Abstract 10873: Prognostic Significance of Enhanced [18F]Fluorodeoxyglucose Accumulation in the Right Ventricular Free Wall in Patients With Pulmonary Hypertension
Background:We have previously demonstrated that [18F] fluorodeoxyglucose (FDG) accumulation evaluated by gated positron emission tomography (PET) is increased in the right ventricular (RV) free wall of patients with pulmonary hypertension (PH) and that this accumulation is ameliorated after medical therapy associated with hemodynamic improvement. However, it remains to be examined whether RV FDG accumulation has a prognostic significance in patients with PH.
Methods and Results: From March 2001 to June 2004, we performed gated FDG-PET in 27 patients with PH, including 18 with pulmonary arterial hypertension and 9 with chronic thromboembolic pulmonary hypertension. Baseline clinical parameters were examined, including RV standardized uptake value (SUV) of FDG corrected for partial volume effect based on the RV free wall thickness. The composite endpoint was defined as all-cause mortality, lung transplantation, hospitalization for progression of PH and deterioration of NYHA functional class and/or >15% reduction in 6-min walk distance from baseline. During a mean follow-up period of 92±36[SD] months, 9 out of the 27 patients (30%) died, including 7 cardiopulmonary causes. Univariate COX hazard analysis showed that the corrected RV SUV of FDG was significantly correlated with the composite endpoint (hazard ratio 1.23, 95% confidence interval 1.01-1.49, P=0.04). This relationship remained significant even after adjustment for 6-min walk distance. Other significant prognostic factors included advanced NYHA functional class, elevated pulmonary arterial pressure, and increased diastolic RV mass index calculated by cardiac MRI or electron beam CT. In Kaplan-Meier analysis, patients with a corrected RV SUV of FDGSUV ≥8.5 had a significantly poor prognosis compared with those with <8.5 (log-rank P=0.008) (Figure).
Conclusions: These results indicate that enhanced FDG accumulation in the RV is a significant prognostic factor in patients with PH.
- © 2012 by American Heart Association, Inc.