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Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction

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Abstract

Purpose

Dynamic 18F-fluorodeoxyglucose (FDG) PET can be used to quantitatively assess the rate of myocardial glucose uptake (MRGlu). The aim of this study was to evaluate the clinical significance and prognostic value of right ventricular (RV) MRGlu in patients with coronary artery disease and heart failure with reduced ejection fraction.

Methods

Patients with left ventricular ejection fraction (LVEF) ≤ 40% were consecutively enrolled for FDG PET between November 2012 and May 2017. Global LV and RV MRGlu (μmol/min/100 g) were analyzed. Outcome events were independently assessed using electronic medical records to determine hospitalization for revascularization, new-onset ischemic events, heart failure, cardiovascular, and all-cause death. Differences between LV and RV MRGlu and associations with clinical characteristics and echocardiographic data were evaluated. Associations among FDG PET findings and outcomes were analyzed using Kaplan-Meier survival analysis.

Results

Seventy-five patients (mean age 62.2 ± 12.7 years, male 85.3%, LVEF 19.3 ± 8.6%) were included for analysis. The mean glucose utilization ratio of RV-to-LV (RV/LV MRGlu) was 89.5 ± 264.9% (r = 0.77, p < 0.001). Positive correlations between RV MRGlu and maximal tricuspid regurgitation peak gradient (r = 0.28, p = 0.033) and peak tricuspid regurgitation jet velocity (r = 0.29, p = 0.021) were noted. LVEF was positively correlated with LV MRGlu (r = 0.27, p = 0.018), but negatively correlated with end-diastolic volume (r = − 0.37, p = 0.001), end-systolic volume (r = − 0.54, p < 0.001), and RV/LV MRGlu (r = − 0.40, p < 0.001). However, RV MRGlu was not well correlated with LVEF. Forty-three patients received revascularization procedures after FDG PET, and 13 patients died in a mean follow-up period of 496 ± 453 days (1–1788 days), including nine cardiovascular deaths. Higher RV and LV MRGlu values, LVEF ≤ 16% and LV end-diastolic volume ≥ 209 ml of gated-PET were associated with poor overall survival and cardiac outcomes.

Conclusions

In patients with coronary artery disease and ischemic cardiomyopathy, RV glucose utilization was positively correlated with RV pressure overload, but not LVEF. Global LV and RV MRGlu, LVEF, and LV end-diastolic volume showed significant prognostic value.

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Acknowledgments

The authors thank Ms. Ya-Huang Chen, Ms. Chia-Wen Lai, Mr. Chao-Chun Huang and Mr. Po-Wei Li for dynamic PET acquisition, and Dr. Kuan-Yin Ko, Ms. Yu-Shuan Hung, and Mr. Chien-Yu Chu for their assistance in PET analyses and clinical data collection.

Funding

This study was funded by Ministry of Science and Technology of Taiwan (MOST-101-2314-B-418-012-MY3, MOST-104-2314-B-418-008, MOST-105-2628-B-418-002-MY2, MOST-107-2314-B-418-006-MY3) and Far Eastern Memorial Hospital (FEMH-101-2314-B-418-012-MY3, FEMH-104-2314-B-418-008, FEMH-105-2628-B-418-002-MY2, FEMH-107-2314-B-418-006-MY3).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist, New Taipei City, 220, Taiwan

    Szu-Ying Tsai, Yen-Wen Wu, Shan-Ying Wang & Yu-Chien Shiau

  2. Ministry of Health and Welfare Nantou Hospital, Nantou County, Taiwan

    Szu-Ying Tsai

  3. Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Yen-Wen Wu, Hao-Yuan Tsai, Chien-Lin Lee, Jung-Cheng Hsu, Chung-Ming Tu, Heng-Hsu Lin & Shan-Hui Huang

  4. National Yang-Ming University School of Medicine, Taipei, Taiwan

    Yen-Wen Wu

  5. Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan

    Shan-Ying Wang

  6. Division of Cardiovascular Surgery, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan

    Kuan-Ming Chiu

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  1. Szu-Ying Tsai
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Corresponding author

Correspondence to Yen-Wen Wu.

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Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Except for financially supported by the Ministry of Science and Technology of Taiwan (MOST-101-2314-B-418-012-MY3, MOST-104-2314-B-418-008, MOST-105-2628-B-418-002-MY2, MOST-107-2314-B-418-006-MY3) and Far Eastern Memorial Hospital (FEMH-101-2314-B-418-012-MY3, FEMH-104-2314-B-418-008, FEMH-105-2628-B-418-002-MY2, FEMH-107-2314-B-418-006-MY3), no other relevant potential conflicts of interest exist. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Corresponding author Yen-Wen Wu has received research grants from Ministry of Science and Technology of Taiwan and Far Eastern Memorial Hospital. The other authors declare that they have no conflict of interest.

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Tsai, SY., Wu, YW., Wang, SY. et al. Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction. Eur J Nucl Med Mol Imaging 46, 2601–2609 (2019). https://doi.org/10.1007/s00259-019-04471-9

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