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Cardiac Efficiency and Oxygen Consumption Measured with ¹¹C-Acetate PET After Long-Term Cardiac Resynchronization Therapy

¹ Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany; ² Clinical Physiology, Department of Medical Sciences, Academic Hospital, Uppsala, Sweden; and ³ Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany

Correspondence: For correspondence or reprints contact: Oliver Lindner, MD, Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, Georgstrasse. 11, D-32545 Bad Oeynhausen, Germany. E-mail: olindner{at}hdz-nrw.de

Cardiac resynchronization therapy (CRT) is a treatment option in patients with severe heart failure and left bundle-branch block (LBBB). This study evaluated the effects of 4 and 13 mo of CRT on myocardial oxygen consumption (MVO₂) and cardiac efficiency as compared with mild heart failure patients without LBBB. Methods: Sixteen patients with severe heart failure and LBBB due to idiopathic cardiomyopathy were studied at baseline and after 4 and after 13 mo of therapy. Thirteen patients with mild heart failure without LBBB served as a comparison group. The clearance rate (k₂) of ¹¹C-acetate was measured with PET to assess MVO₂. Stroke volume was derived from the dynamic PET data according to the Stewart–Hamilton principle and, furthermore, cardiac efficiency using the work metabolic index. Results: After 4 mo of CRT, stroke volume index (SVI) increased by 50% (P = 0.012) and cardiac efficiency increased by 41% (P < 0.001). Global k₂ remained unchanged but regional k₂ demonstrated a more homogeneous distribution pattern. The parameters showed no significant changes during therapy. Under CRT, cardiac efficiency, SVI, and the distribution pattern of regional k₂ did not differ from mild heart failure patients without LBBB. Conclusion: CRT improves cardiac efficiency for at least 13 mo, as demonstrated by a higher SVI, whereas MVO₂ remains unchanged. Cardiac efficiency, SVI, and the MVO₂ distribution pattern reach the level of patients with mild heart failure without LBBB. The unfavorable hemodynamic performance in heart failure with LBBB is effectively restored by long-term CRT to the level of an earlier disease state.

Key Words: heart failure • bundle-branch block • pacing • cardiac output

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