Reduced myocardial 18F-FDG uptake after calcium channel blocker administration. Initial observation for a potential new method to improve plaque detection

Gaeta, Chiara; Fernández, Yolanda; Pavı́a, Javier; Flotats, Albert; Artigas, Carlos; Deportos, Jordi; Geraldo, Llanos; Carrió, Ignasi

doi:10.1007/s00259-011-1873-2

Cited by 28 publications

(22 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a mouse model, Gaeta and colleagues showed significant reduction in myocardial FDG uptake following single administration of verapamil injected 1 hour prior to FDG administration at doses of 1 and 20 mgÁkg -1 . 5 Similar results have not been reproduced in humans. Demeure and colleagues demonstrated similar success in suppressing myocardial FDG uptake (89%) in 9 volunteers pre-treated with oral Verapamil (120 mg) 1 hour before FDG injection who also ate a high-fat lowcarbohydrate meal, followed by a 12-h fasting period when compared to 9 other volunteers who only ate a highfat low-carbohydrate meal, followed by a 12-hour fasting period without verapamil premedication.…”

Section: See Related Article Pp 86-99supporting

confidence: 57%

See 1 more Smart Citation

Challenges of cardiac inflammation imaging with F-18 FDG positron emission tomography

Bhambhvani

2017

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

Reliable hot spot inflammation imaging with fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) in suspected cardiac infection, cardiac sarcoidosis, or vulnerable coronary plaque is only possible when physiologic myocardial FDG uptake can be adequately suppressed. The gamut of perfusion-metabolism patterns possible in cardiac sarcoidosis 1 combined with the erratic and real possibility of inadequate suppression of normal myocardial FDG uptake is a sure recipe for head scratching and challenging image interpretation. A number of preparation methods aimed at suppressing physiologic myocardial glucose utilization have been described without clear consensus on the optimal method. In the present issue of the Journal of Nuclear Cardiology, Osborne and colleagues (doi:10.1007/s12350-016-0502-7) review various preparation protocols and success rates achieved in published studies for FDG cardiac PET and provide useful practical recommendations.A brief overview of cardiomyocyte metabolism is essential to appreciate the challenges and rationale of interventions. The heart uses various substrates as energy sources including free fatty acids (FFAs), glucose, and lactate. In the fasting condition, the normal myocardium utilizes FFAs as the major energy source (90%). Other sources include glucose and lactate.2 Postmeals or in the dysfunctional myocardium (example ischemic heart disease), myocardial metabolism shifts to glucose per the glucose-fatty acid cycle.2,3 Elevated blood insulin and glucose levels with decreased FFAs lead to a relative rise in myocardial glucose consumption. In contrast, during fasting, there is an increase in FFAs with decrease in insulin and glucose levels, shifting myocardial energy consumption away from glucose and toward FFAs. Hence interventions that facilitate myocardial FFAs metabolism while at the same time suppress physiologic glucose metabolism are imperative for successful FDG PET cardiac inflammation imaging. These include avoidance of strenuous exercise prior to imaging (to prevent skeletal muscle glucose utilization), high-fat with low (less than 5 g)-or no carbohydrate diet (to increase blood FFAs and minimize glucose and insulin levels), addition of a high-fat drink to this diet prior to FDG injection (to elevate blood FFAs), fasting for 4-18 hours (to decrease blood glucose and insulin levels and increase FFAs), and certain pharmacologic maneuvers. The latter include unfractionated heparin which induces lipolysis and up to fivefold increase in blood FFAs 4 and calcium channel blockers which reduce myocardial FDG uptake.5 Most studies combine two or more interventions with the goal of complete suppression of normal cardiac FDG uptake.Tang and colleagues in a meta-analysis involving 16 studies and 559 patients evaluated for cardiac sarcoidosis examined various patient preparations that impact the diagnostic performance of FDG PET. They conclude that duration of fasting and heparin administration significantly affected the diagnostic odds ratio (P = .01 and .04, respec...

show abstract

Section: See Related Article Pp 86-99supporting

confidence: 57%

“…The latter include unfractionated heparin which induces lipolysis and up to fivefold increase in blood FFAs 4 and calcium channel blockers which reduce myocardial FDG uptake. 5 Most studies combine two or more interventions with the goal of complete suppression of normal cardiac FDG uptake.…”

Section: See Related Article Pp 86-99mentioning

confidence: 99%

Challenges of cardiac inflammation imaging with F-18 FDG positron emission tomography

Bhambhvani

2017

Journal of Nuclear Cardiology

View full text Add to dashboard Cite

show abstract

“…66 One study explored the use of calcium channel blockade with verapamil to improve myocardial suppression, but verapamil had no clear benefit over other preparations. 58 Performing 18 F-FDG PET on hospitalized patients can be challenging.…”

Section: Other Considerationsmentioning

confidence: 99%

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

Chareonthaitawee

Beanlands

Chen

et al. 2017

Journal of Nuclear Cardiology

173

133

View full text Add to dashboard Cite

“…Gaeta and colleagues [24] are to be congratulated for this proof of principle study. We await their definitive clinical study with a focus on the detection of coronary inflammation.…”

mentioning

confidence: 95%

“…The manuscript by Gaeta et al [24] in this issue of the European Journal of Nuclear Medicine and Molecular Imaging proposes the use of a calcium channel blocker (verapamil) to inhibit myocardial glucose uptake. This approach may be used independently or in association with dietary manipulation.…”

mentioning

confidence: 99%

Myo-Myo: Yes, papa. Eating sugar? No, papa!

Narula

Strausś

2011

Eur J Nucl Med Mol Imaging

View full text Add to dashboard Cite

Reduced myocardial 18F-FDG uptake after calcium channel blocker administration. Initial observation for a potential new method to improve plaque detection

Abstract: In this animal model there was a significant reduction in (18)F-FDG uptake in the myocardium following verapamil administration. This type of intervention could facilitate the definition of coronary atherosclerotic plaque inflammation on (18)F-FDG PET scans.

Cited by 28 publications

References 17 publications

Challenges of cardiac inflammation imaging with F-18 FDG positron emission tomography

Challenges of cardiac inflammation imaging with F-18 FDG positron emission tomography

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

Myo-Myo: Yes, papa. Eating sugar? No, papa!

Contact Info

Product

Resources

About