Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
Ann Nucl Med. 2021 Feb;35(2):195-202. doi: 10.1007/s12149-020-01551-x. Epub 2021 Jan 2.
The variability of physiologic F-FDG uptake in the myocardium has hampered the accurate evaluation of cardiac glucose metabolism. We investigated the effects of multiple factors, including fasting duration and physical activity, on the physiologic uptake of F-FDG by the myocardium in healthy participants.
A total of 446 participants (predominantly male, 91%) in a health screening program were included in this retrospective study. For the visual analysis of myocardial F-FDG uptake, the participants were categorized into three groups according to qualitative visual scales (QVS). For the quantitative analysis, the maximum SUV of the left ventricular myocardium was measured.
Significant differences were observed in fasting duration (p < 0.001), SUV (p < 0.001), aspartate aminotransferase (AST) (p < 0.001), alanine aminotransferase (ALT) (p < 0.001), gamma-glutamyl transpeptidase (γ-GTP) (p = 0.001), and uric acid (p = 0.015) among the QVS groups. Participants who regularly exercised with vigorous activity (p = 0.032) and HbA1c > 6% (p = 0.005) showed significant association with myocardial FDG uptake in the Chi-squared test. The median value of fasting duration decreased significantly as the QVS of the myocardium increased. Twenty-nine of the 31 participants (93.5%) who fasted for 21.5 h or more showed a suppressed FDG uptake (mean SUV = 2.1). In multivariate logistic regression analysis, fasting duration (OR = 0.74, 95% CI 0.69-0.80, p < 0.001), HbA1c > 6% (OR = 0.29, 95% CI: 0.12 - 0.66, p = 0.004), uric acid (OR = 0.82, 95% CI 0.68-1.00, p = 0.049) and regular exercise with vigorous activity (OR = 1.75, 95% CI 1.13-2.70, p = 0.012) were significant factors for physiologic myocardial FDG uptake.
Reduced physiologic F-FDG uptake of the myocardium was associated with longer fasting duration, higher level of HbA1c, and less frequency of regular exercise with vigorous activity. For the preparation of cardiac F-FDG PET, inclusion of longer fasting duration (more than 18 h) might be necessary for the adequate suppression of physiologic F-FDG myocardial uptake.
心肌中生理 F-FDG 摄取的可变性妨碍了对心脏葡萄糖代谢的准确评估。我们研究了多种因素（包括禁食时间和体力活动）对健康参与者心肌中 F-FDG 生理摄取的影响。
本回顾性研究纳入了 446 名（主要为男性，占 91%）健康筛查计划参与者。为了进行心肌 F-FDG 摄取的视觉分析，参与者根据定性视觉量表（QVS）分为三组。为了进行定量分析，测量了左心室心肌的最大 SUV。
QVS 组之间在禁食时间（p<0.001）、SUV（p<0.001）、天冬氨酸转氨酶（AST）（p<0.001）、丙氨酸转氨酶（ALT）（p<0.001）、γ-谷氨酰转肽酶（γ-GTP）（p=0.001）和尿酸（p=0.015）方面存在显著差异。经常进行剧烈体力活动的参与者（p=0.032）和 HbA1c>6%的参与者（p=0.005）与心肌 FDG 摄取呈显著相关，在卡方检验中。随着心肌 QVS 的增加，禁食时间的中位数显著降低。29 名（93.5%）禁食 21.5 小时或更长时间的参与者显示 FDG 摄取受到抑制（平均 SUV=2.1）。多元逻辑回归分析显示，禁食时间（OR=0.74，95%CI 0.69-0.80，p<0.001）、HbA1c>6%（OR=0.29，95%CI：0.12-0.66，p=0.004）、尿酸（OR=0.82，95%CI 0.68-1.00，p=0.049）和经常进行剧烈体力活动（OR=1.75，95%CI 1.13-2.70，p=0.012）是心肌生理 FDG 摄取的显著因素。
心肌生理 F-FDG 摄取减少与禁食时间延长、HbA1c 水平升高和体力活动减少有关。为了进行心脏 F-FDG PET 准备，可能需要更长的禁食时间（超过 18 小时）才能充分抑制生理 F-FDG 心肌摄取。
