Circulation, Vol 73, 433-443, Copyright © 1986 by American Heart Association
AP Selwyn, MJ Shea, R Foale, JE Deanfield, R Wilson, CM de Landsheere, DL Turton, F Brady, VW Pike and DI Brookes
A physiologic means of measuring the distribution of cardiac output and
regional myocardial blood flow has been developed that uses human albumin
microspheres labeled with carbon-11 (11C) and external detection with
positron emission tomography. Ten patients with previous myocardial
infarction were studied to investigate the level of blood flow in normal
and infarcted segments of the heart. After diagnostic catheterization, 4 to
6 mCi of 11C on 2 to 3 million sterile microspheres (15 to 20 micron) were
mixed and injected into the apex of the left ventricle during timed
withdrawal of arterial blood to obtain reference flow values. Regional
activity in brain, heart, lungs, liver, spleen, and kidneys was measured
tomographically. Blood flow was calculated based on the relationship
between total activity in a reference flow and tissue activity in tomograms
of each organ (ml/min/100 g). No adverse effects were noted after injection
of the microspheres. Successive myocardial tomograms showed no loss of
activity. There were no significant differences in flow values in matched
regions of paired organs. Mean cerebral flow was 52.4 +/- 10.0 ml/min/100 g
in the frontal lobes, 54.4 +/- 8.8 in the temporal lobes, 67.6 +/- 8.2 in
the occipital lobes, and 53.0 +/- 9.4 in the basal ganglia. Flow was 16.0
+/- 8.4 ml/min/100 g (range 0 to 40.0) in the center of infarcted
myocardium and 82.0 +/- 32.0 in the remote segments. This method meets most
of the demands for use of microspheres to measure tissue blood flow. The
wide range of flow values in infarcted myocardium may be a function of
infarct size, spatial resolution, or pathologic evidence of islands of
viable tissue. Patients with angina had high flow values in the infarcted
segment, whereas those with heart failure had significantly lower values.
Surviving myocardium in the region of the infarct may need to be considered
if patients complain of angina, particularly when treatment is aimed at
preserving ventricular function.
ARTICLES
Regional myocardial and organ blood flow after myocardial infarction: application of the microsphere principle in man
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