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Myocardial oxidative metabolic supply-demand relationships in patients with nonischemic dilated cardiomyopathy

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Nonischemic dilated cardiomyopathy (NIDCM) is associated with left ventricular remodeling, hypertrophy, and mitochondrial metabolic abnormalities in vitro. We evaluated the hypothesis that energy supply, as judged by the rate of myocardial oxidative metabolism, is inadequate to meet oxygen demand in patients with NIDCM compared with normal subjects.

Methods and Results

We used positron emission tomography to determine the myocardial carbon 11 acetate decay rate (kmono) as an index of energy supply, and we compared kmono with the rate-pressure product (RPP) as an index of metabolic demand in 7 patients with NIDCM and 7 normal subjects. The mean kmono value (SEM) was 0.060 ± 0.006 min-1 in NIDCM patients versus 0.054 ± 0.002 in normal subjects (P = not significant). The RPP was 9949 ± 931 beats/min · mm Hg in NIDCM patients and 6521 ± 476 in normal subjects (P = .007). The relationship of kmono to this index of demand (kmono/RPP) was 6.2 x 10-6 in NIDCM patients but was 8.5 x 10-6 in normal subjects (P = .003). Thus RPP, as an index of myocardial oxygen demand, was poorly matched by the rate of oxidative metabolism in those patients with NIDCM. The kmono was closely related to RPP in normal subjects (r = 0.83, P = .02) but not in NIDCM patients. Furthermore, there was no significant relationship between kmono and wall stress as another index of oxygen demand.

Conclusions

These results are consistent with a mitochondrial metabolic abnormality in heart failure. This metabolic mismatch detected by positron emission tomography may contribute to the pathophysiology of congestive heart failure and left ventricular remodeling.

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Author notes

  1. Marvin W. Kronenberg

    Present address: Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tenn

  2. Gerald I. Cohen

    Present address: Division of Cardiology, St John Hospital, Detroit, Mich

Authors and Affiliations

  1. Division of Cardiology, Wayne State University School of Medicine, Detroit, Mich

    Marvin W. Kronenberg, Gerald I. Cohen, Marlo F. Leonen, Thomas A. Mladsi & Marcelo F. Di Carli

  2. Veterans Affairs Medical Center, Detroit, Mich.

    Marvin W. Kronenberg, Gerald I. Cohen, Marlo F. Leonen, Thomas A. Mladsi & Marcelo F. Di Carli

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  1. Marvin W. Kronenberg
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  2. Gerald I. Cohen
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Correspondence to Marvin W. Kronenberg.

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Supported in part by a grant from Sanofi-Synthelabo, New York, NY.

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Kronenberg, M.W., Cohen, G.I., Leonen, M.F. et al. Myocardial oxidative metabolic supply-demand relationships in patients with nonischemic dilated cardiomyopathy. J Nucl Cardiol 13, 544–553 (2006). https://doi.org/10.1016/j.nuclcard.2006.04.002

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