Evidence for a cardiac metabolic switch in patients with Hodgkin's lymphoma

Abstract

Aims Our aim was to investigate the glucose uptake in cancer patients suffering from different entities, using 18F‐FDG positron emission tomography–computed tomography scans. We further aimed at identifying potential variables altering cardiac and skeletal muscle glucose metabolism. Methods and results In a retrospective cohort study, we analysed cardiac and skeletal muscle 18F‐FDG uptake in onco‐positron emission tomography–computed tomography scans in adult patients suffering from Hodgkin's lymphoma, non‐Hodgkin's lymphoma, and non‐lymphatic cancer including patients suffering from thyroid cancer, bronchial carcinoma, and malignant melanoma. Univariate logistic regression models were created for increased cardiac and skeletal muscle 18F‐FDG uptake using cancer entity, sex, age, previous radiation, previous chemotherapy, diabetes, obesity, serum glucose levels, renal function, and thyroid function as parameters. Multivariate models were created by selecting variables according to Akaike's information criterion in a step‐down approach. Between 2014 and 2018, a total of 337 consecutive patients suffering from Hodgkin's lymphoma (n = 52), non‐Hodgkin's lymphoma (n = 57), and non‐lymphatic cancer (n = 228) were included in the analysis. Univariate logistic regression models showed high serum glucose levels to be associated with lower absorption rates in both cardiac and skeletal muscle (odds ratio [OR] 0.38 [0.23, 0.60, 95% confidence interval—CI], P < 0.0001, and 0.52 [0.33, 0.82, 95% CI], P < 0.005, respectively). Hodgkin's lymphoma was associated with an increase in cardiac uptake (OR 2.4 [1.3, 4.5, 95% CI], P < 0.005). Decreased skeletal muscle 18F‐FDG uptake was noted in elderly and obese patients. In our multivariate analysis, Hodgkin's lymphoma patients showed higher cardiac 18F‐FDG uptake, while non‐Hodgkin's lymphoma patients did not differ significantly from non‐lymphatic cancer patients (OR 1.6 [0.7, 3.3, 95% CI], P = 0.24). High serum glucose levels and prior chemotherapy were both associated with a significantly decreased cardiac 18F‐FDG uptake (OR 0.40 [0.24, 0.65, 95% CI], P < 0.0005, and 0.50 [0.27, 0.90, 95% CI], P < 0.05, respectively). Notably, prior chemotherapy did not influence FDG uptake in skeletal muscle to the same extent. Obesity and older age were both significantly associated with decreased gluteal 18F‐FDG uptake (OR 0.49 [0.27, 0.89, 95% CI], P < 0.05, and 0.47 [0.25, 0.87, 95% CI], P < 0.05). Conclusions Our data provide evidence for metabolic alterations in patients with Hodgkin's lymphoma related to cardiac glucose uptake in humans. This effect was independent from skeletal muscle metabolism.

Relationship Between Cardiac Fibroblast Activation Protein Activity by Positron Emission Tomography and Cardiovascular Disease

“…Multivariate models were created selecting the variables according to Akaike information criterion in a step-down approach. 15 , 18 Logistic regression results were reported with OR and a 95% CI. A Hosmer-Lemeshow goodness of fit test was performed for each model.…”

“…FDG-PET-CT scans were performed as previously described. 15 Measurements were performed as in FAPI-PET-CT scans. SUVs and SUV ratios of different organs were compared between FDG and FAPI using a Kruskal-Wallis test.…”

Myocardial Metabolic Response Predicts Chemotherapy Curative Potential on Hodgkin Lymphoma: A Proof-of-Concept Study

“…In the clinical practice, PET/CT criteria utilized for therapeutic decision are obviously focused on the response of number, size, and metabolic activity of lymphoma lesions. However, this standardized procedure intrinsically allows the evaluation of chemotherapy effect on normal tissues, and particularly on the heart [6]. The relevance of this assessment has been confirmed by the evidence that cardiac FDG uptake increases at interim PET in more than one half of HL patients and predicts the subsequent risk of developing cardiotoxicity [7,8].…”

Establishing an oncocardiology service

“…diagnostic tools are currently being tested in the field of oncocardiology. Among them, positron emission tomographycomputed tomography (PET-CT) to investigate cardiac metabolism and cardiac remodeling is the most promising [24]. Novel protocols for cardiac magnetic resonance imaging (cMRI) studies will also help in the timely identification of patients with potential cardiotoxicity [25].…”