What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac sarcoidosis (n=202). Intervention: Long fasting vs. Heparin loading (50 IU/kg) plus 12-hour fasting. Primary outcome: Complete inhibition of physiological myocardial 18F-FDG uptake (grade 1) in patients with known or suspected cardiac sarcoidosis (OR 4.708, 95% CI 2.268-10.172, p=<0.0001).

What does this research mean for the field?

An 18-hour fast is significantly more effective than heparin loading with a 12-hour fast at suppressing physiological myocardial 18F-FDG uptake in patients evaluated for cardiac sarcoidosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare the efficacy of an 18-hour prolonged fast against heparin loading with a 12-hour fast for suppressing physiological myocardial 18F-FDG uptake during PET evaluation of cardiac sarcoidosis.

January 2, 2014EJNMMI ResearchOpen Access

Long fasting is effective in inhibiting physiological myocardial 18F-FDG uptake and for evaluating active lesions of cardiac sarcoidosis

Q: What are the key findings of this study?

Long fasting of 18 hours or more significantly increased the complete inhibition of physiological myocardial 18F-FDG uptake compared to heparin loading plus a 12-hour fast in patients with cardiac sarcoidosis (OR 4.708).

Q: What does this research mean for the field?

An 18-hour fast is significantly more effective than heparin loading with a 12-hour fast at suppressing physiological myocardial 18F-FDG uptake in patients evaluated for cardiac sarcoidosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare the efficacy of an 18-hour prolonged fast against heparin loading with a 12-hour fast for suppressing physiological myocardial 18F-FDG uptake during PET evaluation of cardiac sarcoidosis.

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Key result

Fasting ≥18 hours is linked to ~371% greater complete myocardial 18F-FDG inhibition versus heparin plus 12-hour fast.

OR 4.708
95% CI 2.268-10.172
P<0.0001
n=202

Why the study?

Does an 18-hour fast improve the inhibition of physiological myocardial 18F-FDG uptake compared to heparin loading plus a 12-hour fast in patients undergoing PET for cardiac sarcoidosis?

Population

202 subjects, including 37 healthy subjects and 165 patients with known or suspected cardiac sarcoidosis (CS).

Comparison

18-hour fast before 18F-FDG PET scan vs Heparin loading plus a 12-hour fast before…

Design

Cohort

Authors

MMMiyako MorookaToho University MMMasao MoroiToho University KUKimiichi UnoYotsuya Medical Cube

Discussion

Member takes

Implication

Longer fasting may enhance FDG suppression on cardiac sarcoidosis PET; leaves open optimal protocols pending randomized confirmation.

Key Points

To compare the efficacy of an 18-hour prolonged fast against heparin loading with a 12-hour fast for suppressing physiological myocardial 18F-FDG uptake during PET evaluation of cardiac sarcoidosis.
Compared an 18-hour fast (LF) against heparin loading combined with a 12-hour fast (HEP) prior to 18F-FDG PET imaging.
Evaluated healthy subjects (n=19 in LF; n=18 in HEP) alongside patients with known or suspected cardiac sarcoidosis (n=69 in LF; n=96 in HEP).
Scored myocardial 18F-FDG uptake on a visual 4-point scale benchmarked to liver uptake, utilizing logistic regression and regression trees to assess suppression determinants.
In healthy participants, myocardial 18F-FDG uptake scores were significantly lower with LF (1.68 ± 1.06) than with HEP (3.17 ± 1.16; p < 0.0001).
In cardiac sarcoidosis patients, myocardial 18F-FDG uptake scores were likewise significantly reduced with LF (1.48 ± 0.99) compared to HEP (2.48 ± 1.33; p < 0.0001).
Logistic regression identified prolonged fasting as the most effective method for physiological suppression, with serum free fatty acid levels at injection identifying metabolic readiness.

Study Design

Type

Cohort (n=202)

Blinding

Single-blind

Multicenter

Structured PICO

Does an 18-hour fast improve the inhibition of physiological myocardial 18F-FDG uptake compared to heparin loading plus a 12-hour fast in patients undergoing PET for cardiac sarcoidosis?

Population

202 participants, including 37 healthy subjects and 165 patients with known or suspected cardiac sarcoidosis, underwent 18F-FDG PET imaging following either an 18-hour fast or heparin loading plus a 12-hour fast.

Intervention

18-hour fast (long fasting, LF) before 18F-FDG PET scan

Comparator

Heparin loading plus a 12-hour fast (HEP) before 18F-FDG PET scan

Outcome

Myocardial 18F-FDG uptake assessed by a visual four-point scale in comparison with hepatic uptakesurrogate

Main Result

Odds Ratio: 4.708 (95% CI 2.268–10.172)

Absolute Event Rate: 78.3% vs 38.5%

p-value: p=<0.0001

An 18-hour fast is more effective than heparin loading plus a 12-hour fast at inhibiting physiological myocardial 18F-FDG uptake, improving the evaluation of active cardiac sarcoidosis lesions on PET.

Limitations

Non-randomized study design
Patients with diabetes mellitus were not analyzed
Lack of dietary control (e.g., low-carbohydrate/high-fat diet) prior to fasting
Heparin was administered as a single injection rather than a continuous infusion

Cite This Study

Morooka et al. (2014) conducted a cohort in Cardiac sarcoidosis (n=202). Long fasting vs. Heparin loading (50 IU/kg) plus 12-hour fasting was evaluated on Complete inhibition of physiological myocardial 18F-FDG uptake (grade 1) in patients with known or suspected cardiac sarcoidosis (OR 4.708, 95% CI 2.268-10.172, p=<0.0001). Long fasting of 18 hours or more significantly increased the complete inhibition of physiological myocardial 18F-FDG uptake compared to heparin loading plus a 12-hour fast in patients with cardiac sarcoidosis (OR 4.708).

synapsesocial.com/papers/6aa930791ed6af7fb80e06df https://doi.org/10.1186/2191-219x-4-1

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Long fasting is effective in inhibiting physiological myocardial 18F-FDG uptake and for evaluating active lesions of cardiac sarcoidosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Long fasting is effective in inhibiting physiological myocardial 18F-FDG uptake and for evaluating active lesions of cardiac sarcoidosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

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