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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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.
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.
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).
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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About this Article
- 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
European Journal of Nuclear Medicine and Molecular Imaging
Volume 40, Issue 12 , pp 1876-1883
- Cover Date
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- Online ISSN
- Springer Berlin Heidelberg
- Additional Links
- Gated myocardial PET
- Cardiac resynchronization therapy
- Ventricular dyssynchrony
- Industry Sectors
- Author Affiliations
- 1. Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany
- 2. Medical Department I, University of Munich, Munich, Germany
- 3. Cedars-Sinai Medical Center, Los Angeles and David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- 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