Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction

Tsai, Szu-Ying; Wu, Yen‐Wen; Wang, Shan-Ying; Shiau, Yu‐Chien; Chiu, Kuan–Ming; Tsai, Hao-Yuan; Lee, Chien-Lin; Hsu, Jung-Cheng; Tu, Chung-Ming; Lin, Herng‐Ching; Huang, Shan-Hui

doi:10.1007/s00259-019-04471-9

Cited by 8 publications

(5 citation statements)

References 47 publications

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“…Few studies have addressed this previously. In the most comprehensive study [19], dynamic FDG PET data were used as prognostic indicators for mortality and MACE. It included 75 HF patients characterized by LV EF <40%, where more than half of the subjects had diabetes (53.7%).…”

Section: The Prognostic Impact Of Mgu and Diabetesmentioning

confidence: 99%

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

et al. 2021

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Background & aims: The connection between peripheral insulin resistance (IR) and coronary artery disease is well-established. Both are major risk factors for the development of ischemic cardiomyopathy potentially leading to heart failure (HF). Whether cardiac IR also impacts overall survival and morbidity is still debated. We therefore aimed to test if cardiac IR predicts mortality and major cardiovascular events (MACE) in patients with HF scheduled for cardiac viability testing before revascularization. Methods: This retrospective study included 131 patients with a clinical diagnosis of ischemic HF (114 (87%) male, 33 (25%) with diabetes) referred to a viability Rubidium-82 (perfusion) and dynamic 18 F-Fluorodeoxyglucose (metabolism) positron emission tomography combined with computed tomography prior to a potential revascularization procedure. Cardiac IR was assessed by myocardial glucose uptake (MGU) in a remote (non-scarred) area of the left ventricle during a hyperinsulinemic-euglycemic clamp (1mIE/kg/min). Results: MGU correlated with skeletal muscle glucose uptake (p < 0.001) and whole-body glucose uptake (M-value) (p < 0.001), whereas no association was observed for individuals with diabetes. MGU did not predict the risk of death or MACE. However, both overt diabetes and reduced coronary flow reserve predicted overall survival. Conclusion: Even though diabetes and related small-vessel disease is associated with increased mortality, cardiac IR per se does not predict cardiovascular morbidity and mortality.

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Section: The Prognostic Impact Of Mgu and Diabetesmentioning

confidence: 99%

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

et al. 2021

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“…Standard cardiac FDG-PET uses static scanning and provides standardized uptake value (SUV) for the characterization of myocardial glucose metabolism. Alternatively, dynamic FDG-PET has also been investigated for quantitative myocardial imaging [16][17][18]. With compartmental modeling [19][20][21][22] or graphical analysis [23][24][25][26][27], most of these existing dynamic cardiac FDG-PET studies focused on quantitative evaluation of glucose metabolism.…”

Section: Introductionmentioning

confidence: 99%

Multiparametric Cardiac ¹⁸F-FDG PET in Humans: Kinetic Model Selection and Identifiability Analysis

Zuo

Badawi

Foster

et al. 2020

IEEE Trans. Radiat. Plasma Med. Sci.

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Cardiac 18 F-FDG PET has been used in clinics to assess myocardial glucose metabolism. Its ability for imaging myocardial glucose transport, however, has rarely been exploited in clinics. Using the dynamic FDG-PET scans of ten patients with coronary artery disease, we investigate in this paper appropriate dynamic scan and kinetic modeling protocols for efficient quantification of myocardial glucose transport. Three kinetic models and the effect of scan duration were evaluated by using statistical fit quality, assessing the impact on kinetic quantification, and analyzing the practical identifiability. The results show that the kinetic model selection depends on the scan duration. The reversible two-tissue model was needed for a one-hour dynamic scan. The irreversible two-tissue model was optimal for a scan duration of around 10-15 minutes. If the scan duration was shortened to 2-3 minutes, a one-tissue model was the most appropriate. For global quantification of myocardial glucose transport, we demonstrated that an early dynamic scan with a duration of 10-15 minutes and irreversible kinetic modeling was comparable to the full one-hour scan with reversible kinetic modeling. Myocardial glucose transport quantification provides an additional physiological parameter on top of the existing assessment of glucose metabolism and has the potential to enable single tracer multiparametric imaging in the myocardium.

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“…In one study looking at PET scans in heart failure with low ejection fraction, RV glucose uptake was found to correlate with RV pressure overload and to have significant prognostic value. 50 In PAH, RV glucose uptake has been shown to correlate with RV function and pressure overload. 13 , 51 – 53 Here we show a cutoff of RV/LV FDG PET that may be associated with worse clinical outcomes with increased transplant and death in the PH group with higher RV glucose uptake.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac PET scans are mainly used in left‐sided disease to assess myocardial perfusion and viability. In one study looking at PET scans in heart failure with low ejection fraction, RV glucose uptake was found to correlate with RV pressure overload and to have significant prognostic value 50 . In PAH, RV glucose uptake has been shown to correlate with RV function and pressure overload 13,51–53 .…”

Section: Discussionmentioning

confidence: 99%

Metabolic endophenotype associated with right ventricular glucose uptake in pulmonary hypertension

et al. 2021

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Alterations in metabolism and bioenergetics are hypothesized in the mechanisms leading to pulmonary vascular remodeling and heart failure in pulmonary hypertension (PH). To test this, we performed metabolomic analyses on 30 PH individuals and 12 controls. Furthermore, using 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), we dichotomized PH patients into metabolic phenotypes of high and low right ventricle (RV) glucose uptake and followed them longitudinally. In support of metabolic alterations in PH and its progression, the high RV glucose group had higher RVSP (p < 0.001), worse RV function as measured by RV fractional area change and peak global longitudinal strain (both p < 0.05) and may be associated with poorer outcomes (33% death or transplantation in the high glucose RV uptake group compared to 7% in the low RV glucose uptake group at 5 years follow up, log-ranked p = 0.07). Pathway enrichment analysis identified key metabolic pathways including fructose catabolism, arginine-nitric oxide metabolism, tricarboxylic acid (TCA) cycle, and ketones metabolism. Integrative human protein-protein interactome network analysis of metabolomic and transcriptomic data identified key pathobiological pathways: arginine biosynthesis, TCA cycle, purine metabolism, hypoxia-inducible factor 1 and apelin signaling. These findings identify a PH metabolomic endophenotype, and for the first time link this to disease severity and outcomes.

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Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction

Cited by 8 publications

References 47 publications

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

Multiparametric Cardiac ¹⁸F-FDG PET in Humans: Kinetic Model Selection and Identifiability Analysis

Metabolic endophenotype associated with right ventricular glucose uptake in pulmonary hypertension

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Clinical significance of quantitative assessment of right ventricular glucose metabolism in patients with heart failure with reduced ejection fraction

Cited by 8 publications

References 47 publications

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

Ischemic heart failure mortality is not predicted by cardiac insulin resistance but by diabetes per se and coronary flow reserve: A retrospective dynamic cardiac 18F-FDG PET study

Multiparametric Cardiac 18F-FDG PET in Humans: Kinetic Model Selection and Identifiability Analysis

Metabolic endophenotype associated with right ventricular glucose uptake in pulmonary hypertension

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Multiparametric Cardiac ¹⁸F-FDG PET in Humans: Kinetic Model Selection and Identifiability Analysis