Characterization of a highly effective preparation for suppression of myocardial glucose utilization

Sophia R. Larson; Justin A. Pieper; Edward A. Hulten; Edward P. Ficaro; James R. Corbett; Venkatesh L. Murthy; Richard L. Weinberg

doi:10.1007/s12350-019-01786-w

Characterization of a highly effective preparation for suppression of myocardial glucose utilization

Sophia R. Larson, Justin A. Pieper, Edward A. Hulten, Edward P. Ficaro, James R. Corbett, Venkatesh L. Murthy, Richard L. Weinberg^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

29 Scopus citations

Abstract

Background: With appropriate protocols, F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can visualize myocardial inflammation. Optimal protocols and normative myocardial FDG uptake values are not well-established. Methods: We evaluated 111 patients referred for inflammation cardiac FDG PET/CT. Patients followed a low-carbohydrate, high-fat diet for 36 hours before imaging and received unfractionated heparin. Glucose and fatty acid metabolism biomarkers were obtained. Mean blood pool and maximum myocardial uptake (SUV_mean, SUV_max) were measured, avoiding areas of abnormal FDG uptake or spillover. Results: Adequate suppression of myocardial FDG uptake occurred in 95% of patients (n = 106). Myocardial SUV_max was significantly below background blood pool SUV_mean: septal myocardial to blood pool ratio 0.75 (95% CI 0.73-0.77; P < 0.001); lateral myocardial to blood pool ratio 0.70 (95% CI 0.68-0.72; P < 0.001). Glucose, insulin, and C-peptide correlated to blood pool SUV_mean (Spearman r_s = 0.39, P < 0.01; r_s = 0.40, P < 0.01; r_s = 0.35, P < 0.01) and myocardial SUV_max (Spearman r_s = 0.31, P < 0.01; r_s = 0.31, P < 0.01; r_s = 0.26, P < 0.01). Fatty acid metabolism biomarkers did not correlate to myocardial SUV_max. Conclusions: Patients following intensive metabolic preparation have myocardial FDG SUV_max below background SUV_mean. Biomarkers of glucose metabolism modestly correlate to FDG uptake.

Original language	English (US)
Pages (from-to)	849-861
Number of pages	13
Journal	Journal of Nuclear Cardiology
Volume	27
Issue number	3
DOIs	https://doi.org/10.1007/s12350-019-01786-w
State	Published - Jun 1 2020

Funding

S. R. Larson, J.A. Pieper, E. A. Hulten, and R. L. Weinberg have no disclosures or conflicts of interest related to this publication. E. P. Ficaro and J. R. Corbett have financial interest in INVIA Medical Imaging Solutions, which licenses the commercial software used for imaging processing. INVIA Medical Imaging Solutions did not provide direct support to this study. V. L. Murthy has received consulting fees and stock options from Ionetix, Inc., owns stock in General Electric and Cardinal Health, has a research grant from Siemens Medical Imaging, and has provided expert witness testimony on behalf of Jubilant Draximage. V. L. Murthy is supported by 1R01HL136685 from the National, Heart, Lung, Blood Institute and 1R01AG059729 from the National Institute on Aging. The views expressed are those of the author and do not reflect official policy of Fort Belvoir Community Hospital, the Defense Health Agency, the Department of Defense, or the United States Government.

Keywords

FDG
PET/CT
metabolic preparation
myocardial inflammation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Radiology Nuclear Medicine and imaging

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10.1007/s12350-019-01786-w

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@article{ec343a80df6640f3aef683f4da2fcd18,

title = "Characterization of a highly effective preparation for suppression of myocardial glucose utilization",

abstract = "Background: With appropriate protocols, F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can visualize myocardial inflammation. Optimal protocols and normative myocardial FDG uptake values are not well-established. Methods: We evaluated 111 patients referred for inflammation cardiac FDG PET/CT. Patients followed a low-carbohydrate, high-fat diet for 36 hours before imaging and received unfractionated heparin. Glucose and fatty acid metabolism biomarkers were obtained. Mean blood pool and maximum myocardial uptake (SUVmean, SUVmax) were measured, avoiding areas of abnormal FDG uptake or spillover. Results: Adequate suppression of myocardial FDG uptake occurred in 95% of patients (n = 106). Myocardial SUVmax was significantly below background blood pool SUVmean: septal myocardial to blood pool ratio 0.75 (95% CI 0.73-0.77; P < 0.001); lateral myocardial to blood pool ratio 0.70 (95% CI 0.68-0.72; P < 0.001). Glucose, insulin, and C-peptide correlated to blood pool SUVmean (Spearman rs = 0.39, P < 0.01; rs = 0.40, P < 0.01; rs = 0.35, P < 0.01) and myocardial SUVmax (Spearman rs = 0.31, P < 0.01; rs = 0.31, P < 0.01; rs = 0.26, P < 0.01). Fatty acid metabolism biomarkers did not correlate to myocardial SUVmax. Conclusions: Patients following intensive metabolic preparation have myocardial FDG SUVmax below background SUVmean. Biomarkers of glucose metabolism modestly correlate to FDG uptake.",

keywords = "FDG, PET/CT, metabolic preparation, myocardial inflammation",

author = "Larson, {Sophia R.} and Pieper, {Justin A.} and Hulten, {Edward A.} and Ficaro, {Edward P.} and Corbett, {James R.} and Murthy, {Venkatesh L.} and Weinberg, {Richard L.}",

note = "Publisher Copyright: {\textcopyright} 2019, American Society of Nuclear Cardiology.",

year = "2020",

month = jun,

day = "1",

doi = "10.1007/s12350-019-01786-w",

language = "English (US)",

volume = "27",

pages = "849--861",

journal = "Journal of Nuclear Cardiology",

issn = "1071-3581",

publisher = "Springer New York",

number = "3",

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TY - JOUR

T1 - Characterization of a highly effective preparation for suppression of myocardial glucose utilization

AU - Larson, Sophia R.

AU - Pieper, Justin A.

AU - Hulten, Edward A.

AU - Ficaro, Edward P.

AU - Corbett, James R.

AU - Murthy, Venkatesh L.

AU - Weinberg, Richard L.

PY - 2020/6/1

Y1 - 2020/6/1

N2 - Background: With appropriate protocols, F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can visualize myocardial inflammation. Optimal protocols and normative myocardial FDG uptake values are not well-established. Methods: We evaluated 111 patients referred for inflammation cardiac FDG PET/CT. Patients followed a low-carbohydrate, high-fat diet for 36 hours before imaging and received unfractionated heparin. Glucose and fatty acid metabolism biomarkers were obtained. Mean blood pool and maximum myocardial uptake (SUVmean, SUVmax) were measured, avoiding areas of abnormal FDG uptake or spillover. Results: Adequate suppression of myocardial FDG uptake occurred in 95% of patients (n = 106). Myocardial SUVmax was significantly below background blood pool SUVmean: septal myocardial to blood pool ratio 0.75 (95% CI 0.73-0.77; P < 0.001); lateral myocardial to blood pool ratio 0.70 (95% CI 0.68-0.72; P < 0.001). Glucose, insulin, and C-peptide correlated to blood pool SUVmean (Spearman rs = 0.39, P < 0.01; rs = 0.40, P < 0.01; rs = 0.35, P < 0.01) and myocardial SUVmax (Spearman rs = 0.31, P < 0.01; rs = 0.31, P < 0.01; rs = 0.26, P < 0.01). Fatty acid metabolism biomarkers did not correlate to myocardial SUVmax. Conclusions: Patients following intensive metabolic preparation have myocardial FDG SUVmax below background SUVmean. Biomarkers of glucose metabolism modestly correlate to FDG uptake.

AB - Background: With appropriate protocols, F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) can visualize myocardial inflammation. Optimal protocols and normative myocardial FDG uptake values are not well-established. Methods: We evaluated 111 patients referred for inflammation cardiac FDG PET/CT. Patients followed a low-carbohydrate, high-fat diet for 36 hours before imaging and received unfractionated heparin. Glucose and fatty acid metabolism biomarkers were obtained. Mean blood pool and maximum myocardial uptake (SUVmean, SUVmax) were measured, avoiding areas of abnormal FDG uptake or spillover. Results: Adequate suppression of myocardial FDG uptake occurred in 95% of patients (n = 106). Myocardial SUVmax was significantly below background blood pool SUVmean: septal myocardial to blood pool ratio 0.75 (95% CI 0.73-0.77; P < 0.001); lateral myocardial to blood pool ratio 0.70 (95% CI 0.68-0.72; P < 0.001). Glucose, insulin, and C-peptide correlated to blood pool SUVmean (Spearman rs = 0.39, P < 0.01; rs = 0.40, P < 0.01; rs = 0.35, P < 0.01) and myocardial SUVmax (Spearman rs = 0.31, P < 0.01; rs = 0.31, P < 0.01; rs = 0.26, P < 0.01). Fatty acid metabolism biomarkers did not correlate to myocardial SUVmax. Conclusions: Patients following intensive metabolic preparation have myocardial FDG SUVmax below background SUVmean. Biomarkers of glucose metabolism modestly correlate to FDG uptake.

KW - FDG

KW - PET/CT

KW - metabolic preparation

KW - myocardial inflammation

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UR - http://www.scopus.com/inward/citedby.url?scp=85068015951&partnerID=8YFLogxK

U2 - 10.1007/s12350-019-01786-w

DO - 10.1007/s12350-019-01786-w

M3 - Article

C2 - 31236832

AN - SCOPUS:85068015951

SN - 1071-3581

VL - 27

SP - 849

EP - 861

JO - Journal of Nuclear Cardiology

JF - Journal of Nuclear Cardiology

IS - 3

ER -

Characterization of a highly effective preparation for suppression of myocardial glucose utilization

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