Aoki T.

Fukumoto Y.

Kagaya Y.

Miura M.

Miura Y.

Nochioka K.

Oikawa-Wakayama M.

Satoh K.

Shimokawa H.

Sugimura K.

Tashiro M.

Tatebe S.

Yamamoto S.

紀要類（bulletin）departmental bulletin pape

Tatebe, S.

Fukumoto, Y.

Oikawa-Wakayama, M.

Sugimura, K.

Satoh, K.

Miura, Y.

Aoki, T.

Nochioka, K.

Miura, M.

Yamamoto, S.

Tashiro, M.

Kagaya, Y.

Shimokawa, H.

Tohoku University Repository (TOUR) / 東北大学機関リポジトリ

Enhanced [18F]Fluorodeoxyglucose Accumulationin the Right Ventricular Free Wall PredictsLong-term Mortality of Patients with PulmonaryHypertension著者 Tatebe S., Fukumoto Y., Oikawa-Wakayama M.,Sugimura K., Satoh K., Miura Y., Aoki T.,Nochioka K., Miura M., Yamamoto S., TashiroM., Kagaya Y., Shimokawa H.journal orpublication titleCYRIC annual reportvolume 2014-2015page range 82-84year 2015URL http://hdl.handle.net/10097/00120753 82  CYRIC Annual Report 2014-2015    VII. 2.  Enhanced [18F]Fluorodeoxyglucose Accumulation in the Right Ventricular Free Wall Predicts Long-term Mortality of Patients with Pulmonary Hypertension    Tatebe S.1, Fukumoto Y.1, Oikawa-Wakayama M.2, Sugimura K.1, Satoh K.1, Miura Y.1, Aoki T.1, Nochioka K.1, Miura M.1, Yamamoto S.1, Tashiro M.3, Kagaya Y.1, and Shimokawa H.1  1Tohoku University Graduate School of Medicine 2Japanese Red Cross Sendai Hospital, Sendai 3Cyclotron and Radioisotope Center, Tohoku University    Background: We have previously demonstrated that [18F]fluorodeoxyglucose (FDG) accumulation evaluated by ECG gated positron emission tomography (PET) is increased in the right ventricular (RV) free wall of patients with pulmonary hypertension (PH) and that this accumulation is ameliorated after medical therapy associated with hemodynamic improvement1). However, it remains to be examined whether RV FDG accumulation has a prognostic significance in patients with PH.  Methods and Results: From March 2001 to June 2004, we performed gated FDG-PET in 27 patients with PH, including 18 with pulmonary arterial hypertension (PAH) and 9 with chronic thromboembolic pulmonary hypertension. We reviewed baseline clinical parameters, invasive hemodynamic data, and imaging data with cardiac MR, electron beam CT and FDG-PET quantified by calculating standardized uptake value (SUV) and corrected for partial volume effect based on the RV free wall thickness. We examined the relationship between baseline clinical parameters and the composite primary endpoint defined as all-cause mortality, lung transplantation, hospitalization for progression of PH and deterioration of WHO functional class and/or >15% reduction in 6-min walk distance (6MWD) from baseline, and all-cause mortality as the second endpoint. During the mean follow-up period of 69±49 [SD] months, 15 patients reached the composite primary endpoint, including all-cause mortality in 4, lung transplantation in 1, hospitalization for PH progression in 9, deterioration of WHO functional class and/or >15% reduction in 6MWD from baseline in 1 and death in 11 (41%). In FDG-PET measurements, corrected RV free  83  wall SUV was significantly increased in the endpoint group compared with the no endpoint group (10.1±2.7 vs. 7.6±2.2, P=0.02) (Fig. 1). Univariate COX hazard analysis showed that the corrected RV SUV of FDG was significantly correlated with the composite endpoint (hazard ratio 1.25, 95% confidence interval 1.04-1.51, P=0.02). This relationship remained significant even after adjustment for WHO functional class. In Kaplan-Meier analysis for the composite primary endpoint, patients with a corrected RV SUV ≥8.3 had a significantly poor prognosis compared with those with <8.3 (log-rank P=0.005 for the composite endpoint, P=0.07 for all-cause mortality) (Fig. 2).  Discussion: In this study we demonstrate that enhanced RV free wall SUV of FDG predicts long-term prognosis of PH patients. Regarding substrate metabolism, our previous study using autoradiography has demonstrated the shift in cardiac substrate utilization from fatty acids to glucose in pressure-overloaded rats2). We also have demonstrated that myocardial glucose uptake was increased in the pressure-overloaded RV free wall in rats with constricted pulmonary artery3). Furthermore, we demonstrated that FDG-uptake in the RV free wall was significantly increased in accordance with the severity of RV pressure overload in patients with PH1). Thus, RV free wall SUV of FDG could become an early biomarker of RV metabolic dysfunction and make it possible to identify PH patients at a risk of poor prognosis.  Conclusions: These results indicate that enhanced FDG accumulation in the RV is a useful prognostic factor in patients with PH.  Acknowledgements We thank Shoichi Watanuki for excellent technical support and Satoshi Miyata for support of the statistical analysis. This work was supported in part by the grants-in-aid from the Japanese Ministry of Education, Culture, Sports, Science, and Technology, Tokyo, Japan (Grant Number JP25461037).   This study was reported in “Eur Heart J Cardiovasc Imaging” in 20144).   References  1) Oikawa M., et al., J Am Coll Cardiol 45 (2005) 1849.  84  2) Kagaya Y., et al., Circulation 81 (1990) 1353. 3) Otani H, et al., Cardiovasc Res 29 (1995) 763. 4) Tatebe S, Fukumoto Y, Sugimura K, et al., Eur Heart J Cardiovasc Imag 15 (2014) 666.   Figure 1.  Evaluation of Right Ventricular Glucose Metabolism by FDG-PET in PH Patients Representative FDG-PET image is shown in a patient with composite endpoint (a) and that without it (b). cRV = corrected right ventricular; SUV = standardized uptake value.     Figure 2.  Prognostic Impact of Enhanced Right Ventricular Free Wall FDG Uptake in PH Patients Kaplan-Meier curves shows that the cut-off level of cRV-SUV of 8.3 is useful to predict the long-term survival free from clinical worsening (a) and the long-term survival free from all-cause mortality (b) in PH patients. See Fig. 1 for abbreviations.  

Enhanced [18F]Fluorodeoxyglucose Accumulation in the Right Ventricular Free Wall Predicts Long-term Mortality of Patients with Pulmonary Hypertension

Enhanced [18F]Fluorodeoxyglucose Accumulation in the Right Ventricular Free Wall Predicts Long-term Mortality of Patients with Pulmonary Hypertension

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