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Effect of prolonged fasting and low molecular weight heparin or warfarin therapies on 2-deoxy-2-[18F]-fluoro-D-glucose PET cardiac uptake

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Whether anticoagulants other than unfractionated heparin are able to suppress cardiac PET uptake of 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) is unknown.

Methods

One-hundred-seventy-four patients without history and clinical evidence of cardiac dysfunction and/or coronary heart disease underwent a 18F-FDG PET/CT study. All patients were studied with a >12-hours fasting and divided into 2 groups: group-1 without anticoagulant therapy (n:75); group-2 patients on low molecular weight heparin (n:60) or warfarin therapy (n:39). Cardiac 18F-FDG uptake was estimated qualitatively using a 4-point scale and semiquantitatively as total LV glycolysis (LVG) and metabolic volume (MV), drawing isocontour volume of interest (VOI) including the whole LV.

Results

Qualitatively, LV 18-FDG uptake was scored 0 or 1, indicating a good suppression, in 10/75 (13%) patients of group-1 and 77/99 (78%) of group-2 (p < .001). Semiquantitatively, patients of group-1 showed higher values of 18-FDG uptake than patients of group-2, assessed as LVG (802,649 ± 468,442 vs 198,989 ± 261,439, p < .0001) or MV (219 ± 77 vs 57 ± 48 cm3, p < .0001). Subanalysis for anticoagulant drugs showed similar results.

Conclusions

Prolonged fasting combined to anticoagulants other than unfractionated heparin is able to minimize glucose cardiac metabolism. Our data confirm previous observation on the possibility to influence the metabolic pattern of the heart before the PET scan and broadens the spectrum of pharmacological options.

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Abbreviations

PET:

Positron emission tomography

18F-FDG:

2-deoxy-2-[18F]-fluoro-D-glucose

LV:

Left ventricle

SUVmax and SUVmean:

Standardized uptake value max and mean

MV:

Metabolic LV total volume

LVG:

Total LV glycolysis

LMWH:

Low molecular weight heparin

WF:

Warfarin

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Authors’ contributions

AG and DG contributed to the conception, design, analysis, and interpretation of data and manuscript preparation and submission. GM and MM had access to the database of the Institute and provided patient’s selection and clinical information. EF and AB participated to imaging analysis and manuscript preparation. ME and PM participated to the design, data analysis, and revised the manuscript.

Disclosure

The authors Assuero Giorgetti, Gavino Marras, Dario Genovesi, Elena Filidei, Antonio Bottoni, Maurizio Mangione, Michele Emdin, and Paolo Marzullo declare that they have no competing interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Correspondence to Assuero Giorgetti MD.

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Giorgetti, A., Marras, G., Genovesi, D. et al. Effect of prolonged fasting and low molecular weight heparin or warfarin therapies on 2-deoxy-2-[18F]-fluoro-D-glucose PET cardiac uptake. J. Nucl. Cardiol. 25, 1364–1371 (2018). https://doi.org/10.1007/s12350-017-0800-8

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  • DOI: https://doi.org/10.1007/s12350-017-0800-8

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