Low septal to lateral wall 18F-FDG ratio is highly associated with mechanical dyssynchrony in non-ischemic CRT candidates

• Published in: EJNMMI research Vol. 9; no. 1; pp. 1 - 10
• Main Authors: Degtiarova, Ganna, Claus, Piet, Duchenne, Jürgen, Cvijic, Marta, Schramm, Georg, Nuyts, Johan, Voigt, Jens-Uwe, Gheysens, Olivier
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 09.12.2019; Springer Nature B.V; SpringerOpen
• Subjects: Ammonia; Blood flow; Cardiac Imaging; Cardiac resynchronization therapy; Echocardiography; Fluorine isotopes; Imaging; Mechanical dyssynchrony; Medicine; Medicine & Public Health; Metabolism; Nuclear Medicine; Oncology; Original Research; Orthopedics; Perfusion; Positron emission tomography; Radiology; Septum; Metabolism; Cardiac resynchronization therapy; Perfusion; Positron emission tomography; Mechanical dyssynchrony
• ISSN: 2191-219X; 2191-219X
• DOI: 10.1186/s13550-019-0575-9

Background In order to better understand the concept of mechanical dyssynchrony, a promising hallmark of cardiac resynchronization therapy (CRT) response, we investigated its effect on regional myocardial metabolism and myocardial blood flow (MBF) in non-ischemic CRT candidates. Results Thirty consecutive non-ischemic CRT eligible patients underwent static 18 F-FDG and resting dynamic 13 N-NH 3 PET/CT. 18 F-FDG uptake and MBF for septal and lateral wall were analysed and septal-to-lateral wall ratios (SLR) were calculated. Based on the presence of mechanical dyssynchrony (septal flash and/or apical rocking) on echocardiography, patients were divided into 2 groups, with ( n  = 23) and without ( n  = 7) mechanical dyssynchrony. Patients with mechanical dyssynchrony had significantly lower 18 F-FDG SUVmean in the septum compared with the lateral wall (5.58 ± 2.65 vs 11.19 ± 4.10, p  < 0.0001), while patients without mechanical dyssynchrony had a more homogeneous 18 F-FDG distribution (7.33 ± 2.88 vs 8.31 ± 2.50, respectively, p  = 0.30). Similarly, MBF was significantly different between the septal and lateral wall in the dyssynchrony group (0.57 ± 0.11 ml/g/min vs 0.92 ± 0.23 ml/g/min, respectively, p  < 0.0001), whereas no difference was observed in the non-dyssynchrony group (0.61 ± 0.23 ml/g/min vs 0.77 ± 0.21 ml/g/min, respectively, p  = 0.16). 18 F-FDG SLR, but not MBF SLR, was associated with the presence of mechanical dyssynchrony and showed a significant inverse correlation with volumetric reverse remodeling after CRT ( r  = − 0.62, p  = 0.001). Conclusions Non-ischemic heart failure patients with mechanical dyssynchrony demonstrate heterogeneous regional metabolism and MBF compared with patients without dyssynchrony. However, only 18 F-FDG SLR appeared to be highly associated with the presence of mechanical dyssynchrony. Trial registration Clinicaltrials, NCT02537782 . Registered 2 September 2015.