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Sympathetic denervation in patients with ischemic cardiomyopathy and risk on ventricular tachy-arrhythmias. A pilot
Walter Noordzij1, Arif Elvan2, Fatma Demirel2
1Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands - w.noordzij@umcg.nl.
Insights
Cardiac sympathetic denervation is impaired in ischemic cardiomyopathy patients. Large denervated areas detected by [11C]-mHED imaging predict all-cause mortality, suggesting a role beyond LVEF for risk stratification.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Ischemic cardiomyopathy (ICM) patients face ventricular arrhythmia risks, often managed with implantable cardioverter defibrillators (ICDs).
- Left ventricular ejection fraction (LVEF) is a key metric, but cardiac sympathetic innervation visualization may offer additional prognostic value.
- This study investigated the role of sympathetic denervation in ventricular arrhythmia development in ICM patients.
Purpose of the Study:
- To assess the role of sympathetic denervation in the genesis of ventricular arrhythmias in patients with ischemic cardiomyopathy.
- To explore if cardiac sympathetic innervation imaging can enhance risk stratification for ICD therapy.
Main Methods:
- Twenty ICM patients with LVEF <30% were enrolled and stratified by arrhythmia history.
- Cardiac sympathetic denervation was assessed using carbon-11 labelled meta-hydroxy-ephedrine ([11C]-mHED) imaging.
- Myocardial ischemia, viability, and [11C]-mHED retention were evaluated, with follow-up for one year.
Main Results:
- No significant difference in global [11C]-mHED retention was observed between patients with and without a history of arrhythmias.
- Seven patients developed ventricular arrhythmias, and four died during the follow-up period.
- A larger size of the denervated area, identified by [11C]-mHED defects, was significantly associated with all-cause mortality (P=0.002).
Conclusions:
- Cardiac sympathetic innervation is demonstrably impaired in patients with ischemic cardiomyopathy.
- Extensive sympathetic denervation, visualized via [11C]-mHED imaging, is linked to increased all-cause mortality in ICM.
- These findings suggest sympathetic denervation imaging may improve risk stratification for ICM patients.
Background:
Patients with ischemic cardiomyopathy (ICM) are at risk for ventricular arrhythmias and are protected by an implantable cardioverter defibrillator (ICD). Visualization of cardiac sympathetic innervation may play an additional role to left ventricular ejection fraction (LVEF) in identifying those patients who will benefit from ICD therapy. The purpose of this study was to detect the role of sympathetic denervation in the genesis of ventricular arrhythmias in ICM patients.
Methods:
Twenty patients with ICM and LVEF <30% were included in this pilot study. Included patients were equally stratified into two groups: no history of arrhythmias (group A) and recurrent arrhythmias (group B). All patients underwent cardiac sympathetic denervation (using carbon-11 labelled meta-hydroxy-ephedrine ([11C]-mHED)), myocardial ischemia and viability detection. Patients were followed up to one year after the imaging studies.
Results:
Mean age was 63±7.5 years. Mean global retention of [11C]-mHED was 0.055±0,012 min-1, and was not different between the two patient groups: 0.056±0.011 min-1 vs. 0.054±0.013 min-1 for group A vs. group B, respectively. During follow-up, seven patients developed ventricular arrhythmias, and four patients died. No difference in [11C]-mHED retention was found between patients with and without ventricular arrhythmia during follow-up. However, size of denervated area was larger in patients who died during follow-up: 10±1 segments vs. 6±2 segments, P=0.002.
Conclusions:
Cardiac sympathetic innervation is impaired in patients with ischemic cardiomyopathy. All-cause mortality occurred in those patients with large areas of [11C]-mHED defect.
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