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Different Mechanisms for Changes in Glucose Uptake of the Right and Left Ventricular Myocardium in Pulmonary Hypertension

¹ Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
² Department of Internal Medicine I, University of Leipzig, Leipzig, Germany
³ Institute of Interdisciplinary Isotope Research, Leipzig, Germany

View larger version (14K): [in a new window]   FIGURE 1. Set of 12 ROIs manually drawn on apical, midventricular, and basal short-axis slices. ROIs 1, 3, 4, 7, 8, and 9 represent RV myocardium, ROIs 2, 6, 11, and 12 represent LV myocardium, and ROIs 5 and 10 represent interventricular septum.

View larger version (11K): [in a new window]   FIGURE 2. Relationship between mean PAR (dyn x s x 10–5) and right-to-left counting rate ratios in 99mTc-tetrofosmine studies (A) and 18F-FDG studies (B). Significant correlation was found for regional 18F-FDG uptake (r = 0.767; P < 0.001; y = 0.391 + 0.416E-03x) but not for regional perfusion (r = 0.16; not statistically significant).

View larger version (10K): [in a new window]   FIGURE 3. Relationship between mean PAR (dyn x s x 10–5) and metabolic rate of glucose uptake in free RV myocardium (A) and LV myocardium (B). There was no correlation in right ventricle (r = 0.189; not statistically significant) but significant negative correlation in free LV wall (r = –0.547; P < 0.01; y = 31.59 – 8.68E-03x). MR = metabolic rate of glucose uptake.

View larger version (48K): [in a new window]   FIGURE 4. Characteristic short-axis slices from 18F-FDG PET images of 3 patients with different severities of PH. From left to right, images show increasing degree of PAR and decreasing LV metabolic rate of glucose uptake. CO = cardiac output; SW = stroke work; MR = metabolic rate of glucose uptake.

View larger version (11K): [in a new window]   FIGURE 5. Correlations between cardiac output, LV stroke work, and PAR: cardiac output vs. PAR (nonlinear; y = 112.733x–0.4949; r = –0.828; P < 0.001) (A), stroke work vs. PAR (nonlinear; y = 4922.29x–0.6615; r = –0.838; P < 0.001) (B), and stroke work vs. cardiac output (linear; y = –18.091 + 19.3088x; r = 0.938; P < 0.001) (C). CO = cardiac output.

View larger version (13K): [in a new window]   FIGURE 6. Relationships between metabolic rate of glucose uptake in free RV wall and RV stroke work (r = 0.124; not statistically significant) (A) and metabolic rate of glucose uptake in free LV wall and LV stroke work (y = 12.457 + 0.1572x; r = 0.518; P < 0.01) (B).

View larger version (33K): [in a new window]   FIGURE 7. Relationship between RV metabolic rate of glucose uptake and Tei index is shown in C. Characteristic short-axis slices from 18F-FDG PET images of 2 patients with different Tei indices are shown in A and B. Parameters for A vs. B: Tei index, 0.49 vs. 1.05; metabolic rate of glucose uptake, right, 11.75 vs. 31 µmol/100 g/min; metabolic rate of glucose uptake, left, 20.75 vs. 24.3 µmol/100 g/min; PAP, 39 vs. 55 mm Hg; PAR, 540 vs. 874 dyn x s x 10–5; stroke work, right, 20.5 vs. 34.7; stroke work, left, 54.4 vs. 55.5; New York Heart Association class, II vs. III; right heart failure, no vs. yes. (C) y = –3.3343 + 26.7048x; r = 0.78; P < 0.001. MR = metabolic rate of glucose uptake.