Characterization of a highly effective preparation for suppression of myocardial glucose utilization

Larson, Sophia; Pieper, Justin; Hulten, Edward; Ficaro, Edward P.; Corbett, James R.; Murthy, Venkatesh L.; Weinberg, Richard L.

doi:10.1007/s12350-019-01786-w

Cited by 31 publications

(14 citation statements)

References 31 publications

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“…In our study, endogenous BHB levels had an AUROC of 0.88 for predicting MGS, and a cutoff of 0.58 mmol/L accurately classified MGS 92% of the time. This predictive ability of BHB was stronger than those with insulin, glucagon, glucose, and NEFA, consistent with other studies that have found modest predictive ability for these biomarkers ( 15 ), and clarifies that ketosis is a more potent driver, or predictive biomarker, of MGS than these other metabolic processes. Such potent prediction has clinical implications, as BHB levels can be routinely assessed before 18 F-FDG PET to ensure adequate patient preparation.…”

Section: Discussionsupporting

confidence: 89%

Comparison of Exogenous Ketone Administration versus Dietary Carbohydrate Restriction on Myocardial Glucose Suppression: A Crossover Clinical Trial

et al. 2021

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Section: Discussionsupporting

confidence: 89%

Comparison of Exogenous Ketone Administration versus Dietary Carbohydrate Restriction on Myocardial Glucose Suppression: A Crossover Clinical Trial

et al. 2021

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“…There is some evidence that an intravenous heparin injection 15 min prior to FDG injection has an additive effect on physiological myocardial FDG uptake when used in conjunction with the HFLC diet [30], though other studies that evaluated heparin injection found variable results [31][32][33]. Because of the available, yet limited evidence for its additive value, when no contra-indications exist against the use of heparin, it may be considered as an adjunct to an HFLC diet.…”

Section: Patient Preparationmentioning

confidence: 99%

18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

et al. 2021

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Purpose of Review Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. Recent Findings There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Summary Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.

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“…However, based on its higher specificity, 18 F-FDG PET/CT could be considered in patients with possible NVE after doubtful or negative TTE or with a contra-indication for TEE [ 17 , 22 ]. Since the scans results have major implications on patient management, it is of the utmost importance to implement standardized preparation protocols with higher rate of adequate 18 F-FDG myocardial suppression [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Performance of 18F-FDG PET/CT in Native Valve Endocarditis: Systematic Review and Bivariate Meta-Analysis

et al. 2020

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Background: Infectious endocarditis is a life-threatening disease, requiring prompt and accurate diagnosis. The aim of this article is to perform a systematic review and meta-analysis of the literature to estimate the performance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for the diagnosis of native valve endocarditis (NVE). Methods: Selected articles evaluating the diagnostic accuracy of 18F-FDG PET/CT in patients with suspected NVE, resulting from a comprehensive literature search through the PubMed/MEDLINE and Cochrane library databases until April 2020, were included for the systematic review and meta-analysis. Results: Seven studies (351 episodes of suspected NVE) were included. 18F-FDG PET/CT yielded a pooled sensitivity of 36.3% and a pooled specificity of 99.1% for the diagnosis of NVE. The pooled positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 8.3, 0.6, and 15.3, respectively. The sensitivity increased using contemporary PET/CT device with state-of-the-art patient preparation as well as innovative image acquisitions or adding the results of 18F-FDG PET/CT in a multimodality strategy. Conclusions: In our systematic review and meta-analysis, 18F-FDG PET/CT yielded a poor pooled sensitivity with an otherwise excellent pooled specificity for the diagnosis of NVE; however, several factors may increase the sensitivity without affecting the specificity and these factors should be better evaluated in future studies.

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Characterization of a highly effective preparation for suppression of myocardial glucose utilization

Cited by 31 publications

References 31 publications

Comparison of Exogenous Ketone Administration versus Dietary Carbohydrate Restriction on Myocardial Glucose Suppression: A Crossover Clinical Trial

Comparison of Exogenous Ketone Administration versus Dietary Carbohydrate Restriction on Myocardial Glucose Suppression: A Crossover Clinical Trial

18F-FDG PET/CT in Infective Endocarditis: Indications and Approaches for Standardization

Diagnostic Performance of 18F-FDG PET/CT in Native Valve Endocarditis: Systematic Review and Bivariate Meta-Analysis

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