{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:17:15Z","timestamp":1791274635313,"version":"4.1.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","funder":[{"name":"NOVA BIOMEDICAL","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Fluorine-18 fluorodeoxyglucose (FDG) with positron emission tomography (PET) is the standard for detecting myocardial inflammation in cardiac sarcoidosis, requiring preparation with the ketogenic diet (KD) to achieve myocardial glucose suppression. Despite this, incomplete myocardial glucose suppression remains a significant issue, and strategies to reduce myocardial glucose uptake (MGU) and identify incomplete myocardial glucose suppression are required. This study sought to understand the relationship between point-of-care beta-hydroxybutyrate (BHB) and different patterns of MGU and between KD and fasting duration with MGU in patients undergoing evaluation for cardiac sarcoidosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We prospectively included 471 outpatients who underwent FDG-PET for cardiac sarcoidosis evaluation, followed the KD for 1 (n=100), 2 (n=29), and \u22653 days (n=342), fasted for at least 12 hours, and had BHB levels measured immediately before FDG injection. Images were classified as (1) no MGU (negative), (2) focal\/multifocal (positive), (3) diffuse (nondiagnostic), or (4) nonspecific uptake (NS-MGU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Cardiac FDG-PET scans were interpreted as the following: 376 (79.83%) negative; 61 (12.95%) positive; 14 (2.97%) diffuse; and 20 (4.25%) NS-MGU. There was a strong negative relationship between BHB levels and MGU (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001). BHB levels increased significantly with KD duration (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001) and fasting time (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.0067). The combined rate of diffuse, NS-MGU, and positive scans (34%, 28%, 16%) decreased inversely with KD duration (1, 2, and \u22653 days, respectively). However, MGU was not different across different fasting times (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.6). Blood glucose levels were not associated with MGU (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.17) and only weakly associated with BHB levels (R\n                      <jats:sup>2<\/jats:sup>\n                      =0.03;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>We observed a strong inverse relationship between ketosis and patterns of MGU. Longer KD and fasting durations are associated with higher ketosis. However, only KD duration was associated with lower rates of MGU. Measurement of BHB levels before FDG-PET using point-of-care testing is feasible and may facilitate the management of patients referred for myocardial inflammation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.124.016774","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T05:18:16Z","timestamp":1722403096000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Relationship of Ketosis With Myocardial Glucose Uptake Among Patients Undergoing FDG PET\/CT for Evaluation of Cardiac Sarcoidosis"],"prefix":"10.1161","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7701-8757","authenticated-orcid":true,"given":"Mahesh K.","family":"Vidula","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine (M.K.V., S.S., W.K., L.R.G., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8418-7623","authenticated-orcid":true,"given":"Senthil","family":"Selvaraj","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine (M.K.V., S.S., W.K., L.R.G., P.E.B.), University of Pennsylvania, Philadelphia, PA."},{"name":"Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC (S.S.)."},{"name":"Duke Molecular Physiology Institute, Durham, NC (S.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7457-9014","authenticated-orcid":true,"given":"Chaitanya","family":"Rojulpote","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology (C.R., A.B., M.H., E.S., M.F., D.P., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1383-1992","authenticated-orcid":true,"given":"Abhijit","family":"Bhattaru","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology (C.R., A.B., M.H., E.S., M.F., D.P., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8992-6472","authenticated-orcid":true,"given":"Wumesh","family":"Kc","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine (M.K.V., S.S., W.K., L.R.G., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Hansbury","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology (C.R., A.B., M.H., E.S., M.F., D.P., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9105-5829","authenticated-orcid":true,"given":"Erin","family":"Schubert","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology (C.R., A.B., M.H., E.S., M.F., D.P., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin B.","family":"Clancy","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Medicine (C.B.C., M.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton","family":"Rossman","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Department of Medicine (C.B.C., M.R.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7906-9638","authenticated-orcid":true,"given":"Lee R.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine (M.K.V., S.S., W.K., L.R.G., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0650-4747","authenticated-orcid":true,"given":"Michael","family":"Farwell","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology (C.R., A.B., M.H., E.S., M.F., D.P., P.E.B.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Pryma","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology (C.R., A.B., M.H., E.S., M.F., D.P., P.E.B.), University of Pennsylvania, 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