Summary
Regional myocardial perfusion and glucose metabolism were assessed in six normal volunteers and 29 patients with coronary heart disease and stable or unstable angina using rubidium-82 (Rb-82) and F-18 fluoro 2-deoxy-D-glucose (FDG) with positron emission tomography.
All normals and patients were studied following overnight fasting, at rest, with no angina or electrocardiographic signs of acute myocardial ischemia or necrosis. Rb-82 myocardial cross-sectional images were obtained employing the continuous infusion technique, while dynamic FDG imaging was employed after intravenous tracer bolus injection. Regional Rb-82 and FDG myocardial concentrations were then calculated by drawing regions of interest over the interventricular septum, anterior and lateral wall of the left ventricle.
The mean Rb-82 uptake for each left ventricular region analyzed was found to be similar between both groups of patients and normal volunteers. The mean myocardial glucose utilization was found to be similar in normal volunteers and patients with stable angina (0.023±0.032 vs. 0.012±0.008 μm ml/min p<0.42). However, myocardial glucose utilization was found to be significantly higher in patients with unstable angina compared with both normals and patients with stable angina (0.048±0.047 μM/ml/min p<0.001 for both comparisons). Thus, in patients with severe coronary artery disease and unstable angina, myocardial glucose utilization was enhanced in spite of the absence of clinical, electrocardiographic, or detectable perfusion evidence of acute ischemia.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ellis SG, Henschki CI, Sandor T, Wynne J, Braunwald E, Kloner RA. Time course of functional biochemical recovery of myocardium salvaged by reperfusion. J Am Coll Cardiol 1983;1 (4):1047–1055.
Becker LC, Levine JH, DiPaula AF, Guarnieri T, Aversano T. Reversal of dysfunction in postischemic stunned myocardium by epinephrine and postextrasystolic potentiation. J Am Coll Cardiol 1986;7:580–589.
Popio KA, Gorlin R, Bechtel D, Levine JA. Postextrasystolic potentiation as a predictor of potential myocardial viability: Preoperative analyses compared with studies after coronary bypass surgery. Am J Cardiol 1977;39:944.
Reimer KA, Hill ML, Jennings RB. Prolonged depletion of ATP and of the adenine nucleotide pool due to delayed resynthesis of adenine nucleotides following reversible myocardial ischemic injury in dogs. J Mol Cell Cardiol 1981; 13:229.
Kloner R, DeBoer WV, Darsee JR, Ingwall JS, Braunwald E. Recovery from prolonged abnormalities of canine myocardium salvaged from ischemic necrosis by coronary perfusion. Proc Natl Acad Sci USA 1981;78:7152.
Schwaiger M, Schelbert HR, Ellison D, Hansen H, Yeatman L, Vinten-Johansen J, Selin C, Barrio J, Phelps ME. Sustained regional abnormalities in cardiac metabolism after transient ischemia in the chronic dog model. J Am Coll Cardiol 1985;6:336–347.
Most AS, Gorlin R, Soeldner JS. Glucose extraction by the human myocardium during pacing stress. Circulation 1972; 45:92.
Gertz EW, Wisenski JA, Neese R, Bristow JD, Seale GL, Hanlon JT. Myocardial lactate metabolism: Evidence of lactate release during net chemical extraction in man. Circulation 1981;63:1273.
Camici P, Araujo LI. Spinks T, Lammerstsma AA, Kaski JC, Shea MJ, Selwyn AP, Jones T, Maseri A. Increased uptake of 18 F-fluorodeoxyglucose in postischemic myocardium of patients with exercise-induced angina. Circulation 1986; 74:81–88.
Selwyn AP, Allan RM, L'Abbate A, Horlock P, Camici P, O'Brien HA, Grant PA. Relation between regional myocardial uptake of rubidium-82 and perfusion: Absolute reduction of cation uptake in ischemia. Am J Cardiol 1982;50: 122.
Deanfield JE, Shea M, Ribiero P, de Landsheere CE, Wilson RA, Horlock P, Selwyn AP. Transient ST-segment depression as a marker of myocardial ischemia during daily life. Am J Cardiol 1984;54:1195–1200.
Gallagher BM, Ansari A, Atkins H, Casella V, Christmas DR, Fowler JS, Ido T, MacGregor RR, Som P, Wan CN, Wolfe AP, Kuhl DE, Reivich M. Radiopharmaceuticals XXVII. F-18 labeled 2-fluoro-D-glucose as a radiopharmaceutical for measuring regional myocardial glucose metabolism in vivo: Tissue distribution and imaging studies in animals. J Nucl Med 1977;18:990.
Clark JC, Buckingham PD. Short-lived Gases for Clinical Use. London: Butterworths, 1975:237.
Patlak CS, Blasberg RG, Fenstermacher JD. Graphical evaluation of blood to brain transfer constants from multiple uptake data. J Cereb Blood Flow Metabol 1983;3:1.
Neely JR, Morgan HE. Substrate and energy metabolism of heart. In: Conroe Jr JH, ed. Annual Reviews of Physiology (Palo Alto, CA) 1974;36:413.
Rhodes CG, Valind SO, Brudin L, Suzuki T, Palmer AJ, Makepeace P, Jones T, Hughes JM. Modulation of pulmonary glucose utilization by dietary state in man. Clin Sci 1985;68:21 (abstract).
Tillish J, Brunken R, Marshall R, Schwaiger M, Mandelkern M, Phelps M, Schelbert HR. Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. New Engl J Med 1986;314:884–888.
Camici P, Bailey I. Time course of myocardial glycogen repletion following acute myocardial ischemia. Circulation 1984;70(Suppl II):II-85 (abstract).
Schwaiger M, Fishbein MC, Wijns W, Kulber D, Chai A, Araujo L, Phelps ME, Schelbert HR. Prolonged glycogen depletion and increase of glucose utilization in perfusion canine myocardium. Circulation 1986;74(Suppl II):II-211 (abstract).
Liedtke JA, Nellis SH, Whitesell LF. Effects of regional ischemia on metabolic function in adjacent aerobic myocardium. J Mol Cell Cardiol 1982;14:195–205.
Hoffman EJ, Huang SC, Phelps ME. Quantitation in positron emission tomography. 1. Effect of the object size. J Comput Assist Tomogr 1979;3:299.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Araujo, L.I., Camici, P., Spinks, T.J. et al. Abnormalities in myocardial metabolism in patients with unstable angina as assessed by positron emission tomography. Cardiovasc Drug Ther 2, 41–46 (1988). https://doi.org/10.1007/BF00054251
Issue Date:
DOI: https://doi.org/10.1007/BF00054251