Lower global myocardial metabolic rate of glucose was independently associated with improved MACE-free survival in patients with ischemic cardiomyopathy (HR 0.48; 95% CI 0.27-0.87).
Cohort (n=120)
Does dynamic FDG PET-derived myocardial glucose metabolism predict major adverse cardiac events in patients with ischemic cardiomyopathy?
Dynamic FDG PET-derived quantification of myocardial glucose metabolism provides prognostic information beyond traditional viability assessment in ischemic cardiomyopathy, with low global metabolism and preserved metabolic heterogeneity predicting favorable outcomes.
Hazard Ratio: 0.48 (95% CI 0.27–0.87)
Background/Objectives: To evaluate whether global myocardial glucose metabolism and its regional heterogeneity, quantified using dynamic 18F-fluorodeoxyglucose positron emission tomography (FDG PET), are associated with cardiovascular outcomes in patients with ischemic cardiomyopathy. Methods: The analytic cohort included 120 patients with suspected ischemic cardiomyopathy who underwent thallium-201 perfusion single photon emission tomography and dynamic FDG PET. Global myocardial metabolic rate of glucose (MRGlu) and coefficient of variation in FDG uptake were calculated from scar-excluded myocardium. Major adverse cardiac events (MACEs) were assessed over a median follow-up of 2.5 years. Public myocardial gene-expression datasets (GSE116250 and GSE135055) were analyzed to explore glucose metabolism-related transcriptional patterns relevant to the imaging findings. Results: Fifty-one patients (42.5%) experienced MACEs. Lower global MRGlu was independently associated with improved MACE-free survival (hazard ratio 0.48, 95% confidence interval 0.27–0.87). Among patients with low global MRGlu, a high coefficient of variation predicted favorable outcomes (hazard ratio 0.35, 95% confidence interval 0.18–0.68), indicating beneficial metabolic heterogeneity. Analysis of external gene-expression data demonstrated consistent downregulation of glucose-handling genes in end-stage heart failure across ischemic and dilated etiologies. A higher expression of SLC2A1, HK1, IRS1, and PKM was associated with faster progression to transplantation. Conclusions: In ischemic cardiomyopathy, dynamic FDG PET-derived quantification of myocardial glucose metabolism provides prognostic information beyond traditional viability assessment. Low global metabolism combined with preserved metabolic heterogeneity helps identify patients with favorable clinical outcomes.
Ko et al. (Fri,) conducted a cohort in Ischemic cardiomyopathy (n=120). Lower global myocardial metabolic rate of glucose (MRGlu) vs. Higher global MRGlu was evaluated on Major adverse cardiac events (MACEs) (HR 0.48, 95% CI 0.27-0.87). Lower global myocardial metabolic rate of glucose was independently associated with improved MACE-free survival in patients with ischemic cardiomyopathy (HR 0.48; 95% CI 0.27-0.87).