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The introduction of tracer kinetic modeling techniques in conjunction with nuclear imaging has allowed the assessment of physiologic processes in the myocardium in a noninvasive and quantitative manner. Alongside the development of novel radiopharmaceuticals for both positron emission tomography and single photon emission computed tomography is the clarification of their pharmacology, pharmacokinetics, and modeling strategies for assessment of physiologic rates from imaging data. Image analysis and tracer kinetic modeling techniques used in nuclear cardiology must address unique considerations related to the heart. The most commonly used tracers and modeling techniques are presently discussed, with particular attention given to methods that allow absolute quantitation of physiologic processes. The applications of these techniques are obvious in research protocols and may find more use in future clinical studies.

Background: Rapid reperfusion of an occluded coronary artery salvages regional mechanical function, but this benefit may not be realized for hours or days because of postischemic stunning. Recovery from stunning is incompletely understood but may involve adaptive changes in heart glucose metabolism., Methods and Results: To examine whether reversible coronary occlusion produces sustained changes in regional glucose metabolism in vivo, we performed a 20-minute left coronary artery occlusion followed by 24 hours of open-artery reperfusion in intact rats. Coronary occlusion produced stunning of the anterolateral left ventricle that resolved over 24 hours. When examined at 24 hours, reperfused regions were fully contractile and viable by vital staining and microscopy but demonstrated 25% reduction in blood flow and 50% increased uptake of circulating glucose, as estimated by in vivo [(13)N]NH(3) and [(18)F]fluorodeoxyglucose (FDG) tracer uptake. Reperfused regions had largely inactive glycogen synthase, low rates of glycogen synthesis, and persistent 50% glycogen depletion but increased flux of plasma [1-(13)C]glucose into myocardial [3-(13)C]alanine, indicating preferential shunting of imported glucose away from storage and into glycolysis., Conclusions: Sustained increases in regional glycolytic consumption of circulating glucose occur during reperfusion of a limited-duration coronary occlusion. This suggests a role for glycolytic ATP in the recovery from postischemic stunning in vivo. Furthermore, [(13)N]NH(3) /FDG regional mismatch may constitute a clinically accessible late metabolic signature of regional myocardial ischemia.

To develop a compartmental model for estimating myocardial oxygen consumption rate (MVO2) with [1-11C]acetate, the metabolic fate of radiolabeled acetate was determined in normoxic and ischemic conditions in isolated perfused rat hearts. Glutamate composed 63 +/- 1 and 44 +/- 7% of the total tissue radioactivity 2 min postinjection in normoxic and ischemic myocardium, respectively, and radiolabeled glutamate remained the largest fraction throughout 40 min of perfusion. Based on the biochemical pathway of the tracer and the temporal distribution of 14C-labeled metabolites, a six-compartment model was formulated. Studies using [1-11C]acetate and a pair of NaI detectors were then performed in the same perfused heart system to validate the model. Consistency between the model predictions and biochemical measurements of tissue and effluent metabolites supported the validity of the kinetic model in normoxic and ischemic conditions. Model-estimated MVO2 correlated well with experimentally measured MVO2 for normoxic, hypoxic, and ischemic conditions, with a slope of 0.97 (r = 0.95). In addition, the model-estimated rate constant, k42, which corresponded to the oxidative flux, correlated strongly with the myocardial clearance rate (k1 or kmono) determined from the tissue kinetics. These findings provide a mechanistic basis for the use of k1 or kmono as an index of MVO2 in both normoxic and ischemic myocardium studied with [1-11C]acetate and positron emission tomography.

The lumped constant (LC) that relates the steady-state phosphorylation rate of 2-[18F]-fluoro-2-deoxy-D-glucose (2-FDG) to that of glucose was determined in an isolated working rat heart model by direct assay of phosphorylation product formation. Five conditions were tested: 5 and 30 mM glucose without insulin, and 2, 3.5, and 5 mM glucose + 10 mU/ml insulin, all at high external work load. Hearts were continuously perfused with 2-FDG and tritiated glucose without recirculation. The steady-state production of tritiated water was used to monitor the glucose phosphorylation rate. Perfused hearts were freeze-clamped and extracted in perchloric acid, and 2-FDG-6-phosphate was separated from 2-FDG with a formate column. The accumulation of 2-FDG phosphorylation products in tissue was also determined from the slopes of the total tissue radioactivity time courses measured by external gamma-ray detection. Without insulin, the LC value decreased 18% as perfusate glucose concentration was increased sixfold (0.94 +/- 0.06 at 5 mM vs. 0.77 +/- 0.17 at 30 mM). With insulin, the LC rose from 0.33 +/- 0.03 at 5 mM to 1.19 +/- 0.05 at 2 mM glucose concentration. The trends can be interpreted in terms of the concept of control strength; the LC value rises as glycolysis becomes rate limited by transport into cells. This potential variability of the LC must be addressed in the quantitative interpretation of myocardial deoxyglucose studies.

[18F]1-Fluoro-2,4-dinitrobenzene (FDNB), a substrate for the detoxification enzyme glutathione-S-transferase, was prepared by 18F-Cl exchange. It was administered as a rapid bolus in the perfused working rat heart and the kinetics of the label were followed by external coincidence detection and by analysis of the coronary effluents and tissue homogenates. The data suggest that part of the extracted tracer was released, part was dehalogenated and part was reversibly incorporated into a large tissue pool of FDNB that was not a substrate for defluorination. The rates of the specific processes, estimated from the residue data, may be sensitive to changes in the glutathione detoxification system and therefore applicable to investigation of the compromised myocardium.

Myocardial extraction and the characteristic tissue clearance of radioactivity following bolus injections of a radioiodinated (125I) long chain fatty acid (LCFA) analog 15-p-iodophenylpentadecanoic acid (IPPA) were examined in the isolated perfused working rat heart. Radioactivity remaining in the heart was monitored with external scintillation probes. A compartmental model which included nonesterified tracer, catabolite, and complex lipid compartments successfully fitted tissue time-radioactivity residue curves, and gave a value for the rate of IPPA oxidation 1.8 times that obtained from steady-state release of tritiated water from labeled palmitic acid. The technique was sensitive to the impairment of LCFA oxidation in hearts of animals treated with the carnitine palmitoyltransferase I inhibitor, 2[5(4-chlorophenyl)pentyl]oxirane-2-carboxylate (POCA). IPPA or similar modified fatty acids may be better than 11C-labeled physiological fatty acids such as palmitate in this type of study, because efflux of unoxidized tracer and catabolite(s) from the heart are kinetically more distinct, and their contributions to the early data can be reliably separated. This technique may be suitable for extension to in vivo measurements with position tomography and appropriate modified fatty acids.

When isolated rat hearts were perfused with medium containing 3-O-methyl-D-glucose (3MG) a compound with the chromatographic behavior expected for 3MG-6-phosphate was formed. This assignment is supported by the action of alkaline phosphatase and by production of an identical peak on incubation of 3MG with yeast hexokinase in a buffer containing adenosine triphosphate and Mg++ ions. The clearance of labeled 3MG from isolated perfused rat hearts was biphasic and eventually total. Since sugar phosphates do not cross cellular membranes, this behavior is consistent with both formation and dephosphorylation of 3MG-6-phosphate, with dephosphorylation rate-limiting the slow phase of the clearance. Phosphatase activity was also indicated by a decrease in 3MG-6-phosphate when hearts were not chilled and homogenized immediately after perfusion. The common assumption that 3MG is not metabolized after transport into cells is shown by these experiments to be erroneous.

Long-chain fatty acid oxidation by the isolated perfused rat heart was assayed by external counting using [125I]16-iodohexadecanoic acid as substrate after administration of the hypoketonemic and hypoglycemic compound 2[5(4-chlorophenyl)pentyl]oxirane-2-carboxylate to rats. Glucose metabolism was also assessed by measuring release of tritium from [2-T]glucose. The oxidation of long chain fatty acids was virtually suppressed in hearts from fed or starved rats given 2[5(4-chlorophenyl)pentyl]oxirane-2-carboxylate while glucose utilization was increased 2-2.5 fold.

Adrenaline 1 micrograms markedly elevated the activity of adenylate cyclase in ventricular tissue of rat hearts. delta 1-THC 25, 50 and 100 micrograms significantly reduced the adenylate cyclase activity with the maximum effect observed with the dose of 25 micrograms. Doses below or above this range did not produce any significant effect on the enzyme activity. Neither delta 6-THC 25 and 100 micrograms nor PVP 400 micrograms had any significant action on adenylate cyclase. The delta 1-THC-induced lowering of the cyclic AMP concentration in ventricular tissue of rat hearts can be explained, at least partly, by its ability to reduce the activity of adenylate cyclase in these tissues. It is suggested that this enzyme inhibition underlies the cardiac depressant action of delta 1-THC.

Four aspects of the behavior of 3-deoxy-3-fluoro-D-glucose (D-3FDG) were studied. The distribution of label in rat tissues after intravenous administration of [18F]D-3FDG was compared with that seen with labeled 3-deoxy-3-fluoro-L-glucose (L-3FDG). Results were consistent with a larger volume of distribution for the physiological D-isomer coupled with some degree of reabsorption by the kidneys. L-3FDG, but not its D-isomer, was excluded from the brain. D-3FDG competitively inhibited uptake of glucose by isolated perfused rat hearts. The inhibition constant was 12.8 +/- 1.6 mM compared with 6.1 +/- 1.1 mM for 3-O-methyl-D-glucose. Residue curves obtained after bolus administration of [18F]D-3FDG to isolated hearts indicated phosphorylation of the tracer at a lower rate than for 2-deoxy-2-fluoro-D-glucose but with subsequent dephosphorylation at a faster rate. Chromatographic analysis of 18F remaining in tissues after administration of [18F]D-3FDG revealed in addition to free D-3FDG three other peaks. These disappeared after treatment with alkaline phosphatase and were thus assigned as phosphates. The principal metabolite had the same retention time as D-3FDG-6-phosphate prepared with hexokinase. No phosphorylated metabolites were detected in blood. D-3FDG labeled with 18F may be a useful tracer in studies of glucose transport and metabolism.

Time courses of radioactivity (residue curves) were obtained following bolus injection into working rat hearts of two 125I-labeled long chain fatty acids: 16-iodohexadecanoic acid (IHDA) and 15-p-iodophenylpentadecanoic acid (IPPA). Residue curves were analyzed in terms of a rapid vascular washout component, an early tissue clearance component, and a very slow late component. For IHDA and IPPA in control hearts, early myocardial clearance kinetics were rate limited by the diffusion of catabolites. Sensitivity of the kinetics to impaired fatty acid oxidation was examination by pretreatment of animals with 2[5(4-chlorophenyl)pentyl]oxirane-2-carboxylate (POCA). Decreased fatty acid oxidation was indicated in IHDA and IPPA residue curves by a decrease in the relative size of the early clearance component. Analysis of radiolabeled species in coronary effluent and heart homogenates showed that back diffusion of IPPA was slower than that of IHDA; this discrepancy was most apparent in POCA hearts. In vitro binding assays suggested higher tissue:albumin relative affinity for IPPA than for IHDA. Thus, IPPA early clearance kinetics were more closely related to the clearance of labeled catabolite(s) and were therefore more sensitive to the oxidation rate of long chain fatty acids.

A new two-sensor technique for measurement of O2 consumption in isolated organs without venous cannulation was successfully applied to the isolated rat heart. Because this technique eliminates the net exchange of O2 between venous effluent and the environment, measurement of the O2 concentration is conveniently made by use of a polarographic sensor in a collected pool of effluent at the bottom of a closed organ chamber. The method was validated against conventional techniques using cannulation of the pulmonary artery. The two-sensor technique allows O2 consumption measurements to be made in isolated organ preparations in which representative venous cannulation is prohibitively difficult, for example in organs with multiple venous drains, or those in which cannulation would be expected to cause excessive perturbation of physiological status.