Safety and feasibility of cardiac FDG SPECT following oral administration of Acipimox, a nicotinic acid derivative: Comparison of image quality with hyperinsulinemic euglycemic clamping in nondiabetic patients.
BACKGROUND
Image quality of cardiac fluorine-18-deoxyglucose (FDG) studies is highly dependent on the metabolic conditions during the study; hyperinsulinemic euglycemic clamping ensures adequate image quality. However, the approach is time-consuming. Data in a small number of patients suggest that oral administration of a nicotinic acid derivative (Acipimox, 250 mg; Byk, The Netherlands) results in good image quality.


RESULTS
The safety and image quality of cardiac FDG single photon emission computed tomography studies after Acipimox administration were evaluated (21 patients, group 2); the results were compared with studies performed during hyperinsulinemic euglycemic clamping (69 patients, group 1). Image quality was assessed visually and quantitatively with use of heart-to-lung, heart-to-liver, and myocardium-to-background ratios. Blood samples were drawn at baseline and at the time of FDG injection to determine levels of glucose, free fatty acids, and insulin. Baseline characteristics of group 1 and 2 patients were comparable. No side effects occurred in group 1. Four patients in group 2 (19%) had paroxysmal flushing. Image quality, assessed visually, was good in 100% of group 1 patients and in 86% of group 2 patients. Images were uninterpretable in only 1 patient in group 2 (5%). All quantitative parameters of image quality (heart-to-lung, heart-to-liver, and myocardium-to-background ratios) were comparable between group 1 and 2 patients. Baseline plasma levels of all substrates were comparable between groups. At the time of FDG injection, plasma levels of glucose and free fatty acids were comparable between groups; insulin was higher in group 1 patients.


CONCLUSIONS
Cardiac FDG single photon emission computed tomography after Acipimox is a simple and safe approach that renders comparable image quality to that obtained during hyperinsulinemic euglycemic clamping.
Bax
Jeroen J
JJ
Leiden University Medical Center, Leiden, Free University Hospital, Amsterdam, The Netherlands. jbax@knoware.nl
Visser
Frans C
FC
Poldermans
Don
D
Van Lingen
Arthur
A
Elhendy
Abdou
A
Boersma
Eric
E
Sloof
Gerrit W
GW
Visser
Cees A
CA
D000284:Administration, Oral; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D015309:Glucose Clamp Technique; D006321:Heart / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D009539:Nicotinic Acids; D011719:Pyrazines / Q000009:adverse effects*; D011786:Quality Control; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology
D009539:Nicotinic Acids; D011719:Pyrazines; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C027696:acipimox