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The effects of cardiac resynchronization therapy on left ventricular function, myocardial energetics, and metabolic reserve in patients with dilated cardiomyopathy and heart failure

Jan Sundell, MD^*, Erik Engblom, MD, Juhani Koistinen, MD, Antti Ylitalo, MD, Alexandru Naum, MD^*, Kira Q. Stolen, PhD^*, Riikka Kalliokoski, MSc^*, Stephan G. Nekolla, MD, K. E. Juhani Airaksinen, MD, Jeroen J. Bax, MD^|| and Juhani Knuuti, MD^*,*

^* Turku PET Centre, Turku, Finland
Departments of Medicine, University of Turku, Turku, Finland
Department of Medicine, Satakunta Central Hospital, Pori, Finland
Klinik und Poliklinik fuer Nuklearmedizin, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Muenchen, Germany
^|| Department of Cardiology, Leiden University, Leiden, Netherlands

View larger version (13K): [in a new window]   Figure 1 Study design: patients were studied on two separate occasions: while cardiac resynchronization therapy (CRT) was switched on and after CRT was switched off for 24 h. Serum natriuretic peptides were measured immediately preceding the positron emission tomography (PET) studies. Myocardial blood flow was quantitated using PET and [15O]water ([15O]H2O) at baseline and during adenosine infusion (140 µg/kg/min for 7.5 min). Left ventricular oxidative metabolism was measured using PET and [11C]acetate at baseline and during low-dose dobutamine infusion (5 µg/kg/min for 60 min). Left ventricular function was measured using two-dimensional echocardiography first at rest and then during dobutamine infusion. Open bars = perfusion measurement; solid bars = oxidative metabolism measurement.

View larger version (22K): [in a new window]   Figure 2 Cardiac resynchronization therapy (CRT) enhanced left ventricular stroke volume significantly at baseline but not during dobutamine-induced stress. Open bars = CRT on; solid bars = CRT off.

View larger version (19K): [in a new window]   Figure 3 Cardiac resynchronization therapy (CRT) had no significant effect on basal- or adenosine-stimulated myocardial blood flow.

View larger version (23K): [in a new window]   Figure 4 Left ventricular (LV) oxidative metabolism (Kmono) was unchanged by cardiac resynchronization therapy (CRT), but dobutamine-induced stress significantly increased Kmono values. Open bars = CRT on; solid bars = CRT off.

View larger version (21K): [in a new window]   Figure 5 Cardiac resynchronization therapy (CRT) significantly increased basal myocardial efficiency, and the same, but weaker, trend was seen during dobutamine-induced stress. Open bars = CRT on; solid bars = CRT off.