van Campen C M C, Visser Frans C, van der Weerdt Arno P, Knaapen Paul, Comans Emile F I, Lammertsma Adriaan A, de Cock Carel C, Visser Cees A
Department of Cardiology, VU University Medical Centre, Amsterdam, The Netherlands.
Eur J Nucl Med Mol Imaging. 2007 Mar;34(3):309-15. doi: 10.1007/s00259-006-0235-y. Epub 2006 Sep 26.
Although resynchronisation therapy (CRT) is a promising addition to heart failure therapy, a substantial number of patients do not respond to CRT. As FDG PET has routinely been used for prediction of improvement after revascularisation in ischaemic cardiomyopathy, it was hypothesised that there is also a relationship between the extent of viable tissue and improvement as a result of CRT.
Thirty-nine patients with ischaemic cardiomyopathy (ejection fraction 27 +/- 9%) and a wide QRS complex underwent temporary pacing to determine the optimal pacing combination, i.e. that with the highest increase in cardiac index (CI) compared with baseline (measured by Doppler echocardiography). All patients also underwent FDG PET imaging. In 19 patients, CI measurements were repeated 10-12 weeks after permanent biventricular pacemaker implantation.
Echocardiography (13-segment model) showed a mean of 9.8 +/- 1.6 dyssynergic segments, with preserved FDG uptake in 4.1 +/- 2.4 segments. CI improvement at the optimal pacing site was 20 +/- 9%. There was a linear relationship between the extent of viable tissue and CI improvement during pacing (p < 0.001). Using a cut-off value of more than three viable segments (ROC analysis), FDG PET had a sensitivity of 72% and a specificity of 71% for detection of the presence of haemodynamic improvement (i.e. a CI improvement >15%). The relation between CI improvement and viable tissue was similar at follow-up.
A correlation was found between the extent of viable tissue and the haemodynamic response to CRT in patients with ischaemic cardiomyopathy, suggesting that FDG PET imaging may be useful to discriminate between responders and non-responders to CRT.
尽管心脏再同步治疗（CRT）是心力衰竭治疗中一项很有前景的补充治疗方法，但仍有相当数量的患者对CRT无反应。由于氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）已常规用于预测缺血性心肌病血管重建术后的改善情况，因此推测存活心肌组织范围与CRT导致的改善之间也存在关联。
39例缺血性心肌病患者（射血分数27±9%）且QRS波增宽，接受临时起搏以确定最佳起搏组合，即与基线相比心脏指数（CI）增加幅度最大的组合（通过多普勒超声心动图测量）。所有患者均接受FDG PET成像。19例患者在植入永久性双心室起搏器10 - 12周后重复测量CI。
超声心动图（13节段模型）显示平均有9.8±1.6个节段运动不同步，4.1±2.4个节段FDG摄取保留。最佳起搏部位的CI改善为20±9%。起搏期间存活心肌组织范围与CI改善之间存在线性关系（p<0.001）。使用三个以上存活节段的截断值（ROC分析），FDG PET检测血流动力学改善（即CI改善>15%）的敏感性为72%，特异性为71%。随访时CI改善与存活组织之间的关系相似。
在缺血性心肌病患者中，发现存活心肌组织范围与CRT的血流动力学反应之间存在相关性,这表明FDG PET成像可能有助于鉴别CRT的反应者和无反应者。
