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Metabolic heterogeneous zone assessed by 18 FDG‐PET is predictive of postablation mortality in patients with ventricular tachycardia
Author(s) -
Miller Brian,
Vunnam Rama,
Mesubi Olurotimi,
Smith Mark F.,
Chen Wengen,
Mahat Jagat Bandhu,
Bentzen Soren M.,
See Vincent,
Restrepo Alejandro,
Shorofsky Stephen,
Dilsizian Vasken,
Dickfeld TimmMichael L.
Publication year - 2021
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.15130
Subject(s) - medicine , ventricular tachycardia , nuclear medicine , perfusion , positron emission tomography , cardiology , fluorodeoxyglucose , predictive value , tachycardia
Purpose We sought to study the predictive value of the metabolic heterogeneous zone (HZ) as determined by 18 Fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET) viability studies in ventricular tachycardia (VT) patients. Methods PET studies utilizing 82 Rubidium ( 82 Rb) tracer for perfusion and 18 FDG tracer for viability were analyzed using PMOD (PMOD Technologies) and further analyzed using 684‐segment plots. 18 FDG uptake was normalized to the area with maximal perfusion on the rest 82 Rb study. Metabolic scar, HZ, and healthy segments were defined with perfusion‐normalized 18 FDG uptake between 0%–50%, 50%–70%, and >70%, respectively. Results Thirty‐four VT patients (age, 63 ± 12 years) were evaluated with 18 FDG‐PET viability study. Most ( n = 31) patients underwent VT ablation. Patients were categorized to HZ < median versus HZ ≥ median based on a median HZ area size of 21.0 cm 2 . HZ size was significantly larger in the deceased group than the alive group (35.2 cm 2 vs. 18.1 cm 2 , p = .01). Deaths were significantly higher in HZ ≥ 21 cm 2 group than HZ < 21 cm 2 group (58.8% vs. 11.8%, p = .005). Survival analysis showed significantly higher mortality in the HZ ≥ 21 cm 2 group than the HZ < 21 cm 2 group (HR = 4.1, 95% CI: 1.3–12.6, p = .016). In a multivariable analysis, HZ was found to be an independent predictor for all‐cause mortality (HR = 1.07, 95% CI: 1.02–1.12, p = .01) Conclusions Increased HZ size of myocardium was associated with increased mortality. Metabolic HZ quantification may be of value in risk stratification and management of ischemic and nonischemic patients with VT.