Acute improvement of cardiac efficiency measured by 11C-acetate PET after cardiac resynchronization therapy and clinical outcome
Acute improvement of cardiac efficiency measured by 11C-acetate PET after cardiac resynchronization therapy and clinical outcome
复制标题
DOI：
10.1007/s10554-009-9549-8
复制
发表时间：
2010-03
期刊：
影响因子：
--
通讯作者：
Kenji Kitaizumi;K. Yukiiri;H. Masugata;H. Takinami;Y. Iwado;T. Noma;N. Hosomi;K. Ohmori;S. Senda;M. Kohno
中科院分区：
文献类型：
--
作者：
Kenji Kitaizumi;K. Yukiiri;H. Masugata;H. Takinami;Y. Iwado;T. Noma;N. Hosomi;K. Ohmori;S. Senda;M. Kohno
本研究的目的是检查11 C-醋酸正电子发射断层扫描（PET）评估心脏起搏治疗（CRT）的有效性。本研究入组了20例重度心力衰竭患者。所有患者均在CRT后1周内接受了11 C-醋酸盐PET。用单指数法测定11 C-醋酸盐清除率（Kmono），用作功代谢指数（EMT）测定心脏效率（CE）。心搏量指数计算公式为心搏量指数×收缩压×心率/Kmono。患者分为两组：14例患者CE改善（从5.27 ± 0.91到6.77 ± 1.12）和6例CE恶化的患者改良CE组的Kmono从0.053 ± 0.006降至0.046 ± 0.003（p= 0.028），但恶化CE组从0.049 ± 0.006增加至0.050 ± 0.006（p= 0.036）。CRT开启时，两组的每搏输出量指数、收缩压和心率均未发生变化。在1年随访时，CE恶化组的主要心脏不良事件发生率显著高于CE改善组（p= 0.032）。因此，在CRT后早期通过11 C-醋酸盐PET评估的CE改善是由显示CRT良好反应的患者的耗氧量降低引起的。因此，CRT后早期氧耗量的减少是预测CRT后良好临床结局的有用指标。
The purpose of this study was to examine the usefulness of11C-acetate positron emission tomography (PET) for assessing the efficacy of cardiac resynchronization therapy (CRT). Enrolled in this study were 20 patients with severe heart failure. All patients underwent 11C-acetate PET within 1 week after CRT. The oxygen consumption was measured by the monoexponential clearance rate of 11C-acetate (Kmono) for both CRT-off and -on. Cardiac efficiency (CE) was determined using the concept of the work metabolic index (WMI). WMI was calculated as WMI = (stroke volume index) × (systolic blood pressure) × (heart rate)/Kmono. The patients were divided into two groups: 14 patients with improved CE (from 5.27 ± 0.91 to 6.77 ± 1.12) and 6 patients with deteriorated CE (from 5.35 ± 0.92 to 4.86 ± 0.84) by CRT-on. Kmonodecreased from 0.053 ± 0.006 to 0.046 ± 0.003 by CRT-on in the improved CE group (p= 0.028), but increased from 0.049 ± 0.006 to 0.050 ± 0.006 in the deteriorated-CE group (p= 0.036). Stroke volume index, systolic blood pressure, and heart rate did not change by CRT-on for either group. At the one-year follow-up, there were significantly higher rates of major cardiac adverse events in the deteriorated-CE group than in the improved-CE group (p= 0.032). Therefore, the improvement of CE, as assessed by 11C-acetate PET in the early period after CRT, is produced by the decrease in oxygen consumption in patients showing good responses to CRT. The decrease in oxygen consumption in the early period after CRT is thus a useful marker for predicting a good clinical outcome after CRT.