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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

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.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CMR:

Cardiac magnetic resonance

CRT:

Cardiac resynchronization therapy

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

FDG:

18F-fluorodeoxyglucose

HF:

Heart failure

LBBB:

Left bundle branch block

LGE:

Late-gadolinium enhancement

LV:

Left ventricle

SLR:

Septal-to-lateral wall ratio

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Funding

This work was supported by a KU Leuven research grant (OT/12/084). OG and JUV are senior clinical investigators of the Fund for Scientific Research Flanders (FWO).

Author information

Author notes

  1. Olivier Gheysens

    Present address: Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium

Authors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium

    Ganna Degtiarova, Johan Nuyts & Olivier Gheysens

  2. Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium

    Ganna Degtiarova & Olivier Gheysens

  3. Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium

    Piet Claus, Jürgen Duchenne, Gabor Vöros, Rik Willems & Jens-Uwe Voigt

  4. Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium

    Jürgen Duchenne, Gabor Vöros, Rik Willems & Jens-Uwe Voigt

  5. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    Jan Bogaert

  6. Department of Cardiology, Oslo University Hospital, Oslo, Norway

    Camilla Kjellstad Larsen, John M. Aalen & Otto Armin Smiseth

  7. Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

    Jan Gunnar Fjeld, Caroline Stokke & Einar Hopp

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  1. Ganna Degtiarova
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Contributions

Substantial contributions to the conception: GD, PC, JD, JB, JN, GV, RW, CKL, JA, JGF, CS, EH, OAS, JUV, and OG. Design of the work: GD, PC, JB, GV, CKL, OAS, JUV, and OG. The acquisition and analysis of data: GD, JD, JB, CKL, JA, JUV, and OG. Interpretation of data: GD, PC, JD, JB, JN, RW, CKL, JA, JGF, JUV, and OG. The creation of new software used in the work: JN. Drafting of the work or substantively revising it: GD, PC, JD, JB, JN, OAS, JUV, and OG. Approval of the submitted version: GD, PC, JD, JB, JN, GV, RW, CKL, JA, JGF, CS, EH, OAS, JUV, and OG.

Corresponding author

Correspondence to Piet Claus.

Ethics declarations

Competing interests

RW reports research funding from Biotronik, Boston Scientific, Medtronic; speakers and consultancy fees from Medtronic, Boston Scientific, Biotronik, Abbott, Microport. RW is supported as postdoctoral clinical researcher by the Fund for Scientific Research Flanders. All other authors report no relationships that could be construed as a conflict of interest.

Ethics approval and consent to participate

The study was approved by the local institutional ethics committees and all patients gave written and informed consent prior to inclusion. The WORK-CRT study was registered at ClinicalTrials.gov (NCT02537782).

Consent for publication

Consent for publication of the images has been obtained from the patients.

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Not applicable.

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This article is part of the Topical Collection on Cardiology

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Degtiarova, G., Claus, P., Duchenne, J. et al. Left ventricular regional glucose metabolism in combination with septal scar extent identifies CRT responders. Eur J Nucl Med Mol Imaging 48, 2437–2446 (2021). https://doi.org/10.1007/s00259-020-05161-7

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  • DOI: https://doi.org/10.1007/s00259-020-05161-7

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