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. 2024 Jan 17;9(4):459-471.
doi: 10.1016/j.jacbts.2023.11.001. eCollection 2024 Apr.

Left Atrial Glucose Metabolism Evaluation by 18F-FDG-PET in Persistent Atrial Fibrillation and in Sinus Rhythm

Sébastien Marchandise  1   2 , Véronique Roelants  3   4 , Tristan Raoult  1   2 , Quentin Garnir  1 , Christophe Scavée  1   2 , Varnavas Varnavas  1   2 , Aurélien Wauters  1   2 , Damien Gruson  1   2 , Eric Nellessen  1   2 , Michel Hesse  3   4 , Christophe Beauloye  1   2 , Bernhard L Gerber  1   2
Affiliations

Left Atrial Glucose Metabolism Evaluation by 18F-FDG-PET in Persistent Atrial Fibrillation and in Sinus Rhythm

Sébastien Marchandise et al. JACC Basic Transl Sci. .

Abstract

The role of atrial metabolism alterations for initiation and atrial fibrillation (AF) persistence remains poorly understood. Therefore, we evaluated left atrial glucose metabolism by nicotinic acid derivative stimulated 18-fluorodeoxyglucose positron emission tomography in 36 patients with persistent AF undergoing catheter ablation before and 3 months after return to sinus rhythm and compared values against healthy controls. Under identical hemodynamics and metabolic conditions, and although left ventricular FDG uptake remained unchanged, patients in persistent AF presented significantly higher total left atrial and left atrial appendage uptake, which decreased significantly after return to sinus rhythm, despite improvement of passive and active atrial contractile function. These findings support a role of altered glucose metabolism and metabolic wasting underlying the pathophysiology of persistent AF.

Keywords: FDG-PET; atrial cardiomyopathy; atrial fibrillation; glucose metabolism.

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Conflict of interest statement

Grant support by the Fonds pour la Chirurgie Cardiaque de l’Université Libre de Bruxelles and by an unrestricted grant by Pfizer and Daiichi Sankyo to the cardiology division. Dr Gerber has received the grant support from the La Chirurgie Cardiaque de l'Universite Libre de Bruxelles. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Workflow of Segmentation and Postprocessing of Left Atrial FDG-PET Images (A) PET images were co-registered with CMR angiographic images. Then a mask of the inner and outer contours of the LA was manually defined on CMR angiographic images, pulmonary veins and mitral valve were cut and the mask was copied to the PET images. This allowed definition of a 3D ROI of the FDG uptake of the LA wall. (B) Rendered 3D volumetric model of the left atrium, before (top) and after (bottom) color coded for maximum FDG SUV intensity from different views. CMR = cardiac magnetic resonance; FDG-PET = 18-fluorodesoxyglucose positron emission tomography; LA = left atrial; LAA = left atrial appendage; LIPV = left inferior pulmonary vein; LSPV = left superior pulmonary vein; MV = mitral valve; RIPV = right inferior pulmonary vein; ROI = region; RSPV = right superior pulmonary vein of interest.
Figure 2
Figure 2
Difference in FDG Uptake Parameters Between Persistent Atrial Fibrillation Patients, 3 Months After SR Restore and Healthy Volunteers in 3 ROIs Box plot showing difference in mean standardized uptake value (SUV), target to background ratio (TBR), and LA/LV SUV mean ratio between patients with persistent atrial fibrillation (AF) 3 months after SR restore and healthy volunteers (HV) in three ROIs (left ventricle [LV], LA, and LAA). The box represents IQR, the line within the box indicates the median value, whiskers show minimum/maximum values. ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. SR = sinus rhythm; other abbreviations as in Figure 1.
Figure 3
Figure 3
Individual Evolution of LA FDG Uptake and Atrial Contractile Function Between Persistent AF and After SR Restore Spaghetti plots showing the difference of LA FDG uptake (top) and atrial contractile function (bottom) between persistent AF and restoration of SR. Lines connect symbols for each subject and represent individual variation of FDG uptake or echocardiographic parameters. The box represents IQR, the line within the box indicates the median value, whiskers show minimum/maximum values. ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. AF = atrial fibrillation; FAC = fractional area change; FDG = fluorodeoxyglucose; GPALS = global peak atrial longitudinal strain; LAEF = left atrial ejection fraction; LV = left ventricle; other abbreviations as in Figures 1 and 2.
Figure 4
Figure 4
Reduction of Atrial FDG Uptake in a Patient During Persistent AF and 3 Months After SR Restore Patient preparation and metabolic conditions and image analysis and postprocessing were identical. Abbreviations as in Figures 1 and 2.
Figure 5
Figure 5
Representative 3D FDG Uptake Mapping in a Patient Without Electrical LA Remodeling FDG-PET rendered LA model in posterior-anterior (A) and antero-posterior (B) views show homogeneous distribution of the tracer. Corresponding 3D electroanatomic maps during AF (C and D) shows electrically normal atrial tissue without low voltage area (purple color). Abbreviations as in Figure 1.
Figure 6
Figure 6
A 3D FDG Uptake Mapping Example in a Patient With LA Electrical Remodeling FDG-PET-rendered LA model in posterior-anterior (A) and antero-posterior (B) views show heterogeneous distribution of the tracer of the LA with low FDG uptake areas (green). Corresponding 3D electroanatomic maps (C and D) show low voltage area (green/red) in similar areas. Abbreviations as in Figure 1.
See this image and copyright information in PMC

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