Fatty Acid Imaging of the Heart |
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Authors: | Kenneth N Giedd Steven R Bergmann |
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Institution: | Thomas A. Killip Division of Cardiology, Beth Israel Medical Center, New York, NY 10003, USA. |
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Abstract: | Imaging metabolic processes in the human heart yields valuable insights into the mechanisms contributing to myocardial pathology
and allows assessment of the efficacy of therapies designed to treat cardiac disease. Recent advances in fatty acid (FA) imaging
using positron emission tomography (PET) include the development of a method to assess endogenous triglyceride metabolism
and the design of new fluorine-18 labeled tracers. Studies of patients with diabetes have shown that the heart is resistant
to insulin-mediated glucose uptake and that metabolism of nonesterified FA is upregulated. Cardiac PET imaging has also recently
shown the increase in myocardial FA uptake seen in obese patients can be reversed with weight loss. And a pilot study of patients
with chronic kidney disease demonstrated that PET imaging can reveal myocardial metabolic alterations that parallel the decline
in estimated glomerular filtration rate. Recent advances in FA imaging using single photon emission computed tomography (SPECT)
have been accomplished with the tracer β-methyl-p-123I]-iodophenyl-pentadecanoic acid (BMIPP). Two meta-analyses showed this imaging technique has a diagnostic accuracy for the
detection of obstructive coronary artery disease that compares favorably with SPECT myocardial perfusion imaging and that
BMIPP imaging yields excellent prognostic data in patients across the spectrum of coronary artery disease. A recent multicenter
study of patients presenting with acute coronary syndromes found BMIPP SPECT imaging has greater diagnostic sensitivity than,
and enhances the negative predictive value of, clinical assessment alone. Because of their exquisite sensitivity, nuclear
imaging techniques facilitate the study of physiologic processes that are the key to our understanding of cardiac metabolism
in health and disease. |
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