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Noninvasive Estimation of Regional Myocardial Oxygen Consumption by Positron Emission Tomography with Carbon-11 Acetate in Patients with Myocardial Infarction

Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri

Correspondence: For reprints contact: Mary Norine Walsh, MD, Cardiovascular Division, Washington University School of Medicine, Box 8086, 660 S. Euclid Ave., St. Louis, MO 63110.

ABSTRACT

We previously demonstrated in experimental studies that myocardial oxygen consumption (MVO₂) can be estimated noninvasively with positron emission tomography (PET) from analysis of the myocardial turnover rate constant (k) after administration of carbon-11 (¹¹C) acetate. To determine regional k in healthy human subjects and to estimate alterations in MVO₂ accompanying myocardial ischemia, we administered [¹¹C]acetate to five healthy human volunteers and to six patients with myocardial infarction. Extraction of [¹¹C]acetate by the myocardium was avid and clearance from the blood-pool rapid yielding myocardial images of excellent quality. Regional k was homogeneous in myocardium of healthy volunteers (coefficient variation = 11%). In patients, k in regions remote from the area of infarction was not different from values in myocardium of healthy human volunteers (0.061 ± 0.025 compared with 0.057 ± 0.008 min^–1). In contrast, MVO₂ in the center of the infarct region was only 6% of that in remote regions (p < 0.01). In four patients studied within 48 hr of infarction and again more than seven days after the acute event, regional k and MVO² did not change. The approach developed should facilitate evaluation of the efficacy of interventions designed to enhance recovery of jeopardized myocardium and permit estimation of regional MVO₂ and metabolic reserve underlying cardiac disease of diverse etiologies.

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