Myocardial (18)F-FDG Uptake Pattern for Cardiovascular Risk Stratification in Patients Undergoing Oncologic PET/CT

Objective: Positron emission tomography/computed tomography with (18)F-fluorodeoxy-glucose ((18)F-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 (18)F-FDG uptake patterns of patients undergoing oncologic PET/CT can be used for cardiovascular risk stratification. Methods: Myocardial (18)F-FDG uptake pattern was assessed in 302 patients undergoing both oncologic whole-body (18)F-FDG-PET/CT and myocardial perfusion imaging by single-photon emission computed tomography (SPECT-MPI) within a six-month period. Primary outcomes were myocardial (18)F-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 (18)F-FDG uptake, 77 (25.5%) showed diffuse myocardial (18)F-FDG uptake, 24 (7.9%) showed focal (18)F-FDG uptake, and 92 (30.5%) had a focal on diffuse myocardial (18)F-FDG uptake pattern. In contrast to the other uptake patterns, focal myocardial (18)F-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 (18)F-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 (18)F-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 (18)F-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.