Ischemic patterns assessed by positron emission tomography predict adverse outcome in patients with idiopathic dilated cardiomyopathy.
BACKGROUND
Although patients with idiopathic dilated cardiomyopathy (DCM) have no coronary artery disease, regional impairment of myocardial perfusion combined with preserved metabolism has been found using positron emission tomography (PET). Our aim was to assess the prognostic relevance of PET-mismatch between stress myocardial perfusion and glucose uptake on clinical outcome in DCM.


METHODS
In 24 patients with DCM who underwent both myocardial perfusion and metabolism PET scanning, "mismatch" was assessed and the association with clinical outcome (hospitalization, mortality, and heart transplantation) was investigated.


RESULTS
Mismatch was found in 16 patients (66.7%). Univariate analysis showed that the presence of mismatch was associated with adverse outcome (P = 0.03). After adjustment for sex and age, the association remained significant with an adjusted relative risk of 10.4 (95% CI 1.1-103; P = 0.04) for death, heart transplant, or hospitalization. Univariate analysis also showed that a higher extent of mismatch was significantly associated with adverse outcome (P = 0.02). After adjusting for sex and age, the association remained significant with an adjusted relative risk of 6.5 [95% CI 1.2-36; P = 0.03] for death, heart transplantation, or hospitalization.


CONCLUSIONS
PET stress perfusion-metabolism mismatch, indicative for ischemia, is frequently found in DCM patients and related to a poorer outcome.
de Jong
Richard M
RM
Thoraxcenter, Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. R.M.de.Jong@thorax.umcg.nl
Tio
Rene A
RA
van der Harst
Pim
P
Voors
Adriaan A
AA
Koning
Paul M
PM
Zeebregts
Clark J A M
CJ
van Veldhuisen
Dirk J
DJ
Dierckx
Rudi A J O
RA
Slart
Riemer H J A
RH
D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology; D049268:Positron-Emission Tomography / Q000379:methods*; D015995:Prevalence; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate