Key result
Biventricular pacing increases cardiac efficiency ~33% and reduces oxidative consumption vs pacing cessation.
Why the study?
The effects of cardiac resynchronization therapy on myocardial oxidative metabolism and cardiac efficiency in severe heart failure with ventricular dyssynchrony were not well characterized.
Does cardiac resynchronization therapy improve myocardial oxidative metabolism and cardiac efficiency in a patient with severe heart failure and ventricular dyssynchrony?
Case Report (n=1)
No
Does cardiac resynchronization therapy improve myocardial oxidative metabolism and cardiac efficiency in a patient with severe heart failure and ventricular dyssynchrony?
This case demonstrates that (11)C-acetate PET can effectively quantify improvements in myocardial oxidative metabolism and cardiac efficiency following cardiac resynchronization therapy.
A 65-year-old man with a history of coronary artery bypass grafting was admitted because of severe heart failure. Echocardiography showed diffuse severe hypokinesis of the left ventricle (ejection fraction 25%) and severe mitral regurgitation caused by tethering of the leaflet secondary to left ventricular (LV) dilation. He underwent mitral valve annuloplasty and LV papillary muscle imbrication, but postoperative sustained ventricular tachycardia developed and echocardiography showed ventricular dyssynchrony with a long septal-to-posterior wall motion delay (>130 ms). Cardiac resynchronization therapy (CRT) was performed using a biventricular pacing system with an implantable cardioverter defibrillator, but biventricular pacing prolonged the QRS duration from 130 to 160 ms, so (11)C-acetate positron emission tomography was performed to evaluate the CRT. During biventricular pacing, myocardial oxidative consumption decreased by 15% and cardiac efficiency increased by 33%. The plasma brain natriuretic peptide level, which was 9,500 pg/ml preoperatively, decreased to 173 pg/ml just before discharge from hospital.
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Kitaizumi et al. (2008) conducted a case report in Severe heart failure (n=1). Cardiac resynchronization therapy (biventricular pacing) vs. Cessation of biventricular pacing (CRT Off) was evaluated on Myocardial oxidative consumption and cardiac efficiency measured by 11C-acetate PET. During biventricular pacing, myocardial oxidative consumption decreased by 15% and cardiac efficiency increased by 33% compared to cessation of pacing.
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