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Myocardial Perfusion, Glucose Utilization and Oxidative Metabolism in a Patient with Left Bundle Branch Block, Prior Myocardial Infarction and Diabetes

Department of Nuclear Medicine and PET Center, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy

Correspondence: For correspondence or reprints contact: Pierluigi Zanco, Medicina Nucleare-Centro PET, USSL 8-Ospedale di Castelfranco V., via Ospedale 18, 31033 Castelfranco Veneto (TV), Italy.

ABSTRACT

A diabetic patient affected by insulin-dependent diabetes, significant stenosis of left anterior descending (LAD) coronary, thrombolyzed myocardial infarction and complete left bundle branch block (LBBB) was examined by PET. Myocardial perfusion, glucose utilization and oxidative metabolism were evaluated by ¹³N-ammonia, ¹⁸F-fluoro-deoxyglucose (FDG) and ¹¹C-acetate, respectively. Despite severe damage in ¹⁸F-FDG uptake in the septum, with a septum-to-lateral ratio (S/L R)equal to 0.38, the oxidative metabolism in this area, evaluated quantitatively by dynamic acquisition, was relatively preserved (S/L R = 0.82), with a distribution similar to perfusion (S/L R = 0.87). These data reveal selective damage in glucose utilization in the septum in LBBB, unrelated to perfusion reduction and with preserved oxidative metabolism. Moreover, our experience could suggest an overestimation of the necrotic area by ¹⁸F-FDG in LBBB patients.

Key Words: left bundle branch block • PET • fluorine-18-fluorodeoxy-glucose • nitrogen-13-ammonia • carbon-11-acetate

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