Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Effect of prolonged fasting and low molecular weight heparin or warfarin therapies on 2-deoxy-2-[18F]-fluoro-D-glucose PET cardiac uptake. Assuero Giorgetti, MD, 1 Gavino Marras, BSc, 1 Dario Genovesi, MD, 1 Elena Filidei, MD,1 Antonio Bottoni, MD, 1 Maurizio Mangione, BSc, 1 Michele Emdin, MD, PhD, FESC, 1,2, Paolo Marzullo, MD1,3   1 Fondazione "G. Monasterio" CNR/Regione Toscana, Pisa, Italy 2 Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy 3 Institute of Clinical Physiology, CNR, Pisa, Italy Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND 1- PET imaging 18F-FDG can be useful in the evaluation of cardiac inflammatory diseases. 2- However, the physiological uptake of 18F-FDG by the LV wall often make it diffucult the clinical interpretation of PET images. 3- To minimize cardiac 18F-FDG uptake clinical protocols combining prolonged fasting, diet modifications and unfractionated heparin i.v. administration have been proposed. 4- Whether other anticoagulants beyond unfractionated heparin are able to block cardiac carbohydrate metabolism has been not yet investigated. Copyright American Society of Nuclear Cardiology

METHODS Study type: retrospective/observational. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type: retrospective/observational. Study subjects: patients fasting>12h, without cardiac dysfunction and/or coronary heart disease, and without anticoagulant therapy (G1, n:75) or receiving low molecular weight heparin or warfarin therapy (G2, n:99) underwent a 18F-FDG PET/CT study. Study endpoints: to evaluate 18F-FDG myocardial uptake in patients receiving low molecular weight heparin or warfarin anticoagulants. Study variables: Cardiac 18F-FDG uptake was estimated qualitatively using a 4-point scale and semiquantitatively as total LV glycolysis (LVG) and metabolic volume (MV). Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Prolonged fasting alone (G1 patients, blue columns) had an unsatisfactory rate of myocardial 18F-FDG suppression (top) and higher values of semiquantitative parameters (bottom), when compared to prolonged fasting combined to anticoagulant therapies (G2 patients, red columns). Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS 18F-FDG myocardial uptake in a control patient (Control, left), in a patient receiving low molecular weight heparin (LMWH, middle) and in a patient under warfarin therapy (WF, right). Control patient showed an intense 18F-FDG myocardial uptake on both total body MIP (upper) and transaxial images (bottom), while patients receiving anticoagulants did not. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS 1- Our study demonstrates that in patients without history and symptoms of cardiac diseases and with normal LV function, prolonged fasting combined with chronic anticoagulation (with LMWH or warfarin) is able to suppress cardiomyocyte 18F-FDG uptake in a significant majority of cases. 2- Our data add novel tools to influence the metabolic pattern of the heart before the 18F-FDG PET scan and potentially broadens the spectrum of pharmacological options available to block cardiac glucose metabolism. Copyright American Society of Nuclear Cardiology