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 [N-13]ammonia, [C-11]acetate, and F-18-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 F-18 was increased relative to N-13 activity or ''PET match'' if N-13 and F-18 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 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.