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

Arend F.L. Schinkel, MD1, Jeroen J. Bax, MD2, Roelf Valkema, MD3, Abdou Elhendy, MD1, Ron T. van Domburg, PhD1, Eleni C. Vourvouri, MD1, Manolis A. Bountioukos, MD1, Eric P. Krenning, MD3, Jos R.T.C. Roelandt, MD1 and Don Poldermans, MD, PhD1

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



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  		FIGURE 1. Bar graft demonstrates plasma glucose levels measured at baseline (white bars) and immediately before 18F-FDG injection (black bars). *P < 0.0001 vs. no diabetes. **P < 0.005 vs. no diabetes. {dagger}P < 0.001 vs. immediately before 18F-FDG injection. Values are expressed as mean ± SD.

 


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  		FIGURE 2. Plasma concentration of free fatty acids (FFA) in patients with diabetes mellitus and those without diabetes, at baseline (white bars) and after oral administration of acipimox (black bars). *P < 0.0001 vs. after acipimox.

 


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  		FIGURE 3. Quality of 18F-FDG SPECT images (M/B ratio) was comparable in patients with and without diabetes mellitus.

 


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  		FIGURE 4. Examples of image quality obtained with 18F-FDG SPECT after oral administration of acipimox. (A) Baseline 99mTc-tetrofosmin (left), dual-isotope simultaneous acquisition (DISA) 99mTc-tetrofosmin (middle), and DISA 18F-FDG (right) short-axis images of patient with NIDDM. All images are of good quality; this patient had M/B ratio of 4.2. (B) Baseline 99mTc-tetrofosmin (left), DISA 99mTc-tetrofosmin (middle), and DISA 18F-FDG (right) short-axis images of patient with IDDM. 18F-FDG images are of poor quality. This patient had M/B ratio of 2.1.

 


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  		FIGURE 5. Number of viable (normal perfusion or blood-flow-metabolism mismatch) and nonviable dysfunctional myocardial segments as assessed by 18F-FDG SPECT in patients with and without diabetes mellitus.

 


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  		FIGURE 6. Region-of-interest analysis demonstrated that type of diabetes, IDDM vs. NIDDM, had no influence on 18F-FDG image quality. NS = not statistically significant.

 




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