIA Medical Imaging Solutions, Ann Arbor, MI, USA

    Edward P. Ficaro PhD & James R. Corbett MD

  5. Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Keri M. Hiller BS, CNMT, RT(N), Edward P. Ficaro PhD & Venkatesh L. Murthy MD, PhD

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  1. Michael Ghannam MD
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  2. Krasimira Mikhova MD
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Correspondence to Michael Ghannam MD.

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Ghannam, M., Mikhova, K., Yun, H.J. et al. Relationship of non-invasive quantification of myocardial blood flow to arrhythmic events in patients with implantable cardiac defibrillators. J. Nucl. Cardiol. 26, 417–427 (2019). https://doi.org/10.1007/s12350-017-0975-z

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  • DOI: https://doi.org/10.1007/s12350-017-0975-z

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