Summary
Positron emission tomography (PET) permits sequential, noninvasive assessment of myocardial perfusion and metabolism. Based on the pattern of substrate use, clinical studies have utilized PET to define the location and extent of myocardial infarction, to identify areas of jeopardized but viable myocardium, and to assess the metabolic response of the myocardium to pharmacological therapy as well as to interventions such as coronary thrombolysis and coronary artery bypass surgery. The ability to noninvasively assess specific metabolic pathways should facilitate our understanding of normal myocardial metabolism, its perturbations with cardiac disease, and thereby improve the diagnosis and treatment of the biochemical processes underlying cardiac dysfunction.
Similar content being viewed by others
References
Bing RJ: Cardiac metabolism. Physiol Rev 45: 171–213, 1965
Neely JR, Morgan HE: Relationship between carbohydrate and lipid metabolism and the energy balance of heart muscle. Ann Rev Physiol 36: 413–459, 1974
Liedtke AJ: Alterations of carbohydrate and lipid metabolism in the acutely ischemic heart. Prog Cardiovasc Dis 23: 321–336, 1981
Bergmann SR, Fox KAA, Geltman EM, Sobel BE: Positron emission tomography of the heart. Prog Cardiovasc Dis 28: 165–194, 1985
Fox KAA, Abendschein DR, Ambos HD, Sobel BE, Bergmann SR: Efflux of metabolized and nonmetabolized fatty acid from canine myocardium. Circ Res 57: 232–243, 1985
Rosamond TL, Abendschein DR, Sobel BE, Bergmann SR, Fox KAA: Metabolic fate of radiolabeled palmitate in ischemic canine myocardium: implications for positron emission tomography. J Nucl Med 28: 1322–1329, 1987
Weiss ES, Hoffman EJ, Phelps ME, Welch MJ, Henry PD, Ter-Pogossian MM, Sobel BE: External detection and visualization of myocardial ischemia with 11C-substrates in vitro and in vivo. Circ Res 39: 24–32, 1976
Bergmann SR, Clark RE, Sobel BE: An improved isolated heart preparation for external assessment of myocardial metabolism. Am J Physiol: Heart Circ Physiol 236: H644-H651, 1979
Goldstein RA, Klein MS, Welch MJ, Sobel BE: External assessment of myocardial metabolism with C-11 palmitate in vivo. J Nucl Med 21: 342–348, 1980
Lerch RA, Ambos HD, Bergmann SR, Welch MJ, Ter-Pogossian MM, Sobel BE: Localization of viable, ischemic myocardium by positron-emission tomography with 11C-palmitate. Circulation 64: 689–699, 1981
Lerch RA, Bergmann SR, Ambos HD, Welch MJ, Ter-Pogossian MM, Sobel BE: Effect of flow-independent reduction of metabolism on regional myocardial clearance of 11C-palmitate. Circulation 65: 731–738, 1982
Schon HR, Schelbert HR, Robinson G, Najafi A, Huang S-C, Hansen H, Barrio J, Kuhl DE, Phelps ME: C-11 labeled palmitic acid for the noninvasive evaluation of regional myocardial fatty acid metabolism with positron-computed tomography. I. Kinetics of C-11 palmitic acid in normal myocardium. Am Heart J 103: 532–547, 1982
Schon HR, Schelbert HR, Najafi A, Hansen H, Huang H, Barrio J, Phelps ME: C-11 labeled palmitic acid for the noninvasive evaluation of regional myocardial fatty acid metabolism with positron-computed tomography. II. Kinetics of C-11 palmitic acid in acutely ischemic myocardium. Am Heart J 103: 548–561, 1982
Schelbert HR, Henze E, Schon HR, Keen R, Hansen H, Selin C, Huang S-C, Barrio JR, Phelps ME: C-11 palmitate for the noninvasive evaluation of regional myocardial fatty acid metabolism with positron computed tomography. III. In vivo demonstration of the effects of substrate availability on myocardial metabolism. Am Heart J 105: 492–504, 1983
Schelbert HR, Henze E, Sochor H, Grossman RG, Huang S-C, Barrio JR, Schwaiger M, Phelps ME: Effects of substrate availability on myocardial C-11 palmitate kinetics by positron emission tomography in normal subjects and patients with ventricular dysfunction. Am Heart J 111: 1055–1064, 1986
Weiss ES, Ahmed SA, Welch MJ, Williamson JR, Ter-Pogossian MM, Sobel BE: Quantification of infarction in cross sections of canine myocardium in vivo with positron emission transaxial tomography and 11C-palmitate. Circulation 55: 66–73, 1977
Sobel BE, Weiss ES, Welch MJ, Siegel BA, Ter-Pogossian MM: Detection of remote myocardial infarction in patients with positron emission transaxial tomography and intravenous 11C-palmitate. Circulation 55: 853–857, 1977
Ter-Pogossian MM, Klein MS, Markham J, Roberts R, Sobel BE: Regional assessment of myocardial metabolic integrity in vivo by positron-emission tomography with 11C-labeled palmitate. Circulation 61: 242–255, 1980
Geltman EM, Biello D, Welch MJ, Ter-Pogossian MM, Roberts R, Sobel BE: Characterization of nontransmural myocardial infarction by positron-emission tomography. Circulation 65: 747–755, 1982
Billadello JJ, Smith JL, Ludbrook PA, Tiefenbrunn AJ, Jaffe AS, Sobel BE, Geltman EM: Implications of ‘reciprocal’ ST segment depression associated with acute myocardial infarction identified by positron tomography. J Am Coll Cardiol 2: 616–624, 1983
Bergmann SR, Lerch RA, Fox KAA, Ludbrook PA, Welch MJ, Ter-Pogossian MM, Sobel BE: Temporal dependence of beneficial effects of coronary thrombolysis characterized by positron tomography. Am J Med 73: 573–581, 1982
Jaffe AS, Biello DR, Sobel BE, Geltman EM: Enhancement of metabolism of jeopardized myocardium by nifedipine. Int'l J Cardiol 15: 77–89, 1987
Sobel BE, Geltman EM, Tiefenbrunn AJ, Jaffe AS, Spadaro JJ, Ter-Pogossian MM, Collen D, Ludbrook PA: Improvement of regional myocardial metabolism after coronary thrombolysis induced with tissue-type plasminogen activator or streptokinase. Circulation 69: 983–990, 1984
Knabb RM, Rosamond TL, Fox KAA, Sobel BE, Bergmann SR: Enhancement of salvage of reperfused ischemic myocardium by diltiazem. J Am Coll Cardiol 8: 861–871, 1986
Knabb RM, Bergmann SR, Fox KAA, Sobel BE: The temporal pattern of recovery of myocardial perfusion and metabolism delineated by positron emission tomography after coronary thrombolysis. J Nucl Med 28: 1563–1570, 1987
Schwaiger M, Schelbert HR, Ellison D, Hansen H, Yeatman L, Vinten-Johansen J, Selin C, Barrio J, Phelps ME: Sustained regional abnormalities in cardiac metabolism after transient ischemia in the chronic dog model. J Am Coll Cardiol 6: 336–347, 1985
Grover-McKay M, Schelbert HR, Schwaiger M, Sochor H, Guzy PM, Krivokapich J, Child JS, Phelps ME: Identification of impaired metabolic reserve by atrial pacing in patients with significant coronary artery stenosis. Circulation 74: 281–292, 1986
Geltman EM, Smith JL, Beecher D, Ludbrook PA, Ter-Pogossian MM, Sobel BE: Altered regional myocardial metabolism in congestive cardiomyopathy detected by positron tomography. Am J Med 74: 773–785, 1983
Eisenberg JD, Sobel BE, Geltman EM: Differentiation of ischemic from nonischemic cardiomyopathy with positron emission tomography. Am J Cardiol 59: 1410–1414, 1987
Sochor H, Schelbert HR, Schwaiger M, Henze E, Phelps ME: Studies of fatty acid metabolism with positron emission tomography in patients with cardiomyopathy. Eur J Nucl Med 12: S66-S69, 1986
Livni E, Elmaleh DR, Levy S, Brownell GL, Strauss WH: Beta-methyl[1-11C]heptadecanoic acid: a new myocardial metabolic tracer for positron emission tomography. J Nucl Med 23: 169–175, 1982
Abendschein DR, Fox KAA, Ambos HD, Sobel BE, Bergmann SR: Metabolism of beta-methyl[1-11C]heptadecanoic acid in canine myocardium. Nucl Med Biol 14: 579–585, 1987
Ratib O, Phelps ME, Huang S-C, Henze E, Selin CE, Schelbert HR: Positron tomography with deoxyglucose for estimating local myocardial glucose metabolism. J Nucl Med 23: 577–586, 1982
Marshall RC, Huang S-C, Nash WW, Phelps ME: Assessment of the [18F]fluorodeoxyglucose kinetic model in calculations of myocardial glucose metabolism during ischemia. J Nucl Med 24: 1060–1064, 1983
Krivokapich J, Huang S-C, Selin CE, Phelps ME: Fluorodeoxyglucose rate constants, lumped constant, and glucose metabolic rate in rabbit heart. Am J Physiol: Heart Circ Physiol 252: H777-H787, 1987
Marshall RC, Tillisch JH, Phelps ME, Huang S-C, Carson R, Henze E, Schelbert HR: Identification and differentiation of resting myocardial ischemia and infarction in man with positron computed tomography, 18F-labeled fluorodeoxyglucose and N-13 ammonia. Circulation 67: 766–786, 1983
Schwaiger M, Brunken R, Grover-McKay M, Krivokapich J, Child J, Tillish JH, Phelps ME, Schelbert HR: Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography. J Am Coll Cardiol 8: 800–808, 1986
Tillisch J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps M, Schelbert H: Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. N Engl J Med 314: 884–888, 1986
Schwaiger M, Brunken RC, Krivokapich J, Child JS, Tillisch JH, Phelps ME, Schelbert HR: Beneficial effect of residual anterograde flow on tissue viability as assessed by positron emission tomography in patients with myocardial infarction. Eur Heart J 8: 981–988, 1987
Camici P, Araujo LL Spinks T, Lammertsma AA, Kaski JC, Shea MJ, Selwyn AP, Jones T, Maseri A: Increased uptake of 18F-fluorodeoxyglucose in postischemic myocardium of patients with exercise-induced angina. Circulation 74: 81–88, 1986
Brunken R, Tillisch J, Schwaiger M, Child JS, Marshall R, Mandelkern M, Phelps ME, Schelbert HR: Regional perfusion, glucose metabolism, and wall motion in patients with chronic electrocardiographic O wave infarctions: evidence for persistence of viable tissue in some infarct regions by positron emission tomography. Circulation 73: 951–963, 1986
Perloff JK, Henze E, Schelbert HR: Alterations in regional myocardial metabolism, perfusion, and wall motion in Duchenne muscular dystrophy studied by radionuclide imaging. Circulation 69: 33–42, 1984
Goldstein RA, Klein MS, Sobel BE: Detection of myocardial ischemia before infarction, based on accumulation of labeled pyruvate. J Nucl Med 21: 1101–1104, 1980
Fox KAA, Ambos HD, Bergmann SR, Sobel BE: External measurement of myocardial oxygen utilization with 0–15 labeled oxygen. Circulation 68: III-82, 1983 (abstract)
Brown M, Marshall DR, Sobel BE, Bergmann SR: Delineation of myocardial oxygen utilization with carbon-11labeled acetate. Circulation 76: 687–696, 1987
Brown MA, Myears DW, Bergmann SR: Noninvasive assessment of canine myocardial oxidative metabolism with 11C-acetate and positron emission tomography. J Am Coll Cardiol 12: 1054–1063, 1988
Brown MA, Myears DW, Bergmann SR: Validity of estimates of myocardial oxidative metabolism with carbon-11-acetate and positron emission tomography despite altered patterns of substrate utilization. J Nucl Med 30: 187–193, 1989
Brown MA, Walsh MN, Weinheimer CJ, Geltman EM, Sobel BE, Bergmann SR: Assessment of regional oxidative metabolism by positron tomography with C-11-acetate in patients with myocardial infarction. J Nucl Med 29: 818, 1988 (Abstr)
Walsh MN, Brown MA, Henes CG, Weinheimer CJ, Geltman EM, Sobel BE, Bergmann SR: Estimation of regional myocardial oxidative metabolism by positron emission to mography with carbon-11-acetate in patients. Circulation 78: II-599, 1988 (Abstr)
Brown MA, Nohara R, Vered Z, Perez JE, Bergmann SR: The dependence of recovery of stunned myocardium on restoration of oxidative metabolism. Circulation 78: II-467 1988 (Abstr)
Gelbard AS, Benua RS, Reiman RE, McDonald JM, Vomero JJ, Laughlin JS: Imaging of the human heart after administration of L-(N-13)glutamate. J Nucl Med 21: 988–991, 1980
Henze E, Schelbert HR, Barrio JR, Egbert JE, Hansen HW, MacDonald NS, Phelps ME: Evaluation of myocardial metabolism with N-13- and C-11-labeled amino acids and positron computed tomography. J Nucl Med 23: 671–681, 1982
Zimmerman R, Tillmanns H, Knapp WH, Helus F, Georgi P, Rauch B, Neumann F-J, Girgensohn S, Maier-Borst W, Kubler W: Regional myocardial nitrogen-13 glutamate uptake in patients with coronary artery disease: inverse poststress relation to thallium-201 uptake in ischemia. J Am Coll Cardiol 11: 549–556, 1988
Shelton ME, Dence CS, Hwang D-R, Welch MJ, Bergmann SR: Myocardial kinetics of fluorine-18 misonidazole: A marker of hypoxic myocardium. J Nucl Med 30: 351–358, 1989
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bergmann, S.R. Clinical applications of assessments of myocardial substrate utilization with positron emission tomography. Mol Cell Biochem 88, 201–209 (1989). https://doi.org/10.1007/BF00223445
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00223445