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Biomedical subjects

H R Schelbert

Publications and source records attributed to H R Schelbert.

At least 109 records · Page 6Linked to original sources
PubMed1991

Measurement of regional glucose metabolic rates in reperfused myocardium.

Regional myocardial glucose utilization was measured with [18F]fluorodeoxyglucose (FDG) and positron emission tomography in normal and postischemic tissue after 3 h of intracoronary balloon occlusion in closed-chest chronically instrumented anesthetized dogs. Estimates of glucose metabolic rates were made using the Sokoloff model, assuming the lumped constant to be unchanged in reperfused tissue. Myocardial sectors were classified as normal, reversibly injured, or infarct containing based on occlusion blood flow images and postmortem histology. Occlusion flow, measured by microspheres, was reduced by 38% in reversibly injured and 74% in infarct-containing sectors, recovering to 91 and 66%, respectively, 1 h postreperfusion. One month postreperfusion, flow was normal in reversibly injured sectors but remained depressed at 60% in infarct-containing sectors. Glucose utilization at baseline was homogeneous, averaging 0.8 mumol.g-1.min-1. After 3 h of reperfusion following occlusion of the left anterior descending coronary artery, regional glucose metabolic rate was increased 60% relative to baseline in normal myocardium but not in postischemic sectors, leading to an enhancement of FDG uptake in normal relative to postischemic myocardium. At 24 h postreperfusion, the glucose metabolic rate decreased in normal remote tissue to 46% of baseline levels, probably reflecting increased plasma free fatty acid levels, but was not significantly altered in reversibly injured myocardium, leading to enhanced FDG uptake in reversibly injured relative to normal myocardium. Subsequently, glucose metabolism in normal and postischemic sectors was not significantly different. Prolonged relative enhancement of glucose metabolic rate in postischemic tissue was found when the glucose metabolic rate in normal myocardium was low. Myocardial glucose utilization correlated with hg, the rate constant for FDG phosphorylation under all conditions (r = 0.88).

Animals↗
PubMed1991

Noninvasive quantification of hepatic arterial blood flow with nitrogen-13-ammonia and dynamic positron emission tomography.

To determine if dynamic PET and 13N-ammonia can be utilized to quantitate regional hepatic arterial blood flow (rHABF) noninvasively, eight anesthetized dogs and eight human volunteers were examined with PET following intravenous bolus administration of 13N-ammonia. Hepatic time-activity curves and the arterial input function were derived from ROIs drawn over the right lateral superior segment of the liver and the left ventricle of the heart, respectively. rHABF was quantitated using a two-compartment model, with comparison with simultaneously acquired microsphere blood flow measurement (MS) in the canine studies. rHABF derived from canine dynamic PET with 13N-ammonia were linearly related to microsphere values (rHABF = 0.92 x MS + 0.04, r = 0.98), with a mean of 0.40 ml/min/g. The results in eight normal volunteers gave a rHABF value of 0.26 +/- 0.07 ml/min/g. Dynamic 13N-ammonia hepatic PET allows noninvasive quantification of rHABF.

Adult↗
PubMed1991

Positron emission tomography for the assessment of myocardial viability.

The detection of viable myocardium or ischemically injured myocardium with a reversible impairment of contractile function remains clinically important but challenging. Detection of reversible dysfunction and distinction from irreversible tissue injury by positron emission tomography is based on identification of preserved or even enhanced glucose metabolism with F-18 2-fluoro 2-deoxyglucose. Regional patterns of myocardial glucose utilization and blood flow, defined as perfusion-metabolism mismatches or matches, on positron emission tomography in patients with chronic or even acute ischemic heart disease are highly accurate in predicting the functional outcome after interventional revascularization. Compared with thallium-201 redistribution scintigraphy, positron emission tomography appears to be diagnostically more accurate, especially in patients with severely impaired left ventricular function. While larger clinical trials are needed for further confirmation, positron emission tomography has already proved clinically useful for stratifying patients with poor left ventricular function to the most appropriate therapeutic approach.

Coronary Circulation↗
PubMed1991

Use of the metabolic tracer carbon-11-acetate for evaluation of regional myocardial perfusion.

The high first-pass myocardial extraction fraction of carbon-11-acetate suggests that its initial uptake depends on blood flow. Accordingly, regional uptake of 11C-acetate at 4 min was compared to regional perfusion determined with nitrogen-13-ammonia in 119 segments in 15 patients with stable coronary artery disease by two methods. A close correlation was observed between initial relative myocardial concentrations (segmental activity normalized to maximal activity) of both tracers (11C-acetate = 0.88; 13N-ammonia + 0.079; s.e.e. = 0.064, r = 0.94, p less than 0.001). Furthermore, segmental net extractions (E.F), as calculated from the input function and segmental activities, of the two tracers correlated closely by E.FC-11 = 0.55E.FN-13 + 0.080 (s.e.e. = 0.045, r = 0.87, p less than 0.001). These relationships indicate that initial regional myocardial uptake of 11C-acetate reflects perfusion and that 11C-acetate permits near simultaneous evaluation of regional oxidative metabolism and of regional myocardial perfusion.

Acetates↗
PubMed1991

Parametric images of myocardial metabolic rate of glucose generated from dynamic cardiac PET and 2-[18F]fluoro-2-deoxy-d-glucose studies.

We describe a method for generating parametric images of the myocardial metabolic rate of glucose (MMRGlc) with positron emission tomography (PET). The method employs serially acquired images of 2-[18F]fluoro-2-deoxy-D-glucose (FDG) uptake and a Patlak graphical analysis of the image data. The arterial input function is derived from images of the left ventricular blood pool calibrated with 18F-plasma measurements. The approach is computationally fast enough to be used in a clinical environment. The MMRGlc parametric images improve myocardial contrast relative to non-parametric images, especially in studies with poor myocardial uptake of FDG. In addition, MMRGlc parametric images consolidate the large amount of data in a dynamic PET study into a clinically usable image set.

Adult↗
PubMed1990

Afterload reduction with vasodilators and diuretics decreases mitral regurgitation during upright exercise in advanced heart failure.

In advanced heart failure, mitral regurgitation increases the burden of the failing ventricle and decreases effective stroke volume. Although tailored afterload reduction decreases mitral regurgitation at rest, it is not known if this benefit is maintained during upright exercise. Simultaneous radionuclide ventriculography and thermodilution stroke volumes were compared to measure the forward ejection fraction in 10 patients during upright bicycle exercise before and after therapy with vasodilators and diuretics tailored to decrease pulmonary capillary wedge pressure and systemic vascular resistance. Ventricular volumes, total ejection fraction and the forward ejection fraction did not change during exercise at baseline. At rest, tailored therapy decreased average pulmonary capillary wedge pressure from 36 to 19 mm Hg (p less than 0.01), systemic vascular resistance from 1,570 to 1,210 dynes.s.cm-5 (p less than 0.05), and left ventricular volume index from 251 to 177 ml/m2 (p less than 0.01), while increasing the forward ejection fraction from 0.53 to 0.85 (p less than 0.01) without change in total ejection fraction (0.18 from 0.17). During steady state exercise at low work load, tailored therapy decreased left ventricular volume index from 279 to 213 (p less than 0.05) and increased forward ejection fraction from 0.52 to 0.79 (p less than 0.01) without change in total ejection fraction (0.20 from 0.19). The total stroke volume during exercise was not increased after therapy; the increase in forward stroke volume after therapy appeared to result instead from the decrease in mitral regurgitant flow. The benefits of tailored afterload reduction are maintained throughout upright exercise.

Bumetanide↗
PubMed1990

Dynamic positron tomographic imaging with nitrogen-13 glutamate in patients with coronary artery disease: comparison with nitrogen-13 ammonia and fluorine-18 fluorodeoxyglucose imaging.

This study was designed to test the usefulness of nitrogen-13 (N-13) glutamate imaging with positron emission tomography in defining myocardial ischemia in humans. Seventeen patients who had undergone coronary arteriography were studied with N-13 glutamate at peak supine exercise using a bicycle ergometer, as well as with the flow tracer N-13 ammonia at peak exercise during a second similar exercise test. Six of the patients also underwent imaging with N-13 glutamate at rest before exercise testing; in the remaining 11 patients imaging with fluorine-18 (F-18) fluorodeoxyglucose was performed to assess glucose metabolism after the second exercise test. Seven patients had classic metabolism-flow mismatches consistent with ischemia (that is, decreased N-13 ammonia uptake in a region with relatively increased F-18 fluorodeoxyglucose uptake). There was no evidence of increased N-13 glutamate uptake in the ischemic mismatched regions in any of these patients. In all 17 patients, the uptake of N-13 glutamate during exercise paralleled the uptake of N-13 ammonia during exercise, suggesting that N-13 glutamate behaves as a flow tracer rather than as a metabolic marker of ischemia in humans.

Aged↗
PubMed1990

Validation of [1-11C]acetate as a tracer for noninvasive assessment of oxidative metabolism with positron emission tomography in normal, ischemic, postischemic, and hyperemic canine myocardium.

Extraction and clearance kinetics of [1-11C]acetate were examined in 65 experiments in 30 open-chest dogs. Twenty-nine studies were performed at control, 13 during ischemia, eight after reperfusion, 13 during dipyridamole-induced hyperemia, and two during alteration of cardiac workload. [1-11C]Acetate was injected directly into the left anterior descending coronary artery, and myocardial tissue-time activity curves were recorded with a gamma probe. The single-pass extraction fraction averaged 64.2 +/- 9.7% in control, 65.3 +/- 9.1% in ischemia, 70.0 +/- 4.4% in reperfusion, and 46.5 +/- 7.4% in dipyridamole-induced hyperemia groups. 11C clearance was biexponential in all cases. The rate constant k1 for the first rapid clearance phase correlated closely with myocardial oxygen consumption (r = 0.94) in control, ischemia, reperfusion, and dipyridamole-induced hyperemia groups. Monoexponential fitting of only the first linear part of the clearance curve yielded the rate constant kmono, which also correlated with myocardial oxygen consumption (r = 0.96). Arterial lactate concentrations and the amount of free fatty acid oxygen equivalents consumed by the myocardium were shown to have a small but statistically significant impact on the relation between [1-11C]acetate clearance rate constants and myocardial oxygen consumption. The fraction of 14CO2 activity contributing to overall 14C activity leaving the myocardium after simultaneous injection of [1-14C]acetate (n = 24) was relatively high in all cases (97.4 +/- 2.5% in control, 89 +/- 2.6% in ischemia, 94.1 +/- 3.5% in reperfusion, and greater than 99% in dipyridamole groups), indicating that externally measured 11C clearance corresponds to CO2 production and thus to tricarboxylic acid cycle activity. In conclusion, the results validate the use of [1-11C]acetate as a tracer of oxidative myocardial metabolism for use with positron emission tomography.

Acetates↗
PubMed1990

[Cardiac positron emission tomography--current status and future perspectives].

Positron emission tomography (PET) permits the non-invasive examination of myocardial metabolism. At present, combined imaging of myocardial blood flow and glucose metabolism are used to distinguish viable myocardium from scar tissue, which is particularly important for deciding on therapeutic interventions. In the future, further indications for PET imaging are foreseeable, with refined imaging techniques and development of new tracer substances. Tracers for assessment of adrenergic and muscarinic myocardial receptor density, as well as new positive markers of myocardial ischemia are currently being explored. Labeled amino acids are being employed for assessment of protein metabolism. Finally, C-11 acetate as a tracer of tricarboxylic acid cycle activity and myocardial oxygen consumption has been suggested for clinical use in initial studies in man.

Coronary Circulation↗
PubMed1990

Future perspectives: diagnostic possibilities with positron emission tomography.

While evaluation of regional myocardial metabolism for diagnostic purposes is currently confined to ischemic heart disease, the emergence and implementation of new tracer approaches is likely to expand the scope of clinical applications. Evaluation of neuronal control of the heart with tracers of adrenergic neuron densities and beta-adrenergic and cholinergic post-synaptic activity promises to be useful in patients with electrical instability and with cardio-myopathies as well as for verifying responses to therapeutic interventions. The possibility to measure regional oxidative metabolism should further prove useful for distinguishing between residual oxidative and anaerobic metabolism in ischemia and thus prove useful for more accurate characterization of the ischemic injury. The method should further become useful for examining cardiac efficiency and detecting the effect of therapeutic interventions. Lastly, techniques for measurements of protein synthesis are likely to become important for defining myocardial maturation, compensatory adjustments of the myocardium to increased pressure and volume loading as well as assessment of repair processes after injury to myocardium.

Coronary Circulation↗
PubMed1989

Myocardial ischemia and clinical applications of positron emission tomography.

Positron emission tomography (PET) uniquely permits the noninvasive study and quantification of regional rates of blood flow and metabolism in human myocardium. In myocardial ischemia, PET identifies the presence and extent of viability in dysfunctional myocardium and distinguishes it from irreversible ischemic injury and scar tissue formation. Because metabolic markers have proved more accurate and reliable for identifying viability than conventional diagnostic approaches, PET has become increasingly useful for characterizing the severity and extent of an ischemic injury and for assigning patients with acute or chronic coronary artery disease to the most efficacious treatment.

Cardiomyopathy, Dilated↗
PubMed1989

Regional myocardial blood flow and metabolism at rest in mildly symptomatic patients with hypertrophic cardiomyopathy.

Previous observations and clinical manifestations suggest the presence of ischemia in the disproportionately thickened septum of patients with hypertrophic cardiomyopathy. Metabolic consequences of ischemia can be demonstrated with positron emission tomography. Therefore, 10 patients with hypertrophic cardiomyopathy and an echocardiographic septum to posterior wall thickness ratio of 1.8 +/- 0.4 cm (range 1.3 to 2.5) were studied with the use of nitrogen (N)-13 ammonia, carbon (C)-11 palmitate and fluoro (F)-18 2-deoxyglucose as tracers of myocardial blood flow, fatty acid metabolism and exogenous glucose utilization. The results of positron emission tomography in 9 patients with hypertrophic cardiomyopathy were compared with those in 10 normal volunteers. In the hypertrophic cardiomyopathy group, observed myocardial activity of N-13 ammonia and C-11 palmitate in the septum was similar to that in the lateral wall. Septum to lateral wall tissue activity ratios averaged 1.04 +/- 0.15 for N-13 ammonia and 1.04 +/- 0.18 for C-11 palmitate, and were similar to those in the normal volunteers (0.98 +/- 0.07 and 0.98 +/- 0.03, respectively; p = NS). Myocardial clearance half-time and residual fraction of C-11 palmitate did not differ significantly between the septum and lateral wall. However, F-18 2-deoxyglucose uptake was significantly lower in the septum than in the lateral wall (15,768 +/- 4,314 versus 19,818 +/- 5,234 counts/pixel; p less than 0.003). The mean septum to lateral wall activity ratio of 0.83 +/- 0.21 was less than that observed in normal volunteers (0.92 +/- 0.07; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

PET detection of viable tissue in myocardial segments with persistent defects at T1-201 SPECT.

To assess myocardial glucose metabolism and perfusion in 142 myocardial segments with defects seen at thallium-201 single photon emission computed tomography (SPECT), 27 studies with positron emission tomography (PET) utilizing nitrogen-13 ammonia and fluorine-18 deoxyglucose were performed in 26 patients. Myocardial infarction was defined on the basis of concordant reductions in segmental perfusion and glucose utilization; myocardial ischemia, on the basis of preservation of glucose utilization (metabolic viability) in segments with hypoperfusion at rest. Of the 142 segments analyzed, 101 had fixed defects, 31 had partially reversible defects, and ten had completely reversible defects. Preserved glucose utilization was identified in 47 (46.5%) of the segments with fixed defects and 20 (64.5%) of the segments with partially reversible defects. Of the ten segments with completely reversible defects, five (50%) were normal, and five (50%) exhibited ischemia at PET. Visual improvement in a persistent thallium defect at delayed imaging was not associated with residual glucose metabolic activity. Thus, PET can be used to detect glucose metabolic activity in a significant proportion of myocardial segments with fixed or partially redistributing defects seen at thallium SPECT, which suggests that the extent of tissue viability in patients with ischemic heart disease is underestimated at thallium scintigraphy.

Aged↗
PubMed1989

Rabbit myocardial 82Rb kinetics and a compartmental model for blood flow estimation.

Quantification of regional myocardial blood flow (MBF) with rubidium-82 (82Rb) and positron emission tomography (PET) requires the validation of a tracer kinetic model that adequately describes the kinetics of 82Rb in tissue. We performed 134 82Rb kinetic experiments in 24 isolated, arterially perfused rabbit interventricular septa at different flow rates (0.5-4.5 ml.min-1.g-1) and under the following conditions: varied concentrations of glucose (2.8-11 mM), insulin (0-5 mU/ml), and potassium (5-8 mM); varied pH (7.2-7.8); varied workload; and the addition of acetylstrophanthidin (1.0 microM). The measured 82Rb tissue time-activity curves consisted of two exponential components, with half times inversely related to MBF. The size of the slow component decreased as MBF increased (from 70% at 0.3 ml.min-1.g-1 to 30% at 2.0 ml. min-1.g-1). The kinetics were not strongly dependent on the conditions studied and were consistent with a compartmental model containing two communicating compartments. The volume of the fast exchangeable compartment and the transport rate constant from the fast to the slow compartment were found to be independent of MBF. Values of MBF were estimated with the compartmental model from 82Rb kinetics, and they correlated well with the directly measured MBF (r = 0.91; slope = 1.03).

Animals↗
PubMed1989

Noninvasive quantitation of regional myocardial oxygen consumption in vivo with [1-11C]acetate and dynamic positron emission tomography.

The usefulness of [1-11C]acetate as a tracer of overall myocardial oxidative metabolism for use with positron emission tomography has been investigated in 12 closed-chest dogs. Myocardial 11C activity clearance kinetics after intravenous administration of [1-11C]acetate in dogs have been determined noninvasively by positron emission tomography. Biexponential fitting of regional myocardial 11C time-activity curves was performed to give clearance half-times and fractional distribution. The rate constant k1 for the early rapid phase of 11C activity clearance was found to correlate linearly with myocardial oxygen consumption (y = 0.0156x + 0.039; SEE = 0.023; r = 0.95). k1 was approximately 7% lower in septal sectors compared with the left ventricular free wall, suggesting that regional oxygen consumption in the septum was lower; a concomitant regional attenuation of blood flow in the septum relative to the left ventricular free wall was also observed. In dogs using carbohydrates as the predominant fuel, k1 oxygen consumption was somewhat more than in dogs using predominantly free fatty acids (0.021 +/- 0.002 compared with 0.018 +/- 0.002, p less than 0.01), indicating that increased carbohydrate consumption is associated with a small increase in k1 at constant oxygen consumption. It is concluded that measurement of myocardial [1-11C]acetate kinetics allows noninvasive determination of cardiac oxygen consumption by positron emission tomography and that the technique is relatively insensitive to myocardial fuel selection.

Acetates↗
PubMed1989

Regional myocardial oxygen consumption determined noninvasively in humans with [1-11C]acetate and dynamic positron tomography.

Experimental studies of animals have previously demonstrated the validity of [1-11C]acetate as a tracer of oxidative metabolism for use with positron emission tomography. The present study was undertaken to define in normal human volunteers the relation between myocardial clearance kinetics of [1-11C]acetate, and the rate-pressure product as an index of myocardial oxygen consumption. Twenty-two studies were performed of 12 volunteers. The rate-pressure product was increased with continuous supine bicycle exercise in six studies. Of the 16 resting studies, seven were performed in the fasted state and nine following an oral glucose load, to define possible effects of substrate availability on the tracer-tissue kinetics. Myocardial tissue time-activity curves were biexponential. Clearance of activity was homogeneous throughout the myocardium. The rate constants k1, obtained from biexponential fitting, and kmono, obtained by monoexponential fitting of the initial linear portion of the time-activity curves, correlated well with the rate-pressure product. Although the correlation coefficient was higher for k1 than for kmono (0.95 vs. 0.91), analysis on a sectorial basis showed less regional variability in kmono. This suggests that kmono, which is more practical than k1 because it requires shorter acquisition times, may be more clinically and experimentally useful for detection of myocardial segments with abnormal oxygen consumption. Overall, changes in myocardial substrate supply were without significant effect on the relation between the rate constants (k1 and kmono) and the rate-pressure product, although a small decrease in kmono/rate-pressure product was observed following oral glucose by paired analysis in four subjects. It is concluded that [1-11C]acetate can be used for the noninvasive measurement of myocardial oxygen consumption in humans with positron emission tomography, and, thus, has clinical and experimental potential as a tool for the understanding and diagnosis of myocardial disease.

Acetates↗