title: Shifts in myocardial fatty acid and glucose metabolism in pulmonary arterial hypertension: a potential mechanism for a maladaptive right ventricular response.
abstract: OBJECTIVE
  We investigated the role of metabolic alterations in the development of a maladaptive right ventricular (RV) response in pulmonary arterial hypertension (PAH), which has not previously been undertaken. This study evaluated relationships between glucose and fatty acid metabolism obtained using PET with invasive pulmonary haemodynamics, RV measurements, and RV function to gain insight into the mechanism of RV maladaptation.
  
  
  RESULTS
  Seventeen consecutive PAH patients (mean age 56 ± 15) who underwent right heart catheterization [mean pulmonary arterial pressure (mPAP) 43 ± 12 mmHg] had cardiac 18F-fluoro-2-deoxyglucose (FDG) and (18)F-fluoro-6-thioheptadecanoic acid (FTHA) PET imaging. RV and left ventricular (LV) FDG and FTHA uptake standard uptake values (SUVs) were measured. The SUV was corrected for the partial volume effect (SUVPVE) based on cardiac magnetic resonance imaging (CMR). Right ventricular ejection fraction (RVEF) was determined by CMR. There was a significant positive correlation between mPAP and RV/LV FDG SUVPVE(r = 0.68, P = 0.003), and the ratio of RV/LV FDG SUV : RV/LV FTHA SUV (r = 0.60, P = 0.02). RVEF was negatively correlated with RV/LV FDG SUVPVEuptake (r = -0.56, P = 0.02) and RV/LV FTHA SUVPVE(r = -0.62, P = 0.019).
  
  
  CONCLUSIONS
  Increased pulmonary arterial pressures are associated with increases in the ratio of FDG/FTHA uptake in the RV. Inverse correlation between the uptake of the metabolic tracers and RV function may reflect a shift towards increased fatty acid oxidation and glycolysis associated with RV failure in maladaptive remodelling.
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohira
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: deKemp
authors.affiliation: Department of Medical Imaging, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Elena
authors.initials: E
authors.lastname: Pena
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Davies
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Duncan J
authors.initials: DJ
authors.lastname: Stewart
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Division of Respirology and Division of General Internal Medicine, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Chandy
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Division of Respirology and Division of General Internal Medicine, Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Contreras-Dominguez
authors.affiliation: Department of Medical Imaging, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.|Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Carole
authors.initials: C
authors.lastname: Dennie
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Mc Ardle
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Ran
authors.initials: R
authors.lastname: Mc Klein
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Renaud
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Jean N
authors.initials: JN
authors.lastname: DaSilva
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Pugliese
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dunne
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.|Department of Medical Imaging, University of Ottawa and The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Rob
authors.initials: R
authors.lastname: Beanlands
authors.affiliation: Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Mielniczuk
mesh_terms: D000046:Academic Medical Centers; D000222:Adaptation, Physiological; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005227:Fatty Acids / Q000378:metabolism*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods; D009864:Ontario; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology
chemical_list: D005227:Fatty Acids; D019788:Fluorodeoxyglucose F18; D005947:Glucose
keywords: cardiac metabolism; maladaptation; positron emission tomography; pulmonary arterial hypertension; right heart failure; right ventricular hypertrophy