Positron emission tomographic demonstration of myocardial oxidative metabolism in a case of left ventricular restoration after cardiac resynchronization therapy.
A 65-year-old man with a history of coronary artery bypass grafting was admitted because of severe heart failure. Echocardiography showed diffuse severe hypokinesis of the left ventricle (ejection fraction 25%) and severe mitral regurgitation caused by tethering of the leaflet secondary to left ventricular (LV) dilation. He underwent mitral valve annuloplasty and LV papillary muscle imbrication, but postoperative sustained ventricular tachycardia developed and echocardiography showed ventricular dyssynchrony with a long septal-to-posterior wall motion delay (>130 ms). Cardiac resynchronization therapy (CRT) was performed using a biventricular pacing system with an implantable cardioverter defibrillator, but biventricular pacing prolonged the QRS duration from 130 to 160 ms, so (11)C-acetate positron emission tomography was performed to evaluate the CRT. During biventricular pacing, myocardial oxidative consumption decreased by 15% and cardiac efficiency increased by 33%. The plasma brain natriuretic peptide level, which was 9,500 pg/ml preoperatively, decreased to 173 pg/ml just before discharge from hospital.
Kitaizumi
Kenji
K
Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kita-gun, Kagawa, Japan.
Yukiiri
Kazushi
K
Masugata
Hisashi
H
Shinomiya
Kaori
K
Ohara
Minako
M
Takinami
Hiroyuki
H
Iwado
Yasuyoshi
Y
Yoshida
Junji
J
Noma
Takahisa
T
Ohmori
Koji
K
Yamashita
Yoichi
Y
Horii
Taiko
T
Senda
Shoich
S
Kohno
Masakazu
M
D000368:Aged; D004452:Echocardiography; D004554:Electric Countershock; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000378:metabolism*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000378:metabolism; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010084:Oxidation-Reduction; D010101:Oxygen Consumption; D049268:Positron-Emission Tomography; D011859:Radiography; D020257:Ventricular Remodeling
D020097:Natriuretic Peptide, Brain