title: Decreased glycolytic metabolism in non-compaction cardiomyopathy by 18F-fluoro-2-deoxyglucose positron emission tomography: new insights into pathophysiological mechanisms and clinical implications.
abstract: OBJECTIVE
  The pathophysiological mechanisms of left ventricular non-compaction cardiomyopathy (LVNC) remain controversial. This study performed combined 18F-fluoro-2-deoxyglucose dynamic positron emission tomography (FDG-PET) and 99mTc-sestamibi single-photon emission computed tomography (SPECT) studies to evaluate myocardial glucose metabolism and perfusion in patients with LVNC and their clinical implications.
  
  
  RESULTS
  Thirty patients (41 ± 12 years, 53% male) with LVNC, diagnosed by cardiovascular magnetic resonance (CMR) criteria, and eight age-matched healthy controls (42 ± 12 years, 50% male) were prospectively recruited to undergo FDG-PET with measurement of the myocardial glucose uptake rate (MGU) and SPECT to investigate perfusion-metabolism patterns. Patients with LVNC had lower global MGU compared with that in controls (36.9 ± 8.8 vs. 44.6 ± 5.4 μmol/min/100 g, respectively, P = 0.02). Of 17 LV segments, MGU levels were significantly reduced in 8, and also a reduction was observed when compacted segments from LVNC were compared with the segments from control subjects (P < 0.001). Perfusion defects were also found in 15 (50%) patients (45 LV segments: 64.4% match, and 35.6% mismatch perfusion-metabolism pattern). Univariate and multivariate analyses showed that beta-blocker therapy was associated with increased MGU (beta coefficient = 10.1, P = 0.008). Moreover, a gradual increase occurred in MGU across the beta-blocker dose groups (P for trend = 0.01).
  
  
  CONCLUSIONS
  The reduction of MGU documented by FDG-PET in LVNC supports the hypothesis that a cellular metabolic pathway may play a role in the pathophysiology of LVNC. The beneficial effect of beta-blocker mediating myocardial metabolism in the clinical course of LVNC requires further investigation.
authors.affiliation: Heart Failure Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44. Cerqueira César, São Paulo, 05403-000, Brazil.
authors.forename: Marcelo Dantas
authors.initials: MD
authors.lastname: Tavares de Melo
authors.affiliation: Nuclear Medicine Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44. Cerqueira César, São Paulo, 05403-000, Brazil.
authors.forename: Maria Clementina Pinto
authors.initials: MCP
authors.lastname: Giorgi
authors.affiliation: Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Antonildes Nascimento
authors.initials: AN
authors.lastname: Assuncao
authors.affiliation: Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Roberto Nery
authors.initials: RN
authors.lastname: Dantas
authors.affiliation: Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Jose de Arimateia
authors.initials: JA
authors.lastname: Araujo Filho
authors.affiliation: Cardiovascular Magnetic Resonance and Computed Tomography Sector, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Jose Rodrigues
authors.initials: JR
authors.lastname: Parga Filho
authors.affiliation: Indeed Teaching and Research Institute, Hospital Sírio-Libanes, São Paulo, Brazil.
authors.forename: Ana Luiza de Souza
authors.initials: ALS
authors.lastname: Bierrenbach
authors.affiliation: Heart Failure Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44. Cerqueira César, São Paulo, 05403-000, Brazil.
authors.forename: Camila Rocon
authors.initials: CR
authors.lastname: de Lima
authors.affiliation: Nuclear Medicine Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44. Cerqueira César, São Paulo, 05403-000, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Soares
authors.affiliation: Nuclear Medicine Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44. Cerqueira César, São Paulo, 05403-000, Brazil.
authors.forename: José Claudio
authors.initials: JC
authors.lastname: Meneguetti
authors.affiliation: Cardiomyopathy Unit (CM), Department of Cardiopneumology, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
authors.affiliation: Indeed Teaching and Research Institute, Hospital Sírio-Libanes, São Paulo, Brazil.
authors.forename: Ludhmila Abrahão
authors.initials: LA
authors.lastname: Hajjar
authors.affiliation: Indeed Teaching and Research Institute, Hospital Sírio-Libanes, São Paulo, Brazil.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
authors.affiliation: Heart Failure Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44. Cerqueira César, São Paulo, 05403-000, Brazil.
authors.forename: Edimar Alcides
authors.initials: EA
authors.lastname: Bocchi
authors.affiliation: Heart Failure Unit, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44. Cerqueira César, São Paulo, 05403-000, Brazil.
authors.forename: Vera Maria Cury
authors.initials: VMC
authors.lastname: Salemi
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007089:Image Enhancement; D056830:Isolated Noncompaction of the Ventricular Myocardium / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D019788:Fluorodeoxyglucose F18; D005947:Glucose
keywords: PET; metabolism ; pathophysiology ; perfusion ;  non-compaction 