Author + information
- Received April 29, 2019
- Revision received July 26, 2019
- Accepted August 21, 2019
- Published online July 6, 2020.
- Jens Sörensen, MD, PhDa,b,
- Hendrik Johannes Harms, PhDb,
- John M. Aalen, MDc,d,e,f,g,h,
- Tomasz Baron, MD, PhDi,j,k,
- Otto Armin Smiseth, MD, PhDc,d,e,f,g,h and
- Frank A. Flachskampf, MD, PhDg,h,∗ ()
- aDepartment of Nuclear Medicine and PET, Surgical Sciences, Uppsala University, Sweden
- bDepartment of Nuclear Medicine and PET, Clinical Institute, Aarhus University, Aarhus, Denmark
- cInstitute for Surgical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- dCenter for Cardiological Innovation, Oslo University Hospital, Oslo, Norway
- eDepartment of Cardiology, Oslo University Hospital, Oslo, Norway
- fInstitute of Clinical Medicine, University of Oslo, Oslo, Norway
- gDepartment of Medical Sciences, Uppsala University, Uppsala, Sweden
- hDepartment of Clinical Physiology, Akademiska University Hospital, Uppsala, Sweden
- iDepartment of Medical Sciences, Uppsala University and Akademiska Hospital, Uppsala, Sweden
- jDepartment of Radiology, Uppsala University and Akademiska Hospital, Uppsala, Sweden
- kDepartment of Cardiology, Uppsala University and Akademiska Hospital, Uppsala, Sweden
- ↵∗Address for correspondence:
Dr. Frank A. Flachskampf, Department of Medical Sciences, Uppsala University, 751 85 Uppsala, Sweden.
• Myocardial external efficiency is a performance measure of the myocardium linking metabolism to mechanical work that can be measured by PET.
• The diagnostic and prognostic potential of myocardial efficiency in heart disease, especially heart failure, is only beginning to be explored. Decreasing costs and automation of PET will make this information increasingly available and may in the future guide the selection of drugs and therapeutic interventions in heart disease.
• Because of prohibitive costs and low availability due to the need for a cyclotron, evaluation of myocardial efficiency has in the past been a research tool. Both restrictions will decrease dramatically in the near future, enabling myocardial efficiency as a fundamental cardiac performance parameter to be tested in larger studies and making translation to clinical practice possible.
Myocardial external efficiency is the relation of mechanical energy generated by the left (or right) ventricle to the consumed chemical energy from aerobic metabolism. Efficiency can be calculated invasively, and, more importantly, noninvasively by using positron emission tomography, providing a single parameter by which to judge the adequacy of myocardial metabolism to generated mechanical output. This parameter has been found to be impaired in heart failure of myocardial or valvular etiology, and it changes in a characteristic manner with medical or interventional cardiac therapy. The authors discuss the concept, strengths, and limitations, known applications, and future perspectives of the use of myocardial efficiency.
This work was supported in part by the Swedish Heart-Lung Foundation (Hjärtlungfonden). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received April 29, 2019.
- Revision received July 26, 2019.
- Accepted August 21, 2019.
- 2020 American College of Cardiology Foundation
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