Complete somatostatin-induced insulin suppression combined with heparin loading does not significantly suppress myocardial 18F-FDG uptake in patients with suspected cardiac sarcoidosis

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• 作者：Lars C. Gormsen MD ; PhD (1)
  Nana Louise Christensen MLT (1)
  Elisabeth Bendstrup MD (2)
  Lars Poulsen Tolbod PhD (1)
  Sren Steen Nielsen MD (3)
  
• 关键词：Cardiac sarcoidosis ; fluorodeoxyglucose ; inflammation ; heart failure
• 刊名：Journal of Nuclear Cardiology
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：20
• 期：6
• 页码：1108-1115
• 全文大小：
• 作者单位：Lars C. Gormsen MD, PhD (1)
  Nana Louise Christensen MLT (1)
  Elisabeth Bendstrup MD (2)
  Lars Poulsen Tolbod PhD (1)
  Sren Steen Nielsen MD (3)
  
  1. Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Nrrebrogade 44, 8000, Aarhus C, Denmark
  2. Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Nrrebrogade 44, 8000, Aarhus C, Denmark
  3. Department of Nuclear Medicine, Hospital of Southwest Denmark, 6700, Esbjerg, Denmark
  
• ISSN：1532-6551

文摘

Background Cardiac 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography preceded by extended fasting is used to demonstrate active cardiac sarcoidosis. However, physiological insulin-dependent myocardial 18F-FDG uptake often obscures 18F-FDG uptake in sarcoid lesions. We therefore aimed to completely suppress physiological myocardial 18F-FDG uptake by pharmaceutically blocking endogenous insulin secretion while elevating free fatty acids (FFAs). Methods and results Six patients with suspected cardiac sarcoidosis were studied in a randomized cross-over design: (1) 12hours fasting followed by 2hours saline infusion (SALINE), and (2) 12hours fasting followed by 2hour infusions of somatostatin (300/hour) and heparin (70mIE/kg/minutes) (SOMA). 18F-FDG PET scans were performed post-infusion. Glucose, insulin, and FFA levels were measured and left ventricle SUV-values were recorded. During the SALINE infusion, insulin, glucose, and FFAs remained stable. By design, the SOMA infusions rapidly (<60minutes) suppressed insulin completely, while FFA levels peaked at 1.130.23mM. However, SOMA infusions only suppressed cardiac 18F-FDG uptake insignificantly globally [SUVmean (g/mL): 4.03.3 (SALINE) vs 2.41.2 (SOMA), P=.15] and regionally. Conclusions Complete insulin suppression combined with markedly increased circulating FFAs does not completely suppress physiological myocardial 18F-FDG uptake and thus conveys no extra diagnostic value compared with extended fasting.