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The utility of beta-hydroxybutyrate in detecting myocardial glucose uptake suppression in patients undergoing inflammatory [18F]-FDG PET studies

  • Original Article
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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

We evaluated whether serum beta-hydroxybutyrate (BHB) can identify adequate suppression of the left ventricle (LV) among patients undergoing [18F]-fluorodeoxyglucose positron emission tomography ([18F]-FDG PET) for cardiac inflammatory/infectious studies.

Methods

Consecutive patients who underwent [18F]-FDG PET imaging were included. Serum BHB levels were measured in all patients on the day of imaging prior to injecting [18F]-FDG. Myocardial [18F]-FDG suppression was defined if [18F]-FDG uptake in the walls of myocardium, measured using standardized uptake values (SUV), was lower than the blood pool. The optimal threshold of BHB to identify myocardial suppression was based on receiver operating characteristics (ROC) in a random 30% sample of the study population (derivation cohort) and tested in the remaining 70% of sample (validation cohort).

Results

A total of 256 images from 220 patients were included. Patients with sufficient LV suppression had significantly higher BHB levels compared to those with non-suppressed myocardium (median (IQR) BHB 0.6 (0.3–0.8) vs. 0.2 (0.2–0.3) mmol/l, p < 0.001, respectively). BHB level ≥ 0.335 mmol/l had a sensitivity of 84.90% and a specificity of 92.60% to identify adequate LV suppression in the validation cohort. All patients (100%) with BHB ≥ 0.41 mmol/l had adequate myocardial suppression compared to 29.63% of patients with BHB ≤ 0.20 mmol/l.

Conclusion

Serum BHB level can be used at the point of care to identify sufficient LV suppression in patients undergoing [18F]-FDG PET cardiac inflammatory/infectious studies.

Graphical abstract

Central illustration (image to the right) shows representative cases of patient images and BHB and, in the image to the left, shows the sensitivity and specificity to identify left myocardial suppression using BHB in validation group.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AUC:

Area under the curve

BHB:

Beta-hydroxybutyrate

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

FDG:

Fluorodeoxyglucose

PET:

Positron emission tomography

ROC:

Receiver operating characteristics

SUV:

Standardized uptake value

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Authors and Affiliations

  1. Weill Cornell Medical College, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA

    Moath Said Alfawara, Ahmed Ibrahim Ahmed, Jean Michel Saad, Yushui Han, Fares Alahdab, Mahmoud Al Rifai, Mahwash Kassi, William A. Zoghbi & Mouaz H. Al-Mallah

  2. University of Kentucky, Lexington, KY, USA

    Talal Alnabelsi

Authors
  1. Moath Said Alfawara
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  2. Ahmed Ibrahim Ahmed
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Contributions

Mouaz Al-mallah contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Moath Said Alfawara, Ahmed Ibrahim Ahmed, Jean Michel Saad, Yushui Han, Fares Alahdab, and Mahmoud Al Rifai. The first draft of the manuscript was written by Moath Said Alfawara, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mouaz H. Al-Mallah.

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Dr. Al-Mallah receives support from the Houston Methodist Research Institute and Siemens. No other potential conflicts of interest relevant to this article exist.

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Alfawara, M.S., Ahmed, A.I., Saad, J.M. et al. The utility of beta-hydroxybutyrate in detecting myocardial glucose uptake suppression in patients undergoing inflammatory [18F]-FDG PET studies. Eur J Nucl Med Mol Imaging 50, 1103–1110 (2023). https://doi.org/10.1007/s00259-022-06062-7

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  • DOI: https://doi.org/10.1007/s00259-022-06062-7

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