Changes in myocardial oxidative metabolism after biventricular pacing as evaluated by [11C]acetate positron emission tomography

被引:0
作者
Tsutomu Araki
Naohiro Yoshida
Taketsugu Tsuchiya
Masatoshi Ikeda
Masanobu Namura
Takahiro Higuchi
Junichi Taki
机构
[1] Kanazawa Cardiovascular Hospital,Department of Cardiology
[2] Kanazawa Cardiovascular Hospital,Department of Radiology
[3] Kanazawa University Graduate School of Medical Sciences,Department of Biotracer Medicine
来源
Annals of Nuclear Medicine | 2003年 / 17卷
关键词
[; C]acetate; positron emission tomography; myocardial oxidative metabolism; biventricular pacing;
D O I
暂无
中图分类号
学科分类号
摘要
A 70-year-old woman with dilated cardiomyopathy and recurrent severe heart failure was admitted for biventricular pacing (BVP), which was recently reported to have clinical efficacy for severe heart failure with intraventricular conduction delay. An electrocardiogram showed complete left bundle branch block, and the QRS interval was markedly prolonged at 195 msec. Echocardiogram showed marked dilatation, diffuse hypokinesis and dyssynchrony of the left ventricle, and grade III mitral valve regurgitation. The patient underwent implantation of an atriobiventricular pacemaker and three pacing leads transvenously. The QRS interval shortened to 165 msec immediately after the BVP therapy, and improvements in echocardiographic parameters were seen at 5 months after BVP therapy. Myocardial oxidative metabolism was assessed by the monoexponential clearance rate of [11C]acetate (Kmono) as measured by positron emission tomography (PET), and myocardial efficiency was assessed by the work metabolic index (WMI) at 1 and 5 months after the BVP therapy. The PET images obtained 5 months after BVP therapy showed a decrease in the clearance of [11C]acetate compared with that obtained 1 month after BVP therapy. The Kmono of the whole left ventricle decreased from 0.051 at 1 month to 0.038 min−1 at 5 months after BVP therapy, and that of the septum, anterior wall, lateral wall and posterior wall also decreased. The WMI increased from 4.2×106 to 6.8×106 mmHg·ml/m2. These results suggest that BVP improved left ventricular function without increasing myocardial oxidative metabolism, resulting in improved myocardial efficiency, and that BVP may improve the long-term prognosis of heart failure patients with ventricular dyssynchrony. [11C]acetate PET is a useful method of evaluating global and regional myocardial oxidative metabolism in patients who have undergone BVP therapy.
引用
收藏
页码:605 / 608
页数:3
相关论文
共 49 条
[1]  
Cazeau S(2001)Effects of multisite biventricular pacing in patients with heart failure and interventricular conduction delay N Engl J Med 344 873-880
[2]  
Leclerco C(2002)Cardiac resynchronization in chronic heart failure N Engl J Med 346 1845-1853
[3]  
Lavergne T(2002)Effects of long-term biventricular stimulation for resynchronization on echocardiographic measures of remodeling Circulation 105 1304-1310
[4]  
Walker S(1993)Acute effects of dobutamine on myocardial oxygen consumption and cardiac efficiency measured using C-11 acetate kinetics in patients with dilated cardiomyopathy J Am Coll Cardiol 22 1389-1398
[5]  
Varma C(1986)Potential deleterious effects of inotropic agents in the therapy of chronic heart failure Circulation 73 III 184-190
[6]  
Linde C(1991)Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Group N Engl J Med 325 1468-1475
[7]  
Abraham WT(1999)Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST) Am Heart J 138 78-86
[8]  
Fisher WG(2000)Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block Circulation 102 3053-3059
[9]  
Smith AL(2003)Effect of cardiac resynchronization on myocardial efficiency and regional oxidative metabolism Circulation 107 28-31
[10]  
Delurgio DB(undefined)undefined undefined undefined undefined-undefined