Dataset Information

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 (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.

SUBMITTER: Larson SR

PROVIDER: S-EPMC6928445 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

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

Larson Sophia R SR Pieper Justin A JA Hulten Edward A EA Ficaro Edward P EP Corbett James R JR Murthy Venkatesh L VL Weinberg Richard L RL

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology 20190624 3

<h4>Background</h4>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.<h4>Methods</h4>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 b ...[more]

PMID: 31236832

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Project description:The ketogenic diet (KD) is the standard of care to achieve myocardial glucose suppression (MGS) for assessing inflammation using 18F-FDG PET. However, failure to suppress physiologic glucose uptake remains a significant diagnostic barrier. Although extending the duration of KD may be effective, exogenously delivered ketones may provide a convenient, reliable, and same-day alternative. The aims of our study were to determine whether exogenous ketone administration is noninferior to the KD to achieve MGS and whether serum β-hydroxybutyrate (BHB) levels can predict MGS. Methods: KEETO-CROSS (Ketogenic Endogenous versus Exogenous Therapies for myoCaRdial glucOse SuppresSion) is a crossover, noninferiority trial of the KD (endogenous ketosis) versus ketone ester ([KE] exogenous ketosis) drink. Twenty healthy participants were enrolled into 3 arms: weight-based KE drink, 24-h KD, and 72-h KD (n = 18 completed all arms). The primary outcome was achievement of complete MGS on PET (noninferiority margin 5%). The area under receiver-operating-characteristics (AUROC) of endogenous BHB levels (analyzed in a laboratory and by point-of-care device) for predicting MGS was analyzed in 37 scans completed on the KD. Results: The mean age was 30 ± 7 y, 50% were women, and 45% were nonwhite. The median achieved BHB levels (mmol/L) were 3.82 (25th-75th percentile, 2.55-4.97) (KE drink), 0.77 (25th-75th percentile, 0.58-1.02) (25th-75th percentile, 24-h KD), and 1.30 (25th-75th percentile, 0.80-2.24) (72-h KD). The primary outcome was achieved in 44% (KE drink), 78% (24-h KD), and 83% (72-h KD) of participants (noninferiority P = 0.97 and 0.98 for KE vs. 24-h and 72-h KD). Endogenous BHB levels robustly predicted MGS (AUROC, 0.88; 95% CI 0.71, 1.00). A BHB of 0.58 or more correctly classified 92% of scans. A point-of-care device provided comparable predictive value. Conclusion: In healthy volunteers, KE was inferior to KD for achieving MGS. Serum BHB is a highly predictive biomarker for MGS and can be clinically implemented upstream of 18F-FDG PET, with rapid facilitation by point-of-care testing, to reduce false-positive scans.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

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