Search

Delayed-enhanced magnetic resonance (MR) imaging has recently been shown to be effective in detecting cardiac sarcoidosis. Two cases in which contrast-enhanced multislice computed tomography imaging clearly identified the localization and extension of cardiac sarcoidosis as delayed-enhanced MR imaging are presented.

Objective: The purpose of this study was to evaluate the usefulness of delayed enhanced MRI for detecting cardiac sarcoidosis and to clarify the relationship between the findings of MRI and those of radionuclide imaging., Conclusion: Delayed enhanced MRI is considered a useful method for the early identification of cardiac sarcoidosis. Delayed hyperenhancement is frequently associated with a reduction of regional wall motion and thallium-201 perfusion defects.

Unlabelled: The aims of this study were (a). to compare absolute myocardial blood flow (MBF) during adenosine triphosphate (ATP) infusion with that after dipyridamole administration without caffeine intake and (b). to evaluate the effect of caffeine intake on the hyperemic flow induced by these coronary vasodilator agents., Methods: MBF was quantified with (15)O-labeled water and PET at rest, during ATP infusion (0.16 mg/kg/min for 9 min), and after dipyridamole administration (0.56 mg/kg over 4 min) after a 24-h abstinence from caffeine (baseline evaluation) in 10 healthy volunteers. Within 2 wk, the same PET studies were repeated after caffeine intake to evaluate the effect of caffeine on the hyperemic flow induced by these pharmacologic agents (caffeine study). Myocardial flow reserve (MFR), defined as the ratio of hyperemic to resting blood flow, was also evaluated., Results: Resting MBF in baseline and caffeine studies did not differ significantly (0.79 +/- 0.29 vs. 0.75 +/- 0.31 mL/min/g, P = 0.88). Without caffeine intake, MBF during ATP infusion was significantly higher than that after dipyridamole administration (3.70 +/- 0.67 vs. 3.00 +/- 0.79 mL/min/g, P = 0.003), whereas there was no significant difference in MFR between ATP and dipyridamole stress (5.15 +/- 1.64 vs. 4.11 +/- 1.44, P = 0.07). After caffeine intake, the hyperemic flows induced by ATP and dipyridamole were not significantly different (1.68 +/- 0.37 vs. 1.52 +/- 0.40 mL/min/g, P = 0.50). MFR estimated by ATP and dipyridamole also did not differ significantly in the caffeine studies (2.44 +/- 0.88 vs. 2.25 +/- 0.94, P = 0.73). MBF during ATP infusion and after dipyridamole administration were significantly lower in the caffeine studies than that in the baseline evaluation (1.68 +/- 0.37 vs. 3.70 +/- 0.67 mL/min/g, P < 0.0001, and 1.52 +/- 0.40 vs. 3.00 +/- 0.79 mL/min/g, P < 0.0001, respectively)., Conclusion: This study demonstrates that ATP has the potential to induce greater hyperemia than dipyridamole, whereas hyperemic responses to ATP and dipyridamole are similarly attenuated after caffeine intake. These findings suggest that abstinence from caffeine before ATP stress testing may be needed.

Unlabelled: The use of nitrates is reported to be effective in viability detection in scintigraphic perfusion imaging. The purpose of the study was to evaluate the effect of nitroglycerin (NTG) on myocardial blood flow (MBF) and coronary vascular resistance (CVR) in various segments characterized by rest-redistribution (201)Tl SPECT., Methods: Twenty-three patients with coronary artery disease underwent rest-redistribution (201)Tl SPECT and (15)O-labeled water PET at rest and after NTG spray (0.3 mg). In addition, 11 healthy volunteers were also studied using PET., Results: NTG did not change global MBF in the volunteers or in the patients. In segments with normal (201)Tl uptake and in those with a severe irreversible (201)Tl defect, NTG significantly reduced MBF without changing CVR. NTG reduced CVR in segments with a reversible (201)Tl defect (141 +/- 50 to 114 +/- 29 mm Hg/[mL/min/g], P = 0.004) and in those with a mild-to-moderate irreversible (201)Tl defect (165 +/- 64 to 149 +/- 60 mm Hg/[mL/min/g], P = 0.003), while maintaining MBF., Conclusion: NTG preferentially reduces CVR in the viable myocardium with ischemia. After NTG, tracer uptake in the ischemic myocardium will be relatively increased compared with that in the nonviable and nonischemic myocardium, leading to improvements in viability detection.

Background: In vivo quantitative assessment of positron emission tomography (PET) with 2-deoxy-2-[fluorine 18]fluorodeoxyglucose (FDG) for rat heart has not been explored because of the theoretical limitation of spatial resolution. Our objective was to assess whether FDG uptake measured by PET is correlated with tissue radioactivity of FDG in rat heart directly measured by an automated gamma counter., Methods and Results: Ten Sprague-Dawley rats were used for echocardiographic assessment and FDG-PET. Rats were sacrificed immediately after PET scanning, and the radioactivity of FDG in 4 segmental tissue samples of the middle transverse section was measured. Quantitative PET values in a total of 40 regions of interest, in which partial volume effect was corrected based on the phantom study and wall thickness obtained by echocardiogram, were compared with radioactivity of the corresponding 40 tissue samples. Linear regression analysis revealed that tissue radioactivity of FDG was well correlated with the quantitative PET value (Y = 1.17X; r = 0.985, P <.0001)., Conclusions: Quantitative FDG-PET for rat heart is a reliable approach for assessing glucose metabolism in vivo after correction is made for partial volume effect. These results can be used for various models of heart disease with repeated studies over the disease process in the same animal.

Recently, a method has been proposed for the quantitative measurement of regional myocardial blood flow (MBF) using oxygen-15-labelled water and positron emission tomography (PET). A multicentre project was organized with the intention of evaluating the accuracy of this method, particularly as a multicentre clinical investigative tool. Each of seven institutions performed PET studies on more than five normal volunteers following a specified protocol. The PET study included a transmission scan, a 15O-carbon monoxide static scan and a 15O-water dynamic scan, thereby yielding MBF values which should have been independent of the spatial resolution of the PET scanner employed. Fifty-three subjects (aged 20-63 years, mean+/-SD 36+/-12 years) were studied at rest, and 31 of these subjects were also studied after dipyridamole in five institutions. Inter-institution consistency and intra-subject variation in MBF values were then evaluated. MBF averaged for all subjects was 0.93+/-0.34 ml min(-1) g(-1) at rest and 3.40+/-1.73 ml min(-1) g(-1) after the administration of dipyridamole, and the flow reserve (defined as the ratio of the two MBF values) was 3.82+/-2.12; these values are consistent with previous reports. Resting MBF values were significantly correlated with the heart rate-blood pressure product (RPP) (y=0.31+6.56E-5x, P<0.010), and RPP was in resting MBF observed in all institutions was well explained by the age-dependent RPP. No significant difference was observed in resting MBF among the institutions. Except in one institution, no significant difference was seen in dipyridamole MBF or myocardial flow reserve. No significant difference was found among the myocardial segments. Regional variation was reasonably small in five institutions, but was not acceptable in two institutions, which was attributed to the scanner performance. These observations suggest that the 15O-water PET technique is useful for a multicentre clinical study if the PET scanner can provide time-activity data with good count statistics.

Purpose: This study describes a new 1-day protocol with Tc-99m tetrofosmin that requires only 100 minutes to obtain both stress and resting cardiac images by using a double-injection and subtraction method., Methods: This procedure was performed in 48 consecutive patients. Rest-rest double injections were performed in eight patients (five men, three women; mean age, 69 +/- 9.8 years ) to evaluate count and image reproducibility (subprotocol A), and stress-rest and additional resting perfusion images (true rest) were done on a different day in 11 patients (five men, six women; mean age, 63 +/- 5.9 years) to confirm the validity of the new protocol (subprotocol B)., Results: Image quality scores of the resting image were excellent (35 of 48, or 72.9%), good (7 of 48, or 14.6%), fair (3 of 48, or 6.3%), and poor (3 of 48, or 6.3%). The scintigraphic findings with the new protocol corresponded closely with those of angiography in 26 of 34 cases (76.5%), with a tendency for underestimation (in 5 of 34 cases, or 14.7%) rather than overestimation (in 3 of 34 cases, or 8.8%). In subprotocol A, count reproducibility between the two resting images was excellent (r = 0.95; P < 0.0001); and in subprotocol B, the early-rest images were concordant visually and quantitatively with the true rest images (r = 0.89, P < 0.0001)., Conclusion: Although there are some limitations, this protocol can be used as a routine stress-rest protocol.

Unlabelled: The purpose of this study was to evaluate oxidative metabolism and its response by dobutamine in patients with noninsulin-dependent diabetes mellitus (NIDDM) using 11C-acetate PET., Methods: We studied 16 patients with NIDDM (9 men, 7 women; mean age 53.7 +/- 12.8 yr) and 6 healthy male control subjects (mean age 41.8 +/- 17.2 yr). None of them had an abnormality on stress-perfusion SPECT. The 11C-acetate clearances (Kmono) were compared regionally for five myocardial segments in all subjects at rest and during low-dose dobutamine stress in 13 patients (8 patients with NIDDM, age 51.9 +/- 13.6 yr; 5 healthy male control subjects, age 45.6 +/- 16.3 yr). Correlation between regional Kmono and rate-pressure product (RPP) was also studied., Results: At rest, the clearance of 11C-acetate was slightly heterogeneous for both patients with NIDDM and healthy control subjects, with smaller values in the apex and inferior wall in both groups. The difference became significant during dobutamine stress in the patients. The RPP-to-Kmono (average for five segments) ratio at rest was slightly smaller in the patients (1042.7 +/- 559.1 x 0.01) than in the healthy control subjects (1391.4 +/- 209.6 x 0.01, not significant), and those during dobutamine stress were almost the same in the two groups (1457.3 +/- 737.4 x 0.01 and 1486.0 +/- 211.8 x 0.01, respectively). A significant correlation was seen between regional Kmono and RPP in every segment in the healthy control subjects (average; r = 0.89; p < 0.01), whereas more scattered correlation with greater regional variation was observed in the patients (average; r = 0.31; p value was not significant)., Conclusion: Patients with NIDDM showed slight regional heterogeneity in myocardial oxidative metabolism. They also had more scattered correlation between myocardial oxidative metabolism and cardiac work (RPP) than healthy control subjects, with the smallest correlation coefficient observed in the inferior wall. These findings may help the understanding of dynamics in myocardial oxidative metabolism of NIDDM hearts.

Unlabelled: Impairment of fatty acid uptake is shown to precede myocardial perfusion abnormality using 123I-labeled 15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) in an experimental model of hypertrophic cardiomyopathy (HCM) and in human studies. We have recently demonstrated that abnormalities of both glucose and oxidative metabolism precede the reduction of blood flow in HCM. The main purposes of this study were to assess the frequency of abnormal findings in FDG uptake, BMIPP uptake and oxygen metabolism and to clarify the relationship among these metabolic parameters by using PET and SPECT., Methods: Twenty-eight subjects with HCM underwent FDG- and acetate-PET and thallium- and BMIPP-SPECT studies at rest, respectively. After correcting for partial volume effect, real percentages of FDG and BMIPP uptake were calculated. In addition, the clearance rate constant (K mono) of acetate was measured and normalized (%) to estimate the oxygen metabolism., Results: There were various metabolic abnormalities observed in patients with HCM. BMIPP uptake was often impaired without significant reduction of K mono values or FDG uptake. Thus, abnormality of BMIPP uptake was more frequently observed than that for FDG uptake or K mono values (p < 0.0001, respectively). FDG uptake was relatively maintained even in the segments with reduced K mono values and reduced BMIPP uptake., Conclusion: HCM shows a variety of metabolic patterns; however, the results of our study suggest that reduction of BMIPP uptake appears to be the most sensitive indicator of metabolic abnormalities followed by reduction of oxidative metabolism in patients with HCM.

The effect of the oxygen inhalation on relaxation times was evaluated in various tissues, including the myocardium, liver, spleen, skeletal muscle, subcutaneous fat, bone marrow, and arterial blood, with a [1H]MR system. Statistically significant decrease of T1 relaxation times was observed in the myocardium, spleen, and arterial blood after inhalation of 100% oxygen, whereas no significant change was observed in liver, skeletal muscle, subcutaneous fat, or bone marrow. The T2 relaxation time of these tissues did not differ significantly between before and after inhalation of the oxygen. These results indicate that [1H]MRI can be used to evaluate changes with oxygen inhalation and that the effect of the oxygen inhalation on T1 relaxation time is different among various tissues.

Unlabelled: Autonomic neuropathy along with cardiac denervation is one of the prognostic factors of diabetic patients. The aim of this study was to establish qualitative and quantitative assessment of diabetic cardiac denervation using [123I]metaiodobenzylguanidine (MIBG)., Methods: The study population consisted of 31 diabetic patients and 12 control subjects (C). Diabetic patients were classified into the following three groups according to their presentation of neuropathy: NO, without neuropathy; N1, mild neuropathy; N2, severe neuropathy. All subjects underwent triple-phase MIBG scanning, including dynamic planar imaging as well as early and delayed planar and SPECT imaging. Myocardial uptake ratios of MIBG and heart-to-mediastinum count ratios (H/M) were calculated as global uptake indices. Inferior-to-anterior count ratios and coefficients of variation were calculated as regional distribution indices. The washout rate of the inferior wall and whole myocardium were also studied., Results: MIBG abnormalities were obvious in the inferior wall, which gradually spread to the adjacent segments. All indices of regional uptake showed a significant difference (p < 0.01) among the groups, while only the H/M of the late image showed significant differences in the two global uptake indices (p = 0.02). the washout rate of the inferior wall was enhanced with neuropathy., Conclusion: Diabetic neuropathy involves an MIBG abnormality in its early stages. Since this abnormality occurs in the inferior segment, an inferior-to-anterior count ratio, an index of regional MIBG uptake could be suitable for the evaluation of this condition because of its superior sensitivity.

Background: When patients with severely depressed left ventricular function are treated, it is crucial to know in advance how much functional recovery is expected from coronary revascularization., Methods and Results: We compared the results of 11C acetate positron emission tomography (PET) with dobutamine infusion with changes in regional wall motion evaluated by left ventriculography in 28 patients with old Q-wave anterior myocardial infarctions. Dysfunctional but viable myocardium (group A, n = 13) was separated from nonviable myocardium (group B, n = 15) by echocardiographic assessments of regional wall motion before and after successful coronary revascularization. 11C acetate PET was performed to characterize normalized myocardial blood flow and oxidative metabolism (the clearance rate constant, k mono). While the baseline k monos of the infarct areas of the two groups were different with overlap, the responses to dobutamine infusion were directionally different. In addition, relative perfusion by 11C acetate PET could predict recovery of left ventricular function as well as or better than dobutamine 11C acetate kinetics. The extent of the increase in k monos of the infarct area with dobutamine infusion correlated well (P < .01) with the degree of the increase in the percentage of systolic segment shortening in the infarct area (left ventriculography) after coronary revascularization., Conclusions: 11C acetate PET with dobutamine infusion can predict not only the reversibility of dysfunctioning myocardium after coronary revascularization but also the extent of improvement of regional wall motion in patients with old Q-wave infarction.

Unlabelled: The purpose of this study was to determine the suitability of 62Cu-pyruvaldehyde bis(N4-methylthiosemicarbazone) (62Cu-PTSM) for estimating myocardial blood flow (MBF) over a wide range of flow by comparison with 13N-ammonia (13NH3)., Methods: PET studies using 62Cu-PTSM and 13NH3 were performed at rest and after pharmacological vasodilatation in 9 normal subjects and 13 patients with coronary artery disease (CAD). According to the microsphere method, values for the product of the extraction fraction and MBF (ExMBF) were calculated using both tracers. In static images, the percent uptake (normalized to the peak count) of each tracer was measured in patients with CAD., Results: The myocardial tracer distribution in the normal subjects was significantly higher in the inferior wall in the 62Cu-PTSM studies and lower in the lateral wall in the 13NH3 studies. The ExMBF values showed linear correlation for both tracers in a low flow range. In a high flow range, however, the ExMBF values for 62Cu-PTSM were nonlinearly proportional to the increase of those for 13NH3 (y = 1.1 x -0.21x2, r = 0.81). The percent uptake for both tracers at baseline well correlated linearly (y = 10.4 + 0.88x, R = 0.91). After pharmacological vasodilatation underestimation of blood flow with 62Cu-PTSM was noted compared to that with 13NH3 at high flows (y = 31.8 + 0.63x, r = 0.76)., Conclusion: These results suggest that the MBF estimates using 62Cu-PTSM in a low flow range may be as accurate as those with 13NH3. In a high flow range, however, the extraction fraction of 62Cu-PTSM is considered to be lower than that of 13NH3, and this may limit the estimation of MBF with 62Cu-PTSM after pharmacological vasodilatation.

Unlabelled: We evaluated myocardial blood flow, glucose and oxygen metabolism using PET in hypertrophic cardiomyopathy (HCM)., Methods: PET studies using 18F-fluorodeoxyglucose (FDG) and 11C-acetate were performed at rest in patients with HCM and normal subjects as a control group. The metabolic rate of glucose (MRGlu), K mono value as a marker of oxidative metabolism, and myocardial blood flow were estimated from serial dynamic FDG and 11C-acetate PET studies., Results: Myocardial blood flow (%) did not differ significantly in hypertrophic and nonhypertrophic myocardium (90.3 +/- 3.1 versus 91.7 +/- 3.4). The MRGlu in hypertrophic myocardium, however, was lower than that of hypertrophic and normal myocardium (0.44 +/- 0.10 versus 0.52 +/- 0.15 and 0.53 +/- 0.15 mumole/min/g, respectively, p < 0.05). The K mono values were also lower in hypertrophic myocardium than in nonhypertrophic and normal myocardium (0.05 +/- 0.010 versus 0.066 +/- 0.0011 and 0.065 +/- 0.017 per min, respectively, p < 0.05). The %FDG/%perfusion values in hypertrophic myocardium did not differ significantly from those in nonhypertrophic myocardium (0.96 +/- 0.10 versus 1.02 +/- 0.07)., Conclusion: Myocardial ischemia at rest is observed less frequently in patients with HCM. Impairment of oxidative and glucose metabolism may precede decreased blood flow. Primary metabolic impairment is considered to be dominant in hypertrophic myocardium.

Unlabelled: Hyperthyroid patients often complain of cardiovascular symptoms because of increased metabolism. This study was designed to quantitatively evaluate myocardial oxidative metabolism in these patients., Methods: Dynamic PET with 11C-acetate was performed in 19 patients who had not undergone treatment for hyperthyroidism. Eight were restudied 2 wk after oral administration of propranolol. The clearance rate constant of 11C-acetate (Kmono) was calculated with monoexponential fitting of tracer washout from the myocardium as a marker of myocardial oxidative metabolism. The results were compared with those in nine normal subjects both at rest and during dobutamine infusion., Results: Kmono in our patients (0.109 +/- 0.028 min-1) was significantly increased compared to normal subjects (0.066 +/- 0.016 min-1) (p < 0.05). After propranolol treatment, Kmono decreased (0.082 +/- 0.014 min-1) but remained significantly higher in eight patients than normal subject levels (p < 0.05), while the rate pressure product decreased significantly (7500 +/- 1700) toward the normal range (7900 +/- 1500)., Conclusion: These results suggest the possibility of excessive myocardial oxygen consumption in hyperthyroid patients. The clearance rate of 11C-acetate is a new and valuable index to assess myocardial oxidative metabolism not closely related to the pressure rate product or thyroid hormones in these patients.

Unlabelled: We previously reported that uptake of 123I-labeled 15-iodophenyl 3-methyl pentadecanoic acid (BMIPP) was lower than that of thallium in ischemic myocardium. Such discordant findings between BMIPP and thallium were compared with those of PET using 18F-deoxyglucose (FDG) and 11C-acetate to assess metabolic alterations in such segment., Methods: Sixteen patients with coronary artery disease underwent both BMIPP SPECT and PET. Relative FDG uptake (% FDG uptake) and the clearance rate constant (% Kmono) of 11C-acetate from the myocardium were calculated as markers of glucose and oxidative metabolism, respectively., Results: Relative FDG uptake of the myocardial segments with reduced BMIPP uptake and normal thallium uptake (discordant segments) was similar (85.3 +/- 10.3) to that of the normal segments (86.5 +/- 11.7) but higher than that of segments with reduced uptake of both BMIPP and thallium (67.5 +/- 19.9). Similarly, the discordant segments showed a higher % Kmono value (77.8 +/- 13.1 versus 70.0 +/- 19.1) and FDG-to-perfusion ratio (1.15 +/- 0.08 versus 1.01 +/- 0.22) than in the concordantly reduced segments., Conclusion: BMIPP uptake appears to provide metabolic information independent of thallium uptake. Combined imaging of BMIPP and thallium may potentially identify ischemic but viable myocardium.

Unlabelled: Myocardial sympathetic nervous function has been evaluated with 123I-metaiodobenzylguanidine (MIBG) imaging in various cardiac diseases. Heterogeneous distribution of this tracer has been reported. This study was undertaken to assess whether such heterogeneity is related to age and gender., Methods: Twenty-nine subjects (18 men, 11 women; age range, 21 to 79 yr; mean age 42 +/- 17 yr) with no cardiac disorders were studied. Early (15 min) and late (3-4 hr) planar images were taken, and SPECT images were also obtained 3-4 hr after MIBG injection (111 MBq). The mean counts of the whole heart, mediastinum and the anterior and inferior regions of the heart were obtained to calculate heart-to-mediastinum count ratios, myocardial washout rates and the inferior-to-anterior wall count ratio. On a bull's-eye map of the SPECT images, the left ventricular myocardium was divided into nine sectors to calculate the inferior-to-anterior wall count ratio., Results: There were no significant differences in the heart-to-mediastinum count ratio based on age or gender, but there was a significant inverse correlation between the inferior-to-anterior wall count ratio and age (r = -0.51 on late planar images and r = -0.69 on SPECT; p < 0.01 and p < 0.001, respectively). This correlation was valid in men (r = -0.74 and -0.83, respectively; both p < 0.001), but not in women (r = -0.25 and -0.34, respectively; p = ns)., Conclusion: Inferior wall uptake of MIBG decreased with age in individuals without cardiac diseases, especially men. Such age- and gender-related heterogeneity should be considered in the interpretation of MIBG images.

Quantitative assessment of myocardial tracer uptake in stress-delayed thallium and resting BMIPP imagings were performed in 24 patients with coronary artery disease. Each distribution was displayed on the bull's eye polar map and % uptake of each distribution was calculated as a mean value in 9 myocardial segments on the polar map. Redistribution index (% delayed uptake minus % stress uptake on thallium images) and discordance index (% delayed thallium uptake minus % BMIPP uptake) were also calculated. Each parameter was compared to the visual uptake score and wall motion score on contract left ventriculography. Excellent correlations were obtained between % uptake and the uptake score in each tracer. The % thallium and BMIPP uptake also correlated with regional wall motion score. Furthermore, a significant correlation was observed between redistribution and discordance indexes in the mildly hypoperfused segments. These data indicate that the quantitative analysis of thallium and BMIPP distributions seems to be valuable to understand relationship between perfusion and regional wall motion. The discordant BMIPP uptake may represent asynergic but viable segments. However, several important factors, such as attenuation factor should be also taken into consideration for such quantitative analysis.

Unlabelled: To assess the clinical value of the 99mTc-labeled myocardial perfusion agent, 99mTc-tetrofosmin, the findings of stress and rest myocardial tomography were compared with those of stress and 3-hr delayed 201Tl tomography and coronary arteriography., Methods: Twenty-five patients who had coronary arteriography were studied with both stress tetrofosmin and 201Tl tomography., Results: The image quality of tetrofosmin was superior to that of 201Tl despite a shorter acquisition time. Both the tetrofosmin and 201Tl studies were quite sensitive to detect coronary artery disease (100% and 95%, respectively) (p = ns). The two studies showed similar sensitivity (75% and 73%) and specificity (80% and 77%, respectively) for the detection of significant (> or = 75% diameter) coronary artery stenosis. Stress distribution of tetrofosmin tended to be slightly higher than that of 201Tl (% uptake: 63.3% +/- 13.5% versus 60.4% +/- 12.2%, p = 0.0006; uptake score: 2.33 +/- 1.03 versus 2.22 +/- 1.07, p = 0.007), indicating less defect contrast in the former. A high concordant rate (89%) of the stress perfusion score was observed between the two radiopharmaceuticals. Reversible perfusion abnormalities were observed to be similar between stress-rest tetrofosmin and stress-delayed 201Tl studies., Conclusions: Stress tetrofosmin perfusion tomography is a valuable method to detect coronary artery disease and to assess tissue viability with accuracy similar to that of stress 201Tl tomography.

To assess the biventricular response of the clearance rate of carbon-11 acetate as an index of myocardial oxidative metabolism to increase in work-load, dynamic positron emission tomography was performed at rest and during dobutamine infusion in 14 normal subjects. The clearance rate constant (Kmono) of the left ventricular (LV) myocardium increased during dobutamine infusion (0.112 +/- 0.020 min-1 vs 0.065 +/- 0.015 min-1 at rest) (P < 0.001) in proportion to the increase in the pressure-rate product. Kmono in the right ventricular (RV) myocardium also increased (0.080 +/- 0.018 min-1 vs 0.034 +/- 0.013 min-1 at rest) (P < 0.001), with an excellent correlation with the LV Kmono (r = 0.920). The fact that the increase in RV Kmono during dobutamine infusion was greater (158% +/- 81%) than that in LV Kmono (79% +/- 39%) (P < 0.005) indicates a greater increase in oxidative metabolism in the RV in response to inotropic stimulation in normal subjects.