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CLINICAL STUDIES

Blood flow–metabolism imaging with positron emission tomography in patients with diabetes mellitus for the assessment of reversible left ventricular contractile dysfunction ¹

^a Department of Molecular and Medical Pharmacology, Division of Nuclear Medicine, UCLA School of Medicine, Los Angeles, California, USA
^b Laboratory of Structural Biology and Molecular Medicine, University of California, Los Angeles, California, USA

Manuscript received January 12, 1998; revised manuscript received November 13, 1998, accepted December 24, 1998.

Reprint requests and correspondence: Dr. Heinrich R. Schelbert, Department of Molecular and Medical Pharmacology, UCLA School of Medicine, Los Angeles, California 90095-1735
hschelbert{at}mednet.ucla.edu

OBJECTIVES

The purpose of this study was to evaluate the predictive accuracy of positron emission tomography (PET) blood flow–F-18 fluorodeoxyglucose (FDG) imaging in coronary artery disease (CAD) patients with diabetes mellitus (DM).

BACKGROUND

Positron emission tomography accurately predicts the postrevascularization improvement in left ventricular dysfunction in unselected patients with CAD. In diabetic patients, however, poor myocardial glucose utilization may limit the accuracy of the approach.

METHODS

Forty patients (64 ± 10 years old; 19 with DM = group I; 21 without DM = group II) with reduced left ventricular ejection fraction (LVEF = 29 ± 6%) were studied with N-13 ammonia and FDG PET before coronary revascularization. Studies were performed after intravenous injection of regular insulin (group I) or oral glucose administration (group II). Blood flow–FDG mismatches and matches were identified by polar map analysis in the three vascular territories of the left anterior descending, left circumflex and right coronary artery. Wall motion and LVEF were assessed by two-dimensional echocardiography before and 158 ± 123 days after revascularization.

RESULTS

Of 107 vascular territories analyzed, 46 were classified as mismatch, 29 as match and 32 as normal. The FDG image quality, assessed by F-18 myocardium to blood pool activity ratios, and the predictive accuracy were similar in both groups; presence of a blood flow/FDG mismatch had a sensitivity of 92% (group I) and 94% (group II) and a specificity of 85% (group I) and 79% (group II) for an improvement in regional left ventricular function. A postrevascularization improvement in global left ventricular function was related to the extent of blood flow/FDG mismatch; LVEF increased from 30 ± 7% to 35 ± 7% (p = 0.017) in patients with one mismatch and from 27 ± 4% to 41 ± 7% (p < 0.001) in those with two mismatches.

CONCLUSIONS

The predictive accuracy of blood flow/FDG imaging is maintained in patients with DM when a clinically acceptable study protocol, which guarantees good FDG image quality, is used. The extent of a blood flow/metabolism mismatch is correlated with the magnitude of the postrevascularization improvement in global left ventricular function.

Abbreviations and Acronyms   FDG = F-18 fluorodeoxyglucose   IDDM = insulin-dependent diabetes   LVEF = left ventricular ejection fraction   NIDDM = non–insulin-dependent diabetes   NYHA = New York Heart Association   PET = positron emission tomography

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