Evaluation of cardiac function and efficiency using 11C-acetate PET

Evaluation of cardiac function and efficiency using ¹¹C-acetate PET

• Myocardial oxygen consumption and cardiac efficiency
  • Left ventricle (LV) (1)
  • Right ventricle (RV)
• References

Myocardial oxygen consumption and cardiac efficiency

Left ventricle (LV) (1)

• MVO₂ (mL O₂·min^-1·g^-1 tissue) (2) was calculated from Kmono as

$$MV{O}_2(k_{mono})=\frac{k_{mono}\times 0.0197}{0.0027\times 100}$$

• MVO₂ (mL O₂·min^-1·g^-1 tissue) (2) was also calculated from the 1TCM washout parameter, k2, as

$$MV{O}_2(k_2)=\frac{135\times k_2-0.96}{100}$$

• Myocardial external efficiency (MEE) (3) was calculated as

$$MEE=\frac{SV\times HR\times (MAP+\Delta AVmean)\times 1.33\times 10^{-4}}{MV{O}_2(k_2)\times LVMass\times 20}$$

SV: stroke volume from Echocardiography
HR: heart rate
MAP: mean arterial pressure, $\approx 1/3SBP+2/3DBP$
$\Delta AVmean$: trans-aotic-value gradients, negligible if no aortic stenosis
LV mass: myocardial tissue density(1.05 g·cm^-3) and LV volume

• Work metabolic index (WMI) (4) is a simplified estimate of cardiac efficiency calculated as

$$WMI=\frac{SVi\times HR\times SBP}{k_{mono}}$$

SVi: divide SV by the body surface area
HR: heart rate
SBP: systolic blood pressure
$k_{mono}$: ¹¹C-acetate mono-exponential clearance rate

• Myocardial blood flow (MBF) (5) was estimated using the published expression relating the ¹¹C-acetate uptake rate K₁ to MBF (ML/min/g):

$$K_1=(1-0.637e^{-\frac{1.198}{MBF}})\times MBF$$

Right ventricle (RV)

• RV RPP (6): the product of systolic pulmonary arterial pressure and heart rate

• Stroke work index (6): the product of stroke volume index and (mean pulmonary arterial pressure - mean right atrial pressure)

• The power of the RV was calculated using the following quation (7):

$$RVpower=HR\times mPAP\times SV\times 2.22\times 10^{-6}$$

SV: stroke volume from Echocardiography
HR: heart rate
MAP: mean arterial pressure, $\approx 1/3SBP+2/3DBP$
$\Delta AVmean$: trans-aotic-value gradients, negligible if no aortic stenosis
LV mass: myocardial tissue density(1.05 g·cm^-3) and LV volume

• RV efficiency (7) was calculated as the ratio of RV power output to MVO₂:

$$RVefficiency=\frac{HR\times mPAP\times SV\times 1.33\times 10^{-4}}{RV{k}_{mono}\times RVmass\times 20}$$

References

[1] Wu KY, Dinculescu V, Renaud JM, et al. Repeatable and reproducible measurements of myocardial oxidative metabolism, blood flow and external efficiency using 11C-acetate PET. Journal of Nuclear Cardiology Official Publication of the American Society of Nuclear Cardiology. 2018:1-14.

[2] Sun KT, Yeatman LA, Buxton DB, et al. Simultaneous Measurement of Myocardial Oxygen Consumption and Blood Flow Using [1-Carbon-11 ]Acetate. Journal of Nuclear Medicine. 1998;39:272-280.

[3] Hansson NH, Tolbod L, Harms J, Wiggers H, Kim WY, Hansen E,Zaremba T, Frøkiær J, Jakobsen S, Sørensen J. Evaluation of ECG-gated [11C] acetate PET for measuring left ventricular volumes, mass, and myocardial external efficiency. J Nucl Cardiol 2016;23:670-9.

[4] Beanlands RSB, Bach DS, Raylman R, Armstrong WF, Wilson V, Montieth M, Moore CK, Bates E, Schwaiger M. Acute effects of dobutamine on myocardial oxygen consumption and cardiac efficiency measured using carbon-11 acetate kinetics in patients with dilated cardiomyopathy. J Am Coll Cardiol 1993;22:1389-98.

[5] van den Hoff J, Burchert W, Bo¨rner A-R, Fricke H, Ku¨hnel G, Meyer GJ, Otto D, Weckesser E, Wolpers H-G, Knapp WH. [1–11C] acetate as a quantitative perfusion tracer in myocardial PET. J Nucl Med 2001;42:1174-82.

[6] Keiichiro Y, Hiroshi O, Ichizo T, et al. Attenuated right ventricular energetics evaluated using 11C-acetate PET in patients with pulmonary hypertension. European Journal of Nuclear Medicine & Molecular Imaging. 2014;41:1240-1250.

[7] Wong YY, Raijmakers P, van Campen J, et al. 11C-Acetate clearance as an index of oxygen consumption of the right myocardium in idiopathic pulmonary arterial hypertension: a validation study using 15O-labeled tracers and PET. J Nucl Med. 2013;54:1258-1262.