Left ventricular regional glucose metabolism in combination with septal scar extent identifies CRT responders.
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 evaluatin...
| Publicado en: | European Journal of Nuclear Medicine & Molecular Imaging Vol. 48; no. 8; pp. 2437 - 2447 |
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| Autores principales: | , , , , , , , , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Springer Nature
Jul2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=152814328&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 152814328 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 16197070 NPC jtl: European Journal of Nuclear Medicine & Molecular Imaging issn: 16197070 maglogo: N pubinfo: dt: Jul2021 vid: 48 iid: 8 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 152814328 148007852 10.1007/s00259-020-05161-7 152814328 ppf: 2437 ppct: 10 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Left ventricular regional glucose metabolism in combination with septal scar extent identifies CRT responders. aug: au: Degtiarova, Ganna Claus, Piet Duchenne, Jürgen Bogaert, Jan Nuyts, Johan Vöros, Gabor Willems, Rik Larsen, Camilla Kjellstad Aalen, John M. Fjeld, Jan Gunnar Stokke, Caroline Hopp, Einar Smiseth, Otto Armin Voigt, Jens-Uwe Gheysens, Olivier affil: Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium sug: ab: 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. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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