title: The amount of viable and dyssynchronous myocardium is associated with response to cardiac resynchronization therapy: initial clinical results using multiparametric ECG-gated [18F]FDG PET.
abstract: OBJECTIVE
  There is still a significant amount of patients who do not sufficiently respond to cardiac resynchronization therapy (CRT). Previous studies demonstrated that the amount of dyssynchronous myocardium was predictive of response to CRT. Otherwise, non-response is frequently associated with high amounts of scar tissue. The combination of these parameters might yield a more accurate prediction of response. We hypothesized that the probability of a CRT response increases with the presence of high amounts of "viable and dyssynchronous" myocardium.
  
  
  METHODS
  A total of 19 patients (17 male, 61 ± 10 years) underwent ECG-gated [(18)F]fluorodeoxyglucose (FDG) myocardial positron emission tomography (PET) before CRT device implantation and were followed for 6 months. Response to CRT was defined as clinical improvement of at least one New York Heart Association (NYHA) class in combination with left ventricular (LV) ejection fraction (EF) improvement of >5%. Twelve responders (71%) and seven non-responders (29%) were identified. For each patient bullseye maps of FDG uptake and phase analysis were calculated (QPS/QGS 2012, Cedars-Sinai, Los Angeles, CA, USA) and fused. Amounts of myocardium representing "viable and synchronous", "scar and synchronous", viable and dyssynchronous or "scar and dyssynchronous" myocardium were quantified by planimetric measurements of the fused bullseye maps.
  
  
  RESULTS
  Responders by definition showed significant decrease in NYHA class and significant increase of LVEF. Furthermore, a significantly higher amount of viable and dyssynchronous myocardium was found as compared to non-responders (21 ± 13% vs 6 ± 5%; p < 0.05).
  
  
  CONCLUSIONS
  Combined assessment of myocardial viability and LV dyssynchrony is feasible using multiparametric [(18)F]FDG PET and could improve conventional response prediction criteria for CRT.
authors.affiliation: Department of Nuclear Medicine, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Lehner
authors.forename: Christopher
authors.initials: C
authors.lastname: Uebleis
authors.forename: Franziska
authors.initials: F
authors.lastname: Schüßler
authors.forename: Alexander
authors.initials: A
authors.lastname: Haug
authors.forename: Stefan
authors.initials: S
authors.lastname: Kääb
authors.forename: Peter
authors.initials: P
authors.lastname: Bartenstein
authors.forename: Serge D
authors.initials: SD
authors.lastname: Van Kriekinge
authors.forename: Guido
authors.initials: G
authors.lastname: Germano
authors.forename: Heidi
authors.initials: H
authors.lastname: Estner
authors.forename: Marcus
authors.initials: M
authors.lastname: Hacker
mesh_terms: D058406:Cardiac Resynchronization Therapy; D055424:Cardiac-Gated Imaging Techniques; D004562:Electrocardiography; D005260:Female; D019788:Fluorodeoxyglucose F18; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D049268:Positron-Emission Tomography; D014022:Tissue Survival; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy
chemical_list: D019788:Fluorodeoxyglucose F18
references.citation: J Nucl Cardiol. 2005 Nov-Dec;12(6):687-95
references.pmid: 16344231
references.citation: Pacing Clin Electrophysiol. 2007 Oct;30(10):1201-9
references.pmid: 17897122
references.citation: Am Heart J. 2007 Jan;153(1):105-12
references.pmid: 17174647
references.citation: Heart Rhythm. 2012 Aug;9(8 Suppl):S45-50
references.pmid: 22521929
references.citation: Eur J Nucl Med Mol Imaging. 2007 Mar;34(3):309-15
references.pmid: 17021810
references.citation: J Nucl Med. 2007 Jul;48(7):1104-11
references.pmid: 17574987
references.citation: Eur J Nucl Med Mol Imaging. 2012 Oct;39(10):1561-9
references.pmid: 22752450
references.citation: N Engl J Med. 2011 Apr 28;364(17):1617-25
references.pmid: 21463153
references.citation: J Am Coll Cardiol. 2008 Oct 21;52(17):1402-9
references.pmid: 18940531
references.citation: Am J Cardiol. 2006 Jun 1;97(11):1615-21
references.pmid: 16728225
references.citation: Curr Opin Cardiol. 2006 Jan;21(1):20-6
references.pmid: 16355025
references.citation: N Engl J Med. 2005 Apr 14;352(15):1539-49
references.pmid: 15753115
references.citation: Echocardiography. 2013 Sep;30(8):896-903
references.pmid: 23489174
references.citation: Circulation. 2002 Oct 1;106(14):1760-3
references.pmid: 12356626
references.citation: Am J Cardiol. 2005 May 15;95(10):1223-5
references.pmid: 15877995
references.citation: Am J Cardiol. 2003 Nov 15;92(10):1238-40
references.pmid: 14609610
references.citation: J Nucl Med. 2012 Jan;53(1):47-54
references.pmid: 22159181
references.citation: Lancet. 2011 Aug 20;378(9792):722-30
references.pmid: 21856486
references.citation: J Nucl Cardiol. 2011 Oct;18(5):920-5
references.pmid: 21671145
references.citation: N Engl J Med. 2010 Dec 16;363(25):2385-95
references.pmid: 21073365
references.citation: J Nucl Med. 2011 Jan;52(1):67-71
references.pmid: 21149479
references.citation: J Nucl Med. 2006 Oct;47(10):1565-70
references.pmid: 17015888
references.citation: J Cardiovasc Electrophysiol. 2009 Jan;20(1):50-7
references.pmid: 18803571
references.citation: J Nucl Med. 2009 May;50(5):718-25
references.pmid: 19403876
references.citation: Eur Heart J. 2012 Jul;33(14):1787-847
references.pmid: 22611136
references.citation: Europace. 2013 May;15(5):704-10
references.pmid: 23385052