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(Circulation. 1999;99:3322.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Myocardial [¹⁸F]Fluorodeoxyglucose Uptake After Heterotopic Cardiac Transplantation Assessed by Positron Emission Tomography

Eldad Rechavia, MD

From the Cardiology Division, Rabin Medical Center Beilinson Campus, Tel Aviv University Sackler School of Medicine, Israel, and the Cyclotron Unit Medical Research Council Clinical Sciences Centre, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.

Correspondence to Dr Eldad Rechavia, Cardiology Division, Rabin Medical Center Beilinson Campus, Petach Tikva 49100, Israel.

Metabolic aspects, perfusion autoregulation, and receptor-mediated cardiac responses of the orthotopic cardiac transplant have gained increasing attention in the past few years. We recently assessed glucose uptake in vivo in orthotopic heart transplant recipients.¹ Enhanced myocardial uptake as demonstrated by [¹⁸F]2-fluoro-2-deoxyglucose (¹⁸FDG) and PET scanning was explained by inefficient metabolic utilization of glucose by the transplanted myocardium or by the influence of circulating catecholamines, which may stimulate glucose uptake independently of cardiac workload. We also studied a 48-year-old male patient 6 months after heterotopic heart transplantation. Glucose uptake was assessed by use of ¹⁸FDG and PET imaging, with the basic premise that this parameter gives direct evidence of glucose metabolic state and myocardial viability in both cardiac allograft and the native poorly contracting heart, which was left in situ. Regional ¹⁸FDG uptake (mL · s^-1 · g^-1) was defined as the ratio of the average ¹⁸FDG pixel counts in the various tissue regions of the left ventricle to the integral of the arterial input function, as previously described.¹ Regional ¹⁸FDG uptake was on average 285% higher in the transplanted heart than in the native heart (Figure). This stems largely from the difference in myocardial tissue viability, as well as probably reflecting functional-metabolic coupling of the transplanted heart as opposed to the native heart.

View larger version (73K): [in this window] [in a new window]   Figure 1. Serial transaxial PET images from a patient after heterotopic heart transplantation. 18FDG scan, obtained 60 minutes after tracer injection, outlines difference in metabolic activity between native and transplanted hearts. From apex to base, each section contains native and transplanted hearts located on left and right sides, respectively. Left ventricular cavity of native heart is markedly dilated. 18FDG images reveal an extensive reduction of uptake throughout entire left ventricular myocardium, with severely reduced activity in apical and septal segments, corresponding to an old infarction. By contrast, myocardial glucose utilization of transplanted heart is well preserved, as indicated by homogeneous enhanced uptake of 18FDG. Note prominent activity in mid ventricular segments (top right sections), corresponding to papillary muscles.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

References

1. Rechavia E, de Silva R, Kushwaha SS, Rhodes CG, Araujo LI, Jones T, Maseri A, Yacoub MH. Enhanced myocardial ¹⁸F-2-fluoro-2-deoxyglucose uptake after orthotopic heart transplantation assessed by positron emission tomography. J Am Coll Cardiol. 1997;30:533–538.[Abstract]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rechavia, E. Search for Related Content PubMed PubMed Citation Articles by Rechavia, E. Related Collections Cardiovascular imaging agents/Techniques Nuclear cardiology and PET CV surgery: transplantation, ventricular assistance, cardiomyopathy