Department of Nuclear Medicine, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, China Centre for Pharmacology and Therapeutics, Experimental Medicine, Imperial College London, London, UK.
Center for Diagnosis and Management of Pulmonary Vascular Diseases, Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Eur Heart J Cardiovasc Imaging. 2016 Oct;17(10):1161-8. doi: 10.1093/ehjci/jev297. Epub 2015 Nov 20.
Right ventricular (RV) glucose metabolism disorder in pulmonary arterial hypertension (PAH) has been studied using (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging with inconsistent results. We aimed to quantitatively assess RV glucose metabolism and further identify its role of monitoring RV function in idiopathic PAH (IPAH) patients in a longitudinal study.
Twenty-seven treatment-naïve IPAH patients and 21 healthy control subjects performed FDG-PET dynamic scan for quantification of the rate of myocardium glucose utilization (rMGU) and echocardiography for assessment of cardiac function. Right heart catheterization was conducted for IPAH patients for haemodynamic measurement. A subgroup of 14 patients repeated FDG-PET and echocardiography after 6-month treatment. RV rMGU was significantly increased compared with controls; while the rMGU in left ventricle showed no difference. RV rMGU was significantly correlated with pulmonary artery pressure, pulmonary vascular resistance, RV Tei index, and right atrial area, and negatively correlated with RV ejection fraction (RVEF) and tricuspid annular plane systolic excursion. Six of 14 patients with increased RV rMGU after 6-month treatment showed no change in RVEF, 6-min walk distance (6MWD), and RV Tei index; however, the other 8 patients with decreased RV rMGU demonstrated significantly increased RVEF and 6MWD and decreased RV Tei index. Notably, the change in RV rMGU of 14 patients was significantly correlated with the change in 6MWD and RV Tei index.
Increased RV rMGU of IPAH correlates with RV dysfunction and RV pressure overload. The change in RV glucose metabolism may help monitor RV function after treatment.
使用（18）F-氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）成像研究肺动脉高压（PAH）中的右心室（RV）葡萄糖代谢障碍，但结果不一致。我们旨在通过纵向研究定量评估 RV 葡萄糖代谢，并进一步确定其在特发性 PAH（IPAH）患者中监测 RV 功能的作用。
27 名未经治疗的 IPAH 患者和 21 名健康对照者进行 FDG-PET 动态扫描以定量评估心肌葡萄糖利用率（rMGU），并进行超声心动图评估心功能。对 IPAH 患者进行右心导管检查以进行血流动力学测量。14 名患者中的一个亚组在 6 个月治疗后重复 FDG-PET 和超声心动图。与对照组相比，RV rMGU 明显增加；而左心室的 rMGU 没有差异。RV rMGU 与肺动脉压、肺血管阻力、RV Tei 指数和右心房面积显著相关，与 RV 射血分数（RVEF）和三尖瓣环平面收缩期位移呈负相关。在 6 个月治疗后 RV rMGU 增加的 14 名患者中，有 6 名患者的 RVEF、6 分钟步行距离（6MWD）和 RV Tei 指数没有变化；然而，另外 8 名 RV rMGU 降低的患者显示 RVEF 和 6MWD 显著增加，RV Tei 指数降低。值得注意的是，14 名患者的 RV rMGU 变化与 6MWD 和 RV Tei 指数的变化显著相关。
IPAH 的 RV rMGU 增加与 RV 功能障碍和 RV 压力超负荷有关。RV 葡萄糖代谢的变化可能有助于监测治疗后的 RV 功能。
