title: Low-carbohydrate diet versus euglycemic hyperinsulinemic clamp for the assessment of myocardial viability with 18F-fluorodeoxyglucose-PET: a pilot study.
abstract: Positron emission tomography with (18)F-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 (18)F-fluorodeoxyglucose ((18)F-FDG) administration (PET-CLAMP) with a new proposed technique consisting of a 24-h low-carbohydrate diet before (18)F-FDG injection (PET-DIET), for the assessment of hypoperfused but viable myocardium (hibernating myocardium). Thirty patients with previous myocardial infarction were subjected to rest (99m)Tc-sestamibi-SPECT and two (18)F-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 ((18)F-FDG uptake) in areas with reduced perfusion ((99m)Tc-sestamibi uptake) since (18)F-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.
authors.affiliation: Nuclear Medicine Department, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, CEP: 05403-000, Brazil.
authors.forename: José
authors.initials: J
authors.lastname: Soares
authors.forename: Filadelfo
authors.initials: F
authors.lastname: Rodrigues Filho
authors.forename: Marisa
authors.initials: M
authors.lastname: Izaki
authors.forename: Maria Clementina P
authors.initials: MC
authors.lastname: Giorgi
authors.forename: Rosa M A
authors.initials: RM
authors.lastname: Catapirra
authors.forename: Rubens
authors.initials: R
authors.lastname: Abe
authors.forename: Carmen G C M
authors.initials: CG
authors.lastname: Vinagre
authors.forename: Giovanni G
authors.initials: GG
authors.lastname: Cerri
authors.forename: José Cláudio
authors.initials: JC
authors.lastname: Meneghetti
mesh_terms: D000328:Adult; D000368:Aged; D003326:Coronary Circulation; D050528:Diet, Carbohydrate-Restricted; D005240:Feasibility Studies; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D015309:Glucose Clamp Technique; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D010865:Pilot Projects; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000378:metabolism; D017256:Technetium Tc 99m Sestamibi; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi