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Effect of Diabetes Mellitus on Myocardial ¹⁸F-FDG SPECT Using Acipimox for the Assessment of Myocardial Viability

¹ Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
² Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
³ Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

During the noninvasive assessment of myocardial viability with ¹⁸F-FDG metabolic imaging, adequate regulation of metabolic conditions is needed to ensure optimal image quality. The aim of this study was to compare the feasibility and image quality of cardiac ¹⁸F-FDG SPECT imaging using acipimox in patients with diabetes and patients without diabetes. Methods: Seventy patients with ischemic cardiomyopathy underwent ¹⁸F-FDG SPECT using acipimox for the assessment of myocardial viability, followed by resting 2-dimensional echocardiography to identify dysfunctional myocardial tissue. The image quality was scored visually and quantitatively; the myocardium-to-background ratio was determined by region-of-interest analysis. The plasma concentrations of glucose and free fatty acids were determined to evaluate the metabolic conditions before and during ¹⁸F-FDG imaging. Results: Thirty-four patients had diabetes mellitus; of these, 12 had insulin-dependent diabetes mellitus and 22 had non-insulin-dependent diabetes mellitus. The remaining 36 patients had no diabetes. During ¹⁸F-FDG SPECT, no severe side effects occurred. Acipimox significantly lowered plasma levels of free fatty acids in both groups. Fifteen of 34 patients with diabetes had a plasma glucose level > 9 mmol/L, which was lowered successfully in all patients with additional insulin. Visual evaluation of the ¹⁸F-FDG images showed good, moderate, and poor image quality in 27, 5, and 2 patients, respectively, with diabetes mellitus and in 32, 4, and 0 patients, respectively, without diabetes (P = not statistically significant). The myocardium-to-background ratio of ¹⁸F-FDG SPECT images was comparable in patients with and without diabetes mellitus (3.1 ± 1.0 vs. 3.5 ± 0.9, P = not statistically significant). The type of diabetes had no influence on ¹⁸F-FDG image quality. Conclusion: ¹⁸F-FDG SPECT metabolic imaging after acipimox is safe and practical for routine assessment of viability in patients with ischemic cardiomyopathy. Image quality is good, even in patients with diabetes, although additional insulin is sometimes needed.

Key Words: metabolic imaging • diabetes mellitus • tomography • myocardial viability

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