Hasegawa Shinji, Kusuoka Hideo, Maruyama Kaoru, Nishimura Tsunehiko, Hori Masatsugu, Hatazawa Jun
Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
J Am Coll Cardiol. 2004 Jan 21;43(2):224-33. doi: 10.1016/j.jacc.2003.09.025.
The aim of this study was to elucidate whether the response of idiopathic dilated cardiomyopathy (DCM) patients to beta-blockers can be predicted by positron emission tomography with fluorine-18 fluoro-2-deoxyglucose (FDG-PET).
Patients with DCM often have a poor prognosis, and it is important to predict their response to beta-blocker therapy, which may be effective in DCM. However, no accurate methods of predicting their response have been available.
In 22 DCM patients with reduced left ventricular (LV) systolic function, FDG-PET was performed. Uptake in the LV after glucose loading was evaluated based on the average global percent uptake of the injected dose (G%ID) and the coefficient of variance (CV) in 24 segments of the LV. Uptake during fasting was evaluated semiquantitatively on the basis of the total uptake score. The beta-blocker was administered, and LV function was monitored by echocardiography. The histologic findings were assessed in the 18 patients who underwent endomyocardial biopsy.
The beta-blocker was effective in the majority of patients whose G%ID after glucose loading was >0.7%, and the sensitivity and specificity of G%ID as a predictor of beta-blocker efficacy were 83.3% and 90.0%, respectively. Percent CV did not predict efficacy. Four groups, defined on the basis of the FDG uptake score during fasting and G%ID after glucose loading, had distinctive histologic findings and outcomes.
It has been shown that FDG-PET is a good predictor for the effectiveness of beta-blockers.
本研究旨在阐明氟-18氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）能否预测特发性扩张型心肌病（DCM）患者对β受体阻滞剂的反应。
DCM患者预后通常较差，预测他们对β受体阻滞剂治疗的反应很重要，β受体阻滞剂治疗DCM可能有效。然而，尚无准确预测其反应的方法。
对22例左心室（LV）收缩功能降低的DCM患者进行FDG-PET检查。根据葡萄糖负荷后左心室的平均整体摄取剂量百分比（G%ID）和左心室24个节段的变异系数（CV）评估左心室摄取情况。基于总摄取分数对空腹时的摄取情况进行半定量评估。给予β受体阻滞剂，并通过超声心动图监测左心室功能。对18例行心内膜心肌活检的患者的组织学结果进行评估。
葡萄糖负荷后G%ID>0.7%的大多数患者对β受体阻滞剂有效，G%ID作为β受体阻滞剂疗效预测指标的敏感性和特异性分别为83.3%和90.0%。CV百分比不能预测疗效。根据空腹时的FDG摄取分数和葡萄糖负荷后的G%ID定义的四组患者具有独特的组织学结果和预后。
已表明FDG-PET是β受体阻滞剂疗效的良好预测指标。
