Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction
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Dynamic 18F-fluorodeoxyglucose (FDG) PET can be used to quantitatively assess the rate of myocardial glucose uptake (MRGlu). The aim of this study was to evaluate the clinical significance and prognostic value of right ventricular (RV) MRGlu in patients with coronary artery disease and heart failure with reduced ejection fraction.
Patients with left ventricular ejection fraction (LVEF) ≤ 40% were consecutively enrolled for FDG PET between November 2012 and May 2017. Global LV and RV MRGlu (μmol/min/100 g) were analyzed. Outcome events were independently assessed using electronic medical records to determine hospitalization for revascularization, new-onset ischemic events, heart failure, cardiovascular, and all-cause death. Differences between LV and RV MRGlu and associations with clinical characteristics and echocardiographic data were evaluated. Associations among FDG PET findings and outcomes were analyzed using Kaplan-Meier survival analysis.
Seventy-five patients (mean age 62.2 ± 12.7 years, male 85.3%, LVEF 19.3 ± 8.6%) were included for analysis. The mean glucose utilization ratio of RV-to-LV (RV/LV MRGlu) was 89.5 ± 264.9% (r = 0.77, p < 0.001). Positive correlations between RV MRGlu and maximal tricuspid regurgitation peak gradient (r = 0.28, p = 0.033) and peak tricuspid regurgitation jet velocity (r = 0.29, p = 0.021) were noted. LVEF was positively correlated with LV MRGlu (r = 0.27, p = 0.018), but negatively correlated with end-diastolic volume (r = − 0.37, p = 0.001), end-systolic volume (r = − 0.54, p < 0.001), and RV/LV MRGlu (r = − 0.40, p < 0.001). However, RV MRGlu was not well correlated with LVEF. Forty-three patients received revascularization procedures after FDG PET, and 13 patients died in a mean follow-up period of 496 ± 453 days (1–1788 days), including nine cardiovascular deaths. Higher RV and LV MRGlu values, LVEF ≤ 16% and LV end-diastolic volume ≥ 209 ml of gated-PET were associated with poor overall survival and cardiac outcomes.
In patients with coronary artery disease and ischemic cardiomyopathy, RV glucose utilization was positively correlated with RV pressure overload, but not LVEF. Global LV and RV MRGlu, LVEF, and LV end-diastolic volume showed significant prognostic value.
KeywordsHeart failure 18F-fluorodeoxyglucose Positron emission tomography Rate of myocardial glucose uptake Right ventricle
The authors thank Ms. Ya-Huang Chen, Ms. Chia-Wen Lai, Mr. Chao-Chun Huang and Mr. Po-Wei Li for dynamic PET acquisition, and Dr. Kuan-Yin Ko, Ms. Yu-Shuan Hung, and Mr. Chien-Yu Chu for their assistance in PET analyses and clinical data collection.
This study was funded by Ministry of Science and Technology of Taiwan (MOST-101-2314-B-418-012-MY3, MOST-104-2314-B-418-008, MOST-105-2628-B-418-002-MY2, MOST-107-2314-B-418-006-MY3) and Far Eastern Memorial Hospital (FEMH-101-2314-B-418-012-MY3, FEMH-104-2314-B-418-008, FEMH-105-2628-B-418-002-MY2, FEMH-107-2314-B-418-006-MY3).
Compliance with ethical standards
Research involving human participants and/or animals
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
Except for financially supported by the Ministry of Science and Technology of Taiwan (MOST-101-2314-B-418-012-MY3, MOST-104-2314-B-418-008, MOST-105-2628-B-418-002-MY2, MOST-107-2314-B-418-006-MY3) and Far Eastern Memorial Hospital (FEMH-101-2314-B-418-012-MY3, FEMH-104-2314-B-418-008, FEMH-105-2628-B-418-002-MY2, FEMH-107-2314-B-418-006-MY3), no other relevant potential conflicts of interest exist. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Corresponding author Yen-Wen Wu has received research grants from Ministry of Science and Technology of Taiwan and Far Eastern Memorial Hospital. The other authors declare that they have no conflict of interest.
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