Regional assessment of myocardial metabolic integrity in vivo by positron-emission tomography with 11C-labeled palmitate.

Ter‐Pogossian, Michel M.; Klein, Milton S.; Markham, Joanne; Roberts, Robert; Sobel, Burton E.

doi:10.1161/01.cir.61.2.242

Cited by 147 publications

(23 citation statements)

References 43 publications

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“…The SEE is about 25%, which, on average, gives a 95% confidence limit of ± 50% for the individual IS. Studies in man concerning the accuracy of estimating IS by serum CK and CK-MB measurements have shown a good correlation between accumulated serum CK and CK-MB and different indirect expressions of IS.10, [16][17][18] Whether the kinetics of CK-MB should be described as a one-or multicompartment model has been discussed. The onecompartment theory is supported by a monoexponential elimination of labeled CK in experimental dog studies,9' 29 but this is probably a simplification of a complex biologic system.…”

Section: Content Of Ck-mb In Normal Myocardiummentioning

confidence: 99%

See 1 more Smart Citation

Estimation of acute myocardial infarct size in man by serum CK-MB measurements.

Grande¹,

Hansen²,

Christiansen³

et al. 1982

Circulation

136

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SUMMARY This study was performed to determine the relationship between myocardial infarct size estimated by serum CK-MB methods and the extent of irreversible injury in acute myocardial infarction. In 321 consecutive patients, infarct size was estimated by different mathematical models, and in 22 patients who died in hospital, the extent of myocardial necrosis was determined by autopsy. We also investigated the depletion of CK-MB in infarcted tissue, the recovery of CK-MB in the plasma volume, and the elimination of CK-MB from plasma.Myocardial CK-MB depletion was relatively greater in the larger infarcts, whereas the recovery of enzyme in plasma was independent of the infarct size. Correction of serum CK-MB for changes in plasma volume improved the estimate significantly (p < 0.05). The correlation between the measured infarct size (g) and the estimated infarct size (units per liter and gram-equivalents) was highly significant (r = 0.85-0.89, SEE = 23-27%, p < 0.001). Thus, a semiquantitative expression of the extent of myocardial necrosis can be determined in vivo. AMI. Of these, 72 were excluded: 48 because the symptoms of AMI had lasted more than 15 hours before admission or because the second blood sample did not show higher CK-MB activity than the first and 24 because not enough blood samples had been obtained because patients died or were transferred to another department. The remaining 321 patients form the study group. Forty-three of these patients died within 18 days and were divided into group A, which included 22 patients in whom a detailed heart autopsy was performed, and group B, which included 21 patients in whom no detailed heart autopsy was performed. All patients autopsied had survived for at least 48 hours from the appearance of CK-MB activity in serum and there were no signs of reinfarction before death. Furthermore, all plasma curves showed a pure elimination phase (first-order kinetics).The 22 patients in group A included 12 women and 10 men who died at a mean age of 69.7 years (range 49-88 years). The median time from onset of symptoms until death was 6.4 days (range 2-14 days). Cardiogenic shock was the main cause of death in 12 patients and recurrent ventricular fibrillation in six patients. Two died from asystole and two from noncardiac causes.Heart biopsies were taken postmortem every 6 hours for 30 hours in eight patients from group B. The total enzyme depletion in whole heart homogenates was measured in 10 other patients.In 10 patients who died without signs of heart disease, myocardial biopsies were made to estimate CK and CK-MB activity. Tissue extracts were made from about 0.3 g tissue (wet weight) in a mixture of 10 ml 0.25 mol/ 1 sucrose, 3 ml 0.01 mol/l TRIS buffer (pH 7.4), 3 ml 1 mmol/l EGTA (pH 7.4) and 3 ml 1 mmol/ I mercaptoethanol, and homogenized on ice in an Ultra Turax blender for 1 minute. The homogenate was centrifuged (3500 g) and the supernatant was used to determine isoenzyme activity. The samples were diluted with heat-inactivated serum or TRIS buffer to the line...

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Section: Content Of Ck-mb In Normal Myocardiummentioning

confidence: 99%

“…Recent studies comparing IS estimated from serum CK-MB with indirect indicators indicate that this is the case. [16][17][18] We demonstrated that the IS can be calculated just as well with only few blood samples as with serial samples,"' allowing us to examine the reliability of en-…”

mentioning

confidence: 99%

Estimation of acute myocardial infarct size in man by serum CK-MB measurements.

Grande¹,

Hansen²,

Christiansen³

et al. 1982

Circulation

136

View full text Add to dashboard Cite

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“…If all the fatty acids extracted by the myocardium underwent immediate oxidation, free fatty acids would account for 66-100% of the oxidative metabolism. Recently positron emission tomography with ["Cipalmitic acid has been used to investigate free fatty acid metabolism in normal and ischemic myocardium (16,17). The time-activity curves of the "C tracer are often equated with oxidation of the fatty acid; however, the precise metabolic fate of free fatty acids in the myocardium has not been defined in humans.…”

Section: Introductionmentioning

confidence: 99%

Myocardial metabolism of free fatty acids. Studies with 14C-labeled substrates in humans.

Wisneski¹,

Gertz²,

Neese³

et al. 1987

J. Clin. Invest.

270

199

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Free fatty acids are considered to be the major energy source for the myocardium. To investigate the metabolic fate of this substrate in humans, 24 subjects underwent coronary sinus and arterial catheterization. 13 subjects were healthy volunteers and 11 subjects had symptoms of ischemic heart disease. I1-14CIoleate or 11-'4Cipalmitate bound to albumin was infused at a constant rate of 25 1Ci/h. Oxidation was determined by measuring the '4C02 production. The data demonstrated that a high percentage (84±17%) of the palmitate and oleate extracted by the myocardium underwent rapid oxidation. A highly significant correlation was present between the arterial level and the amount oxidized (r = 0.82, P < 0.001 for palmitate; r = 0.77, P < 0.001 for oleate). The isotope extraction ratio was greater than the chemical extraction ratio. This difference of 6±2 nmol/ml of blood in the young normal subjects was significantly less than the 12±4 nmol/ml observed in the ischemic heart disease patients (P < 0.001).

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“…The total body radiation absorbed from combined myocardial and blood pool tomography using 20 mCi of "IC-palmitate and 30 mCi of "IC-carbon monoxide was < 450 mrem, with a maximum of 2600 mrem delivered to the liver and 1740 mrem delivered to the blood. 6 Tomography was performed with a positronemission transaxial tomograph (PETT-IV), which provides for the simultaneous acquisition of data needed to reconstruct seven parallel transaxial cross sections (slices) of the heart. Midpoints of the sections are separated by approximately 1 cm.…”

Section: Materials and Methods Patientsmentioning

confidence: 99%

“…In general, among patients who exhibited an abnormality on the 201Tl scan, the locus corresponded to regions of Previous studies have shown substantial variability in the sensitivity of thallium imaging for detecting myocardial infarction, depending on the time of the imaging after infarction, the location, intramural extent, and the size of the infarct."' 18-21 A sensitivity of almost 100% has been achieved among patients with transmural infarction imaged within the first [6][7][8][9][10][11][12] hours after onset of infarction.14 20 However, when imaging is delayed by 24 hours, sensitivity is dramatically decreased. Unfortunately, the high early sensitivity may reflect scintigraphic changes due to ischemia rather than infarction per se.…”

Section: Thallium Imagingmentioning

confidence: 99%

Characterization of nontransmural myocardial infarction by positron-emission tomography.

Geltman¹,

Biello²,

Welch³

et al. 1982

Circulation

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SUMMARY The present study was performed to determine whether positron emission tomography (PET) performed after i.v. '1C-palmitate permits detection and characterization of nontransmural myocardial infarction. PET was performed after the i.v. injection of 1'C-palmitate in 10 normal subjects, 24 ture and anatomic distribution of injury with nontransmural compared with transmural myocardial infarction. Materials and Methods PatientsAll 56 subjects gave informed written consent. The group included 10 normal subjects (six males and four females, average age 39 years, range 23-68 years) and 46 patients who had survived acute myocardial infarction for at least 72 hours. Control subjects were seven normal volunteers without a history of chest pain or myocardial infarction and with normal physical examinations and three patients admitted to the coronary care unit for the evaluation of atypical chest pain in whom myocardial infarction was excluded based on serial electrocardiographic and enzymatic criteria. None of the controls had experienced previous myocardial infarction or exhibited Q waves on the ECG.The 46 patients (31 male, 15 female, mean age 57 years, range of 29-84 years) experienced myocardial infarction documented by a history of precordial chest pain of at least 20 minutes duration and serial elevations of total and MB plasma CK. Demographic data are summarized in table 1.Patients with myocardial infarction preceding the index episode were excluded. Transmural myocardial infarction was considered to be present if Q waves of 30 msec duration were seen in recordings from at least two concordant leads. In the absence of these criteria, nontransmural myocardial infarction was considered to be present. Infarction was transmural in 22 and nontransmural in 24 patients. Radiochemicals and Tomographic ProceduresThe "IC-palmitate was prepared with a synthesis developed at Washington University that involves the addition of "CO2 produced in the medical center cyclotron to a Grignard reagent (I-MgBr-pentade-

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Regional assessment of myocardial metabolic integrity in vivo by positron-emission tomography with 11C-labeled palmitate.

Cited by 147 publications

References 43 publications

Estimation of acute myocardial infarct size in man by serum CK-MB measurements.

Estimation of acute myocardial infarct size in man by serum CK-MB measurements.

Myocardial metabolism of free fatty acids. Studies with 14C-labeled substrates in humans.

Characterization of nontransmural myocardial infarction by positron-emission tomography.

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