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Use of a Single 11C-Meta-Hydroxyephedrine Scan for Assessing Flow–Innervation Mismatches in Patients with Ischemic Cardiomyopathy

Mismatch between areas of reduced myocardial blood flow (MBF) and reduced myocardial innervation (defect areas) may be used to estimate the risk for ventricular arrhythmias. The presence of a mismatch zone can be derived using a combined protocol consisting of both an MBF scan and an 11C-meta-hydroxyephedrine (11C-HED) scan. The rate of influx from blood to myocardium (K1) of 11C-HED is proportional to MBF and can potentially be used as an index for defining MBF defects. The aim of this study was to assess whether K1 derived from an 11C-HED scan can be used as an index of MBF, potentially allowing for an assessment of MBF–innervation mismatch areas from a single 11C-HED scan. Methods: Seventeen patients with known ischemic cardiomyopathy underwent dynamic 15O-water and 11C-HED scans. Discrete arterial blood samples were taken during 11C-HED scans for metabolite correction of the image-derived input function. 11C-HED influx rate was obtained using a single-tissue-compartment model and compared with transmural MBF (MBFT), defined as MBF as measured with 15O-water multiplied by perfusable tissue fraction. Defect sizes were obtained from parametric K1 and MBFT images, using 50% of a remote control segment as the cutoff value. Results: There was a significant correlation between MBFT and K1 (y = 0.40x + 0.05 mL·g−1·min−1, r = 0.80, P < 0.001), although K1 was significantly lower than MBFT (slope of the regression line significantly different from 1, P < 0.001). Correlation between MBFT and K1 defect sizes was high (y = 0.89x + 1.38%, r = 0.95, P < 0.001), with no significant difference in mean defect size based on K1 or MBFT (20.9% ± 11.3% and 20.1% ± 10.7% for MBFT and K1, respectively, P = 0.41). Conclusion: 11C-HED influx rate K1 can be used as an alternative to a separate MBF scan for assessing mismatch areas between MBF and myocardial innervation.