Utility of serum ketone levels for assessment of myocardial glucose suppression for 18F-fluorodeoxyglucose PET in patients referred for evaluation of endocarditis

Chaitanya Madamanchi*, Richard L. Weinberg, Venkatesh L. Murthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: 18F-FDG PET/CT is used to diagnose cardiac sarcoidosis and endocarditis. It requires myocardial glucose utilization (MGU) suppression to avoid false positives, which occur in up to 20% of patients. Serum beta-hydroxybutyrate (BHB) levels may help identify incomplete suppression of MGU. We determined the optimal timing and diagnostic thresholds to identify incomplete suppression of MGU. Methods and results: We retrospectively identified 114 patients referred for 18F-FDG PET/CT for endocarditis, wherein myocardial uptake outside of paravalvular regions is not related to pathology and can be confidently ascribed as being due to inadequate suppression of MGU. Patients followed a high-fat, low-carbohydrate diet and received heparin. Serum BHB, insulin, glucose and hemoglobin A1c were measured. Maximum standardized uptake value (SUVmax) of left ventricle (LV) and mean SUV (SUVmean) in LV blood pool (LVBP) was measured. Logistic regression and area under the receiver-operating characteristic analyses were used to quantify the relationship between biomarkers and MGU suppression. A threshold of BHB ≥ 0.35 mmol·L−1 to detect suppression resulted in sensitivity of 88% and specificity of 61%. A threshold of BHB ≥ 0.95 mmol·L−1 resulted in sensitivity of 45% and specificity of 100%. AUC was 0.87. BHB measured ~ 4 hours prior to 18F-FDG injection performed similarly to or better than later timepoints. Conclusions: Serum BHB levels are useful for assessing suppression of MGU and could simplify interpretation of 18F-FDG PET/CT inflammation studies.

Original languageEnglish (US)
Pages (from-to)928-937
Number of pages10
JournalJournal of Nuclear Cardiology
Volume30
Issue number3
DOIs
StatePublished - Jun 2023

Funding

Dr. Murthy is a paid advisor for INVIA Medical Imaging Solutions. Dr. Murthy reports consulting fees and research grants from Siemens Medical Imaging and for INVIA Medical Imaging Solutions. He is a paid advisor for Ionetix. Dr. Murthy owns stock in General Electric and Cardinal Health and stock options in Ionetix. He is supported by NIH grants U01DK123013, R01AG059729, and R01HL136685.and the Melvyn Rubenfire Professorship in Preventive Cardiology. Dr. Madamanchi has no disclosures. Dr. Weinberg reports consulting fees from Ionetix. Drs. Madamanchi, Weinberg, and Murthy have no non-financial interests to disclose.

Keywords

  • Beta-hydroxybutyrate (BHB)
  • F-FDG PET/CT
  • Myocardial glucose utilization (MGU)
  • standardized uptake value (SUV)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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