Abstract 11497: Focal Hibernating Myocardium -A Novel Method to Assess Ventricular Arrhythmogencity Using Molecular Imaging

• Published in: Circulation (New York, N.Y.) Vol. 132; no. Suppl_3 Suppl 3; p. A11497
• Main Authors: Abdulghani, Mohammed, Miller, Brian, Smith, Mark, Chen, Wengen, Ume, Kiddy L, Bob-Manuel, Tamunoinemi, Imanli, Hasan, Saliaris, Anastasios, See, Vincent, Shorofsky, Stephen, Dilsizian, Vasken, Dickfeld, Timm
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 10.11.2015
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.11497

IntroductionHibernating myocardium is associated with increased ventricular tachyarrhythmias and sudden cardiac death. Current algorithms aim to detect only large areas of left ventricular hibernation, likely to respond to revascularization and improve LV EF. However, no current tools allow the determination of small and focal hibernating areas within the ischemic substrate, which could act as VT trigger and substrate modulators, and initiate or maintain ventricular arrhythmias.MethodsCustom-made Matlab-based software was developed to perform quantitative segmental analysis. Patients with ischemic cardiomyopathy undergoing VT ablation underwent pre-procedural FDG and Rubidium-PET/Technicum SPECT to determine the metabolic and perfusion characteristics of the LV myocardium. After co-registering the voxel-based tracer intensity information was transferred into a 36 x 21 +1 matrix (757 segments analysis). After normalization comparative analysis identified functional categories of LV myocardium (normal:>75% uptake perfusion[p]/metabolism[M]; hibernationP and MP+20% or P>50% but P+20%; matched scar P and M<50%).ResultsSoftware was evaluated on metabolism/perfusion scans of 8 patients undergoing VT ablation. While all patients had reported scar, only 2/8 patients (25%) had clinically identified area of hibernation using the currently clinically employed nuclear medicine algorithm. All DICOM files were successfully uploaded into the software module, transformed and analyzed using the pre-specified functional categories of LV myocardium. Post-analysis polar plots of all patients demonstrated matched scar as seen during the clinical read. However, focal areas of hibernation were detected in all patients using the 757 algorithm analytical tool (100% vs. 25% for 757 segmental vs. standard clinical analysis, P<0.001) often adjacent to pre-specified scar category.ConclusioNThe novel quantitative 757 segmental analysis is able to detect and localize focal areas of hibernation in all patients with ischemic VT substrate. This allows the use of molecular imaging techniques to identify potentially proarrhythmic VT trigger and modulators and design novel diagnostic and therapeutic strategies.