Circulation, Vol 88, 884-895, Copyright © 1993 by American Heart Association
J Czernin, G Porenta, R Brunken, J Krivokapich, K Chen, R Bennett, A Hage, C Fung, J Tillisch and ME Phelps
BACKGROUND. Metabolic imaging with positron emission tomography (PET) can
detect tissue viability in clinical infarct regions. With appropriate
tracer kinetic models and serial PET imaging, regional myocardial blood
flow and rates of metabolism can now be quantified in patients with recent
myocardial infarctions. METHODS AND RESULTS. Serial PET imaging with
[13N]ammonia, [11C]acetate, and 18F- deoxyglucose was performed in 22
patients with recent infarctions to measure regional blood flow (in
milliliters per gram per minute), glucose metabolism (in micromoles per
gram per minute), and oxidative metabolism (in clearance rate per minute).
Hypoperfused clinical infarct regions were classified as "PET mismatch" if
18F was increased relative to 13N activity or "PET match" if 13N and 18F
activities were reduced concordantly. Blood flows differed significantly
between normal, mismatch, and match segments (0.83 +/- 0.20, 0.57 +/- 0.20,
and 0.32 +/- 0.12 mL.g-1.min-1, respectively). The relation between
oxidative metabolism and blood flow was piecewise linear and differed
significantly between PET mismatch and PET match. Oxidative metabolism was
less severely reduced than blood flow in mismatch regions but but reduced
in proportion to blood flow in match regions. There was considerable
overlap of blood flows between both types of PET segments. CONCLUSIONS.
Quantification of regional blood flow and substrate metabolism in
postinfarction patients revealed alterations in the relation between
substrate delivery and consumption demonstrated previously only in invasive
animal experiments. The preserved oxidative metabolism in myocardium with
PET mismatches may be ascribed to a regional increase in oxygen extraction.
Such increase together with preserved glucose utilization may be the
prerequisite for survival of ischemically injured myocardium.
ARTICLES
Regional blood flow, oxidative metabolism, and glucose utilization in patients with recent myocardial infarction
Department of Radiological Sciences, UCLA School of Medicine 90024-1721.
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