The glucose analog 18F-fluorodeoxyglucose (FDG) provided, for the first time, the ability to noninvasively probe and characterize the regional metabolism of glucose as a major fuel substrate of the heart. Positron emission tomography (PET) became a tool for demonstrating the metabolic processes directly in the myocardium. Clinical studies showed the dependency of the heart’s substrate selection on circulatory levels of glucose, free fatty acid, and insulin. Regional 18F-FDG uptake markedly in excess of myocardial blood flow in dysfunctional myocardium after infarction, with chronic coronary artery disease or with ischemic cardiomyopathy, became recognized as a hallmark of myocardial viability or potentially reversible contractile dysfunction. Defined as a blood flow metabolism mismatch (Fig. 12.1), the regional glucose uptake pattern identifies patients as being at high risk of cardiac events and identifies patients who will benefit most from surgical revascularization. The patterns predict a postrevascularization improvement in global left ventricular function, in symptoms related to congestive heart failure, and in longterm survival.
KeywordsPositron Emission Tomography Myocardial Perfusion Myocardial Blood Flow Perfusible Tissue Index Rest Perfusion Defect
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