Relation of Myocardial Blood Flow and Initial Cardiac Uptake of 15-(p-123I-Phenyl)-Pentadecanoic Acid in the Canine Heart

Radiopharmaceucticals for cardiovascular imaging

Radionuclide cardiac imaging is a noninvasive technique routinely used to detect coronary artery disease (CAD). This imaging modality includes techniques such as planar, single photon emission computed tomography (SPECT), positron emission tomography (PET) and radionuclide ventriculography--each technique having unique features of its own. Each technique employs various radiopharmaceuticals suitable for assessing different physiological and functional parameters that may become abnormal in the presence of CAD. Various cardiac imaging techniques include myocardial perfusion or blood flow, myocardial metabolism and cardiac function and wall motion. While radionuclide ventriculography gives the global functional status of the heart, SPECT and PET techniques provide information as to the regional blood flow and metabolic status of the myocardium. The following is a review of radiopharmaceuticals that are utilized clinically and in research in different types of nuclear cardiac imaging. Radiopharmaceuticals have been grouped according to the technique employed in which they are used. Various characteristics, merits and disadvantages of each radiopharmaceutical are discussed in detail.

Radiopharmaceuticals for studying cardiac metabolism

(1) Metabolism is the link between myocardial blood flow and physiological performance of the heart. (2) Metabolic myocardial radiopharmaceuticals have the potential to identify metabolic alterations unique to a given intrinsic cardiac disease (e.g. cardiomyopathies), to assess acute metabolic changes or in delineating a specific chronic metabolic defect (e.g. coronary artery disease). (3) Two approaches can be employed to evaluate in vivo myocardial utilization of subtracts: (a) use of radiolabeled "physiologic" substrates e.g. positron emitting 11C-palmitic acid was successfully employed for assessing the in vivo metabolic sequelae of myocardial ischemia, infarction and cardiomyopathies, and (b) use of modified tracers which enter known metabolic pathways. However, because of their unique structure, metabolism of the tracer stops at a certain state thus leaving the radiolabel trapped in the cell, e.g. [18F]FDG for measuring glucose metabolic rate in the human brain and myocardium. (4) Among the radiopharmaceuticals for planar and single photon tomography, the para and the ortho isomers of 123I-phenyl iodoheptadecanoic acids and their beta-methyl derivatives are the most promising tracers for myocardial metabolic studies. (5) Ortho-(123I-phenyl)-pentadecanoic acid (o-IPPA) human myocardial uptake was rapidly and markedly elevated in well perfused segments; myocardial turnover was strikingly prolonged, suggesting some "trapping" phenomenon, resulting in excellent scintigrams. This is in contrast to the relatively shorter clearance of the para isomer from the myocardium. (6) 11C-Palmitic acid and [18F]FDG are the most widely used for PET scanning for following myocardial metabolism. The most important clinical application of these agents is predicting viability of ischemic myocardium. (7) A significant proportion of fixed perfusion defects seen on thallium studies can be demonstrated to be viable myocardium on PET scans using metabolic agents. If the markers of perfusion alone are relied on to assess tissue viability, the extent of salvageable myocardium may be underestimated. The demonstration of myocardial viability is crucial in the decision of the optimal treatment of the disease.

Effect of myocardial perfusion and metabolic interventions on cardiac kinetics of phenylpentadecanoic acid (IPPA) I 123

The effect of regional myocardial perfusion and flow-independent adrenergic stimulation, as well as lactate-mediated inhibition of cardiac lipolysis, on cardiac IPPA uptake and metabolism was examined in canine hearts (flow studies) and in the isolated perfused Langendorff rat heart (metabolic interventions). In both normal and ischaemic myocardium, local perfusion is a major determinant of cardiac IPPA uptake. In pacing-induced hyperaemia, the strict flow-dependence of cardiac IPPA uptake is not preserved. Adrenergic stimulation raises the rate of oxidation of both palmitic acid 14C and IPPA. This change is reflected by increased metabolite production released into the perfusate and radioactivity clearance recorded externally. Lactate in high concentrations exerts the opposite effect on cardiac free fatty acid oxidation. IPPA is stored in this condition preferentially in tissue phospholipids and triglycerides.