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

Abstract

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.

Joint SNMMI–ASNC expert consensus document on the role of 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring

“…Indeed, in healthy volunteers, very low doses of UFH, 10-15 U/kg, at 45 min and 15 min, produced lipolysis and increased plasma free fatty acid levels without significantly prolonging the partial thromboplastin 52,62 However, despite data supporting increased plasma free fatty acid levels with UFH administration, the utility of heparin in the suppression of myocardial glucose uptake is unclear. [62][63][64] Combined Approaches…”

Additional Heparin Preadministration Improves Cardiac Glucose Metabolism Suppression over Low-Carbohydrate Diet Alone in 18F-FDG PET Imaging

“…Several methods to suppress cardiac glucose metabolism have been reported: prolonged intervals of fasting (leading to a decrease in blood glucose and insulin levels and, eventually, an increase in blood FFA levels), low-carbohydrate diets (minimizing blood glucose and insulin levels), fat-rich meals (elevating blood FFA levels), heparin administration (inducing lipolysis in vivo and up to a 5-fold increase in blood FFA levels (9)), and combinations of these methods (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). To date, no standard protocol has been adopted, although combination protocols have been advocated by some studies and recent reviews (2,3).…”

Joint SNMMI–ASNC Expert Consensus Document on the Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring

“…Protocols vary among institutions, but the most published protocol is a single 50 IU/kg intravenous bolus of UFH approximately 15 min before 18 F-FDG administration (52,62). However, despite data supporting increased plasma free fatty acid levels with UFH administration, the utility of heparin in the suppression of myocardial glucose uptake is unclear (62)(63)(64).…”