BACKGROUND F-18-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 induded 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 atrioventricutar blocks in 4.2 t 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 i 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 FOG distribution is associated with a worse arrhythmic outcome and should raise the suspicion of cardiac sarcoidosis. During follow-up, repeated FOG-PET allows myocarditis monitoring to guide immunosuppression withdrawal. (C) 2022 by the American College of Cardiology Foundation.
Clinical Applications of FDG-PET Scan in Arrhythmic Myocarditis / Peretto, Giovanni; Busnardo, Elena; Ferro, Paola; Palmisano, Anna; Vignale, Davide; Esposito, Antonio; De Luca, Giacomo; Campochiaro, Corrado; Sartorelli, Silvia; De Gaspari, Monica; Rizzo, Stefania; Dagna, Lorenzo; Basso, Cristina; Gianolli, Luigi; Della Bella, Paolo; Sala, Simone. - In: JACC. CARDIOVASCULAR IMAGING. - ISSN 1936-878X. - 15:10(2022), pp. 1771-1780. [10.1016/j.jcmg.2022.02.029]
Clinical Applications of FDG-PET Scan in Arrhythmic Myocarditis
Peretto, Giovanni;Palmisano, Anna;Vignale, Davide;Esposito, Antonio;De Luca, Giacomo;Campochiaro, Corrado;Dagna, Lorenzo;
2022-01-01
Abstract
BACKGROUND F-18-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 induded 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 atrioventricutar blocks in 4.2 t 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 i 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 FOG distribution is associated with a worse arrhythmic outcome and should raise the suspicion of cardiac sarcoidosis. During follow-up, repeated FOG-PET allows myocarditis monitoring to guide immunosuppression withdrawal. (C) 2022 by the American College of Cardiology Foundation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
