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October 3, 2012Circulation JournalOpen Access

Serial Changes in Glucose-Loaded 18F-Fluoro-2-Deoxyglucose Positron Emission Tomography, 99mTc-Tetrofosmin and 123I-Beta-Methyl-p-Iodophenyl-Penta-Decanoic Acid Myocardial Single-Photon Emission Computed Tomography Images in Patients With Anterior Acute Myocardial Infarction

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Key result

Glucose-loaded 18F-FDG-PET images showed significantly larger defect areas compared to 123I-BMIPP and 99mTc-TF SPECT images over 9 months of follow-up in patients with anterior acute myocardial infarction.

Why the study?

Does glucose-loaded 18F-FDG-PET show different serial changes in myocardial defect areas compared to 123I-BMIPP and 99mTc-TF SPECT in patients with anterior AMI after successful PCI?

Population

7 consecutive patients with first anterior acute myocardial infarction and single-vessel disease who…

Design

Cohort

Follow-up

9 months

Authors

RFRyota FukuokaYHYuki HoritaMNMasanobu Namura

Discussion

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Member takes

Overview

Larger FDG-PET defects may signal prolonged metabolic impairment after anterior AMI; leaves open its added value over SPECT for post-PCI monitoring.

Study Design

Type

Observational (n=7)

Multicenter

No

Structured PICO

Does glucose-loaded 18F-FDG-PET show different serial changes in myocardial defect areas compared to 123I-BMIPP and 99mTc-TF SPECT in patients with anterior AMI after successful PCI?

P
Population
7 patients with first anterior acute myocardial infarction who successfully underwent percutaneous coronary intervention, followed for 9 months with serial myocardial imaging.
E
Exposure
Serial imaging with glucose-loaded 18F-FDG-PET, 123I-BMIPP SPECT, and 99mTc-TF gated SPECT in acute, subacute, chronic, mid-term, and long-term (9 months) phases.
O
Outcome
Serial changes in total defect score (TDS) evaluated by 3 specialists using a 5-point grading system over 9 months.surrogate

Main Result

p-value: p=<0.001

Glucose-loaded 18F-FDG-PET shows persistently larger defect areas compared to 123I-BMIPP and 99mTc-TF SPECT up to 9 months after successful PCI for anterior AMI, suggesting prolonged impairment of glucose metabolism.

Limitations

  • Small sample size of only 7 patients
  • Inclusion of diabetic patients may have affected 18F-FDG accumulation due to insulin resistance
  • Blood levels of free fatty acids and insulin were not measured during 18F-FDG-PET imaging
  • Used bolus administration of insulin instead of the preferred insulin clamp technique for diabetic patients
  • Differences in modality (SPECT vs PET) might have caused falsely positive perfusion-metabolism mismatch
  • Use of hs-CRP alone as a marker of inflammation was insufficient
  • Diabetic patients included without measuring free fatty acids and insulin during 18F-FDG-PET imaging
  • Insulin clamp technique not used for glucose loading
  • Possibility that differences in modality caused falsely positive perfusion-metabolism mismatch

Cite This Study

Fukuoka et al. (2012) conducted an observational in Anterior acute myocardial infarction (n=7). Glucose-loaded 18F-FDG-PET imaging vs. 123I-BMIPP and 99mTc-TF SPECT imaging was evaluated on Total defect score (TDS) of myocardial scan images (p=<0.001). Glucose-loaded 18F-FDG-PET images showed significantly larger defect areas compared to 123I-BMIPP and 99mTc-TF SPECT images over 9 months of follow-up in patients with anterior acute myocardial infarction.

synapsesocial.com/papers/6a9ebb699fb28041eca535b2https://doi.org/10.1253/circj.cj-12-0011
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Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Prediction of Functional Improvement of Ischemic Myocardium With 123I-BMIPP SPECT and 99mTc-Tetrofosmin SPECT Imaging-A Study of Patients With Large Acute Myocardial Infarction and Receiving Revascularization Therapy-2005 · 21 citations
  2. 2Multifocal, Persistent Cardiac Uptake of [18-F]-Fluoro-Deoxy-Glucose Detected by Positron Emission Tomography in Patients With Acute Myocardial Infarction2008 · 8 citations
  3. 3Relative Rates of Oxidation of Glucose and Free Fatty Acids by Ischaemic and Non‐Ischaemic Myocardium after Coronary Artery Ligation in the Dog*1973 · 135 citations
  4. 4Is There Evidence Supporting Coronary Revascularization in Patients With Left Ventricular Systolic Dysfunction?2010 · 19 citations