The association between diabetes mellitus and reduction in myocardial glucose uptake: a population-based 18F-FDG PET/CT study

Abstract

Background: In diabetes, dysregulated substrate utilization and energy metabolism of myocardium can lead to heart failure. To examine the dynamic changes of myocardium, most of the previous studies conducted dynamic myocardial PET imaging following euglycemic-hyperinsulinemic clamp, which involves complicated procedures. In comparison, the whole-body ¹⁸F-FDG PET/CT scan is a simple and widely used method. Therefore, we hope to use this method to observe abnormal myocardial glucose metabolism in diabetes and determine the influencing factors.

Methods: We retrospectively analyzed PET/CT images of 191 subjects from our medical examination center. The levels of FDG uptake in myocardium were visually divided into 4 grades (Grade 0-3, from low to high). The differences in clinical and metabolic parameters among diabetes mellitus (DM), impaired fasting glucose (IFG), and normal fasting glucose (NFG) groups were analyzed, as well as their associations with myocardial FDG uptake.

Results: Compared with NFG and IFG groups, DM group had more cardiovascular-related risk factors. The degree of myocardial FDG uptake was significantly decreased in DM group; when myocardial FDG uptake ≤ Grade 1, the sensitivity of DM prediction was 84.0%, and the specificity was 58.4%. Univariate analysis showed that the myocardial FDG uptake was weakly and negatively correlated with multiple metabolic-related parameters (r = - 0.173~ - 0.365, P < 0.05). Multivariate logistic regression analysis showed that gender (male), HOMA-IR and nonalcoholic fatty liver disease (NAFLD) were independent risk factors for poor myocardial FDG uptake.

Conclusions: Diabetes is associated with decreased myocardial glucose metabolism, which is mediated by multiple metabolic abnormalities.

Keywords: Diabetes mellitus; FDG; Insulin resistance; Nonalcoholic fatty liver disease; PET.

Fig. 1

The flowcharts of subjects grouping, PET/CT scanning and image analysis. ADA: American Diabetes Association, NFG: normal fasting glucose, IFG: impaired fasting glucose, DM: diabetes mellitus, NAFLD: nonalcoholic fatty liver disease

Fig. 2

Visual grading scale of myocardial FDG uptake. (¹⁸F-FDG PET/CT maximal intensity projection images)

Fig. 3

Myocardial SUVmean for each visual grade. SUVmean of grade 0–3 is 1.29 ± 0.21, 1.95 ± 0.47, 3.60 ± 0.70, 5.97 ± 1.25, respectively. (F = 338.14, P < 0.001)

Fig. 4

Correlation between myocardial glucose uptake and diabetes. a, the distribution of NFG, IFG and DM groups in each myocardial glucose uptake grade; b, the differences in SUVmean between NFG, IFG and DM groups (NFG: 3.42 ± 1.92, IFG: 2.86 ± 1.56, DM: 1.94 ± 0.96, P < 0.05)

Fig. 5

ROC curve analysis was used to assess the efficacy of using visual grading of myocardial FDG uptake to predict diabetes. When FDG uptake ≤ Grade 1, the sensitivity of predicting diabetes was 84%, the specificity was 58.43%, AUC = 0.745, and 95% confidence interval was 0.677 ~ 0.805 (z = 5.859, P < 0.001)