The International Journal of Cardiovascular Imaging

, Volume 30, Issue 2, pp 415–423

Low-carbohydrate diet versus euglycemic hyperinsulinemic clamp for the assessment of myocardial viability with 18F-fluorodeoxyglucose-PET: a pilot study

  • José SoaresJr.
  • Filadelfo Rodrigues Filho
  • Marisa Izaki
  • Maria Clementina P. Giorgi
  • Rosa M. A. Catapirra
  • Rubens Abe
  • Carmen G. C. M. Vinagre
  • Giovanni G. Cerri
  • José Cláudio Meneghetti
Original Paper

DOI: 10.1007/s10554-013-0324-5

Cite this article as:
Soares, J., Rodrigues Filho, F., Izaki, M. et al. Int J Cardiovasc Imaging (2014) 30: 415. doi:10.1007/s10554-013-0324-5

Abstract

Positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET) is considered the gold standard for myocardial viability. A pilot study was undertaken to compare FDG-PET using euglycemic hyperinsulinemic clamp before 18F-fluorodeoxyglucose (18F-FDG) administration (PET-CLAMP) with a new proposed technique consisting of a 24-h low-carbohydrate diet before 18F-FDG injection (PET-DIET), for the assessment of hypoperfused but viable myocardium (hibernating myocardium). Thirty patients with previous myocardial infarction were subjected to rest 99mTc-sestamibi-SPECT and two 18F-FDG studies (PET-CLAMP and PET-DIET). Myocardial tracer uptake was visually scored using a 5-point scale in a 17-segment model. Hibernating myocardium was defined as normal or mildly reduced metabolism (18F-FDG uptake) in areas with reduced perfusion (99mTc-sestamibi uptake) since 18F-FDG uptake was higher than the degree of hypoperfusion–perfusion/metabolism mismatch indicating a larger flow defect. PET-DIET identified 79 segments and PET-CLAMP 71 as hibernating myocardium. Both methods agreed in 61 segments (agreement = 94.5 %, κ = 0.78). PET-DIET identified 230 segments and PET-CLAMP 238 as nonviable. None of the patients had hypoglycemia after DIET, while 20 % had it during CLAMP. PET-DIET compared with PET-CLAMP had a good correlation for the assessment of hibernating myocardium. To our knowledge, these data provide the first evidence of the possibility of myocardial viability assessment with this technique.

Keywords

Cardiology Positron emission tomography 18F-fluordeoxyglucose Myocardial viability Carbohydrate-restricted diet 

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • José SoaresJr.
    • 1
  • Filadelfo Rodrigues Filho
    • 1
    • 3
  • Marisa Izaki
    • 1
  • Maria Clementina P. Giorgi
    • 1
  • Rosa M. A. Catapirra
    • 1
  • Rubens Abe
    • 1
  • Carmen G. C. M. Vinagre
    • 2
  • Giovanni G. Cerri
    • 1
  • José Cláudio Meneghetti
    • 1
  1. 1.Nuclear Medicine Department, Heart Institute (InCor)University of Sao Paulo Medical SchoolSão PauloBrazil
  2. 2.Lipid Metabolism Laboratory, Heart Institute (InCor)University of Sao Paulo Medical SchoolSão PauloBrazil
  3. 3.FortalezaBrazil