Annals of African medicine · 2026
Role of 18F-fluorodeoxyglucose Positron Emission Tomography-computed Tomography in Predicting Response to Cardiac Resynchronization Therapy in Nonischemic Cardiomyopathy.
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Kumar Ashutosh, Goru Bhawani, Patwari Panduranga, Sinha Nishant
Аннотация
BACKGROUND: Despite guideline-directed selection, cardiac resynchronization therapy (CRT) fails to achieve meaningful clinical or echocardiographic improvement in 20%-40% of patients. In nonischemic cardiomyopathy, occult myocardial inflammation may represent an under-recognized determinant of CRT nonresponse. This study evaluated the role of positron emission tomography (PET)-derived myocardial uptake in predicting CRT response and arrhythmic burden.
OBJECTIVES: The objective of this study was to assess whether myocardial inflammation detected by 18F-fluorodeoxyglucose PET-computed tomography (18F-FDG PET-CT) influences response to CRT and device-detected arrhythmias in patients with nonischemic cardiomyopathy.
MATERIALS AND METHODS: In this prospective, single-center observational case-control study, 236 patients evaluated for CRT were screened, of whom 23 patients with nonischemic cardiomyopathy fulfilling Class I indications underwent 18F-FDG PET-CT within 12 weeks of CRT -pacemaker/CRT -defibrillator (CRT-P/CRT-D) implantation. CRT response was defined by ≥10% absolute improvement in left ventricular ejection fraction (LVEF), ≥1 New York Heart Association functional class improvement, or ≥15% improvement in functional surrogate parameters. Patients were categorized as PET-positive or PET-negative based on myocardial FDG uptake. Receiver-operating characteristic (ROC) analysis was used to determine the predictive value of PET uptake.
RESULTS: Among 23 patients, 14 (61%) were classified as CRT responders and 9 (39%) as nonresponders. Responders were significantly younger and had a lower prevalence of atrial high-rate events and clinical congestion. Mean PET uptake was significantly lower in responders compared with nonresponders (2.1 ± 1.8 vs. 10.1 ± 3.2; P < 0.001). A PET uptake threshold ≥5 units was present in 86% of nonresponders but only 11% of responders (P < 0.001). PET uptake demonstrated excellent predictive accuracy for CRT response (area under the curve = 0.86), with a sensitivity of 86% and specificity of 78%.
CONCLUSION: PET-CT provides significant incremental value beyond conventional electrical and echocardiographic criteria and may serve as a useful adjunct in refining patient selection for CRT.
OBJECTIVES: The objective of this study was to assess whether myocardial inflammation detected by 18F-fluorodeoxyglucose PET-computed tomography (18F-FDG PET-CT) influences response to CRT and device-detected arrhythmias in patients with nonischemic cardiomyopathy.
MATERIALS AND METHODS: In this prospective, single-center observational case-control study, 236 patients evaluated for CRT were screened, of whom 23 patients with nonischemic cardiomyopathy fulfilling Class I indications underwent 18F-FDG PET-CT within 12 weeks of CRT -pacemaker/CRT -defibrillator (CRT-P/CRT-D) implantation. CRT response was defined by ≥10% absolute improvement in left ventricular ejection fraction (LVEF), ≥1 New York Heart Association functional class improvement, or ≥15% improvement in functional surrogate parameters. Patients were categorized as PET-positive or PET-negative based on myocardial FDG uptake. Receiver-operating characteristic (ROC) analysis was used to determine the predictive value of PET uptake.
RESULTS: Among 23 patients, 14 (61%) were classified as CRT responders and 9 (39%) as nonresponders. Responders were significantly younger and had a lower prevalence of atrial high-rate events and clinical congestion. Mean PET uptake was significantly lower in responders compared with nonresponders (2.1 ± 1.8 vs. 10.1 ± 3.2; P < 0.001). A PET uptake threshold ≥5 units was present in 86% of nonresponders but only 11% of responders (P < 0.001). PET uptake demonstrated excellent predictive accuracy for CRT response (area under the curve = 0.86), with a sensitivity of 86% and specificity of 78%.
CONCLUSION: PET-CT provides significant incremental value beyond conventional electrical and echocardiographic criteria and may serve as a useful adjunct in refining patient selection for CRT.