Identification and differentiation of resting myocardial ischemia and infarction in man with positron computed tomography, 18F-labeled fluorodeoxyglucose and N-13 ammonia.
- 1 April 1983
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 67 (4), 766-778
- https://doi.org/10.1161/01.cir.67.4.766
Abstract
Studies have shown that the extraction of glucose per unit flow is increased in moderately ischemic myocardium primarily due to anaerobic glucose metabolism manifested as lactate production, whereas myocardial infarction is characterized by the loss of metabolically active myocardium. To determine the feasibility of demonstrating these metabolic abnormalities reflecting both ischemia and infarction, we used positron computed tomography (PCT) to evaluate relative regional myocardial exogenous glucose utilization and perfusion in 15 patients with recent myocardial infarction. The positron-emitting tracers of glucose metabolism and perfusion, 18F-2-fluoro-2-deoxyglucose (FDG) and N-13 ammonia, respectively, were used. Fourteen of 19 documented infarctions were demonstrated by PCT to have concordantly decreased glucose utilization and perfusion. However, in an additional 11 regions, glucose utilization was disproportionately increased relative to perfusion, consistent with ischemic glucose consumption. These findings correlated with the presence of postinfarction angina, the site of ischemic electrocardiographic changes during chest pain, and the presence of regional left ventricular dysfunction and severe coronary artery disease. Because three ECG infarct zones not detected by PCT demonstrated ischemic glucose utilization, only two of 19 electrocardiographically defined infarctions had no detectable metabolic abnormality. We conclude that the changes in regional FDG and N-13 ammonia concentrations detected with PCT in patients who had had a recent myocardial infarction are consistent with regional exogenous glucose utilization and perfusion in moderately ischemic and irreversibly infarcted myocardium. This approach has the potential to identify and differentiate resting myocardial ischemia from infarction and to assess tissue viability after an ischemic event.This publication has 25 references indexed in Scilit:
- Preoperative Prediction of Reversible Myocardial Asynergy by Postexercise Radionuclide VentriculographyNew England Journal of Medicine, 1982
- Noninvasive assessment of coronary stenoses by myocardial imaging during pharmacologic coronary vasodilation: VI. Detection of coronary artery disease in human beings with intravenous N-13 ammonia and positron computed tomographyThe American Journal of Cardiology, 1982
- Early Post-Infarction AnginaNew England Journal of Medicine, 1981
- Nuclear CardiologyNew England Journal of Medicine, 1981
- Regional myocardial perfusion assessed with N-13 labeled ammonia and positron emission computerized axial tomographyThe American Journal of Cardiology, 1979
- “Variant” angina: One aspect of a continuous spectrum of vasospastic myocardial ischemiaThe American Journal of Cardiology, 1978
- Correlation of electrocardiographic and pathologic findings in healed myocardial infarctionThe American Journal of Cardiology, 1978
- Contractile and biochemical effects of coronary reperfusion after extended periods of coronary occlusionThe American Journal of Cardiology, 1975
- Total and effective coronary blood flow in coronary and noncoronary heart disease.JCI Insight, 1974
- Myocardial Lipid and Carbohydrate Metabolism in Healthy, Fasting Men at Rest: Studies During Continuous Infusion of 3H‐PalmitateEuropean Journal of Clinical Investigation, 1972