Repetitive supply-demand ischemia with dobutamine increases glucose uptake in postischemic and remote myocardium

J Nucl Med. 2003 Jan;44(1):85-91.


The goal of this study was to determine whether myocardial glucose uptake after repetitive ischemia differs in response to coronary occlusion-reperfusion versus supply-demand ischemia induced by dobutamine. Although glucose metabolism is increased after myocardial ischemia, the metabolic effect of supply-demand ischemia induced by dobutamine may increase glucose metabolism within remote myocardium. This would make it difficult to discriminate postischemic from remote myocardium with glucose tracers.

Methods: Eighteen swine with a hydraulic occluder and flow probe on the circumflex artery underwent repetitive ischemia. In group 1 (n = 9), the circumflex artery was occluded, whereas in group 2 (n = 9), circumflex flow was decreased by 30% before dobutamine (40 micro g/kg/min intravenously). Each pig underwent 15 min of ischemia, twice per day for 5 d. Echocardiography and PET to determine myocardial glucose ((18)F-FDG) uptake were performed after final ischemia, and tissue was later analyzed for activation of Akt, p38 mitogen-activated protein, and adenosine monophosphate (AMP) kinase.

Results: Wall thickening in the circumflex region was lower than in remote regions in both groups. (18)F-FDG uptake in the circumflex region was similar in groups 1 and 2 (0.22 +/- 0.03 and 0.23 +/- 0.04 micro mol/min/g, respectively; not statistically significant). In the remote region, (18)F-FDG uptake was lower than in the circumflex region in group 1 (0.14 +/- 0.03 micro mol/min/g; P < 0.05) but was similar to that in the circumflex region in group 2 (0.20 +/- 0.03 micro mol/min/g; not statistically significant). AMP kinase activity in the remote region was significantly lower than in the circumflex region in group 1 but was similar to that in the circumflex region in group 2.

Conclusion: Unlike repetitive coronary artery occlusion-reperfusion, repetitive supply-demand ischemia with dobutamine alters glucose uptake within the remote myocardium, possibly as a result of AMP kinase activation. Clinically, these data suggest that (18)F-FDG studies have a limited role in discriminating postischemic from remote myocardium after dobutamine stress.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Animals
  • Benzamides
  • Dobutamine / administration & dosage*
  • Fasting / metabolism
  • Female
  • Fluorodeoxyglucose F18 / pharmacokinetics
  • Glucose / metabolism*
  • Heart / diagnostic imaging
  • Heart / drug effects
  • Heart / physiopathology
  • Male
  • Myocardial Ischemia / diagnostic imaging*
  • Myocardial Ischemia / metabolism
  • Myocardial Reperfusion*
  • Myocardial Stunning / diagnostic imaging
  • Myocardial Stunning / metabolism
  • Myocardium / metabolism*
  • Radiopharmaceuticals / pharmacokinetics
  • Swine
  • Tomography, Emission-Computed


  • Benzamides
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Dobutamine
  • dobupride
  • Glucose