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CLINICAL RESEARCH: CARDIAC IMAGING

Myocardial positron emission computed tomographic images obtained with fluorine-18 fluoro-2-deoxyglucose predict the response of idiopathic dilated cardiomyopathy patients to beta-blockers

Shinji Hasegawa, MD, PhD^*,*, Hideo Kusuoka, MD, PhD, FACC, Kaoru Maruyama, MD, PhD^*, Tsunehiko Nishimura, MD, PhD, Masatsugu Hori, MD, PhD, FACC and Jun Hatazawa, MD, PhD^*

^* Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, Suita, Japan
Vice Director General, Osaka National Hospital, Osaka, Japan
Department of Radiology, Graduate School of Medical Science Kyoto Prefectural University of Medicine, Kyoto, Japan
Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan

Manuscript received February 3, 2003; revised manuscript received September 5, 2003, accepted September 9, 2003.

^* Reprint requests and correspondence: Dr. Shinji Hasegawa, Department of Tracer Kinetics and Nuclear Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka (D9), Suita, Osaka, Japan 565-0871.
hasegawa{at}tracer.med.osaka-u.ac.jp

OBJECTIVES: The aim of this study was to elucidate whether the response of idiopathic dilated cardiomyopathy (DCM) patients to ß-blockers can be predicted by positron emission tomography with fluorine-18 fluoro-2-deoxyglucose (FDG-PET).

BACKGROUND: Patients with DCM often have a poor prognosis, and it is important to predict their response to ß-blocker therapy, which may be effective in DCM. However, no accurate methods of predicting their response have been available.

METHODS: In 22 DCM patients with reduced left ventricular (LV) systolic function, FDG-PET was performed. Uptake in the LV after glucose loading was evaluated based on the average global percent uptake of the injected dose (G%ID) and the coefficient of variance (CV) in 24 segments of the LV. Uptake during fasting was evaluated semiquantitatively on the basis of the total uptake score. The ß-blocker was administered, and LV function was monitored by echocardiography. The histologic findings were assessed in the 18 patients who underwent endomyocardial biopsy.

RESULTS: The ß-blocker was effective in the majority of patients whose G%ID after glucose loading was >0.7%, and the sensitivity and specificity of G%ID as a predictor of ß-blocker efficacy were 83.3% and 90.0%, respectively. Percent CV did not predict efficacy. Four groups, defined on the basis of the FDG uptake score during fasting and G%ID after glucose loading, had distinctive histologic findings and outcomes.

CONCLUSIONS: It has been shown that FDG-PET is a good predictor for the effectiveness of ß-blockers.

Abbreviations and Acronyms   CV = coefficient of variance   DCM = dilated cardiomyopathy   FDG = fluorine-18 fluoro-2-deoxyglucose   (G)%ID = (global) percent uptake of injected dose per 100 g tissue   HCFI = histopathologic contractility failure index   HF = heart failure   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   PET = positron emission tomography   SPECT = single-photon emission computed tomography

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