L-3-11C-Lactate as a PET Tracer of Myocardial Lactate Metabolism: A Feasibility Study

Lactate is a key myocardial energy source. Lactate metabolism is altered in a variety of conditions, such as exercise and diabetes mellitus. However, to our knowledge, noninvasive quantitative measurements of myocardial lactate metabolism have never been performed because of the lack of an adequate radiotracer. In this study we tested L-3-(11)C-lactate ((11)C-lactate) as such a tracer. Twenty-three dogs were studied under a wide range of metabolic interventions. (11)C-Lactate and (13)C-lactate were injected as boluses and PET data were acquired for 1 h. Concomitant arterial and coronary sinus (ART/CS) blood samples were collected to identify (13)C-lactate metabolites and to measure fractional myocardial extraction/production of (11)C metabolite fractions ((11)C acidic: (11)CO(2) and (11)C-lactate; (11)C basic: (11)C-labeled amino acids; and (11)C neutral: (11)C-glucose). Lactate metabolism was quantified using 2 PET approaches: monoexponential clearance analysis (oxidation only) and kinetic modeling of PET (11)C-myocardial curves. Arterial (11)C acidic, neutral, and basic metabolites were identified as primarily (11)C-labeled lactate + pyruvate, glucose, and alanine, respectively. Despite a significant contribution of (11)C-glucose (23%-45%) and (11)C-alanine (