Circulation, Vol 85, 9-21, Copyright © 1992 by American Heart Association
JL Vanoverschelde, JA Melin, A Bol, R Vanbutsele, M Cogneau, D Labar, A Robert, C Michel and W Wijns
BACKGROUND. Enhanced uptake of the glucose analogue 18F- fluorodeoxyglucose
(FDG) in relation to flow has been proposed as an accurate method of
identifying viable myocardium. The evaluation of myocardial oxidative
metabolism could be an alternate way to identify reversible injury. The aim
of the present study was to investigate in patients with reperfused
anterior infarction whether differences in regional oxidative metabolism
exist among regions with and without flow- metabolism mismatch. METHODS AND
RESULTS. Fifteen patients with reperfused anterior myocardial infarction
were studied between 2 weeks and 3 months after the acute event. Regional
myocardial blood flow (13N- ammonia; three-compartment model), oxidative
metabolism (11C-acetate; monoexponential clearance), and glucose uptake
(FDG, linear graphic analysis) were evaluated with dynamic positron
emission tomography. Flow-metabolism patterns were used to differentiate
reversibly (FDG/flow greater than 1.2) from irreversibly injured myocardium
(FDG/flow less than 1.2) using circumferential profile technique. Relative
13N-ammonia uptake was reduced in 71 of 90 anterior and/or septal segments,
including 24 with (seven patients) and 38 without (eight patients)
flow-metabolism mismatch. Acetate clearance (k), reflecting oxidative
metabolism, was reduced by 51% in the center of the infarct area versus
remote segments (27 +/- 12 versus 55 +/- 13 min- 1.10(-3), p less than
0.001). Compared with infarct segments without flow-metabolism mismatch,
segments exhibiting increased glucose uptake relative to flow had faster
acetate clearance (35 +/- 14 versus 23 +/- 9 min-1.10(-3), p less than
0.01). Similarly, myocardial blood flow was better preserved in segments
with flow-metabolism mismatch (54 +/- 13 versus 45 +/- 8 ml/min/100 g, p
less than 0.01) compared with segments without mismatch. However, at
similar levels of hypoperfusion, there was no significant difference in
acetate clearance among segments with and those without flow-metabolism
mismatch: 37 +/- 14 versus 41 +/- 15 min-1.10(-3), respectively. A positive
correlation (r = 0.89, p less than 0.001) was found between absolute
myocardial blood flow and acetate clearance, regardless of the
flow-metabolism pattern. CONCLUSIONS. In patients with reperfused
myocardial infarction studied between 2 weeks and 3 months after the acute
event, regional oxidative metabolism is reduced in proportion to residual
myocardial blood flow and does not differ significantly among similarly
hypoperfused segments with and without flow-metabolism mismatch.
ARTICLES
Regional oxidative metabolism in patients after recovery from reperfused anterior myocardial infarction. Relation to regional blood flow and glucose uptake
Division of Cardiology, University of Louvain Medical School, Brussels, Belgium.
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