Relationship of Ketosis With Myocardial Glucose Uptake Among Patients Undergoing FDG PET/CT for Evaluation of Cardiac Sarcoidosis.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Imaging Pub Date : 2024-08-01 Epub Date: 2024-07-31 DOI:10.1161/CIRCIMAGING.124.016774

Mahesh K Vidula, Senthil Selvaraj, Chaitanya Rojulpote, Abhijit Bhattaru, Wumesh Kc, Mary Hansbury, Erin Schubert, Caitlin B Clancy, Milton Rossman, Lee R Goldberg, Michael Farwell, Daniel Pryma, Paco E Bravo

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引用次数: 0

Abstract

Background: Fluorine-18 fluorodeoxyglucose (FDG) with positron emission tomography (PET) is the standard for detecting myocardial inflammation in cardiac sarcoidosis, requiring preparation with the ketogenic diet (KD) to achieve myocardial glucose suppression. Despite this, incomplete myocardial glucose suppression remains a significant issue, and strategies to reduce myocardial glucose uptake (MGU) and identify incomplete myocardial glucose suppression are required. This study sought to understand the relationship between point-of-care beta-hydroxybutyrate (BHB) and different patterns of MGU and between KD and fasting duration with MGU in patients undergoing evaluation for cardiac sarcoidosis.

Methods: We prospectively included 471 outpatients who underwent FDG-PET for cardiac sarcoidosis evaluation, followed the KD for 1 (n=100), 2 (n=29), and ≥3 days (n=342), fasted for at least 12 hours, and had BHB levels measured immediately before FDG injection. Images were classified as (1) no MGU (negative), (2) focal/multifocal (positive), (3) diffuse (nondiagnostic), or (4) nonspecific uptake (NS-MGU).

Results: Cardiac FDG-PET scans were interpreted as the following: 376 (79.83%) negative; 61 (12.95%) positive; 14 (2.97%) diffuse; and 20 (4.25%) NS-MGU. There was a strong negative relationship between BHB levels and MGU (P<0.0001). BHB levels increased significantly with KD duration (P<0.0001) and fasting time (P=0.0067). The combined rate of diffuse, NS-MGU, and positive scans (34%, 28%, 16%) decreased inversely with KD duration (1, 2, and ≥3 days, respectively). However, MGU was not different across different fasting times (P=0.6). Blood glucose levels were not associated with MGU (P=0.17) and only weakly associated with BHB levels (R²=0.03; P<0.001).

Conclusions: We observed a strong inverse relationship between ketosis and patterns of MGU. Longer KD and fasting durations are associated with higher ketosis. However, only KD duration was associated with lower rates of MGU. Measurement of BHB levels before FDG-PET using point-of-care testing is feasible and may facilitate the management of patients referred for myocardial inflammation.

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接受 FDG PET/CT 检查以评估心脏肉样瘤病的患者中酮症与心肌葡萄糖摄取量的关系

背景：正电子发射断层扫描（PET）检测氟-18 氟脱氧葡萄糖（FDG）是检测心脏肉样瘤病心肌炎症的标准方法，需要用生酮饮食（KD）进行准备，以实现心肌葡萄糖抑制。尽管如此，不完全的心肌葡萄糖抑制仍是一个重要问题，因此需要采取策略减少心肌葡萄糖摄取（MGU）并识别不完全的心肌葡萄糖抑制。本研究旨在了解接受心脏肉芽肿病评估的患者中，护理点β-羟丁酸（BHB）与不同模式的MGU之间的关系，以及KD和空腹时间与MGU之间的关系：我们前瞻性地纳入了471名接受FDG-PET心脏肉样瘤病评估的门诊患者，他们分别接受了1天（100人）、2天（29人）和≥3天（342人）的KD，禁食至少12小时，并在FDG注射前立即测量了BHB水平。图像分为：(1) 无 MGU（阴性）；(2) 局灶/多灶（阳性）；(3) 弥漫性（非诊断性）；(4) 非特异性摄取（NS-MGU）：心脏 FDG-PET 扫描结果如下：376例（79.83%）阴性；61例（12.95%）阳性；14例（2.97%）弥漫性；20例（4.25%）NS-MGU。BHB 水平与 MGU 之间存在很强的负相关关系（PPP=0.0067）。弥漫性、NS-MGU 和阳性扫描的总比率（34%、28%、16%）随着 KD 持续时间（分别为 1 天、2 天和≥3 天）的延长而呈反比下降。然而，不同空腹时间的 MGU 并无差异（P=0.6）。血糖水平与 MGU 无关（P=0.17），仅与 BHB 水平有微弱关联（R2=0.03；PC 结论：我们观察到酮病与 MGU 模式之间存在密切的反向关系。较长的 KD 和禁食持续时间与较高的酮病有关。然而，只有 KD 持续时间与较低的 MGU 发生率相关。在进行 FDG-PET 前使用护理点检测法测量 BHB 水平是可行的，可促进对转诊的心肌炎患者的管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.