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Biomedical subjects

J Krivokapich

Publications and source records attributed to J Krivokapich.

At least 19 recordsLinked to original sources
PubMed1999

Prognostic value of dobutamine stress echocardiography in predicting cardiac events in patients with known or suspected coronary artery disease.

OBJECTIVES: The study sought to determine the utility of dobutamine stress echocardiography (DSE) in predicting cardiac events in the year after testing. BACKGROUND: Increasingly, DSE has been applied to risk stratification of patients. METHODS: Medical records of 1,183 consecutive patients who underwent DSE were reviewed. The cardiac events that occurred during the 12 months after DSE were tabulated: myocardial infarction (MI), cardiac death, percutaneous transluminal coronary angioplasty (PTCA), and coronary artery bypass surgery (CABG). Patient exclusions included organ transplant receipt or evaluation, recent PTCA, noncardiac death, and lack of follow-up. A positive stress echocardiogram (SE) was defined as new or worsened wall-motion abnormalities (WMAs) consistent with ischemia during DSE. Classification and regression tree (CART) analysis identified variables that best predicted future cardiac events. RESULTS: The average age was 68+/-12 years, with 338 women and 220 men. The overall cardiac event rate was 34% if SE was positive, and 10% if it was negative. The event rates for MI and death were 10% and 8%, respectively, if SE was positive, and 3% and 3%, respectively, if SE was negative. If an ischemic electrocardiogram (ECG) and a positive SE were present, the overall event rate was 42%, versus a 7% rate when ECG and SE were negative for ischemia. Rest WMA was the most useful variable in predicting future cardiac events using CART: 25% of patients with and 6% without a rest WMA had an event. Other important variables were a dobutamine EF <52.5%, a positive SE, an ischemic ECG response, history of hypertension and age. CONCLUSIONS: A positive SE provides useful prognostic information that is enhanced by also considering rest-wall motion, stress ECG response, and dobutamine EF.

Adult↗
PubMed1996

Effects of dobutamine stimulation on myocardial blood flow, glucose metabolism, and wall motion in normal and dysfunctional myocardium.

BACKGROUND: This investigation examines the effects of inotropic stimulation on myocardial blood flow (MBF) and glucose metabolism (MRGlc) in dysfunctional myocardium through the use of positron emission tomography (PET). METHODS AND RESULTS: Nineteen patients with chronic coronary artery disease and 12 normal volunteers were studied with 13N-ammonia, 18F-deoxyglucose, and PET and with two-dimensional echocardiography at baseline and during intravenous dobutamine (5 to 10 micrograms/kg per minute). At rest, MBF in mismatch regions (n = 10) averaged 0.53 +/- 0.19 mL/g per minute and increased by 41.4 +/- 46.6% (P = .01) during dobutamine, whereas in match regions (n = 16) MBF was 0.28 +/- 0.09 mL/g per minute at rest without an increase during dobutamine (26.4 +/- 47.3%; NS). Myocardium with normal rest MBF was classified as normal remote (normal wall motion, n = 8) or abnormal remote (abnormal wall motion, n = 11). Dobutamine raised MBF similarly in normal subjects and in normal remote regions (by 82 +/- 85% and 84 +/- 42%, P < .01) but by only 33 +/- 34% in abnormal remote regions. MRGlc declined by 49 +/- 28% (P < .005) with dobutamine in the normal subjects, remained unchanged in normal and abnormal remote regions of the patients, but increased in mismatch and match regions (by 49 +/- 74% and 46 +/- 77%; P < .05). Wall motion improved with dobutamine only in mismatch and abnormal remote regions but not in match regions. CONCLUSIONS: Blood flow-metabolism mismatch patterns are not consistently associated with a fixed downregulation of MBF; the increased contractile work in response to dobutamine stimulation is associated with an increase in MBF and a greater reliance on glucose utilization, possibly reflecting acute ischemia or alterations in substrate selection by chronically dysfunctional myocardium. Importantly, functionally impaired though normally perfused myocardium frequently exists in chronic coronary artery disease patients and may represent repetitively stunned or, more likely, remodeled left ventricular myocardium.

Adult↗
PubMed1996

Dobutamine positron emission tomography: absolute quantitation of rest and dobutamine myocardial blood flow and correlation with cardiac work and percent diameter stenosis in patients with and without coronary artery disease.

OBJECTIVES: This study sought to measure myocardial blood flow at rest and during dobutamine infusion and to correlate flow with cardiac work and severity of coronary artery disease. BACKGROUND: Dobutamine is used with cardiac imaging to induce possible ischemia in patients with known or suspected coronary artery disease. Positron emission tomography permits noninvasive quantitation of myocardial blood flow. METHODS: Fifteen patients with quantitative coronary arteriography were studied at rest and during dobutamine infusion using nitrogen-13 ammonia flow imaging with positron emission tomography. Myocardial blood flow was determined in regions corresponding to the three major coronary arteries for myocardium with and without dobutamine flow defects and with and without a > 50% diameter stenosis. RESULTS: Eight patients had at least one dobutamine flow defect; four of whom had a previous myocardial infarction. One patient with > 50% diameter stenosis had no flow defects, and one with < 50% diameter stenosis (48%) had one defect. Dobutamine significantly increased myocardial blood flow in regions with and without a dobutamine flow defect or > 50% diameter stenosis, with a greater increase when a defect or > 50% diameter stenosis was not present. Rest and dobutamine flows in regions without > 50% diameter stenosis were 0.93 +/- 0.20 (mean +/- SD) and 2.16 +/- 0.52 ml/min per g (p < 0.01), respectively. The corresponding flows in regions without a defect were 0.94 +/- 0.21 and 2.17 +/- 0.53 ml/min per g (p < 0.01), respectively. This 2, 4-fold increase in flow was significantly correlated (p < 0.001) with a 2.2-fold increase in rate-pressure product induced by dobutamine. The rest and dobutamine flows for regions subtended by a vessel with > 50% diameter stenosis were 0.70 +/- 0.33 and 1.20 +/- 0.54 ml/min per g (p < 0.05), respectively, whereas the corresponding values for regions with a dobutamine flow defect were 0.69 +/- 0.33 ml/min per g at rest and 1.23 +/- 0.54 ml/min per g during dobutamine (p < 0.05). Dobutamine increased flow inversely proportional to percent diameter stenosis. The rest flow for regions with a dobutamine flow defect were not significantly different from that in regions without defects. CONCLUSIONS: Dobutamine resulted in a significant increase in myocardial blood flow that correlated significantly with both increased cardiac work and degree of stenosis.

Adult↗
PubMed1996

Role of transthoracic and transesophageal echocardiography in diagnosis and management of infective endocarditis.

Echocardiography has become a mainstay in the diagnosis of endocarditis. Vegetations were first visualized noninvasively beginning with M-mode echocardiography in the mid-1970s. The evolution of echocardiography, to include first two-dimensional imaging and then Doppler imaging in the 1980s, established echocardiography as the noninvasive test of choice to evaluate for the presence of vegetations as well as for their sequelae. Most recently, the addition of transesophageal echocardiography has expanded the role and yield of echocardiography in diagnosing endocarditis as well as in guiding management.

Echocardiography↗
PubMed1995

Effect of short-term cardiovascular conditioning and low-fat diet on myocardial blood flow and flow reserve.

BACKGROUND: Cardiovascular conditioning reduces resting myocardial oxygen demand by lowering systolic blood pressure and heart rate. Lower myocardial oxygen demand at rest would be expected to be associated with a decrease in resting myocardial blood flow and, consequently, an increase in myocardial flow reserve as the ratio of hyperemic to resting blood flow. However, the effect of controlled exercise together with a low-lipid diet on myocardial blood flow and flow reserve has not been examined in humans. METHODS AND RESULTS: Myocardial blood flow at rest and after dipyridamole-induced hyperemia (0.56 mg/kg i.v.) was quantified with [13N]ammonia and positron emission tomography in 13 volunteers before and upon completion of a 6-week program of cardiovascular conditioning and a low-fat diet. Exercise capacity and serum lipid profiles were also assessed at the start and finish of the program. Eight normal volunteers of similar age not participating in the conditioning program served as a control group. Cardiovascular conditioning lowered the resting rate-pressure product (8859 +/- 2128 versus 7450 +/- 1496, P < .001), serum cholesterol (217 +/- 36 versus 181 +/- 26 mg/dL), LDL cholesterol (140 +/- 32 versus 114 +/- 24 mg/dL), and triglycerides (145 +/- 53 versus 116 +/- 33 mg/dL, all P < .05). Exercise tolerance (metabolic equivalent of the task, METs) improved significantly from 10.0 +/- 3.0 to 14.4 +/- 3.6 (P < .01). Resting blood flow decreased (0.78 +/- 0.18 versus 0.69 +/- 0.14 mL.g-1.min-1, P < .05), whereas hyperemic blood flow increased (2.06 +/- 0.35 versus 2.25 +/- 0.40 mL.g-1.min-1, P < .05), resulting in an improved myocardial flow reserve (2.82 +/- 1.07 versus 3.39 +/- 0.91, P < .05). Overall, the myocardial flow reserve was significantly related to exercise performance (METs). In the control group, no changes in resting rate-pressure product, serum cholesterol levels, exercise performance, resting or hyperemic myocardial blood flow, or flow reserve were observed. CONCLUSIONS: Short-term cardiovascular conditioning together with a low-fat diet results in an improved myocardial flow reserve by lowering resting blood flow and increasing coronary vasodilatory capacity. These changes are associated with an improved exercise capacity and may offer a protective effect in patients with coronary artery disease.

Ammonia↗
PubMed1995

Parameter estimation of cardiac geometry by ECG-gated PET imaging: validation using magnetic resonance imaging and echocardiography.

UNLABELLED: The purpose of this study was to apply and validate a previously developed model-based image analysis technique which derives estimates of regional myocardial wall thickness and the left ventricular radius directly from gated cardiac PET images. METHODS: In 11 normal volunteers, gated myocardial 18F-deoxyglucose (FDG) images with 16 equal gates spanning the entire cardiac cycle were acquired for 20 min. To improve count statistics and thus image quality, 3 and 5 of 16 gates were summed to obtain systolic and diastolic images. Based on a five-parameter model, radial profiles from systolic and diastolic PET images were fit by nonlinear regression for myocardial wall thickness, left ventricular radius and tracer activities in the blood pool, the myocardial tissue and the extracardiac background. Echocardiography and gated magnetic resonance imaging (MRI) were performed in 11 and 7 volunteers, respectively. RESULTS: We observed a significant (p < 0.001) correlation between measurements obtained by gated PET imaging and the correlative imaging modalities for myocardial wall thickness and left ventricular radius. While good agreement was observed between measurements of average radial shortening, estimates of average wall thickening differed significantly. CONCLUSION: This model-based analysis offers accurate estimates of regional recovery coefficients directly from gated cardiac PET images and may also prove useful for the assessment of myocardial contractile function. These recovery coefficients are essential for the correction of partial volume effects when quantitative PET studies are performed.

Deoxyglucose↗
PubMed1994

Responses of blood flow, oxygen consumption, and contractile function to inotropic stimulation in stunned canine myocardium.

To examine the effects of inotropic stimulation on regional myocardial blood flow (MBF), oxidative metabolism, and contractile function in stunned myocardium, nine closed-chest dogs were studied 2 hours postreperfusion after a 25 minute occlusion of the left anterior descending coronary artery (LAD). MBF was determined with microspheres, and regional myocardial oxygen consumption (MVO2) was estimated from the rate constant k1 of the rapid clearance phase of [1-11C] acetate time activity curves, recorded with dynamic positron emission tomography. Myocardium at risk was determined from [13N] ammonia images obtained during occlusion. Wall motion, assessed by two-dimensional echocardiography, was impaired in postischemic myocardium in all dogs 2 hours after reperfusion. Dobutamine infusion increased the rate pressure product by 70% +/- 31% and significantly improved contractile function in the postischemic region in all dogs. In remote myocardium, MVO2 increased from 5.7 +/- 1.2 to 8.6 +/- 1.6 mumol/gm/min, and blood flow from 0.87 +/- 0.16 to 1.52 +/- 0.42 ml/gm/min in response to dobutamine. In reperfused myocardium, MVO2 increased from 3.1 +/- 0.7 to 7.4 +/- 1.5 mumol/gm/min, and blood flow from 0.51 +/- 0.12 to 1.2 +/- 0.4 ml/gm/min. Oxygen extraction increased significantly in reperfused myocardium relative to remote myocardium consistent with a flow-limited response to dobutamine stimulation. The improvement in contractile function failed to correlate significantly with relative increases in MBF or MVO2, suggesting that mechanical function is not as tightly coupled as MBF and MVO2 in postischemic myocardium during inotropic stimulation.

Analysis of Variance↗
PubMed1994

Echocardiography in valvular heart disease.

Transthoracic Doppler echocardiography continues to play a predominant role in the evaluation of patients with valvular heart disease. Current efforts in the research arena have been focused on improving the accuracy of techniques, as well as in further describing the shortcomings. Accurate quantitation of valvular regurgitation continues to be a major stumbling block. However, more sophisticated techniques are being successfully applied to obviate some of the limitations of color flow imaging. Transesophageal echocardiography has provided a new window and clarity of resolution that greatly facilitates evaluation of valvular heart disease in cases where the transthoracic approach is limited, particularly in patients with prosthetic valves.

Bioprosthesis↗
PubMed1993

Assessment of the effects of dobutamine on myocardial blood flow and oxidative metabolism in normal human subjects using nitrogen-13 ammonia and carbon-11 acetate.

The dual purposes of this study with positron emission tomography were to measure the effects of dobutamine on myocardial blood flow and oxidative metabolism, and to compare carbon-11 (C-11) acetate versus nitrogen-13 (N-13) ammonia in quantitating flow in normal subjects. Flow was quantitated with N-13 ammonia at rest and at peak dobutamine infusion (40 micrograms/kg/min) in 21 subjects. In 11 subjects, oxidative metabolism was also estimated at rest and peak dobutamine infusion using the clearance rate of C-11 acetate, k mono (min-1). A 2-compartment kinetic model was applied to the early phase of the C-11 acetate data to estimate flow. The rest and peak dobutamine rate-pressure products were 7,318 +/- 1,102 and 19,937 +/- 3,964 beats/min/mm Hg, respectively, and correlated well (r = 0.77) with rest and peak dobutamine flows of 0.77 +/- 0.14 and 2.25 ml/min/g determined using N-13 ammonia as a flow tracer. Rest and dobutamine flows estimated with C-11 acetate were highly correlated with those determined with N-13 ammonia (r = 0.92). k mono increased from 0.05 +/- 0.01 to 0.18 +/- 0.02 min-1, and correlated highly with the increase in flows (r = 0.91) and rate-pressure products (r = 0.94). Thus, the increase in cardiac demand associated with dobutamine is highly correlated with an increase in supply and oxidative metabolism. C-11 acetate is a unique tracer that can be used to image both flow and metabolism simultaneously.

Adult↗
PubMed1993

Prognostic usefulness of positive or negative exercise stress echocardiography for predicting coronary events in ensuing twelve months.

Stress echocardiography is useful in diagnosing myocardial ischemia in patients with significant coronary artery disease. This study examines the correlation between the results of exercise stress echocardiography and cardiac event rates within 12 months after testing in patients referred for evaluation of possible myocardial ischemia. Cardiac events, defined as myocardial infarction, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty or death, were tabulated for 360 patients with > or = 12 months of follow-up, or a cardiac event within 12 months of follow-up, or both. Wall motion abnormalities at rest were present in 60% of patients. A positive stress echocardiogram, defined as the development of new or worsened wall motion abnormalities, was obtained in 18% of patients (65 of 360), and > or = 1 cardiac event during follow-up was present in 14% (n = 49). A cardiac event occurred in 34% of patients (22 of 65) with a positive stress echocardiogram and in 9% (27 of 295) with a negative one. Myocardial infarctions occurred in 9% of patients with a positive stress echocardiogram compared with 2% with a negative test. An insufficient exercise capacity to reliably exclude ischemia was present in 63% of patients (17 of 27) with a cardiac event despite a negative stress echocardiogram. The predictive value of the stress echocardiographic results was enhanced by combining these results with the electrocardiographic results. In summary, a positive stress echocardiogram was associated with a threefold increased incidence of any cardiac event, and a fourfold increased incidence of myocardial infarction within 12 months of follow-up compared with a negative stress echocardiogram.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

Metabolism in non-ischemic myocardium during coronary artery occlusion and reperfusion.

Blood flow and metabolism in non-ischemic myocardium were studied at baseline and during occlusion and reperfusion of the left anterior descending coronary artery in closed chest dogs using positron emission tomography. Myocardial blood flow (MBF) and oxygen consumption (MVO2) in non-ischemic tissue were each increased by 28% relative to the rate pressure product during occlusion, consistent with increased work to compensate for the dyskinetic segment. MVO2 in non-ischemic sectors remained elevated relative to the rate pressure product early (1-2 h) post-reperfusion, 21% above baseline, but subsequently normalized. When sectors with normal blood flow during occlusion were divided into sectors adjacent to and remote from the risk zone, MBF in the 2 sector groups was similar at all times, but metabolic differences were found. MVO2 was depressed by 15% in adjacent relative to remote sectors 1 day post-reperfusion, with a concomitant 62% increase in glucose metabolic rate; relative increases in glucose metabolism were found only when glucose metabolism was low in remote myocardium, suggesting a decreased suppressibility of glucose metabolism in adjacent myocardium. The kinetics of (1-11C] palmitate were also altered in adjacent sectors, consistent with a small increase in esterification relative to oxidation of long chain fatty acids. Thus, sectors adjacent to ischemic segments show metabolic changes similar to those seen in reversibly injured post-ischemic tissue, despite normal blood flow during occlusion.

Animals↗
PubMed1993

Influence of age and hemodynamics on myocardial blood flow and flow reserve.

BACKGROUND: Aging is associated with changes of the systolic blood pressure that may increase cardiac work and myocardial blood flow at rest and reduce the myocardial flow reserve. This might be misinterpreted as age-related impairment of the coronary vasodilator capacity. METHODS AND RESULTS: Myocardial blood flow was quantified at rest and after administration of intravenous dipyridamole in 40 healthy volunteers (12 women and 28 men) with 13N-ammonia and positron emission tomography. Eighteen of the normal subjects were less than and 22 were older than 50 years (31 +/- 9 versus 64 +/- 9 years). The resting rate-pressure product was lower in the younger than in the older subjects (6895 +/- 1070 versus 8634 +/- 1890; P < 0.01). Myocardial blood flow at rest averaged 0.76 +/- 0.17 mL.min-1.g-1 in the younger volunteers and 0.92 +/- 0.25 mL.min-1.g-1 in the older volunteers (P < 0.05). Hyperemic blood flows did not differ between younger and older subjects (3.0 +/- 0.8 versus 2.7 +/- 0.6 mL.min-1.g-1; P = NS); however, minimal coronary resistance was higher in the older subjects. Corrected for indexes of coronary driving pressure, hyperemic flow was lower in older than in younger normal subjects. The higher resting blood flows combined with similar hyperemic flows resulted in a lower myocardial flow reserve in the older than in the younger normal subjects (4.1 +/- 0.9 versus 3.0 +/- 0.70; P < 0.0001). The flow reserve was more closely correlated with resting than with hyperemic blood flows. CONCLUSIONS: Aging does not alter significantly dipyridamole-induced hyperemic flows; although coronary vascular resistance after dipyridamole was somewhat increased in older subjects. The gradual decline of the myocardial blood flow reserve correlates with an age-related increase of baseline myocardial work and blood flow. These findings suggest that the reduced flow reserve with age is primarily due to increased cardiac work and blood flow at rest rather than to an abnormal vasodilator capacity.

Adult↗
PubMed1993

Regional blood flow, oxidative metabolism, and glucose utilization in patients with recent myocardial infarction.

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.

Coronary Angiography↗
PubMed1993

A refined method for quantification of myocardial oxygen consumption rate using mean transit time with carbon-11-acetate and dynamic PET.

The utility of the mean transit time equation was investigated for estimation of the myocardial clearance rate constant of 11C-acetate, which is proportional to myocardial oxygen consumption rates. The mean transit time approach was also employed to generate parametric images of the clearance rate constant of 11C-acetate with dynamic PET imaging in 20 normal human studies. Input function delays and cutoff errors due to the truncation of the myocardial tissue time-activity curve at a finite time were corrected. The clearance rate constants estimated by mean transit time correlated well with the estimates by conventional monoexponential fitting (15 min (truncation time): Y = 0.01 + 0.94X, correlated coefficient (r) = 0.99; 16 min: Y = 0.03 + 0.94X, r = 0.98; 20 min: Y = 0.03 + 0.84X, r = 0.99). The clearance rate constants estimated by the mean transit time approach also correlated well (r = 0.94) with the measured rate-pressure products. The quality and noise level of parametric images of the clearance rate constants generated by mean transit time are improved over those generated by monoexponential fitting. Additional advantages of the mean transit time approach compared to the standard monoexponential fitting method for estimating myocardial clearance rate constant of 11C-acetate include ease of input function delay correction, less sensitivity to the shape of the input function and elimination of subjective data selection of the linear portion of the clearance data on a semilog plot. Thus, this approach is expected to facilitate objective quantitative analysis of indices of myocardial oxygen consumption.

Acetates↗
PubMed1992

Comparison of maximal myocardial blood flow during adenosine infusion with that of intravenous dipyridamole in normal men.

OBJECTIVE: This study compared quantitatively the efficacy of intravenous adenosine and dipyridamole for pharmacologic induction of myocardial hyperemia. BACKGROUND: Pharmacologic vasodilation is used increasingly for induction of myocardial hyperemia in conjunction with radionuclide imaging of myocardial blood flow. Although both intravenous dipyridamole and adenosine have been used, the magnitude of hyperemia induced by these agents and the hyperemia to baseline blood flow ratios have not been quantified and compared. METHODS: Twenty normal volunteers were studied with dynamic positron emission tomography (PET) and intravenous nitrogen-13 ammonia. Myocardial blood flow was quantified with a two-compartment tracer kinetic model. RESULTS: Myocardial blood flow at rest averaged 1.1 +/- 0.2 ml/min per g and increased significantly to 4.4 +/- 0.9 ml/min per g during adenosine and 4.3 +/- 1.3 ml/min per g after dipyridamole administration. Hyperemia to baseline flow ratios averaged 4.3 +/- 1.6 for adenosine and 4.0 +/- 1.3 for dipyridamole. The average flow ratios and the maximal flows achieved were similar for both agents, but there was considerable variation in the individual response to these agents, as indicated by the range of hyperemia to baseline flow ratios (from 2.0 to 8.4 for adenosine and from 1.5 to 5.8 for dipyridamole). In addition, the hyperemic responses to dipyridamole and to adenosine differed by greater than 1 ml/min per g in nine subjects. CONCLUSIONS: Despite these inter- and intraindividual differences, we conclude that both agents are equally effective in producing myocardial hyperemia.

Adenosine↗
PubMed1992

Quantitative assessment of prolonged metabolic abnormalities in reperfused canine myocardium.

BACKGROUND: Prolonged metabolic abnormalities have been demonstrated previously in postischemic myocardium, including relative increases in glucose uptake and abnormal fatty acid kinetics. However, quantitative metabolic information is limited, and the time course of changes in MVO2 in postischemic myocardium is unknown. To address these issues, chronically instrumented dogs were studied serially over 1 month after transient left anterior descending coronary artery (LAD) occlusion, using positron emission tomography. METHODS AND RESULTS: Dynamic imaging protocols were used in conjunction with tracer kinetic models to quantify blood flow and metabolic rates. Myocardial sectors were defined as normal, predominantly reversibly injured, and infarct-containing, based on occlusion blood flow images and postmortem histochemistry. Myocardial blood flow and metabolism were homogeneous at baseline. During LAD occlusion for 3 hours, myocardial blood flow in reversibly injured and infarct-containing sectors (determined with 13NH3) was decreased to 46% and 23%, respectively, of blood flow in normal tissue. MVO2, determined with [1-11C]acetate, was decreased less than myocardial blood flow, consistent with increased oxygen extraction in the ischemic tissue. After reperfusion, blood flow normalized rapidly in reversibly injured tissue but remained depressed in infarct-containing sectors. Regional myocardial function, assessed by two-dimensional echocardiography, was severely depressed during occlusion and did not improve significantly until 1 week after reperfusion. MVO2 remained depressed after reperfusion in both reversibly injured and infarct-containing sectors, did not improve from occlusion levels until 1 week after reperfusion, and remained significantly depressed 1 month after reperfusion even in reversibly injured sectors; [1-11C]palmitate kinetics were also abnormal in postischemic tissue. As reported previously, glucose metabolic rates were increased relative to baseline in normal but not in postischemic tissue 3 hours after reperfusion. Subsequently, glucose metabolism tended to be higher in postischemic relative to normal myocardium. CONCLUSIONS: The results demonstrate decreased oxidative metabolism in postischemic tissue, with concomitant abnormalities in palmitate kinetics and glucose metabolism. Oxidative metabolism and regional function demonstrated a parallel recovery with time.

Acetates↗
PubMed1991

Noninvasive detection of functionally significant coronary artery stenoses with exercise and positron emission tomography.

Positron emission tomography has been employed in vivo to assess flow using N-13 (nitrogen-13) ammonia and glucose metabolism, with the glucose analog F-18 (fluorine-18) fluorodeoxyglucose. Flow metabolism mismatches in which glucose metabolism is increased with respect to flow have been used to define ischemic, but viable myocardium. The feasibility of detecting exercise-induced ischemia using this technique was explored. Eleven normal volunteers and 16 patients who had undergone coronary arteriography were studied with N-13 ammonia at rest and with bicycle exercise, and with F-18 fluorodeoxyglucose in the postexercise period. Each image was divided into 16 sectors. Comparison of absolute net extractions of N-13 ammonia at rest and with exercise was not sensitive in detecting functionally significant coronary artery lesions. Myocardial uptakes of F-18 fluorodeoxyglucose and exercise N-13 ammonia were normalized to the sector with the highest N-13 ammonia uptake (corresponding to the highest flow rate). The differences and ratios of these normalized uptakes were successfully used to objectively define flow metabolism mismatches and to identify functionally significant coronary artery disease. Our data suggest that exercise flow and metabolic imaging are superior to rest and exercise flow imaging, particularly in patients with prior myocardial infarctions.

Ammonia↗