Stoffwechseluntersuchung am Herzen mit ¹²³J-Fettsäuren und ¹¹C-Methylglukose

Um die extern erfaßbaren Veränderungen im myokardialen Stoffwechsel der freien Fettsäuren und der Glukose bei Ischämie und Kardiomyopathie zu charakterisieren, wurde ω-¹²³J-Heptadekansäure (Stearinsäure-Analog), ⁷⁵Br-Phe-nylpentadekansäure und 3–0–¹¹C-Methyl-D-Glucose als Indikatoren benutzt. Es konnte gezeigt werden, daß mindestens zwei unterschiedliche pathophysiologische Situationen im Stoffwechsel der freien Fettsäuren existieren können. Durch die Störungen der Akkumulationsmechanismen ist die Verfügbarkeit der freien Fettsäuren für die Energieproduktion im Myokard reduziert (diese Störungen werden als Änderungen in der Indikatorakkumulation erkannt). Durch die Störungen der Abbaumechanismen der Fettsäuren wird die Fähigkeit der myokardialen Zelle, die freien Fettsäuren zu verwerten, reduziert (diese Störungen werden als Veränderungen in den Indikatoreliminationsraten erkannt). Im Gegensatz zur koronaren Herzerkrankung konnte bei Kardiomyopathie keine Korrelation zwischen Bereichen veränderter Indikatorakkumulation und pathologischer Indikatoreliminationsraten gefunden werden. Die ¹¹C-Methylglukose erwies sich als ein sensitiver Indikator, der die in-vivo-Beurteilung des Zustandes der Zellmembran-gebundenen Transportsysteme ermöglicht.

To characterize externally detectable changes in the myocardial metabolism of free fatty acids (FFA) and glucose, which are associated with ischemia and cardiomyopathy, ω-¹²³I-heptadecanoic acid (stearic acid analogue), ⁷⁵Br-phenylpenta-decanoic acid, and 3–0–¹¹C-methyl-D-glucose were used as indicators. It could be demonstrated that in the metabolism of free fatty acids at least two different patho-physiological situations may exist. Disturbances in the mechanism of the accumulation of free fatty acids lead to a decrease of the amount of the free fatty acids which are available for energy production (these disturbances can be recognized as indicator accumulation defects). Disturbances associated with the mechanism of free fatty acid catabolism lead to a decrease of the ability of the myocardial cell to utilize the free fatty acids (these disturbances can be recognized as changes in indicator elimination rates). Whereas in ischaemic heart disease, the areas with altered FFA accumulation correlate with the areas of altered FFA-elimination, no correlation was found in the case of cardiomyopathy. The “C-methylglucose seems to be an excellent indicator for the in-vivo assessment of the function of transport systems in the myocardial cell membrane.

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