Left ventricular regional glucose metabolism in combination with septal scar extent identifies CRT responders

Autor: Otto A. Smiseth, Olivier Gheysens, Jürgen Duchenne, Piet Claus, Gabor Voros, Johan Nuyts, Caroline Stokke, John M Aalen, Jan Bogaert, Einar Hopp, Jens-Uwe Voigt, Ganna Degtiarova, Rik Willems, J G Fjeld, C K Larsen
Přispěvatelé: UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Centre du cancer, UCL - (SLuc) Service de médecine nucléaire
Rok vydání: 2021
Předmět:
Male
Positron emission tomography
medicine.medical_specialty
Cardiac magnetic resonance
genetic structures
medicine.medical_treatment
Cardiac resynchronization therapy
Contrast Media
Gadolinium
Carbohydrate metabolism
030218 nuclear medicine & medical imaging
Cardiac Resynchronization Therapy
Cicatrix
03 medical and health sciences
0302 clinical medicine
Scar
Internal medicine
medicine
Humans
Late gadolinium enhancement
Radiology
Nuclear Medicine and imaging
cardiovascular diseases
Ventricular remodeling
Heart Failure
Ventricular Remodeling
medicine.diagnostic_test
business.industry
General Medicine
medicine.disease
Multivariate logistic regression model
Dyssynchrony
Glucose
Treatment Outcome
030220 oncology & carcinogenesis
Heart failure
cardiovascular system
Cardiology
Female
18F-fluorodeoxyglucose
Tomography
X-Ray Computed
business
Zdroj: European journal of nuclear medicine and molecular imaging, Vol. 48, no. 8, p. 2437-2446 (2021)
ISSN: 1619-7089
1619-7070
DOI: 10.1007/s00259-020-05161-7
Popis: BACKGROUND: Cardiac resynchronization therapy (CRT) is effective in selective heart failure (HF) patients, but non-response rate remains high. Positron emission tomography (PET) may provide a better insight into the pathophysiology of left ventricular (LV) remodeling; however, its role for evaluating and selecting patients for CRT remains uncertain. PURPOSE: We investigated if regional LV glucose metabolism in combination with myocardial scar could predict response to CRT. METHODS: Consecutive CRT-eligible HF patients underwent echocardiography, cardiac magnetic resonance (CMR), and 18F-fluorodeoxyglucose (FDG) PET within 1 week before CRT implantation. Echocardiography was additionally performed 12 months after CRT and end-systolic volume reduction ≥ 15% was defined as CRT response. Septal-to-lateral wall (SLR) FDG uptake ratio was calculated from static FDG images. Late gadolinium enhancement (LGE) CMR was analyzed semi-quantitatively to define scar extent. RESULTS: We evaluated 88 patients (67 ± 10 years, 72% males). 18F-FDG SLR showed a linear correlation with volumetric reverse remodeling 12 months after CRT (r = 0.41, p = 0.0001). In non-ischemic HF patients, low FDG SLR alone predicted CRT response with sensitivity and specificity of more than 80%; however, in ischemic HF patients, specificity decreased to 46%, suggesting that in this cohort low SLR can also be caused by the presence of a septal scar. In the multivariate logistic regression model, including low FDG SLR, presence and extent of the scar in each myocardial wall, and current CRT guideline parameters, only low FDG SLR and septal scar remained associated with CRT response. Their combination could predict CRT response with sensitivity, specificity, negative, and positive predictive value of 80%, 83%, 70%, and 90%, respectively. CONCLUSIONS: FDG SLR can be used as a predictor of CRT response and combined with septal scar extent, CRT responders can be distinguished from non-responders with high diagnostic accuracy. Further studies are needed to verify whether this imaging approach can prospectively be used to optimize patient selection.
Databáze: OpenAIRE
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