TY - JOUR T1 - Scar imaging in the dyssynchronous left ventricle: Accuracy of myocardial metabolism by positron emission tomography and function by echocardiographic strain. AU - Larsen,Camilla Kjellstad, AU - Galli,Elena, AU - Duchenne,Jürgen, AU - Aalen,John M, AU - Stokke,Caroline, AU - Fjeld,Jan Gunnar, AU - Degtiarova,Ganna, AU - Claus,Piet, AU - Gheysens,Olivier, AU - Saberniak,Jorg, AU - Sirnes,Per Anton, AU - Lyseggen,Erik, AU - Bogaert,Jan, AU - Kongsgaard,Erik, AU - Penicka,Martin, AU - Voigt,Jens-Uwe, AU - Donal,Erwan, AU - Hopp,Einar, AU - Smiseth,Otto A, Y1 - 2022/11/29/ PY - 2022/09/02/received PY - 2022/10/20/revised PY - 2022/11/22/accepted PY - 2022/12/3/pubmed PY - 2023/1/4/medline PY - 2022/12/2/entrez KW - Dyssynchrony KW - Glucose metabolism KW - Heart failure KW - Late gadolinium enhancement cardiac magnetic resonance KW - Myocardial scar KW - Positron emission tomography KW - Speckle tracking echocardiography KW - Strain SP - 122 EP - 129 JF - International journal of cardiology JO - Int J Cardiol VL - 372 N2 - PURPOSE: Response to cardiac resynchronization therapy (CRT) is reduced in patients with high left ventricular (LV) scar burden, in particular when scar is located in the LV lateral wall or septum. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can identity scar, but is not feasible in all patients. This study investigates if myocardial metabolism by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and contractile function by echocardiographic strain are alternatives to LGE-CMR. METHODS: In a prospective multicenter study, 132 CRT candidates (91% with left bundle branch block) were studied by speckle tracking strain echocardiography, and 53 of these by FDG-PET. Regional myocardial FDG metabolism and peak systolic strain were compared to LGE-CMR as reference method. RESULTS: Reduced FDG metabolism (<70% relative) precisely identified transmural scars (≥50% of myocardial volume) in the LV lateral wall, with area under the curve (AUC) 0.96 (95% confidence interval (CI) 0.90-1.00). Reduced contractile function by strain identified transmural scars in the LV lateral wall with only moderate accuracy (AUC = 0.77, CI 0.71-0.84). However, absolute peak systolic strain >10% could rule out transmural scar with high sensitivity (80%) and high negative predictive value (96%). Neither FDG-PET nor strain identified septal scars (for both, AUC < 0.80). CONCLUSIONS: In CRT candidates, FDG-PET is an excellent alternative to LGE-CMR to identify scar in the LV lateral wall. Furthermore, preserved strain in the LV lateral wall has good accuracy to rule out transmural scar. None of the modalities can identify septal scar. CLINICAL TRIAL REGISTRATION: The present study is part of the clinical study "Contractile Reserve in Dyssynchrony: A Novel Principle to Identify Candidates for Cardiac Resynchronization Therapy (CRID-CRT)", which was registered at clinicaltrials.gov (identifier NCT02525185). SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/36460211/Scar_imaging_in_the_dyssynchronous_left_ventricle:_Accuracy_of_myocardial_metabolism_by_positron_emission_tomography_and_function_by_echocardiographic_strain_ DB - PRIME DP - Unbound Medicine ER -