%0 Journal Article %A Szu-Ying Tsai %A Shan-Ying Wang %A Yen-Wen Wu %T Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction %D 2018 %J Journal of Nuclear Medicine %P 226-226 %V 59 %N supplement 1 %X 226Objectives: Right ventricular (RV) dysfunction is recognized as a major prognostic factor in left-sided heart failure (HF). However, the contribution of RV dysfunction and metabolic alteration in HF with reduced ejection fraction (HFrEF) is unclear. Studies using dynamic FDG PET that quantitatively assess the rate of myocardial glucose uptake (MRGlu) showed RV MRGlu correlates with RV dysfunction and RV pressure overload in patients with pulmonary hypertension, while limited evidence in left ventricular (LV) dysfunction. We aim to evaluate the clinical significance and prognostic value of RV MRGlu in patients with HFrEF. Methods: Patients with coronary artery disease (CAD) and HFrEF (ejection fraction, EF&#8804;40%) were prospectively enrolled for FDG PET between November 2012 and June 2017. Non-diabetic patients received 50 g of glucose orally after fasting for at least 4 hours, whereas diabetic patients were administered soluble insulin intravenously according to their respective blood glucose levels. The scan protocol included 40-min dynamic scan with list mode, then 20-min ECG-gated PET. Global MRGlu (umol/min/100g) of LV and RV were analyzed by a Patlak kinetic model using PMOD 3.7 software (PMOD Technologies, Zurich, Switzerland). Outcome events were independently adjudicated using medical records to determine hospitalization for revascularization, new-onset ischemic events, heart failure, cardiovascular (CV) death and all-cause death. MRGlu between RV and LV, and their relation between the clinical characteristics, echocardiographic data were compared. The associations among FDG PET findings and patients’ outcomes were analyzed using Kaplan - Meier survival analysis. Results: Seventy-six patients (mean age 62.2 ± 12.7y, male 85.5%, EF 19.3 ± 8.6%) were included for analysis. The mean glucose utilization ratio of RV to LV (RV/LV MRGlu) was 0.899 ± 2.632 (r=0.774, p<0.001). Positive correlations between RV MRGlu and maximal tricuspid regurgitation (TR) peak gradient (TRmaxPG; r=0.287, p=0.025), peak tricuspid jet velocity (peak TR vel.; r=0.299, p=0.016), and TR severity in 4-grade (r=0.297, p=0.011) were noted. LVEF positively correlated with LV MRGlu (r=0.273, p=0.018); and negatively correlated with end-diastolic volume (EDV, r=-0.370), end-systolic volume (ESV, r=-0.540) and RV/LV MRGlu (r=-0.404, all p<0.001). However, RV MRGlu did not correlate with LVEF. Dipeptidyl peptidase-4 inhibitors (DPP4i) treated diabetic patients had significantly lower MRGlu in both LV and RV, irrespective of glucose levels at FDG injection or dose of insulin given. Forty-seven patients received revascularization procedures after FDG PET, and a total of 13 patients died in the mean follow-up period of 485 ± 445d (0-1564), including 9 CV deaths. LV EF&#8804; 15% and EDV ≥ 210ml of gated PET were associated with poor cardiac outcomes and overall survival, while MRGlu of LV and RV were not independent prognostic factors. Conclusions: In HFrEF patients with ischemic cardiomyopathy, RV glucose utilization correlated with RV pressure overload and LV failure. Interestingly, antidiabetic drug with DPP4 inhibition could attenuate glucose metabolism which might have impact in cardiometabolic disease. However, global MRGlu of LV and RV did not provide incremental prognostic value besides LV EF and EDV in patients with HFrEF for any given degree of pulmonary hypertension. Table. Patient Characteristics View this table: Figure 1. Representative images. Tl-201 MPI (A) and FDG PET (B) in 3-axis showed hibernating myocardium in the inferior, inferoseptal walls and apex of LV and obvious RV uptake. Dynamic FDG PET with Patlak kinetic analysis (C) of RV MRGlu (D) estimation were displayed. Figure 2. LV EF&#8804; 15% and EDV ≥ 210ml of gated FDG PET were associated with poor overall and cardiac survival. %U