The Relationship Between Right Ventricular Function and Increased Right Ventricular [F] Fluorodeoxyglucose Accumulation in Patients with Heart Failure

Background Left heart failure is characterized by alterations in metabolic substrate utilization, and metabolic modulation may be a future strategy in the management of heart failure (HF). There is little known about cardiac metabolism in the right ventricle and how it relates to other measures of right ventricular function. This study was designed to measure glucose metabolism in the right ventricle (RV) estimated using [F] fluorodeoxyglucose(FDG) PET imaging and to determine the relationship between right ventricular function and FDG uptake in patients with heart failure. Methods and Results A total of 68 patients had cardiac [F] FDG PET scans with measurement of right ventricular FDG uptake as a standardized uptake value (SUV). Perfusion imaging was acquired at rest with rubidium-82 or [N]-ammonia. Right ventricular function was determined using ERVG. Relative RV FDG uptake was determined as the ratio of RV:LV SUV. Fifty-five % of these patients had ischemic cardiomyopathy (CM). The mean LVEF and RVEF were 21±7% and 35±10% respectively. There was a correlation between RVEF and the ratio of RV/LV FDG uptake whether the entire LV myocardium (-0.40, p<0.001) or LV free wall (-0.43, p<0.001) was used. This relationship persisted in the subgroup with nonischemic CM (0.37, p=0.04). RV FDG uptake was weakly related to increased right ventricular systolic pressure but not related to LV size, function nor LV FDG uptake. The correlation between RVEF and RV/LV FDG was maintained after partial volume correction (r=-0.68, p<0.001). Conclusions Right ventricular dysfunction is associated with an increase in the RV FDG uptake, the magnitude of which may correlate with severity.