Correlation between cardiac glycolytic metabolism and clinical-epidemiological variables of cancer patients

Significant advances in the diagnosis and treatment of cancer have improved the life expectancy of cancer patients. However, these therapies can impact the quality of life and survival of these patients due to the detrimental effects of these treatments, especially on the heart. In this context, early diagnosis of cardiotoxicity to chemotherapy drugs is crucial for the implementation of strategies to prevent progression and death from cardiovascular diseases. Positron Emission Tomography-Computed Tomography (PET/CT) with Fluorodeoxyglucose-Fluorine-18 (FDG) is an examination that evaluates glycolytic metabolism and is routinely used in the staging and therapeutic evaluation of various neoplasms. Furthermore, studies have shown the potential benefit of PET/CT in the evaluation of cardiotoxicity through myocardial FDG uptake.

To evaluate the association between myocardial FDG uptake and clinical-epidemiological data of cancer patients.

Cross-sectional and retrospective study. From January to June 2023, clinical-epidemiological data and the presence of myocardial FDG uptake were evaluated in patients referred for FDG PET/CT oncology study at a public and university nuclear medicine service in Northeast Brazil. Patients were grouped according to the absence (G1) or presence (G2) of myocardial FDG uptake, and clinical-epidemiological data were compared between them. Myocardial FDG uptake was considered significant if higher than blood pool uptake in the aorta. A p-value <0.05 was considered statistically significant.

We selected 428 exams, with 63.3% being female, mean age 54 ± 16 years, 34.8% hypertensive, 16.8% diabetic, and 9.6% with dyslipidemia. The analyzed types of cancers were: lymphoma (31.5%), breast (17.8%), melanoma (8.4%), cervical (8.2%), colorectal (6.8%), and lung (6.8%). The most common indications were treatment response evaluation (43.7%), restaging (22.2%), staging (19.4%), and follow-up (12.1%). Cardiac FDG uptake was present in 39.5% of the sample (G2). In the univariate analysis, diabetes was more frequent in G1 (19.1% vs 12.4%, G1 vs G2, respectively, p 0.0498), and male sex was more prevalent in G2 (30.89% vs 45.56%, G1 and G2, respectively, p 0.0021). In the logistic regression analysis, only male sex remained statistically significant between the groups, p= 0.0022.Conclusion: In oncological PET/CT exams, significant myocardial FDG uptake was more prevalent in men. This result may indicate differences between sexes in cellular susceptibility and myocardial mechanisms of metabolic response to oncological treatment toxicity.