Nuclear Medicine Department, Heart Institute (InCor), University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, SP, CEP: 05403-000, Brazil.
Int J Cardiovasc Imaging. 2014 Feb;30(2):415-23. doi: 10.1007/s10554-013-0324-5. Epub 2013 Nov 20.
Positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) is considered the gold standard for myocardial viability. A pilot study was undertaken to compare FDG-PET using euglycemic hyperinsulinemic clamp before (18)F-fluorodeoxyglucose ((18)F-FDG) administration (PET-CLAMP) with a new proposed technique consisting of a 24-h low-carbohydrate diet before (18)F-FDG injection (PET-DIET), for the assessment of hypoperfused but viable myocardium (hibernating myocardium). Thirty patients with previous myocardial infarction were subjected to rest (99m)Tc-sestamibi-SPECT and two (18)F-FDG studies (PET-CLAMP and PET-DIET). Myocardial tracer uptake was visually scored using a 5-point scale in a 17-segment model. Hibernating myocardium was defined as normal or mildly reduced metabolism ((18)F-FDG uptake) in areas with reduced perfusion ((99m)Tc-sestamibi uptake) since (18)F-FDG uptake was higher than the degree of hypoperfusion-perfusion/metabolism mismatch indicating a larger flow defect. PET-DIET identified 79 segments and PET-CLAMP 71 as hibernating myocardium. Both methods agreed in 61 segments (agreement = 94.5 %, κ = 0.78). PET-DIET identified 230 segments and PET-CLAMP 238 as nonviable. None of the patients had hypoglycemia after DIET, while 20 % had it during CLAMP. PET-DIET compared with PET-CLAMP had a good correlation for the assessment of hibernating myocardium. To our knowledge, these data provide the first evidence of the possibility of myocardial viability assessment with this technique.
正电子发射断层扫描术（PET）用（18）F-氟代脱氧葡萄糖（FDG-PET）被认为是心肌存活的金标准。进行了一项初步研究，比较了在给予（18）F-氟代脱氧葡萄糖（FDG）之前使用正葡萄糖高胰岛素钳夹（PET-CLAMP）和在注射（18）F-FDG 之前使用 24 小时低碳水化合物饮食（PET-DIET）的新方法，用于评估低灌注但存活的心肌（冬眠心肌）。30 例有心肌梗死病史的患者接受静息（99m）Tc-替曲膦-SPECT 和两次（18）F-FDG 研究（PET-CLAMP 和 PET-DIET）。使用 17 段模型中的 5 分制视觉评分法对心肌示踪剂摄取进行评分。冬眠心肌定义为灌注减少（（99m）Tc-替曲膦摄取）区域的正常或轻度代谢减少（（18）F-FDG 摄取），因为（18）F-FDG 摄取高于低灌注程度-灌注/代谢不匹配表明更大的血流缺陷。PET-DIET 确定了 79 个节段，PET-CLAMP 确定了 71 个节段为冬眠心肌。两种方法在 61 个节段上一致（一致性=94.5%，κ=0.78）。PET-DIET 确定了 230 个节段，PET-CLAMP 确定了 238 个节段为无存活能力。无糖尿病患者在 DIET 后发生低血糖，而在 CLAMP 中有 20%发生低血糖。与 PET-CLAMP 相比，PET-DIET 对冬眠心肌的评估具有良好的相关性。据我们所知，这些数据首次提供了使用该技术评估心肌存活能力的可能性的证据。
