Erschienen in:
01.02.2012 | Original Article
Reduced septal glucose metabolism predicts response to cardiac resynchronization therapy
verfasst von:
David Birnie, MB, ChB, MD, Rob A. de Kemp, PhD, Anthony S. Tang, MD, FRCPC, Terence D. Ruddy, MD, FRCPC, FACC, Michael H. Gollob, MD, FRCPC, Ann Guo, MEng, Kathryn Williams, MS, Kerry Thomson, BSc, Jean N. DaSilva, PhD, Rob S. Beanlands, MD, FRCPC, FACC
Erschienen in:
Journal of Nuclear Cardiology
|
Ausgabe 1/2012
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Abstract
Background
Up to 50% of patients do not respond to Cardiac Resynchronization Therapy (CRT). Recent work has focused on quantifying mechanical dyssynchrony and left ventricular scar. Septal reverse-mismatch (R-MM) (reduced FDG uptake vs perfusion) has been observed in patients with cardiomyopathy and prolonged QRS duration. We hypothesized that a greater quantity of septal R-MM would indicate a greater potential for reversibility of the cardiomyopathy, when the dyssynchrony is improved with CRT. Therefore, this study’s objective was to assess whether greater septal R-MM pattern predicts response to CRT.
Methods and Results
Forty-nine patients had pre-implant Rubidium-82 and Fluorine-18-fluorodeoxyglucose PET scanning. Total and regional left ventricular scar size and extent of R-MM were calculated. Response to CRT was defined as ≥10% improvement in left ventricular end-systolic volume or ≥5% absolute ejection fraction improvement. In the non-ischemic cardiomyopathy subset non-responders had significantly less septal R-MM than responders (13.1% compared to 27.1%, P = .012). There were correlations between the extent of septal R-MM and the increase in ejection fraction (r = 0.692, P = .0004) and reduction in left ventricular end-systolic volume (r = −0.579, P = .004). For each 5% absolute increase in extent of septal R-MM the odds ratio of being a responder was 2.17 (95% CI 1.15, 4.11, P = .017). Extent of septal R-MM displayed high sensitivity and specificity (area under curve = 0.855, P = .017) to predict response.
Conclusions
In patients with non-ischemic cardiomyopathy, greater extent of septal glucose metabolic R-MM pattern, predicted response to CRT. This parameter may be useful for identifying patients who benefit from CRT.