Comparison of Exogenous Ketone Administration Versus Dietary Carbohydrate Restriction on Myocardial Glucose Suppression: A Crossover Clinical Trial.
Comparison of Exogenous Ketone Administration Versus Dietary Carbohydrate Restriction on Myocardial Glucose Suppression: A Crossover Clinical Trial.
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DOI：
10.2967/jnumed.121.262734
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发表时间：
2022-05
影响因子：
9.3
通讯作者：
Bravo, Paco E.
中科院分区：
文献类型：
--
作者：
Selvaraj, Senthil;Margulies, Kenneth B.;Dugyala, Supritha;Schubert, Erin;Tierney, Ann;Arany, Zoltan;Pryma, Daniel A.;Shah, Svati H.;Rame, J. Eduardo;Kelly, Daniel P.;Bravo, Paco E.
生酮饮食(KD)是使用18F-FDGPET评估炎症反应时实现心肌葡萄糖抑制(MGS)的标准护理。然而，未能抑制生理性葡萄糖摄取仍然是一个重要的诊断障碍。虽然延长KD的持续时间可能是有效的，但外源性递送酮可能提供一种方便、可靠和当天的替代方案。我们研究的目的是确定外源性酮类药物治疗是否不逊于KD以获得微血管痉挛，以及血清β-羟丁酸水平是否能预测微血管痉挛。方法：Keeto-cross(内源性与外源性心肌葡萄糖抑制疗法)是内源性酮病(KD)与外源性酮酯([KE]外源性酮病)饮料的交叉、非劣质试验。20名健康受试者分为3组：体重可饮组、24小时组和72小时组(n=18)。主要结果是在PET上实现了完整的MGS(非劣质边缘为5%)。在KD上完成的37次扫描中，分析了内源性BHb水平的受试者工作特征(AUROC)下的面积(在实验室和护理点设备中分析)以预测MGS。结果：平均年龄为30±7岁，女性占50%，非白人占45%。达标BHb水平中位数/L分别为3.82(第25-75百分位数，2.55-4.97)、0.77(第25-75百分位数，0.58-1.02)(第25-75百分位数，24小时KD)和1.30(第25-75百分位数，0.80-2.24，72小时KD)。44%的参与者(饮用KE饮料)、78%的参与者(24h KD)和83%的参与者(72hKD)获得了初步结果(KE对24h和7hKD的非劣势P=0.97和0.98)。内源性BHb水平是预测MGS的可靠指标(AUROC，0.88；95%CI为0.71，1.00)。BHB为0.58或更高时，92%的扫描被正确分类。医疗点设备提供了类似的预测价值。结论：在健康志愿者中，KE对MGS的达标率低于KD。血清BHb是一种高度预测MGS的生物标志物，可在18F-FDG PET的上游临床实施，并通过护理点检测快速促进，以减少假阳性扫描。
The ketogenic diet (KD) is the standard of care to achieve myocardial glucose suppression (MGS) for assessing inflammation using 18F-FDG PET. However, failure to suppress physiologic glucose uptake remains a significant diagnostic barrier. Although extending the duration of KD may be effective, exogenously delivered ketones may provide a convenient, reliable, and same-day alternative. The aims of our study were to determine whether exogenous ketone administration is noninferior to the KD to achieve MGS and whether serum β-hydroxybutyrate (BHB) levels can predict MGS. Methods: KEETO-CROSS (Ketogenic Endogenous versus Exogenous Therapies for myoCaRdial glucOse SuppresSion) is a crossover, noninferiority trial of the KD (endogenous ketosis) versus ketone ester ([KE] exogenous ketosis) drink. Twenty healthy participants were enrolled into 3 arms: weight-based KE drink, 24-h KD, and 72-h KD (n = 18 completed all arms). The primary outcome was achievement of complete MGS on PET (noninferiority margin 5%). The area under receiver-operating-characteristics (AUROC) of endogenous BHB levels (analyzed in a laboratory and by point-of-care device) for predicting MGS was analyzed in 37 scans completed on the KD. Results: The mean age was 30 ± 7 y, 50% were women, and 45% were nonwhite. The median achieved BHB levels (mmol/L) were 3.82 (25th–75th percentile, 2.55–4.97) (KE drink), 0.77 (25th–75th percentile, 0.58–1.02) (25th–75th percentile, 24-h KD), and 1.30 (25th–75th percentile, 0.80–2.24) (72-h KD). The primary outcome was achieved in 44% (KE drink), 78% (24-h KD), and 83% (72-h KD) of participants (noninferiority P = 0.97 and 0.98 for KE vs. 24-h and 72-h KD). Endogenous BHB levels robustly predicted MGS (AUROC, 0.88; 95% CI 0.71, 1.00). A BHB of 0.58 or more correctly classified 92% of scans. A point-of-care device provided comparable predictive value. Conclusion: In healthy volunteers, KE was inferior to KD for achieving MGS. Serum BHB is a highly predictive biomarker for MGS and can be clinically implemented upstream of 18F-FDG PET, with rapid facilitation by point-of-care testing, to reduce false-positive scans.
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DOI：
10.1007/s12350-016-0502-7
发表时间：
2017-03
期刊：
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
影响因子：
--
作者：
Osborne MT;Hulten EA;Murthy VL;Skali H;Taqueti VR;Dorbala S;DiCarli MF;Blankstein R
通讯作者：
Blankstein R
影响因子：
3.6
作者：
Renguet E;Bultot L;Beauloye C;Horman S;Bertrand L
通讯作者：
Bertrand L
影响因子：
4.1
作者：
RANDLE, PJ;GARLAND, PB;NEWSHOLME, EA
通讯作者：
NEWSHOLME, EA
影响因子：
5.9
作者：
BING, RJ;SIEGEL, A;GILBERT, M
通讯作者：
GILBERT, M
影响因子：
2.4
作者：
Harisankar, Chidambaram Natrajan Balasubramanian;Mittal, Bhagwant Rai;Bhattacharya, Anish
通讯作者：
Bhattacharya, Anish