The amount of viable and dyssynchronous myocardium is associated with response to cardiac resynchronization therapy: ini
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ORIGINAL ARTICLE
The amount of viable and dyssynchronous myocardium is associated with response to cardiac resynchronization therapy: initial clinical results using multiparametric ECG-gated [18F]FDG PET Sebastian Lehner & Christopher Uebleis & Franziska Schüßler & Alexander Haug & Stefan Kääb & Peter Bartenstein & Serge D. Van Kriekinge & Guido Germano & Heidi Estner & Marcus Hacker
Received: 8 April 2013 / Accepted: 7 July 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose There is still a significant amount of patients who do not sufficiently respond to cardiac resynchronization therapy (CRT). Previous studies demonstrated that the amount of dyssynchronous myocardium was predictive of response to CRT. Otherwise, non-response is frequently associated with high amounts of scar tissue. The combination of these parameters might yield a more accurate prediction of response. We hypothesized that the probability of a CRT response increases with the presence of high amounts of “viable and dyssynchronous” myocardium. Methods A total of 19 patients (17 male, 61± 10 years) underwent ECG-gated [ 18 F]fluorodeoxyglucose (FDG) myocardial positron emission tomography (PET) before CRT device implantation and were followed for 6 months. Response to CRT was defined as clinical improvement of at least one New York Heart Association (NYHA) class in combination with left ventricular (LV) ejection fraction
(EF) improvement of >5 %. Twelve responders (71 %) and seven non-responders (29 %) were identified. For each patient bullseye maps of FDG uptake and phase analysis were calculated (QPS/QGS 2012, Cedars-Sinai, Los Angeles, CA, USA) and fused. Amounts of myocardium representing “viable and synchronous”, “scar and synchronous”, viable and dyssynchronous or “scar and dyssynchronous” myocardium were quantified by planimetric measurements of the fused bullseye maps. Results Responders by definition showed significant decrease in NYHA class and significant increase of LVEF. Furthermore, a significantly higher amount of viable and dyssynchronous myocardium was found as compared to non-responders (21±13 % vs 6±5 %; p150 ms (n=5) were included in the present study. The selection criteria for CRT treatment were in accordance with the current European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure [1]. In addition, patients that received revascularization less than 6 months prior to CRT were excluded from the study. All patients underwent a single positron emission tomography (PET)/CT scan at a mean of 10±13 days prior to CRT and received a CRT system with implantable cardioverter-defibrillator backup (Medtronic, St. Jude Medical, Guidant, Biotronik, Inc., Lake Oswego, OR, USA). Two-dimensional transthoracic echocardiography and clinical follow-up Patients received standard two-dimensional transthoracic echocardiography at baseline and during follow-up at 1, 3 and 6 months after CRT in the Department of Cardiology of our clinic, including the assessment of LVEF, left ve
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