Key result
PET stress perfusion-metabolism mismatch in dilated cardiomyopathy is linked to a ~10-fold higher risk of major events.
Why the study?
Does the presence of PET stress perfusion-metabolism mismatch predict adverse clinical outcomes in patients with idiopathic dilated cardiomyopathy?
Cohort (n=24)
No
Does the presence of PET stress perfusion-metabolism mismatch predict adverse clinical outcomes in patients with idiopathic dilated cardiomyopathy?
In patients with idiopathic dilated cardiomyopathy, the presence of PET stress perfusion-metabolism mismatch is frequently observed and strongly predicts adverse clinical outcomes including death, heart transplantation, and heart failure hospitalization.
Supports PET mismatch for prognostic stratification in idiopathic dilated cardiomyopathy; hypothesis-generating and warrants prospective validation before clinical adoption.
BACKGROUND: Although patients with idiopathic dilated cardiomyopathy (DCM) have no coronary artery disease, regional impairment of myocardial perfusion combined with preserved metabolism has been found using positron emission tomography (PET). Our aim was to assess the prognostic relevance of PET-mismatch between stress myocardial perfusion and glucose uptake on clinical outcome in DCM. METHODS: In 24 patients with DCM who underwent both myocardial perfusion and metabolism PET scanning, "mismatch" was assessed and the association with clinical outcome (hospitalization, mortality, and heart transplantation) was investigated. RESULTS: Mismatch was found in 16 patients (66.7%). Univariate analysis showed that the presence of mismatch was associated with adverse outcome (P = 0.03). After adjustment for sex and age, the association remained significant with an adjusted relative risk of 10.4 (95% CI 1.1-103; P = 0.04) for death, heart transplant, or hospitalization. Univariate analysis also showed that a higher extent of mismatch was significantly associated with adverse outcome (P = 0.02). After adjusting for sex and age, the association remained significant with an adjusted relative risk of 6.5 [95% CI 1.2-36; P = 0.03] for death, heart transplantation, or hospitalization. CONCLUSION: PET stress perfusion-metabolism mismatch, indicative for ischemia, is frequently found in DCM patients and related to a poorer outcome.
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Jong et al. (2009) conducted a cohort in Idiopathic dilated cardiomyopathy (n=24). PET stress perfusion-metabolism mismatch vs. No mismatch was evaluated on Cardiac death, heart transplantation, or hospitalization for progressive heart failure (HR 10.4, 95% CI 1.1-103, p=0.04). The presence of PET stress perfusion-metabolism mismatch in patients with idiopathic dilated cardiomyopathy was associated with a significantly increased risk of cardiac death, heart transplantation, or hospitalization (HR 10.4).
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