© 2003 by European Society of Cardiology
Effect of biventricular pacing on metabolism and perfusion in patients affected by dilated cardiomyopathy and left bundle branch block: evaluation by positron emission tomography
1Department of Cardiology ULSS 8, Montebelluna, Italy; 2Department of Nuclear Medicine ULSS 8, Montebelluna, Italy; 3Castelfranco Veneto, Department of Cardiology Rovigo, Italy
AIMS: Evaluate the possible changes in myocardial metabolism and perfusion induced by biventricular pacing (BIVP) in patients affected by dilated cardiomyopathy (DC) and left bundle branch block (LBBB).
METHODS AND RESULTS: Eight male patients (aged 60–79 years, mean 69) affected by DC (NYHA functional class III and ejection fraction <40%) were submitted to cardiac PET in basal condition and 3 weeks after the implantation of a biventricular device. Metabolism was evaluated using F18-fluorodeoxyglucose (FDG), by the glucose load-insulin technique, and perfusion by N13-ammonia (NH3), injected at rest. Visual and a semi quantitative analyses were performed, calculating by ROIs the septum to lateral uptake ratio (SLR). The myocardial blood flow (MBF) was also calculated in ml/min/g using a dynamic acquisition and a modified Patlak method.
In all 8 patients a selective defect in FDG uptake in the septum was present in basal condition (mean SLR 0.59±0.17) with a ‘reverse mismatch’ effect with respect to NH3 (mean SLR 1.07±0.18). During BIVP the distribution of FDG in the septal area significatively improved (mean SLR 0.86±0.15 P=0.011 with respect to basal); on the contrary, no significant changes were found in NH3 uptake (mean SLR 1.02±0.23, P=ns).
On quantitative analysis the mean MBF in the septum was 1.05±0.37 in basal condition and did not significantly change during BIVP (0.95±0.34, P=0.06).
CONCLUSIONS: Our results suggest that, in patients affected by DC and LBBB, BIVP improves the septal glucose metabolism without significant changes in myocardial perfusion.
Key Words: Heart failure, biventricular pacing, positron emission tomography
Correspondence: Dr Gianfilippo Neri, Cardiology Dept. Hospital, Via Montegrappa 32, 31044 Montebelluna (TV). Tel.: 0423611285; Fax: 0423611295; E-mail: gianfilipponeri{at}tin.it
[1] Kerwin WF, Botvinick EH, O'Connel JW, et al. Ventricular contraction abnormalities in dilated cardiomyopathy: effect of biventricular pacing to correct interventricular dyssynchrony. J Am Coll Cardiol 2000; 35: 1221–1227.
[2] Cazeau S, Ritter P, Lazarus A, et al. Multisite pacing for end-stage heart failure: early experience. Pacing Clin. Electrophysiol 1996; 19: 1748–1757.[CrossRef][Medline]
[3] Blanc JJ, Etienne Y, Gilard M. Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an hemodynamic study. Circulation 1997; 96: 3273–3277.
[4] Auricchio A, Stelbrink C, Sack S, et al. The Pacing Therapies for Congestive Heart Failure (PATH-CHF) study: rationale, design and endpoints of a prospective randomized multicenter study. Am J Cardiol 199; 83: 130D–135D.
[5] Leclercq C, Cazeau S, Le Breton H. Acute haemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J Am Coll Cardiol 1998; 32: 1825–1831.
[6] Cazeau S, Leclercq C, Lavergne C, et al. for the Multisite Stilulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001; 344: 873–880.
[7] Altohoefer C, Vom Dahl J, Bares R, Stocklin GL, Bull U. Metabolic mismatch of septal beta-oxidation and glucose utilization in left bundle branch block assessed with PET. J Nucl Med 1995; 36: 2056–2059.
[8] Zanco P, Desideri A, Mobilia G, et al. Effects of left bundle block on myocardial FDG PET in patients without significant coronary stenosis. J Nucl Med 2000; 41: 973–977.
[9] Lewis P, Nunan T, Dynes A, Maisey M. The use of low-dose intravenous insulin in clinical myocardial F-18 FDG PET scanning. Clin Nucl Med 1996; 21: 15–18.[CrossRef][Medline]
[10] Choi Y, Huang SC, Hawkins RA, et al. A simplified method for quantification of myocardial blood flow using Nitrogen-13-Ammonia and dynamic PET. J Nucl Med 1993; 34: 488–497.
[11] Daubert JC, Alonso C, Mabo P, Leclerq C. Rationale for multi-site biventricular pacing to treat refractory heart failure. G Ital Cardiol 1999; 29:suppl 5, 227–232.
[12] Nelson GS, Berger RD, Fetics BJ, et al. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000; 102: 3053–3059.
[13] Ono S, Nohara R, Kambara R, Okuda K, Kawai C. Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block. Circulation 1992; 85: 1125–1131.
[14] Visser FC. Imaging of cardiac metabolism using radiolabelled glucose, fatty acids and acetate. Coron Artery Dis 2001; 12:suppl 1, S12–S18.
[15] Althoefer C. LBBB: challenging our concept of metabolic heart imaging with fluorine-18-FDG and PET? (editorial). J Nucl Med 1998; 39: 263–265.
[16] Neri G, Zanco P, Buchberger R. Myocardial perfusion and metabolic changes induced by biventricular pacing in dilated cardiomyopathy and left bundle branch block: description of a case evaluated by positron emission tomography. Ital Heart J 2001; 2:6 472–474.[Medline]
[17] Baller D, Vogt J, Kammeier A, et al. Adverse impact of left bundle branch block on regional myocardial oxygen consumption – potential reversal upon resynchronization in heart failure indicated by positron emission tomography. Eur Heart J 2001; 22:suppl, 414 (abs).
[18] Zanco P, Chierichetti F, Fini A, Cargnel S, Ferlin G. Myocardial perfusion, glucose utilization and oxidative metabolism in a patient with left bundle branch block, prior myocardial infarction and diabetes. J Nucl Med 1998; 39: 261–263.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. Ukkonen, J. Sundell, and J. Knuuti Effects of CRT on myocardial innervation, perfusion and metabolism Europace, November 1, 2008; 10(suppl_3): iii114 - iii117. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Valzania, F. Gadler, R. Winter, F. Braunschweig, L.-A. Brodin, P. Gudmundsson, G. Boriani, and M. J. Eriksson Effects of cardiac resynchronization therapy on coronary blood flow: Evaluation by transthoracic Doppler echocardiography Eur J Heart Fail, May 1, 2008; 10(5): 514 - 520. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Henneman, E. E. van der Wall, C. Ypenburg, G. B. Bleeker, N. R. van de Veire, N. A. Marsan, J. Chen, E. V. Garcia, J. J.M. Westenberg, M. J. Schalij, et al. Nuclear Imaging in Cardiac Resynchronization Therapy J. Nucl. Med., December 1, 2007; 48(12): 2001 - 2010. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Ashrafian, M. P. Frenneaux, and L. H. Opie Metabolic Mechanisms in Heart Failure Circulation, July 24, 2007; 116(4): 434 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Thompson, G. Saab, D. Birnie, B. J.W. Chow, H. Ukkonen, K. Ananthasubramaniam, R. A. deKemp, L. Garrard, T. D. Ruddy, J. N. DaSilva, et al. Is Septal Glucose Metabolism Altered in Patients with Left Bundle Branch Block and Ischemic Cardiomyopathy? J. Nucl. Med., November 1, 2006; 47(11): 1763 - 1768. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Bax, T. Abraham, S. S. Barold, O. A. Breithardt, J. W.H. Fung, S. Garrigue, J. Gorcsan III, D. L. Hayes, D. A. Kass, J. Knuuti, et al. Cardiac Resynchronization Therapy: Part 2--Issues During and After Device Implantation and Unresolved Questions J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2168 - 2182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Lindner, J. Vogt, D. Baller, A. Kammeier, P. Wielepp, J. Holzinger, B. Lamp, D. Horstkotte, and W. Burchert Global and regional myocardial oxygen consumption and blood flow in severe cardiomyopathy with left bundle branch block Eur J Heart Fail, March 2, 2005; 7(2): 225 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Vernooy, X. A.A.M. Verbeek, M. Peschar, H. J.G.M. Crijns, T. Arts, R. N.M. Cornelussen, and F. W. Prinzen Left bundle branch block induces ventricular remodelling and functional septal hypoperfusion Eur. Heart J., January 1, 2005; 26(1): 91 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gibbons and P. A. Araoz The year in cardiac imaging J. Am. Coll. Cardiol., November 16, 2004; 44(10): 1937 - 1944. [Full Text] [PDF]
|
|
|
|
|
|
P. Knaapen, L. M.C. van Campen, C. C. de Cock, M. J.W. Gotte, C. A. Visser, A. A. Lammertsma, and F. C. Visser Effects of Cardiac Resynchronization Therapy on Myocardial Perfusion Reserve Circulation, August 10, 2004; 110(6): 646 - 651. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||