Abstract 12053: Diagnostic Utility of SGLT2 Inhibitors to Facilitate Myocardial Glucose Suppression During Evaluation of Myocardial Inflammation

Abstract

Background: The non-invasive cornerstone for evaluating cardiac sarcoidosis (CS) remains 18 F-FDG-PET. However, FDG-PET requires suppressing physiologic glucose uptake to highlight pathologic uptake. Short term ketogenic diet (KD) is standard-of-care, yet inadequate suppression occurs in 10-20% which can mimic CS patterns. Ketone metabolic markers strongly predict appropriate glucose suppression, and therefore the ketogenic-SGLT2i may facilitate suppression. Methods: We prospectively evaluated 494 scans from 388 unique patients undergoing evaluation for CS. FDG-PET images were classified as diagnostic (negative or positive for CS-related inflammation) or non-diagnostic (diffuse or non-specific uptake). We used mixed effect linear regression (accounting for clustering at the participant level), adjusting for age, race, sex, days of KD, heart failure (HF), and diabetes mellitus. Results: Mean age was 59.0±10.1 years, 63% were male, 29% were Black, 21% were repeat scans, and 14% were on SGLT2i. SGLT2i use was associated with male sex, features/treatment for HF and diabetes, and higher hemoglobin and ketone levels ( Table , p<0.05 for all comparisons). Diagnostic scans were more frequently achieved in the SGLT2i group (98.6%) vs. non-SGLT2i group (92.0%) (unadjusted beta-coefficient 6.6%, 95%CI 0.0-13.1%, p=0.049; multivariable-adjusted 8.0%, 1.3-14.6%, p=0.019). Adjusting for log-transformed BHB eliminated this relationship (beta-coefficient 4.7%, p=0.17), though hemoglobin adjustment did not (beta-coefficient 7.9%, p=0.038). There were no interactions by days of KD, HF, sex, race, or diabetes (p-interaction>0.05 for all comparisons). Conclusions: SGLT2i facilitated diagnostic FDG-PET scans (number needed-to-treat 13-15), which was nearly universally achieved (99%), and may be mediated by their ketogenic effects. We demonstrate a novel diagnostic niche which may decrease inappropriate treatment, costs, and radiation.