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PAREPET: New approach may lead to better identification of ICD candidates
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BOSTON — Using PET to evaluate the volume of denervated myocardium may help identify a greater number of patients who are at high risk for sudden cardiac arrest and may benefit from implantable cardiac defibrillators, researchers said here.
“Since many patients who suffer a cardiac arrest do not have severely depressed heart function, PET imaging may be able to identify high-risk individuals who, in the future, could be considered candidates for an ICD,” principal investigator John M. Canty Jr., MD, Albert and Elizabeth Rekate professor of medicine, University at Buffalo School of Medicine and Biomedical Sciences, said in a press release.
For the Prediction of Arrhythmic Events with Positron Emission Tomography (PARAPET) study, researchers followed 204 patients (mean age, 67 years) with CAD who were eligible for ICD therapy for a median of 4.2 years. Patients had mean NYHA Class 2 HF and an ejection fraction of 27%.
Approximately half (16%) of all cardiac mortality (34%) that occurred during the study was attributable to sudden cardiac arrest. Volume of denervated myocardium appeared to be a strong determinant of cardiac arrest (P=.001). In multivariable analysis, denervated myocardium (37.6% left ventricle) remained an independent predictor of cardiac arrest (10.3% per year vs. 3% per year; HR=3.5; P=.009). Ejection fraction, infarct volume and hibernating myocardium, however, were not. Results also identified left ventricular end-diastolic volume index, creatinine and lack of ACE inhibitor or angiotensin receptor blocker therapy as additional predictors of sudden cardiac arrest.
“Our results suggest that, in patients with ischemic cardiomyopathy, the quantitative assessment of denervated myocardium may provide for more effective targeting of ICDs to those at greatest risk of sudden cardiac arrest,” James Fallavollita, MD, lead author and professor of medicine at the University at Buffalo, said during a presentation. “While further study is required, our results also suggest that denervated myocardium may be able to potentially identify increased risk of sudden cardiac arrest among those with more preserved LV function.” – by Melissa Foster
For more information:
- Fallavollita J. LB01-3. Presented at: the Heart Rhythm Society’s 33rd Annual Scientific Sessions; May 9-12, 2012; Boston.
Disclosure: The researchers report no relevant financial disclosures.