POSITRON TOMOGRAPHY IN ISCHEMIC HEART DISEASE

拟议研究的统一主题是血流新陈代谢。 位置发射断层扫描观察到的失配是一种 缺血性心脏病患者的心肌存活性。最初 从我们的实验室报告，这种模式的存在已经 已得到其他调查人员的确认，目前正在受雇于其他调查人员。然而， 关于果脯葡萄糖潜在病理生理学的问题 功能障碍心肌中的代谢及其临床意义仍然存在。 拟议的研究将使用新开发的非侵入性方法来 量化局部血流量、葡萄糖利用率、氧气 消耗、蛋白质合成和脂肪酸代谢的评估 绘制这些过程的空间分布图，并 确定异常的地理范围和严重程度。这将是 通过高时间和空间分辨率正电子发射实现 动脉输入功能和心肌摄取的断层成像 N-13氨、F-18 2-脱氧葡萄糖、C-11棕榈酸酯、C-11醋酸酯和C-11 标记的氨基酸。新型PET扫描仪的多层扫描能力 将进一步用于定义这些区域的空间分布 左心室心肌的功能过程。使用这些工具， 这项研究将探索和定义可能 说明观察到的血流代谢不匹配模式，如 范例“冬眠”与“令人震惊”描绘了相关的异常 在血液流动中，氧化代谢和脂肪酸氧化及其 与局部和整体左心功能的关系。这项研究 将进一步研究这些代谢产物的预后意义 冠状动脉疾病患者的异常 慢性阻塞性肺疾病患者的代谢异常及其时空变化 缺血性心脏病或急性心肌梗死后及其 介入恢复血流后恢复正常。这项研究将 同时测定脑缺血、脑缺血后和脑缺血后蛋白质合成率 冠心病患者治疗前后的正常心肌 冠状动脉介入治疗和急性心肌梗死后。结果是 很可能为人类的病理生理学提供新的见解 心肌缺血，应该证明在临床上同样有效的改善 更准确地描述脑缺血的严重程度和程度 损害的心肌以及患者的治疗决定 合并冠状动脉疾病和局部及整体左心室 功能障碍。

The unifying theme of the proposed research is the blood flow metabolism mismatch as observed with position emission tomography as a sign of myocardial viability in patients with ischemic heart disease. Initially reported from our laboratory, the existence of this pattern has been confirmed by and is now being employed by other investigators. However, questions regarding the underlying pathophysiology of preserved glucose metabolism in dysfunctional myocardium and its clinical relevance remain. The proposed research will employ newly developed noninvasive methods for quantifying regional rates of blood flow, glucose utilization, oxygen consumption, protein synthesis and for evaluation of fatty acid metabolism and for mapping the spatial distribution of these processes and to determine geographic extent and severity of abnormalities. This will be accomplished by high temporal and spatial resolution positron emission tomographic imaging of the arterial input function and myocardial uptake of N-13 ammonia, F-18 2-deoxyglucose, C-11 palmitate, C-11 acetate and C-11 labeled amino acids. The multi-slice capability of the new PET scanner will further be used for defining the spatial distribution of these functional process in the left ventricular myocardium. With these tools, the research will explore and define different mechanisms that might account for the observed blood flow metabolism mismatch pattern as for example "hibernation" versus "stunning" delineate associated abnormalities in blood flow, oxidative metabolism and fatty acid oxidation and their relation to regional and global left ventricular function. The research will further examine the prognostic significance of these metabolic abnormalities in patients with coronary artery disease who are of these metabolic abnormalities and their temporal and spatial changes in chronic ischemic heart disease or after an acute myocardial infarction and their recovery after interventional restoration of blood flow. The research will also determine rates of protein synthesis in ischemic, post-ischemic and normal myocardium in patients with coronary artery disease before and after coronary interventions and after acute myocardial infarction. The results are likely to provide new insights into the pathophysiology of human myocardial ischemia and should prove clinically equally useful for improved and more accurate delineation of severity and extent of ischemically compromised myocardium as well as for therapeutic decisions in patients with coronary artery disease and regional and global left ventricular dysfunction.