Dobutamine Stress 99mTc-Tetrofosmin Quantitative Gated SPECT Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Dilated Cardiomyopathy

Journal of Nuclear Medicine

Tadashi Suzuki¹  Yoshiaki Takayama¹  Shuichi Ichikawa¹  Hisao Kumakura¹  Shoichi Tange¹  Takuji Toyama¹  Masahiko Kurabayashi¹  Shu Kasama¹ 

关键词: carvedilol;    gated SPECT;    dobutamine;    dilated cardiomyopathy;   

DOI  :  

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

We evaluated whether dobutamine stress 99mTc-tetrofosmin quantitative gated SPECT (D-QGS) could predict improvement of cardiac function by carvedilol therapy in patients with dilated cardiomyopathy (DCM). Methods: The study included 30 patients with idiopathic DCM and a left ventricular ejection fraction (LVEF) of <45%. D-QGS was performed in all patients to measure LVEF at rest and during dobutamine infusion (10 μg/kg/min). LVEF and left ventricular end-diastolic volume (LVEDV) were determined by echocardiography, plasma brain natriuretic peptide (BNP) was measured, and the New York Heart Association (NYHA) functional class was estimated at baseline and after 1 y of combined treatment with an angiotensin-converting enzyme (ACE) inhibitor, diuretic, and the β-blocker carvedilol. After treatment, the echocardiographic LVEF improved by >5% in 15 patients (group A) but did not improve in the remaining 15 patients (group B). Results: The baseline LVEF, LVEDV, plasma BNP, and NYHA functional class were similar in both groups. However, there was a greater increase of LVEF (ΔLVEF) with dobutamine infusion during D-QGS in group A than that in group B (12.0% ± 5.8% vs. 2.7% ± 4.2%, P < 0.0001). When a cutoff value of 6.6% for ΔLVEF was used to predict the improvement of LVEF by carvedilol therapy, the sensitivity was 86.7%, the specificity was 86.7%, and the accuracy was 86.7%. LVEDV, plasma BNP, and NYHA functional class all showed superior improvement in group A compared with group B. Conclusion: ΔLVEF measured by D-QGS was significantly larger in patients who responded to carvedilol than that in nonresponders. These findings indicate that D-QGS can be used to predict improvement of cardiac function and heart failure symptoms by carvedilol therapy in patients with idiopathic DCM.

【 授权许可】

Unknown