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DOI: 10.1055/s-0038-1625688
Myocardial perfusion/metabolism mismatch and ventricular arrhythmias in the chronic post infarction state[*]
Myokardiales Perfusions-/ Stoffwechsel-Missverhältnis und ventrikuläre Arrhythmien im chronischen Post-Infarkt-Stadium[*]Publikationsverlauf
Eingegangen:
02. März 2004
in revised form:
07. September 2004
Publikationsdatum:
10. Januar 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/200503/lookinside/thumbnails/10-1055-s-0038-1625688_de-1.jpg)
Summary
Aim: Ventricular arrhythmias have been shown to originate in the myocardial peri-infarct region due to irregular heterotopic conduction. Hypoperfused but viable myocardium is often localised in those areas and may be involved in the pathogenesis of arrhythmias. We tested the hypothesis that these myocardial perfusion/metabolism mismatches (MM) are significantly associated with ventricular arrhythmias in the chronic post infarction state. Patients, methods: 47 post infarction patients were included in the study. 33 suffered from ventricular arrhythmia whereas 14 did not. All patients underwent 99mTc tetrofosmin SPECT and 18F-FDG PET. A region-of-interest(ROI)-analysis was used to assess viable myocardium based on predefined MM-criteria. Univariate analyses as well as a logistic regression model for the multivariate analysis were carried out. Results: 94% of the arrhythmic patients displayed at least one MM-segment as compared to 64% of the non-arrhythmic patients. MMsegments and arrhythmia showed a statistically significant relation (p = 0.018). The logistic regression model predicted the occurrence or absence of arrhythmia in 85% of all cases. Multivariate analysis gave consistent results, after adjusting for symptomatic chronic heart failure (CHF), aneurysms and age. Conclusion: Our results support the hypothesis that hypoperfused but viable myocardium represents an arrhythmogenic substrate and is a relevant risk factor for developing ventricular arrhythmias following myocardial infarction. Therefore, the detection of MM-segments allows the identification of patients with a higher risk for future cardiac events.
Zusammenfassung
Ziel: Ventrikuläre Arrhythmien entspringen häufig der myokardialen Peri-Infarktzone aufgrund irregulärer heterotoper Erregungsleitung. In diesen Zonen ist oft minderperfundiertes, jedoch vitales Myokard lokalisiert, das möglicherweise eine wichtige Rolle in der Arrhythmiegenese spielt. Diese Studie testet die Hypothese, dass dieses myokardiale Perfusions-/Stoffwechsel-Missverhältniss (MM) signifikant mit ventrikulären Arrhythmien im chronischen Post-Infarktstadium assoziiert ist. Patienten, Methoden: Einbezogen wurden 47 Post-Infarkt-Patienten (33 mit ventrikulärer Arrhythmie und 14 ohne). Alle Patienten wurden mit 99mTc-Tetrofosmin-SPECT und 18F-FDG-PET untersucht. Anhand definierter MM-Kriterien wurde vitales Myokard mittels einer Region-of-interest(ROI)-Analyse identifiziert. Die statistische Auswertung erfolgte mittels univariater Analyse und logistischer Regression zur multivariaten Analyse. Ergebnisse: 94% der Arrhythmie-Patienten wiesen mindestens ein MM-Segment auf, im Gegensatz zu 64% der Arrhythmie-freien Patienten. Zwischen MM-Segmenten und dem Auftreten von Arrhythmien zeigte sich eine statistisch signifikante Beziehung (p = 0,018). Das logistische Regressionsmodell konnte eine Arrhythmie in 85% der Fälle voraussagen. Die multivariate Analyse führte nach Anpassung für chronische Herzinsuffizienz (CHF), Aneurysmata und Alter zu übereinstimmenden Ergebnissen. Schlussfolgerungen: Die Ergebnisse stützen die Hypothese, dass minderperfundiertes, jedoch vitales Myokard ein arrhythmogenes Substrat darstellt und ein relevanter Risikofaktor für die Entstehung ventrikulärer Arrhythmien im Post-Infarktstadium ist. Die Erkennung von MM-Segmenten ermöglicht die Identifikation von Patienten mit einem höheren Risiko für kardiale Ereignisse.
Keywords
Viable myocardium - ventricular arrhythmias - post infarction state - 99mTc tetrofosmin SPECT - 18F-FDG PETSchlüsselwörter
Vitales Myokard - ventrikuläre Arrhythmien - Post-Infarktstadium - 99mTc-Tetrofosmin-SPECT - 18F-FDG-PET* This study is part of the doctoral thesis of T. D. Poeppel. B. J. Krause and T. D. Poeppel contributed equally to this study.
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