特定肺动脉高压治疗对PET/MRI混合成像随访研究中心肌氟脱氧葡萄糖分布的影响

The impact of specific pulmonary arterial hypertension therapy on cardiac fluorodeoxyglucose distribution in PET/MRI hybrid imaging-follow-up study.

作者信息

Kazimierczyk Remigiusz, Szumowski Piotr, Nekolla Stephan G, Malek Lukasz A, Blaszczak Piotr, Hladunski Marcin, Sobkowicz Bozena, Mysliwiec Janusz, Kaminski Karol A

机构信息

Department of Cardiology, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland.

Department of Nuclear Medicine, Medical University of Bialystok, Curie-Sklodowskiej 24a, 15-276, Bialystok, Poland.

出版信息

EJNMMI Res. 2023 Mar 9;13(1):20. doi: 10.1186/s13550-023-00971-w.

DOI:10.1186/s13550-023-00971-w

PMID:36892707

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9998792/

Abstract

BACKGROUND

PET/MRI hybrid imaging in pulmonary arterial hypertension (PAH) provides important prognostic information identifying patients who might benefit from early therapy escalation, as right ventricle (RV) metabolic alterations are linked with hemodynamics and might precede clinical deterioration. Now, we hypothesize that adequate PAH therapy escalation may result in reversal of unfavourable increased glucose uptake of RV, which is associated with improved prognosis.

METHODS

Out of twenty-six initially clinically stable PAH patients who had baseline PET/MRI scans, twenty (49.9 ± 14.9 years) had second PET/MRI after 24 months. SUV/SUV ratio was used to estimate and compare cardiac glucose uptake. Occurrences of clinical endpoints (CEP), defined as death or clinical deterioration, were assessed during 48-month follow-up from baseline.

RESULTS

In first 24 months of observation, sixteen patients had CEP and needed PAH therapy escalation. At follow-up visits, we observed significant improvement of RV ejection fraction (45.1 ± 9.6% to 52.4 ± 12.9%, p = 0.01), mean pulmonary artery pressure (50.5 ± 18.3 to 42.8 ± 18.6 mmHg, p = 0.03), and SUV/SUV, which tended to decrease (mean change -0.20 ± 0.74). Patients with baseline SUV/SUV value higher than 0.54 had worse prognosis in 48 months observation (log-rank test, p = 0.0007); follow up SUV/SUV > 1 predicted CEP in the following 24 months, regardless of previously escalated treatment.

CONCLUSIONS

PAH therapy escalation may influence RV glucose metabolism, what seems to be related with patients' prognosis. PET/MRI assessment may predict clinical deterioration regardless of previous clinical course, however its clinical significance in PAH requires further studies. Importantly, even mild alterations of RV glucose metabolism predict clinical deterioration in long follow-up. Clinical Trial Registration ClinicalTrials.gov, NCT03688698, 05/01/2016, https://clinicaltrials.gov/ct2/show/study/NCT03688698?term=NCT03688698&draw=2&rank=1.

摘要

背景

肺动脉高压（PAH）患者的PET/MRI混合成像可提供重要的预后信息，识别可能从早期强化治疗中获益的患者，因为右心室（RV）代谢改变与血流动力学相关，且可能先于临床恶化出现。现在，我们假设适当的PAH治疗强化可能导致RV不良的葡萄糖摄取增加逆转，这与预后改善相关。

方法

在26例最初临床稳定且进行了基线PET/MRI扫描的PAH患者中，20例（49.9±14.9岁）在24个月后进行了第二次PET/MRI检查。使用SUV/SUV比值来估计和比较心脏葡萄糖摄取。在从基线开始的48个月随访期间评估临床终点事件（CEP）的发生情况，CEP定义为死亡或临床恶化。

结果

在观察的前24个月，16例患者发生CEP并需要强化PAH治疗。在随访时，我们观察到RV射血分数有显著改善（从45.1±9.6%提高到52.4±12.9%，p=0.01），平均肺动脉压（从50.5±18.3降至42.8±18.6 mmHg，p=0.03），以及SUV/SUV比值有下降趋势（平均变化-0.20±0.74）。基线SUV/SUV值高于0.54的患者在48个月观察期内预后较差（对数秩检验，p=0.0007）；随访时SUV/SUV>1可预测接下来24个月内的CEP，无论之前是否进行过强化治疗。

结论

PAH治疗强化可能影响RV葡萄糖代谢，这似乎与患者预后相关。PET/MRI评估可能预测临床恶化，无论之前的临床病程如何，但其在PAH中的临床意义需要进一步研究。重要的是，即使RV葡萄糖代谢的轻微改变也可预测长期随访中的临床恶化。临床试验注册ClinicalTrials.gov，NCT03688698，2016年1月5日，https://clinicaltrials.gov/ct2/show/study/NCT03688698?term=NCT03688698&draw=2&rank=1 。