Superiority of C-11 acetate compared with F-18 fluorodeoxyglucose in predicting myocardial functional recovery by positron emission tomography in patients with acute myocardial infarction

doi:10.1016/S0002-9149(96)00601-7

The American Journal of Cardiology

Volume 78, Issue 11, 1 December 1996, Pages 1230-1235

https://doi.org/10.1016/S0002-9149(96)00601-7 Get rights and content

Abstract

In patients with chronic coronary artery disease, preservation of myocardial oxidative metabolism measured by positron emission tomography (PET) with ¹¹C-acetate is a more accurate predictor of subsequent myocardial functional recovery than is maintenance of glucose metabolism estimated with ¹⁸F-fluorodeoxyglucose. However, whether measurements of myocardial oxidative metabolism are more accurate than measurements of glucose metabolism in predicting functional recovery in patients with recent myocardial infarction is unknown. Myocardial oxidative metabolism was measured within 10 days of infarction in 19 patients by analysis of the rate of myocardial clearance of ¹¹C-acetate. Metabolism of glucose was assessed by analysis of the uptake of ¹⁸F-fluorodeoxyglucose. Criteria for prediction of the recovery of function based on measurements of oxidative metabolism and glucose metabolism were compared. Threshold criteria with ¹¹C-acetate exhibited superior positive and negative predictive values (89% and 73%, respectively) compared with the criteria of ¹⁸F-fluorodeoxyglucose (65% and 57%, respectively) (p < 0.025). In addition, the magnitude of functional recovery after revascularization correlated with the severity of the metabolic abnormality present initially. In patients with recent myocardial infarction, the extent of functional recovery can be predicted accurately by measurement of regional oxidative metabolism by PET with ¹¹C-acetate, and these measurements are superior to those of ¹⁸fluorodeoxyglucose.

References (28)

N Tamaki et al.
Positron emission tomography using F-18-deoxyglucose in evaluation of coronary artery bypass grafting
Am J Cardiol
(1989)
RJ Gropler et al.
Functional recovery after revascularization for chronic coronary artery disease is dependent on maintenance of oxidative metabolism
J Am Coll Cardiol
(1992)
RJ Gropler et al.
Comparison of C-11 acetate with F-18 fluorodeoxyglucose for delineating viable myocardium by positron emission tomography
J Am Coll Cardiol
(1993)
M Schwaiger et al.
Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography
J Am Coll Cardiol
(1986)
LA Pierard et al.
Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography
J Am Coll Cardiol
(1990)
RJ Gropler et al.
The dependence of recovery of contractile function on maintenance of oxidative metabolism after myocardial infarction
J Am Coll Cardiol
(1992)
MA Brown et al.
Noninvasive assessment of canine myocardial oxidative metabolism with carbon-11 acetate and positron emission tomography
J Am Coll Cardiol
(1988)
EO Feigl et al.
Interrelations between coronary artery pressure, myocardial metabolism and coronary blood flow
J Mol Cell Cardiol
(1990)
RJ Hicks et al.
Metabolic imaging by positron emission tomography early after myocardial infarction as a predictor of recovery of myocardial function after reperfusion
J Nucl Cardiol
(1994)
A Conversano et al.
Delineation of myocardial stunning and hibernation by positron emission tomography in advanced coronary artery disease
Am Heart J
(1996)

RS Gibson et al.

Prospective assessment of regional myocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy

J Am Coll Cardiol

(1983)

RJ Gropler et al.

Myocardial viability. What is the definition?

J Nucl Med

(1991)

J Tillisch et al.

Reversibility of cardiac wall motion abnormalities predicted by positron tomography

N Engl J Med

(1986)

TH Marwick et al.

Metabolic responses of hibernating and infarcted myocardium to revascularization

Circulation

(1992)

Cited by (37)

PET imaging of heart diseases by Acetate
2022, Nuclear Medicine and Molecular Imaging: Volume 1-4
Acetate has a pivotal role in the intermediary metabolism of living cells. Glucose, fatty acids and other carbon sources for oxidation are converted to acetate before entering the mitochondrial tricarboxylic acid cycle. ¹¹C-acetate PET is an established technique in cardiac imaging since decades and allows accurate estimates of both regional myocardial blood flow (MBF) and oxygen consumption (MVO₂) to be obtained simultaneously from a single scan of less than 30 min duration. Image acquisition is based on dynamic imaging and analysis requires kinetic modeling approaches for optimal results. These requirements, as well as the need for an on-site cyclotron for carbon-11 production, so far limited the clinical use to advanced PET facilities. In recent years, myocardial ¹¹C-acetate PET has seen a renewed interest in heart failure research into myocardial external efficiency (MEE). MEE is defined as the ratio of the energy associated with external pressure-volume work (cardiac output x systemic blood pressure, converted to Joule) and chemical energy consumed (MVO₂ x left ventricular mass (LVM), converted to Joule). Cardiac output and LVM can be measured by echocardiography, magnetic resonance imaging or directly from the ¹¹C-acetate PET scan, and hence provides a fully non-invasive approach to detailing important aspects of the inner workings of the heart. MEE is increasingly used to evaluate new therapies in heart failure and has been validated for that purpose. MEE has a high reproducibility and might potentially also be of use for early diagnosis of heart failure before symptoms develop.
This chapter describes scanning parameters with image analysis and summarizes the clinical utility of MBF, MVO₂ and MEE measurements obtained from ¹¹C-acetate PET.
Positron-Emission Tomography Imaging
2014, Pathobiology of Human Disease: A Dynamic Encyclopedia of Disease Mechanisms
During the last two decades, we have witnessed a significant improvement in the prevention and management of coronary artery disease (CAD) and its devastating consequences. Despite these efforts, however, cardiovascular disease (especially CAD and its sequelae) remains highly prevalent and it represents a health-care burden in industrialized and developing countries. This has resulted in a continued expansion and refinement of our noninvasive imaging approaches to improve diagnosis and risk prediction. Positron-emission tomography is a powerful noninvasive imaging tool for phenotyping patients at risk or with known CAD that has been evolving over the past 30 years.
Assessment of Myocardial Viability with Positron Emission Tomography
2010, Clinical Nuclear Cardiology: State of the Art and Future Directions
Assessment of myocardial viability with positron emission tomography
2010, Clinical Nuclear Cardiology
Development of myocardial microcirculation and metabolism in acute ST-elevation myocardial infarction evaluated with positron emission tomography
2005, Journal of Nuclear Cardiology
Early reperfusion is an established therapeutic objective in acute myocardial infarction (MI). The relationship of regional myocardial microcirculation and metabolism toward outcome in acute human MI is not well known.
In 8 patients, positron emission tomography (PET) was performed with oxygen 15-labeled water at 3 hours, 24 hours, and 3 weeks after the start of fibrinolytic treatment, with carbon 11 acetate at 3 hours and with fluorine 18 fluorodeoxyglucose at 24 hours and 3 weeks. Absolute quantification of perfusion and water-perfusable tissue fraction (PTF), metabolic activity, and substrate extraction in 4 regions of interest was performed. Coronary angiography was performed at 24 hours. Short-term outcome at 3 weeks was evaluated by contractile reserve with dobutamine stress echocardiography and lung water measurements with PET. Early regional perfusion, PTF, and extraction and utilization of oxygen and glucose decreased closer to the infarct region (P < .001 for all). Infarct-related oxygen utilization and extraction of oxygen and glucose were closely related to outcome (P < .01 for all). PTF improved significantly in the infarct-related regions over time in proportion to early oxygen extraction and utilization.
This pilot study indicates that PET might be useful in the evaluation of treatment efficacy and that restoration of oxidative metabolism is more closely related to myocardial damage recovery than perfusion in the early phase after MI.
Robotic preparation of Sodium Acetate C 11 Injection for use in clinical PET
2002, Nuclear Medicine and Biology
Sodium Acetate C 11 Injection is a radiopharmaceutical commonly used for clinical studies with positron emission tomography (PET). We have designed a fully-automated robotic system for the compounding of this 20-minute half-lived tracer in the clinical setting. The system is comprised of five modular workstations that are configured in a flexible manner to accommodate all of the steps in the production of the labeled drug. The Trapping Station isolates cyclotron-produced [¹¹C]CO₂ gas from the target and directs carbonation of methylmagnesium Grignard in diethyl ether. The Heating Station hydrolyzes the intermediate, and removes ether and unreacted [¹¹C]CO₂ from the mixture. The Extraction Station removes ionic and organic contaminants from the drug using solid-phase extraction (AG 11A8 and C18 resin). The Filtration Station sterilizes the radiopharmaceutical, and tests membrane patency post filtration. The Assay Station measures the weight and radioactivity content of the Final Product Container, facilitating calculation of activity concentration in a remote manner. Rapid quality control methodology has also been developed that is suitable for pre-release analysis of the drug product. For a 7.5 min irradiation with a 40 μA proton beam, 223–300 mCi of Acetate C 11 Injection with purity meeting USP standards is produced within 23 min. This robotic system is a reliable method for producing Sodium Acetate C 11 Injection, USP in the clinical setting with minimal personnel exposure. Moreover, its design flexibility permits synthesis of additional ¹¹C- or ¹⁸F-labeled PET tracers within the same shielded hot cell.

View all citing articles on Scopus

^☆: This work was supported in part by a grant from the Edward Mallinckrodt, Jr. Foundation, St. Louis, Missouri; and by grants HL17646 (SCOR in Coronary and Vascular Diseases) and HL13851 from the National Institutes of Health, Bethesda, Maryland. This study was performed during Dr. Gropler's tenure as a Clinician-Scientist Awardee and Dr. Dávila-Román's tenure as a Minority Scientist Development Awardee, both from the American Heart Association.

View full text

Superiority of C-11 acetate compared with F-18 fluorodeoxyglucose in predicting myocardial functional recovery by positron emission tomography in patients with acute myocardial infarction☆

Abstract

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Mol Cell Cardiol

J Nucl Cardiol

Am Heart J

J Am Coll Cardiol

Myocardial viability. What is the definition?

J Nucl Med

Reversibility of cardiac wall motion abnormalities predicted by positron tomography

N Engl J Med

Metabolic responses of hibernating and infarcted myocardium to revascularization

Circulation