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PET abnormalities in patients with nonischemic cardiomyopathy
James O O'Neill1, Patrick M McCarthy, Richard C Brunken
1Kaufman Center for Heart Failure, Department of Cardiovascular Medicine and Cardiothoracic Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.
Journal of Cardiac Failure
|June 11, 2004
Summary
Regional defects are common in dilated cardiomyopathy (DCM), with scar tissue found in 91% of patients. The extent of this scar correlates with QRS duration, impacting treatment decisions for cardiac resynchronization therapy.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiac Electrophysiology
Background:
- Dilated cardiomyopathy (DCM) is often viewed as a global left ventricular disease.
- However, the extent of regional wall motion and metabolic abnormalities in DCM is not fully understood.
- QRS width and positron emission tomography (PET) metabolic defects are known predictors of survival.
Purpose of the Study:
- To determine the prevalence of regional defects in advanced nonischemic DCM using multiple imaging techniques.
- To investigate the relationship between QRS duration and these regional defects.
Main Methods:
- Review of imaging modalities (PET, 2D echocardiography, radionuclide ventriculography) in consecutive patients with advanced nonischemic DCM.
- Quantification of regional metabolic and wall motion abnormalities.
- Correlation with clinical and electrocardiographic parameters, specifically QRS duration.
Main Results:
- PET imaging revealed scar in 91% of patients, averaging 25% of the left ventricle, often in the left anterior descending artery distribution.
- Regional wall motion abnormalities were observed in 51% (echocardiography) and 59% (nuclear scintigraphy) of patients.
- QRS duration positively correlated with the extent of myocardial scarring (r=.52, P=.0007).
Conclusions:
- Myocardial scar in advanced DCM, identified by PET, does not always indicate coronary artery disease, necessitating angiography for etiological diagnosis.
- The extent of myocardial scar correlates with QRS duration.
- These findings have potential implications for cardiac resynchronization therapy in DCM patients.