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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, Wolfgang M. Schaefer, MD, PhD^*, Karl-Christian Koch, MD, Hans-Juergen Kaiser, PhD^*, Peter Hanrath, MD, FACC, Udalrich Buell, MD^* and Christoph Stellbrink, MD

^* Department ofNuclear Medicine, University Hospital, Aachen University of Technology, Aachen, Germany
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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