Radionuclide assessment of regional differences in left ventricular wall motion and myocardial perfusion in idiopathic dilated cardiomyopathy

Juillière, Yves; Marié, Pierre; Danchin, Nicolás; Gillet, Claudine; Paille, F.; Karcher, Gilles; Bertrand, Anne; Cherrier, F

doi:10.1093/eurheartj/14.9.1163

Cited by 55 publications

(33 citation statements)

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“…Besides focal myocardial fibrosis, 22,[27][28][29] recent studies have suggested that perfusion and metabolism may be affected by endothelial dysfunction in DCM. [30][31][32] LBBB is known to impair LV mechanical function and is an important predictor of cardiac mortality in patients with HF caused by DCM. 10,33 Previous studies found that perfusion and glucose metabolism were reduced in cases with LBBB, [34][35][36][37][38][39][40][41][42] and the extent of scarring correlates with QRS duration.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Naya

Tsukamoto

et al. 2008

Circ J

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eart failure (HF) is the final common stage of various heart diseases and has a significant effect on quality of life and prognosis. The heart relies almost exclusively on an aerobic oxidative substrate for the generation of ATP, which is required to maintain its contractile function. The balance between oxygen demand and supply is disturbed in many disease processes. The progression to HF is associated with a gradual decline in the activity of mitochondrial respiratory pathways, leading to diminished capacity for ATP production. 1 Cardiac metabolic alterations could be either adaptive or maladaptive. Furthermore, the specific etiology of HF may be of importance in the process. Cardiac metabolic alterations may correlate with the degree of left ventricular (LV) dysfunction, symptoms of HF, prognosis and the response to medical treatments. [1][2][3] For a better understanding of the pathophysiology of cardiac metabolic alterations, it is important to measure myocardial oxygen consumption (MV • O2). The clearance kinetics of 11 C-acetate, measured by positron emission tomography (PET), can be used to measure tricarboxylic acid cycle flux and thus enable noninvasive quantification of myocardial oxidative metabolism at both the global and regional levels. [2][3][4][5][6][7] The level of myocardial oxidative metabolism with failing LV systolic function has been reported to be comparable to or lower than normal LV function. 8,9 Dyssynchrony is a predictor of poor outcome and may be associated with heterogeneity of myocardial oxidative metabolism in patients with HF. Previous studies have only evaluated rather small populations because of limited availability, and clinical significance has not been clarified in broader populations with HF. In addition, the differences between ischemic (ICM) and idiopathic dilated cardiomyopathy (DCM) have not been fully investigated.Accordingly, the aims of this study were to evaluate myocardial oxidative metabolism by using 11 C-acetate PET in a cohort and to compare the oxidative alterations with clinical variables, such as symptoms of HF, left bundle branch block (LBBB) and echocardiographic parameters, in patients with ICM and DCM. Methods Study PopulationThe study population comprised 100 consecutive pa- Yuji Kuge, PhD**; Hiroyuki Tsutsui, MD*; Nagara Tamaki, MD** Background The 11 C-acetate positron emission tomography can estimate myocardial oxidative metabolism, but previous studies have only evaluated small populations and the difference between ischemic (ICM) and idiopathic dilated cardiomyopathy (DCM) has not been fully investigated. The present aims were to evaluate global and regional myocardial oxidative metabolism in a well-characterized, large population with left ventricular (LV) dysfunction in order to clarify the metabolic differences between ICM and DCM. Methods and ResultsSeventy-eight patients with ejection fraction (EF) ≤50% (33 ICM; 45 DCM) were compared with 14 healthy controls. Myocardial oxidative metabolism was estimated with a clearance rate constant (Kmono...

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Section: Discussionmentioning

confidence: 99%

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Naya

Tsukamoto

et al. 2008

Circ J

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“…14,15,17,18,27 We also limited our analysis to DCM patients with widened QRS complexes, and it remains possible that some individuals with more narrow complexes might also benefit. Previous studies have reported regional wall motion abnormalities, heterogeneous wall stress, and myocardial perfusion in DCM patients with normal-appearing epicardial vessels, 28,29 although none reported QRS durations to test correlations with these phenomena. Certainly, surface ECG-based estimates may underestimate the temporal spread of depolarization if early and late portions have relatively low voltages.…”

Section: Study Design Limitationsmentioning

confidence: 99%

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

et al. 2000

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Background-VDD pacing can enhance systolic function in patients with dilated cardiomyopathy and discoordinate contraction; however, identification of patients likely to benefit is unclear. We tested predictors of systolic responsiveness on the basis of global parameters as well as directly assessed mechanical dyssynchrony. Methods and Results-Twenty-two DCM patients with conduction delay were studied by cardiac catheterization with a dual-sensor micromanometer to measure LV and aortic pressures during sinus rhythm and LV free-wall pacing. Pacing enhanced isovolumetric (dP/dt max ) and ejection-phase (pulse pressure, PP) systolic function by 35Ϯ21% and 16.4Ϯ11%, respectively, and these changes correlated directly (rϭ0.7, Pϭ0.001). %⌬dP/dt max was weakly predicted by baseline QRS (rϭ0.6, PϽ0.02), more strongly by baseline dP/dt max (rϭ0.7, Pϭ0.001), and best by bidiscriminate analysis combining baseline dP/dt max Յ700 mm Hg/s and QRS Ն155 ms to predict %⌬dP/dt max Ն25% and %⌬PP Ն10% (PϽ0.0005, 2 ), with no false-positives. Benefit could not be predicted by %⌬QRS. To test whether basal mechanical dyssynchrony predicted responsiveness to LV pacing, circumferential strains were determined at Ϸ80 sites throughout the LV by tagged MRI in 8 DCM patients and 7 additional control subjects. Strain variance at time of maximal shortening indexed dyssynchrony, averaging 28.0Ϯ7.1% in normal subjects versus 201.4Ϯ84.3% in DCM patients (Pϭ0.001). Mechanical dyssynchrony also correlated directly with %⌬dP/dt max (rϭ0.85, Pϭ0.008). Conclusions-These results show that although mechanical dyssynchrony is a key predictor for pacing efficacy in DCM patients with conduction delay, combining information about QRS and basal dP/dt max provides an excellent tool to identify maximal responders.

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“…IDC patients have a marked heterogeneity of regional ventricular function [59,60]; this mirrors the heterogeneity of regional wall stress (increased stress, decreased function), which is one of the main determinants of MVO 2 [61,62]. 11 C-acetate imaging [63,64] demonstrated regional heterogeneity of myocardial oxidative metabolism (most commonly increased in the lateral wall), where regional oxidative metabolism was related to regional function.…”

Section: Metabolically Trapped Fatty Acids and Acetatementioning

confidence: 99%

Myocardial metabolic and receptor imaging in idiopathic dilated cardiomyopathy

et al. 2002

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Idiopathic dilated cardiomyopathy (IDC) is a distinct disease of the myocardium, of unknown etiology. The disease can occur acutely, or evolve in a subacute fashion. IDC is often associated with a substantial impairment of ventricular function, which may recover over time. Although spontaneous recovery of LV function occurs in 20%-45% of newly diagnosed patients, the majority of patients do not do well. IDC has an average 5-year mortality of 20%. Abnormalities of energetics, perfusion, and adrenergic control of the myocardium are markers of the status of LV dysfunction. As the heart fails, changes occur in the production and catabolism of high-energy substrates, the efficiency of mitochondrial oxidative processes, the distribution of resting perfusion and coronary vasodilating capacity and the adrenergic receptor density and function. This article reviews the information provided by metabolic and receptor imaging in patients with IDC, and the role the data may play in patient management.

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Radionuclide assessment of regional differences in left ventricular wall motion and myocardial perfusion in idiopathic dilated cardiomyopathy

Cited by 55 publications

References 0 publications

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Heterogeneous Reduction of Myocardial Oxidative Metabolism in Patients With Ischemic and Dilated Cardiomyopathy Using C-11 Acetate PET

Predictors of Systolic Augmentation From Left Ventricular Preexcitation in Patients With Dilated Cardiomyopathy and Intraventricular Conduction Delay

Myocardial metabolic and receptor imaging in idiopathic dilated cardiomyopathy

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