PET measurement of myocardial metabolism

There is growing evidence that perturbations in myocardial substrate use play a key role in a variety of normal and abnormal cardiac states. A decline in myocardial fatty acid metabolism and a preference for glucose as an energy substrate characterize pressure-overload left ventricular hypertrophy. Conversely, an overdependence on myocardial fatty acid metabolism with a parallel decline in carbohydrate use is characteristic of the myocardial metabolic adaptation in diabetes mellitus. What is unclear is the extent to which these metabolic switches are adaptive and to what extent they have the propensity to become maladaptive.