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The amount of viable and dyssynchronous myocardium is associated with response to cardiac resynchronization therapy: initial clinical results using multiparametric ECG-gated [18F]FDG PET

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Abstract

Purpose

There is still a significant amount of patients who do not sufficiently respond to cardiac resynchronization therapy (CRT). Previous studies demonstrated that the amount of dyssynchronous myocardium was predictive of response to CRT. Otherwise, non-response is frequently associated with high amounts of scar tissue. The combination of these parameters might yield a more accurate prediction of response. We hypothesized that the probability of a CRT response increases with the presence of high amounts of “viable and dyssynchronous” myocardium.

Methods

A total of 19 patients (17 male, 61 ± 10 years) underwent ECG-gated [18F]fluorodeoxyglucose (FDG) myocardial positron emission tomography (PET) before CRT device implantation and were followed for 6 months. Response to CRT was defined as clinical improvement of at least one New York Heart Association (NYHA) class in combination with left ventricular (LV) ejection fraction (EF) improvement of >5 %. Twelve responders (71 %) and seven non-responders (29 %) were identified. For each patient bullseye maps of FDG uptake and phase analysis were calculated (QPS/QGS 2012, Cedars-Sinai, Los Angeles, CA, USA) and fused. Amounts of myocardium representing “viable and synchronous”, “scar and synchronous”, viable and dyssynchronous or “scar and dyssynchronous” myocardium were quantified by planimetric measurements of the fused bullseye maps.

Results

Responders by definition showed significant decrease in NYHA class and significant increase of LVEF. Furthermore, a significantly higher amount of viable and dyssynchronous myocardium was found as compared to non-responders (21 ± 13 % vs 6 ± 5 %; p < 0.05).

Conclusion

Combined assessment of myocardial viability and LV dyssynchrony is feasible using multiparametric [18F]FDG PET and could improve conventional response prediction criteria for CRT.

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Abbreviations

CRT:

Cardiac resynchronization therapy

LBBB:

Left bundle branch block

LVEF:

Left ventricular ejection fraction

LVESV:

Left ventricular end-systolic volume

FDG:

Fluorodeoxyglucose

PET:

Positron emission tomography

CT:

Computed tomography

SD:

Standard deviation

VS:

Viable and synchronous

VD:

Viable and dyssynchronous

NVS:

Non-viable and synchronous

NVD:

Non-viable and dyssynchronous

LVEDD:

Left ventricular end-diastolic diameter

LVEDV:

Left ventricular end-diastolic volume

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Conflicts of interest

Cedars-Sinai Medical Center receives royalties for the licensure of software used in the quantitative assessment of function, perfusion and viability, a portion of which is distributed to some of the authors of this article.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany

    Sebastian Lehner, Christopher Uebleis, Alexander Haug & Peter Bartenstein

  2. Medical Department I, University of Munich, Munich, Germany

    Franziska Schüßler, Stefan Kääb & Heidi Estner

  3. Cedars-Sinai Medical Center, Los Angeles and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Serge D. Van Kriekinge & Guido Germano

  4. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Theraphy, Medical University of Vienna, Währinger Gürtel 18-20, Floor 5L, 1090, Vienna, Austria

    Marcus Hacker

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  1. Sebastian Lehner
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Correspondence to Marcus Hacker.

Additional information

Sebastian Lehner and Christopher Uebleis contributed equally to this work

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Lehner, S., Uebleis, C., Schüßler, F. et al. The amount of viable and dyssynchronous myocardium is associated with response to cardiac resynchronization therapy: initial clinical results using multiparametric ECG-gated [18F]FDG PET. Eur J Nucl Med Mol Imaging 40, 1876–1883 (2013). https://doi.org/10.1007/s00259-013-2516-6

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  • DOI: https://doi.org/10.1007/s00259-013-2516-6

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