JC39302

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1 J Cardiol 2002 Mar; 39 3 : : 2- Deoxy-2 18 F Fluoro-d-Glucose Positron Emission Tomography Efficacy of Biventricular Pacing on Myocardial Glucose Metabolism in a Patient With Heart Failure Using 2-Deoxy-2 18 F Fluoro-d-Glucose Positron Emission Tomography: A Case Report Yasuo Toshiyuki Nobukazu Takashi Shinichi Tsukasa Kohei Youhei Kazuaki Sho Kazuo Tomio Satoshi OKUSU, MD ISHIKAWA, MD, FJCC TAKAHASHI, MD OKA, MD SUMITA, MD KOBAYASHI, MD MATSUSHITA, MD YAMAKAWA, MD UCHINO, MD MATSUBARA, MD KIMURA, MD INOUE, MD UMEMURA, MD Abstract A 61-year-old-male with dilated cardiomyopathy and congestive heart failure was treated by implantation of a biventricular pacemaker. Myocardial glucose metabolism was evaluated by positron emission tomography with 2-deoxy-2 18 F fluoro-d-glucose FDG during atrial-right ventricular pacing or atrialbiventricular pacing. Percentage uptake of FDG decreased in the lower septal area of the left ventricle during right ventricular pacing, but the decrease was improved during biventricular pacing 74.7% vs 91.6%. Biventricular pacing may improve myocardial glucose metabolism in patients with congestive heart failure. J Cardiol 2002 Mar; 39 3 : Key Words Glucose FDG Heart failure, treatment Pacing biventricular Metabolism Radionuclide imaging PET 2-deoxy-2 18 F fluoro-d-glucose FDG positron emission tomography PET FDG : The Second Department of Internal Medicine, 1 Division of Radiology, Yokohama City University School of Medicine, Yokohama Address for correspondence : OKUSU Y, MD, The Second Department of Internal Medicine, Yokohama City University School of Medicine, Fukuura 3 9, Kanazawa-ku, Yokohama Manuscript received July 30, 2001; revised September 3, October 17 and November 15, 2001 ; accepted November 15,

2 FDG PET 61 : : : : 3 /40 30 /40 : /min DDDR : 164 cm 50.7 kg 80/50 mmhg 64/min 4 Levine / : 10.1g/dl 29.2% 45 mg/dl 1.72mg/dl X 65% 75/min QRS 202 msec Fig. 1 A DDD /min 150 msec Ishikawa 9 A 90 msec single photon emission computed tomography SPECT22 FDG SPECT 99m Tc-methoxy-isobutyl-isonitrile MIBI 740 MBq 1 2 Millennium VG GE RR matrix FDG PET 5 75g 68 Ga/ 68 Ge 60 FDG 185 MBq 60 8 FDG 185 MBq mm 63 PET FDG 100% J Cardiol 2002 Mar; 39 3 :

3 167 Fig. 1 Electrocardiograms during atrial-biventricular pacing A and atrial-right ventricular pacing B A : The QRS duration was 202 msec. B : The QRS duration was 241 msec. QRS 202msec Fig. 1 A l/min QRS 241 msec Fig. 1 B 3.9l/min SPECT Fig. 2 A SPECT 13% 298ml 261ml FDG PET Fig. 2 B FDG FDG MIBI FDG 91.6%74.7% 16.9% Fig PQ PQ 9,11 3 PQ J Cardiol 2002 Mar; 39 3 :

168 Fig. 2 Technetium-99 m-mibi SPECT and FDG PET scans A: Technetium-99 m-mibi images showing low uptake in the anterior, inferior and posterior areas. B: FDG PET images.

Left column : Apex level short-axis view. Middle column : Middle level short-axis view. Right column : Basal level short-axis view.

4 168 Fig. 2 Technetium-99 m-mibi SPECT and FDG PET scans A: Technetium-99 m-mibi images showing low uptake in the anterior, inferior and posterior areas. B: FDG PET images. Atrial-biventricular pacing mode images upper row show greater uptake of FDG in the infero-septal area arrow than the atrial-right ventricular pacing mode images lower row. Left column : Apex level short-axis view. Middle column : Middle level short-axis view. Right column : Basal level short-axis view. MIBI methoxy-isobutyl isonitrile; SPECT single photon emission computed tomography; FDG 2- deoxy-2 18 F fluoro-d-glucose ; PET positron emission tomography Bakker 6 FDG PET TlCl I- -methyl-p-iodophenyl-pentadecanoic J Cardiol 2002 Mar; 39 3 :

5 169 Fig. 3 Polar map of the FDG percentage uptake The greatest change in the FDG percentage uptake occurred in the infero-septal wall 16.9%. Abbreviation as in Fig. 2. acid BMIPP 18 FDG Tc-MIBI Fig. 2 A NH 3 PET 23 FDG FDG FDG 2 FDG PET BMIPP FDG 24 FDG PET 2-deoxy-2 18 F fluoro-d-glucose FDG positron emission tomography PET 1 61 FDG PET 91.6% 74.7% J Cardiol 2002 Mar;39 3 : J Cardiol 2002 Mar; 39 3 :

6 170 1 Yokoyama I, Momomura S, Ohtake T, Yonekura K, Inoue Y, Kobayakawa N, Aoyagi T, Sugiura S, Nishikawa J, Sasaki Y, Omata M: Role of positron emission tomography using fluorine-18 fluoro-2-deoxyglucose in predicting improvement in left ventricular function in patients with idiopathic dilated cardiomyopthy. Eur J Nucl Med 1998 ; 25: Hochleitner M, Hörtnagl H, Ng CK, Hörtnagl H, Gschnitzer F, Zechmann W : Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy. Am J Cardiol 1990; 66 : Nishimura RA, Hayes DL, Holmes DR Jr, Tajik AJ : Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction: An acute Doppler and catheterization hemodynamic study. J Am Coll Cardiol 1995 ; 25: Auricchio A, Sommariva L, Salo RW, Scafuri A, Chiariello L: Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual chamber pacing with shortened AV delay. Pacing Clin Electrophysiol 1993 ; 16: Watanabe T, Okazaki O, Izumo K, Akutsu Y, Katagiri T, Harumi K: Evaluation of appropriate pacing with myocardial perfusion and cardiac function as a treatment of endstage idiopathic dilated cardiomyopathy. Pacing Clin Electrophysiol 1999 ; 22: Bakker PF, Meijberg H, de Jonge, van Mechelen R, Wittkampf W, Mower M, Thomas A: Beneficial effects of biventricular pacing in congestive heart failure. Pacing Clin Electrophysiol 1994 ; 17 Pt 2 ; 820 abstr 7 Auricchio A, Stellbrink C, Block M, Sack S, Vogt J, Bakker P, Klein H, Kramer A, Ding J, Salo R, Tockman B, Pochet T, Spinelli J: Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation 1999; 99: Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC : Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001 ; 344 : Ishikawa T, Sumita S, Kimura K, Kikuchi M, Kosuge M, Kuji N, Endo T, Sugano T, Sigemasa T, Kobayashi I, Tochikubo O, Usui T: Prediction of optimal atrioventricular delay in patients with implanted DDD pacemakers. Pacing Clin Electrophysiol 1999; 22 : Labovitz AJ, Buckingham TA, Habermehl K, Nelson J, Kennedy HL, Williams GA: The effects of sampling site on the two-dimensional echo-doppler determination of cardiac output. Am Heart J 1985; 109: Ishikawa T, Sumita S, Kimura K, Kuji N, Nakayama R, Nagura T, Miyazaki N, Tochikubo O, Usui T, Kashiwagi M, Ishii M: Critical PQ interval for the appearance of diastolic mitral regurgitation and optimal PQ interval in patients implanted with DDD pacemakers. Pacing Clin Electrophysiol 1994 ; 17: Nelson GS, Berger RD, Fetics BJ, Talbot M, Hare JM, Kass DA, Spinelli JC: Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundlebranch block. Circulation 2000; 102: Abildskov JA, Eich RH, Harumi K, Smulyan H : Observations on the relation between ventricular activation sequence and the hemodynamic state. Circ Res 1965; 17 : Zile MR, Blaustein AS, Shimizu G, Gaasch WH : Right ventricular pacing reduces the rate of left ventricular relaxation and filling. J Am Coll Cardiol 1987; 10: Burkhoff D, Oikawa RY, Sagawa K : Influence of pacing site on canine left ventricular contraction. Am J Physiol 1987; 251: H428 H Grines CL, Bashore TM, Boudoulas H, Olson S, Shafer P, Wooley CF: Functional abnormalities in isolated left bundle branch block : The effect of interventricular asynchrony. Circulation 1989; 79: Tse HF, Lau CP: Long-term effect of right ventricular pacing on myocardial perfusion and function. J Am Coll Cardiol 1997; 29 : Yoshida H, Shirotani M, Mochizuki M, Sakata K : Assessment of myocardial fatty acid metabolism in atrioventricular synchronous pacing : Analysis of iodine 123- labeled beta-methyl iodophenyl pentadecanoic acid SPECT. J Nucl Cardiol 1999 ; 6: Zanco P, Desideri A, Mobilia G, Cargnel S, Milan E, Celegon L, Buchberger R, Ferlin G: Effects of left bundle branch block on myocardial FDG PET in patients without significant coronary artery stenoses. J Nucl Med 2000; 41 : Altehoefer C : LBBB : Challenging our concept of metabolic heart imaging with fluorine-18-fdg and PET? J Nucl Med 1998; 39: Altehoefer C, vom Dahl J, Bares R, Stöcklin GL, Büll U : Metabolic mismatch of septal beta-oxidation and glucose utilization in left bundle branch block assessed with PET. J Nucl Med 1995; 36: Altehoefer C, vom Dahl J, Büll U : Septal glucose metabolism in patients with coronary artery disease and left bundle-branch block. Coron Artery Dis 1993; 4: Zanco P, Desideri A, Mobilia G, Cargnel S, Milan E, Celegon L, Buchberger R, Ferlin G: Effects of left bundle branch block on myocardial FDG PET in patients without significant coronary artery stenoses. J Nucl Med 2000; 41 : Altehoefer C, vom Dahl J, Bares R, Stocklin GL, Büll U : Metabolic mismatch of septal beta-oxidation and glucose utilization in left bundle branch block assessed with PET. J Nucl Med 1995; 36: J Cardiol 2002 Mar; 39 3 :

JC42504

JC42504 J Cardiol 2003 Nov; 42 5 : 221 226 1 Beneficial Biventricular Pacing in a Patient With Cardiac Sarcoidosis and Refractory Heart Failure: A Case Report FJCC Akinori Takahiro Magdy Makoto Akihiko Yuji SATO,