Key result
SGLT2 inhibitor use was associated with significantly greater suppression of myocardial glucose utilization, with absent myocardial FDG uptake in 64.7% of treated patients compared to 37.4% of untreated patients.
Why the study?
SGLT2 inhibitors confer cardioprotective effects without acting directly on the myocardium, but their impact on myocardial glucose utilization required evaluation.
Does SGLT2 inhibitor treatment reduce myocardial glucose utilization in patients undergoing 18F-FDG PET?
Cohort (n=374)
No
Does SGLT2 inhibitor treatment reduce myocardial glucose utilization in patients undergoing 18F-FDG PET?
Absolute Event Rate: 64.7% vs 37.4%
p-value: p=<0.001
SGLT2 inhibitor use is associated with significantly reduced myocardial glucose utilization, providing insight into their metabolic effects on the heart.
SGLT2i use may increase myocardial glucose suppression on oncologic FDG-PET; leaves open implications for imaging protocols and clinical outcomes.
BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have cardioprotective effects without acting directly on the myocardium. OBJECTIVES: The purpose of the study was to evaluate the impact of SGLT2i on myocardial glucose utilization. METHODS: This retrospective propensity-matched cohort study examined subjects who underwent whole-body 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography for oncologic purposes between 2016 and 2024. A 1:1 propensity match analyzed positron emission tomography-derived myocardial FDG uptake, maximum myocardial standardized uptake value (SUV), and total myocardial glycolysis in SGLT2i-treated vs untreated patients. RESULTS: , P = 0.001), and total myocardial glycolysis (1.6 g vs 20.6 g, P < 0.001) were significantly lower in patients treated with SGLT2i vs those untreated. SGLT2i use blunted insulin-induced increases in total myocardial glycolysis (P-interaction 0.036). There was no difference in background SUVmax and SUVmean in the blood pool and liver. CONCLUSIONS: SGLT2i use was associated with a greater suppression of myocardial glucose without affecting background tissue glycolysis despite higher prescan glucose levels. These findings add to the understanding of the effect of SGLT2i on the myocardium and may have implications with respect to cardiac imaging protocols that require glucose manipulation.
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Sperry et al. (2025) conducted a cohort in Oncologic conditions requiring FDG PET (n=374). SGLT2 inhibitors vs. No SGLT2 inhibitors was evaluated on Absent myocardial FDG uptake (p=<0.001). SGLT2 inhibitor use was associated with significantly greater suppression of myocardial glucose utilization, with absent myocardial FDG uptake in 64.7% of treated patients compared to 37.4% of untreated patients.
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