Abstract
Objective: Positron emission tomography/computed tomography with 18F-fluorodeoxy-glucose (18F-FDG-PET/CT) has become the standard staging modality in various tumor entities. Cancer patients frequently receive cardio-toxic therapies. However, routine cardiovascular assessment in oncologic patients is not performed in current clinical practice. Accordingly, this study sought to assess whether myocardial 18F-FDG uptake patterns of patients undergoing oncologic PET/CT can be used for cardiovascular risk stratification. Methods: Myocardial 18F-FDG uptake pattern was assessed in 302 patients undergoing both oncologic whole-body 18F-FDG-PET/CT and myocardial perfusion imaging by single-photon emission computed tomography (SPECT-MPI) within a six-month period. Primary outcomes were myocardial 18F-FDG uptake pattern, impaired myocardial perfusion, ongoing ischemia, myocardial scar, and left ventricular ejection fraction. Results: Among all patients, 109 (36.1%) displayed no myocardial 18F-FDG uptake, 77 (25.5%) showed diffuse myocardial 18F-FDG uptake, 24 (7.9%) showed focal 18F-FDG uptake, and 92 (30.5%) had a focal on diffuse myocardial 18F-FDG uptake pattern. In contrast to the other uptake patterns, focal myocardial 18F-FDG uptake was predominantly observed in patients with myocardial abnormalities (i.e., abnormal perfusion, impaired LVEF, myocardial ischemia, or scar). Accordingly, a multivariate logistic regression identified focal myocardial 18F-FDG uptake as a strong predictor of abnormal myocardial function/perfusion (odds ratio (OR) 5.32, 95% confidence interval (CI) 1.73–16.34, p = 0.003). Similarly, focal myocardial 18F-FDG uptake was an independent predictor of ongoing ischemia and myocardial scar (OR 4.17, 95% CI 1.53–11.4, p = 0.005 and OR 3.78, 95% CI 1.47–9.69, p = 0.006, respectively). Conclusions: Focal myocardial 18F-FDG uptake seen on oncologic PET/CT indicates a significantly increased risk for multiple myocardial abnormalities. Obtaining and taking this information into account will help to stratify patients according to risk and will reduce unnecessary cardiovascular complications in cancer patients.
Highlights
18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is widely used for initial cancer staging [1,2]
We investigated the association of myocardial 18F-FDG uptake patterns with myocardial perfusion and the left ventricular ejection fraction (LVEF) in 302 patients (70.9% men; mean age 66.8 ± 10.2 years)
When baseline characteristics were stratified by myocardial perfusion/function findings, abnormal myocardial perfusion/function was more frequently observed in patients with known coronary artery disease (CAD), previous MI, and previous PCI/CABG (p < 0.001, Table 2)
Summary
18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is widely used for initial cancer staging [1,2] It provides incremental prognostic information and enables personalized anti-neoplastic therapy [3,4]. A recent population-based study encompassing more than 3 million US cancer patients revealed that the highest number of cardiovascular deaths occurred in the first year following initial cancer diagnosis [17]. This finding was attributed to the aggressive treatment at initial cancer diagnosis and calls for a close cardiovascular monitoring; routine cardiovascular assessment in oncologic patients is not yet performed in current clinical practice
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