Clinical Applications of FDG-PET Scan in Arrhythmic Myocarditis,JACC: Cardiovascular Imaging

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Clinical Applications of FDG-PET Scan in Arrhythmic Myocarditis
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2022-05-11 , DOI: 10.1016/j.jcmg.2022.02.029
Giovanni Peretto ₁ , Elena Busnardo ₂ , Paola Ferro ₃ , Anna Palmisano ₄ , Davide Vignale ₄ , Antonio Esposito ₄ , Giacomo De Luca ₅ , Corrado Campochiaro ₆ , Silvia Sartorelli ₆ , Monica De Gaspari ₇ , Stefania Rizzo ₇ , Lorenzo Dagna ₈ , Cristina Basso ₇ , Luigi Gianolli ₃ , Paolo Della Bella ₉ , Simone Sala ₁₀

Affiliation

Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiac Thoracic Vascular Sciences and Public Health, Cardiovascular Pathology, Padua University, Padua, Italy.
School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Myocarditis Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Background

¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan has no recognized role in diagnosis, prognosis, and disease monitoring in patients with arrhythmic myocarditis.

Objectives

The purpose of this study was to investigate the value of FDG-PET scan in arrhythmic myocarditis.

Methods

The authors enrolled 75 consecutive patients (age 47 ± 14 years, 65% men) undergoing FDG-PET scan for arrhythmic myocarditis. Myocarditis was diagnosed by endomyocardial biopsy (EMB) and, whenever applicable, cardiac magnetic resonance (CMR).

Results

Indications for FDG-PET scan included either contraindication to CMR (n = 50) or mismatch between CMR and EMB (n = 25). Overall, 50 patients (67%) had positive FDG-PET. Sensitivity was 75% referring to EMB, and 73% to CMR. Specificity was 67% referring to EMB, and 59% to CMR. FDG-PET accuracy was lower in the presence of borderline myocarditis, and either late (>30 days) or on-immunosuppression FDG-PET scanning. Anteroseptal distribution pattern, found in 12 of 50 (24%) patients including 7 of 7 cardiac sarcoidosis cases, was associated with greater occurrence of ventricular arrhythmias and atrioventricular blocks in 4.2 ± 1.7 years of follow-up (10 of 12 vs 7 of 38, and 7 of 12 vs 0 of 38, respectively; both P < 0.001). In 39 patients (52%), FDG-PET was repeated by 13 ± 2 months, allowing immunosuppression withdrawal after FDG uptake normalization either by first (76%) or second reassessment (24%).

Conclusions

FDG-PET scan may be a clinically useful diagnostic technique in arrhythmic myocarditis, in particular when CMR is unsuitable because of irregular heartbeat or implantable cardioverter-defibrillator–related artifacts. Anteroseptal FDG distribution is associated with a worse arrhythmic outcome and should raise the suspicion of cardiac sarcoidosis. During follow-up, repeated FDG-PET allows myocarditis monitoring to guide immunosuppression withdrawal.

中文翻译：

FDG-PET扫描在心律失常性心肌炎中的临床应用

背景

¹⁸ F-氟脱氧葡萄糖正电子发射断层扫描 (FDG-PET) 扫描在心律失常性心肌炎患者的诊断、预后和疾病监测中没有公认的作用。

目标

本研究的目的是探讨 FDG-PET 扫描在心律失常性心肌炎中的价值。

方法

作者连续招募了 75 名接受 FDG-PET 扫描的心律失常性心肌炎患者（年龄 47 ± 14 岁，65% 为男性）。心肌炎通过心内膜心肌活检 (EMB) 诊断，并且在适用的情况下，通过心脏磁共振 (CMR) 诊断。

结果

FDG-PET 扫描的适应症包括 CMR 的禁忌症 (n = 50) 或 CMR 和 EMB 之间的不匹配 (n = 25)。总体而言，50 名患者 (67%) 的 FDG-PET 呈阳性。对 EMB 的敏感性为 75%，对 CMR 的敏感性为 73%。EMB 的特异性为 67%，CMR 的特异性为 59%。FDG-PET 准确性在存在临界性心肌炎、晚期（>30 天）或免疫抑制 FDG-PET 扫描时较低。在 4.2 ± 1.7 年的随访中，50 名患者中有 12 名（24%）发现了前间隔分布模式，包括 7 名心脏结节病病例中的 7 名，这与室性心律失常和房室传导阻滞的发生率较高相关（12 人中有 10 人，38 人中有 7 人） , 和 7 of 12 vs 0 of 38, 分别; 两者P <0.001)。在 39 名患者 (52%) 中，FDG-PET 重复 13 ± 2 个月，允许在 FDG 摄取正常化后通过第一次 (76%) 或第二次重新评估 (24%) 停用免疫抑制。