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J Am Coll Cardiol, 2003; 41:1523-1528, doi:10.1016/S0735-1097(03)00257-2
© 2003 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Cardiac resynchronization therapyhomogenizes myocardial glucosemetabolism and perfusion in dilatedcardiomyopathy and left bundle branch block

Bernd Nowak, MD*,*, Anil M. Sinha, MD, PhD{dagger}, Wolfgang M. Schaefer, MD, PhD*, Karl-Christian Koch, MD{dagger}, Hans-Juergen Kaiser, PhD*, Peter Hanrath, MD, FACC{dagger}, Udalrich Buell, MD* and Christoph Stellbrink, MD{dagger}

* Department ofNuclear Medicine, University Hospital, Aachen University of Technology, Aachen, Germany
{dagger} Internal Medicine I (Cardiology), University Hospital, Aachen University of Technology, Aachen, Germany

Manuscript received September 17, 2002; revised manuscript received December 23, 2002, accepted December 27, 2002.

* Reprint requests and correspondence: Dr. Bernd Nowak, Department of Nuclear Medicine, University Hospital Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany.
bnowak{at}ukaachen.de

OBJECTIVES: We investigated whether cardiac resynchronization therapy (CRT) affects myocardial glucose metabolism and perfusion in dilated cardiomyopathy (DCM) and left bundle branch block (LBBB).

BACKGROUND: Patients with DCM and LBBB present with asynchronous left ventricular (LV) activation, leading to reduced septal glucose metabolism. Cardiac resynchronization therapy recoordinates LV activation, but its effects on myocardial glucose metabolism and perfusion remain unknown.

METHODS: In 15 patients (10 females; 61 ± 13 years) with DCM and LBBB (QRS width 165 ± 15 ms), gated 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and technetium-99m (99mTc)-sestamibi single-photon emission computed tomography were performed before and after two weeks of CRT. Uptake of FDG and 99mTc-sestamibi was determined in four LV wall areas. Ejection fraction and volumes were calculated from gated PET.

RESULTS: Baseline FDG uptake was heterogeneous (p < 0.0001), with lowest uptake in the septal region (56 ± 12%) and highest uptake in the lateral region (89 ± 6%). During CRT, septal and anterior increases (p < 0.01) and lateral decreases (p < 0.01) resulted in homogeneously distributed glucose metabolism. Baseline heterogeneity (p < 0.0001) in 99mTc-sestamibi uptake was modest (lowest septal 65 ± 10%; maximum lateral 84 ± 5%) and also reduced with CRT, although some heterogeneity (p < 0.05) remained. The septal-to-lateral ratio increased with CRT for FDG (0.62 ± 0.12 to 0.91 ± 0.26, p < 0.001) and 99mTc-sestamibi uptake (0.77 ± 0.13 to 0.85 ± 0.16, p < 0.01). The LV end-diastolic and end-systolic volumes decreased from 293 ± 160 to 272 ± 158 ml (p < 0.05) and from 244 ± 164 to 220 ± 160 ml (p < 0.01), respectively. Ejection fraction increased from 22 ± 12% to 25 ± 13% (p < 0.01).

CONCLUSIONS: Glucose metabolism is reduced more than perfusion in the septal compared with LV lateral wall in patients with DCM and LBBB. Cardiac resynchronization therapy restores homogeneous myocardial glucose metabolism with less influence on perfusion.

Abbreviations and Acronyms
  CRT = cardiac resynchronization therapy
  DCM = dilated cardiomyopathy
  FDG = 18F-fluorodeoxyglucose
  HF = heart failure
  LBBB = left bundle branch block
  LV = left ventricular
  LVEDV andLVESV = left ventricular end-diastolic and end-systolic volume, respectively
  LVEF = left ventricular ejection fraction
  PET = positron emission tomography
  SPECT = single-photon emission computed tomography
  99mTc = technetium-99m




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