Acil, T.

Al-Housni, M.

Banner, N.

Bartenstein, N.

Breithardt, G.

Brisse, B.

Brunchkhorst, C.

Cheetham, A.

Comte, N.

Eskola, O.

Haaparanta, M.

Hellermann, J.

Honjo, T.

Ichikawa, S.

Jenni, R.

Jääskeläinen, P.

Kasama, S.

Kaufmann, P.

Kelion, A.

Klainguti, M.

Knuuti, J.

Koepfli, P.

Kurabayashi, M.

Kuusisto, J.

Laakso, M.

Mason, M.

Namdar, M.

Nuutila, P.

Peuhkurinen, K.

Pollack, C.

Range, F.

Scharf, C.

Schober, O.

Schurr, U.

Schäfers, K.

Schäfers, M.

Siegrist, P.

Smith, R.

Toikka, J.

Toyama, T.

Tuunanen, H.

Wichter, T.

RERO DOC Digital Library

Radionuclide image in chronic heart failureOral abstract session11:00-12:309.1Characterisation of cardiac phenotype in genetically defined hypertrophic cardio-myopathy.H. Helena Tuunanen1, J. Kuusisto2, J. Toikka3, P. Ja¨a¨skela¨inen2, M. Haaparanta1, K.Peuhkurinen2, O. Eskola1, P. Nuutila1, M. Laakso2, J. Knuuti.1 1Turku PET-Centre,Turku, Finland, 2Kuopio University Hospital, Department of Medicine, Kuopio,Finland, 3Tampere University Central Hospital, Department of Clinical Physiology,Tampere, FinlandBackground: Abnormalities in myocardial metabolism and mechanical performanceare known to characterize hypertrophic cardiomyopathy (HCM). This study evaluatedmyocardial perfusion, oxidative and substrate metabolism in genetically homogenousHCM patients with different phenotypic expressions.Methods: Eight patients with HCM caused by the Asp175Asn substitution in thealpha-tropomyosin gene underwent in fasting state myocardial blood flow, oxygenconsumption (Kmono) and free fatty acid (FFA) uptake measurements using positronemission tomography and [15O]H20, [11C]acetate and [18F]FTHA respectively.Echocardiographic measurements were used to assess myocardial function and work.Efficiency of forward work was calculated.Results: As compared to normal values, patients with HCM were characterised withnormal global perfusion but increased oxygen consumption and reduced efficiency.Myocardial FFA uptake was within the normal range. Global perfusion and Kmono aswell as efficiency were inversely correlated with LV mass and were significantly lowerin patients with LV mass  180g (n 4) than LV mass  180 g (n 4) (p  0.05).Global myocardial FFA uptake was not associated with degree of hypertrophy.Typical for HCM, hypertrophy was heterogenous affecting more commonly septal wall.At individual level, regional FFA uptake and Kmono correlated nicely in patients withmild LV hypertrophy (R 0.73-0.99, avg 0.85) whereas the correlation was mainlyinverse in patients with more advanced hypertrophy (R 0.88-0.68, avg 0.24).Conclusions: Genetically defined homogenous HCM patients with Asp175Asn muta-tion in the alpha-tropomyosin gene are characterized with increased oxygen consump-tion and reduced efficiency of forward work but normal perfusion and FFA uptake.However, cardiac phenotypic expression is also associated with changes in perfusion,oxygen consumption and efficiency. The patients with advanced LV hypertrophy arecharacterised with uncoupling of regional oxidative metabolism and FFA utilizationindicating switch in cardiac substrate metabolism not attributable to genetic factors.Key words: hypertrophic cardiomyopathy, myocardial metabolism, efficiency9.2Impaired myocardial blood flow and flow reserve associated with increasedcoronary resistance in persistent idiopathic atrial fibrillation.M. Michael Scha¨fers1, F. Range1, T. Acil2, K. Scha¨fers1, B. Brisse2, G. Breithardt2, O.Schober1, T. Wichter.2 1University Mu¨nster, Nuclear Medicine, Mu¨nster, Germany,2University Hospital, Cardiology, Muenster, GermanyBackground: Many patients with atrial fibrillation (AF) present with signs and symptomsof myocardial ischemia despite exclusion of coronary artery disease. In this respect aregulatory disorder of the small vessels has been discussed. Aim of this study was toquantify myocardial perfusion and perfusion reserve in AF patients non-invasively bypositron emission tomography and radioactive-labeled water (H215O-PET).Methods and Results: Thirty patients (25 male, 5 female, age: 5913 years) withpersistent idiopathic AF were enrolled in this study. Using H215O-PET, myocardialperfusion was quantified at rest, during intravenous adenosine infusion provoking themaximal hyperaemic myocardial perfusion and during cold pressor testing (CPT) to obtainthe maximal perfusion stimulated by the endothelial response. Values were compared tothose in a group of 33 healthy volunteers (12 male, 21 female, age: 4013 years).Resting myocardial perfusion was reduced in AF patients as compared to the controlsubjects (0.890.22 vs. 1.020.25 mL/min/g; P0.026). Hyperaemic perfusionreserve was significantly diminished in AF vs. controls (2.921.32 vs. 3.951.33mL/min/g; P0.024). Accordingly, endothelium-stimulated myocardial blood flow wasreduced in AF patients after CPT as compared to controls (1.020.38 vs. 1.320.42mL/min/g; P0.005). Coronary vascular resistance, calculated from myocardial bloodflow and mean arterial pressure, was significantly increased in AF patients whencompared with controls at rest (11033 vs. 9023 mmHg*mL-1*g-1*min-1;P0.007), under adenosine infusion (4321 vs. 248 mmHg*mL-1*g-1*min-1;P0.001) and following cold stress (11341 vs. 7621 mmHg*mL-1*g-1*min-1;P0.001).Conclusion: AF reduces baseline myocardial perfusion as well as stimulated myocar-dial perfusion reserves and is associated with increased coronary resistance. Studies toelucidate the underlying cause are warranted to give further pathophysiological insights.9.3Effects of candesartan on cardiac sympathetic nerve activity in patients withcongestive heart failure and preserved left ventricular ejection fraction.S. Shu Kasama1, T. Honjo1, S. Ichikawa1, T. Toyama2, M. Kurabayashi.2 1KitakantoCardiovascular Hospital, Internal Medicine, Gunma, Japan, 2Gunma University Schoolof Medicine, Department of Cardiovascular Medicine, Maebashi, JapanOBJECTIVES We sought to evaluate the effects of angiotensin receptor blocker(ARB) on cardiac sympathetic nerve activity in patients with congestive heart failure(CHF) with preserved left ventricular ejection fraction (LVEF).BACKGROUND Approximately 50% of patients with CHF show preservation of theLVEF. It has been reported that ARB therapy improves cardiac sympathetic nerveactivity in CHF patients and a reduced LVEF. However, the effect of ARB therapy oncardiac sympathetic nerve activity evaluated by 123I-meta-iodobenzylguanidine(MIBG) scitigraphy has not been determined in CHF patients with preserved LVEF.METHODS We selected 50 patients with nonischemic CHF and an LVEF greater than40% who were treated with standard therapy. Twenty-five patients were randomized toadditionally receive candesartan, while the remaining 25 patients received placebo. Thedelayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), andwashout rate (WR) were determined by 123I-MIBG scintigraphy before and after 6months of therapy. The left ventricular end-diastolic volume (LVEDV) and LVEF weredetermined by echocardiography, and the plasma brain natriuretic peptide (BNP)concentration was also measured.RESULTS In patients receiving candesartan, TDS decreased from 288 to 238(p0.0005), the H/M ratio increased from 1.870.24 to 2.000.22 (p0.005), and WRdecreased from 3711% to 328% (p0.005). In addition, LVEDV decreased from11438 ml to 9027 ml (p0.05), and LVEF increased from 547% to 5810%(p0.05). In contrast, there were no significant changes of these parameters in thepatients receiving placebo. There was a significant correlation between the changes of123I-MIBG scintigraphic findings and the percent change of BNP from baseline to 6months in patients receiving candesartan (TDS, r0.587, p0.005; H/M ratio,r-0.509, p0.01; and WR, r0.602, p0.005).CONCLUSIONS Adding candesartan to standard therapy can improve cardiacsympathetic nerve activity and left ventricular performance in CHF patients withpreserved LVEF.9.4Long-term prognosis in patients with chronic ischemic left ventricular dysfunctionafter viability testing with PET and revascularization.C. Pollack1, J.P. Hellermann2, M. Namdar1, P. Koepfli1, P. T. Patrick Siegrist1, N. Bartenstein1,U. Schurr3, R. Jenni2, P.A. Kaufmann.1 1University Hospital Zurich, Nuclear Cardiology,Zurich, Switzerland, 2University Hospital Zurich, Cardiovascular Center, Zurich,Switzerland, 3University Hospital Zurich, Cardiac Surgery, Cardiovascular Center,Zurich, SwitzerlandBackground: Most outcome studies in patients with ischemic left ventricular dysfunc-tion (LVD) and hibernating myocardium as assessed with PET are limited by short-termfollow-up or small patient populations.Aim: To assess the impact of myocardial viability testing with PET and revasculariza-tion (revasc) on long-term prognosis in a large study population with LVD.Methods: The baseline characteristics and the follow up (f/u) of 246 consecutive patients (age6010 years) with ischemic LVD who underwent FDG and NH3 PET scan for evaluation ofhibernating myocardium (NH3/FDG mismatch) were assessed.Results: see table 1Conclusion: Our results demonstrate a strong association between myocardial viabilityon PET testing and improved survival after revascularization in patients with chronicischemic LVD. Viable tissue seems to represent a risk factor, as lack of revasculariza-tion is associated with increased mortality. Absence of viability is associated with nosignificant difference in outcomes, irrespective of treatment strategy.Table 1.Hibernating Hibernating No Hibernating No HibernatingRevasc No Revasc Revasc No Revascn 49 38 52 107age, years 5811 5810 599 609gender, male 87% 82% 83% 88%LVEF (%) 3010 2911 325 29123-vessel disease 80% 37% 47% 46%mean f/u, years 4.52.4 4.22.8 4.52.2 4.32.6annual mortality 12.0% 19.3% 11.0% 9.5%survivors, end of f/u 63.0% 27.9% 64.0% 53.0%TUESDAYMAY10TUESDAYMAY10Journal of Nuclear CardiologyS58 Tuesday, May 10, 20059.5Biventricular pacing improves left ventricular synchrony irrespective of AV-delayin patients with congestive heart failure.P. T. Siegrist1, N. Comte1, P. Pascal Koepfli2, M. Namdar1, M. Klainguti1, C.Brunchkhorst1, C. Scharf1, P. A. Kaufmann.1 1University Hospital Zurich, Cardiovas-cular Center, Zurich, Switzerland, 2Cardiovascular Center, University Hospital Zurich,Zurich, SwitzerlandBackground: Biventricular pacing (bivPM) in patients with heart failure results inimproved left ventricular performance through resynchronization of systolic myocardialcontraction. A prolonged AV-delay improves diastolic left ventricular filling but isassociated with increased probability of AV fusion beats that may interfere with resynchro-nization. The relative influence of these two potentially opposing effects is unknown so far.Aim: To assess the influence of different AV-delays on left ventricular synchrony andleft ventricular ejection fraction (EF) using multigated acquisition radionuclide ven-triculography (MUGA).Methods: In 12 patients with severe congestive heart failure EF and synchrony wasassessed without (noPM) and during bivPM at different AV-delays (80ms, 100ms, 120ms,140ms, 160ms) with MUGA. Synchrony was defined by the standard deviation in thephase-delay within the left ventricle (LV-SD). This was calculated by use of a phase-histogram and expressed as fraction of a 360° heart cycle. EF was compared to LV-SD atthe different AV-delays using Pearson Correlation.Results: see table 1.Conclusion: bivPM for congestive heart failure improves left ventricular synchronyirrespective of the chosen AV-delay. Left ventricular synchrony is closely related to EF.Table 1A:AV-delay of bivPM (ms) 80 100 120 140 160 noPMLV-SD (°) 66 68 67 69 67 76p-values vs. noPM 0.006 .004 0.003 0.006 0.001B:correlation of LV-SDwith EF0.85 0.88 0.82 0.92 0.82 0.84p-value for correlation 0.000 0.000 0.001 0.000 0.001 0.001A: LV-SD was significantly reduced by bivPM at any AV-delay. B: LV-SD was inverselycorrelated to EF.9.6Selection of heart failure patients for cardiac resynchronisation therapy: Could therebe a role for equilibrium radionuclide angiography with Fourier phase analysis?A. Cheetham, MB. Al-Housni, R. Smith, M. Mason, N. Banner, AD. Andrew Kelion.Harefield Hospital, Nuclear Medicine Department, Harefield, United KingdomBackground. Equilibrium radionuclide angiography (ERNA) with Fourier phase analysis couldbe used to identify heart failure patients likely to benefit from cardiac resynchronisation therapy(CRT). We compared phase indices in patients with left ventricular failure (LVF) with a “controlgroup” of patients post orthotopic cardiac transplantation (OCT).Methods. 138 patients with severe LVF due to coronary disease (CAD; n19) ordilated cardiomyopathy (DCM; n45), or who were clinically stable post OCT with(n28) or without (n46) LV dysfunction (ejection fraction (EF) 50%) underwentroutine ERNA. A left anterior oblique projection was acquired with 32 frames per cycle.Results. LV phase standard deviation (SD) and interventricular phase difference(RV-LV) increased with increasing QRS duration and decreasing LV EF (Figure).Phase values were low with little variability in normal LV OCT patients, withprogressively higher values for impaired LV OCT and LVF patients (Table). There waslittle overlap between normal LV and LVF groups for SD, but more for RV-LV.Conclusion. SD and RV-LV increase with increasing QRS and decreasing LV EF, butthe scatter implies that independent information is provided. Compared with RV-LV,SD may provide a clearer cut-off for selecting patients for CRT.TableOCT healthy OCT impaired DCM CAD PLV SD (deg) 4.3 (1.6) 7.4 (4.7) 17.3 (9.8) 20.3 (9.1) 0.001RV-LV (deg) 6.7 (6.7) 4.3 (9.4) 2.6 (15.8) 1.8 (12.0) 0.001Mean (SD) values of phase indices in different patient groupsVariation of LV phase SD with EFTUESDAYMAY10TUESDAYMAY10Journal of Nuclear Cardiology Abstracts S59Volume 12, Number 2 Tuesday, May 10, 2005

Radionuclide image in chronic heart failure oral abstract session

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Radionuclide image in chronic heart failure oral abstract session

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