Fatty acid imaging of the heart.
Fatty acid imaging of the heart.
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DOI：
10.1007/s11886-010-0163-0
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发表时间：
2011-04-01
影响因子：
3.7
通讯作者：
Bergmann, Steven R
中科院分区：
文献类型：
--
作者：
Giedd, Kenneth N;Bergmann, Steven R
对人类心脏代谢过程进行成像，可对心肌病理学机制产生有价值的见解，并可评估旨在治疗心脏病的疗法的疗效。正电子发射断层扫描（PET）在脂肪酸（FA）成像方面的最新进展包括评估内源性甘油三酯代谢的方法的开发和新的氟-18标记示踪剂的设计。对糖尿病患者的研究表明，心脏对胰岛素介导的葡萄糖摄取具有抵抗性，并且非酯化FA的代谢上调。心脏PET成像最近也显示肥胖患者心肌FA摄取的增加可以随着体重减轻而逆转。一项针对慢性肾脏疾病患者的初步研究表明，PET成像可以揭示与估计肾小球滤过率下降平行的心肌代谢改变。使用单光子发射计算机断层扫描（SPECT）的FA成像的最新进展已经用示踪剂β-甲基-p-[（123）I]-碘苯基-十五烷酸（BMIPP）完成。两项荟萃分析显示，该成像技术在检测阻塞性冠状动脉疾病方面具有与SPECT心肌灌注成像相比更高的诊断准确性，并且BMIPP成像在冠状动脉疾病谱的患者中产生了极好的预后数据。最近一项对急性冠状动脉综合征患者的多中心研究发现，BMIPP SPECT成像比单独的临床评估具有更高的诊断灵敏度，并提高了阴性预测值。由于其灵敏度极高，核成像技术促进了生理过程的研究，而这些过程是我们了解健康和疾病中心脏代谢的关键。
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 beta-methyl-p-[(123)I]-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.