Patients with diabetes suffer twofold regarding ischemic myocardiopathy: They are at increased risk for the disease, and their metabolism wreaks havoc with nuclear medicine tracer kinetics.

Researchers in the Netherlands have found that oral administration of acipimox, a nicotinic acid derivative, improves the quality of fluorine-18 FDG-SPECT imaging for detecting myocardial viability in patients with diabetes. Currently not available in the U.S., acipimox enhances myocardial FDG uptake by reducing free fatty acids, which appear to be the main determinant of image quality.

Seventy patients with chronic coronary artery disease and a moderately to severely impaired left ventricular function were prospectively studied. Thirty-four patients had diabetes mellitus, 12 of them insulin-dependent. The remaining 36 patients did not have diabetes.

Quality of SPECT images were as follows: 27 patients with diabetes had good images, five moderate, and two poor. Thirty-two nondiabetic patients had good images, and four were moderate. The study was published in the June issue of the Journal of Nuclear Medicine.