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CLINICAL RESEARCH: PULMONARY HYPERTENSION

Increased [¹⁸F]Fluorodeoxyglucose Accumulation in Right Ventricular Free Wall in Patients With Pulmonary Hypertension and the Effect of Epoprostenol

Minako Oikawa, MD^_*, Yutaka Kagaya, MD, PhD^_*,_*, Hiroki Otani, MD, PhD^_*, Masahito Sakuma, MD, PhD^_*, Jun Demachi, MD^_*, Jun Suzuki, MD, PhD^_*, Tohru Takahashi, MD, PhD^_*, Jun Nawata, MD, PhD^_*, Tatsuo Ido, PhD, Jun Watanabe, MD, PhD^_* and Kunio Shirato, MD, PhD^_*

^_* Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
Cyclotron and Radioisotope Center, Tohoku University, Sendai, Japan

Manuscript received November 29, 2004; revised manuscript received January 16, 2005, accepted February 22, 2005.

^_* Reprint requests and correspondence: Dr. Yutaka Kagaya, Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aoba-ku, Sendai 980-8574, Japan. (Email: kagaya{at}cardio.med.tohoku.ac.jp).

OBJECTIVES: We examined whether right ventricular (RV) [¹⁸F]fluorodeoxyglucose (FDG) accumulation is increased in patients with pulmonary hypertension using gated positron emission tomography (PET) and whether RV FDG accumulation changes after therapy with epoprostenol.

BACKGROUND: Myocardial glucose utilization is increased in animal models with ventricular pressure overload.

METHODS: We performed gated FDG-PET in 24 patients with pulmonary hypertension. The RV standardized uptake value (SUV) of FDG was corrected for the partial volume effect based on the wall thickness measured by electron-beam computed tomography or magnetic resonance imaging.

RESULTS: The corrected RV SUV of FDG was significantly correlated with the pulmonary vascular resistance, mean pulmonary artery pressure, right atrial pressure, RV wall stress, and plasma brain natriuretic peptide levels, but not with the RV wall thickness and mass. After pulmonary vasodilator therapy with epoprostenol for three months, the corrected RV SUV of FDG significantly decreased in the responders, but not in the non-responders, and the percentage change of the corrected RV SUV of FDG was significantly correlated with the percentage change of the pulmonary vascular resistance (r = 0.78; p < 0.01) and RV systolic wall stress (r = 0.76; p < 0.05).

CONCLUSIONS: The RV FDG accumulation corrected for the partial volume effect was significantly increased in accordance with the severity of the RV pressure overload (i.e., the RV peak-systolic wall stress) in patients with pulmonary hypertension. Furthermore, the corrected RV FDG accumulation was decreased after the treatment with epoprostenol in accordance with the degree of reduction in the pulmonary vascular resistance and RV peak-systolic wall stress.

Abbreviations and Acronyms   BNP = brain natriuretic peptide   EBCT = electron-beam computed tomography   ECG = electrocardiogram/electrocardiography   FDG = [18F]fluorodeoxyglucose   LV = left ventricle/ventricular   MRI = magnetic resonance imaging   PET = positron emission tomography   ROI = region of interest   RV = right ventricle/ventricular   SUV = standardized uptake value

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