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European Journal of Nuclear Medicine and Molecular Imaging

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01.08.2013 | Original Article

Reverse blood flow-glucose metabolism mismatch indicates preserved oxygen metabolism in patients with revascularised myocardial infarction

verfasst von: Yoshitomo Fukuoka, Akira Nakano, Hiroyasu Uzui, Naoki Amaya, Kentaro Ishida, Kenichiro Arakawa, Takashi Kudo, Hidehiko Okazawa, Takanori Ueda, Jong-Dae Lee, Hiroshi Tada

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 8/2013

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Abstract

Purpose

Positron emission tomography (PET) with ¹⁸F-fluorodeoxyglucose (FDG) has been reported to be unreliable for identifying viable myocardium in acute myocardial infarction (AMI), especially in areas with discordance in myocardial blood flow (MBF) and glucose metabolism. In myocardium with decreased FDG uptake but preserved MBF, referred to as exhibiting reverse mismatch, myocardial viability remains controversial and little is known about the metabolic state. The aims of this study were to clarify substrate use and to estimate myocardial viability in infarct areas exhibiting reverse mismatch.

Methods

Eighteen AMI patients with successful revascularisation were included in this study. Two weeks after onset, ¹¹C-acetate and ¹⁸F-FDG PET were performed to evaluate regional oxygen consumption (k _mono), MBF and glucose metabolism. Free fatty acid (FFA) metabolism was evaluated with ¹²³I-15-(p-iodophenyl)-3-(R, S)-methylpentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT). To assess wall motion, movement in left ventricular endocardial surface was calculated using ECG-gated ^99mTc-tetrofosmin SPECT.

Results

The %k _mono values in reverse mismatch segments (52.6 ± 13.6 %) were not significantly different from those in non-infarct segments (60.4 ± 12.8 %, p = 0.071) and normal match segments (preserved MBF and FDG uptake) (58.6 ± 11.6 %, p = 0.396), although regional wall motion was more severely impaired (3.06 ± 2.52 mm vs 6.78 ± 3.17 mm, p < 0.0001, and vs 5.30 ± 2.33 mm, p = 0.042, respectively). Compared to segments with reduced match (reduced MBF and FDG uptake), %k _mono and %BMIPP uptake were significantly higher in reverse mismatch segments (52.6 ± 13.6 % vs 37.4 ± 8.9 %, p = 0.0002, and 58.8 ± 10.6 % vs 40.2 ± 10.7 %, p < 0.0001).

Conclusion

Reverse mismatch in reperfused AMI patients, high oxygen consumption and FFA metabolism were observed despite decreased glucose metabolism. We conclude that reverse mismatch indicated the myocardium with early restoration of MBF and aerobic FFA metabolism.

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Titel: Reverse blood flow-glucose metabolism mismatch indicates preserved oxygen metabolism in patients with revascularised myocardial infarction
verfasst von: Yoshitomo Fukuoka
Akira Nakano
Hiroyasu Uzui
Naoki Amaya
Kentaro Ishida
Kenichiro Arakawa
Takashi Kudo
Hidehiko Okazawa
Takanori Ueda
Jong-Dae Lee
Hiroshi Tada
Publikationsdatum: 01.08.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 8/2013
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-013-2423-x

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

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