Clinical applications of assessments of myocardial substrate utilization with positron emission tomography.

Positron emission tomography (PET) permits sequential, noninvasive assessment of myocardial perfusion and metabolism. Based on the pattern of substrate use, clinical studies have utilized PET to define the location and extent of myocardial infarction, to identify areas of jeopardized but viable myocardium, and to assess the metabolic response of the myocardium to pharmacological therapy as well as to interventions such as coronary thrombolysis and coronary artery bypass surgery. The ability to noninvasively assess specific metabolic pathways should facilitate our understanding of normal myocardial metabolism, its perturbations with cardiac disease, and thereby improve the diagnosis and treatment of the biochemical processes underlying cardiac dysfunction.