From the Editor

Professor F.C. Visser
Department of Cardiology, University Hospital, Vrije Universiteit, Amsterdam, The Netherlands

Two years ago this journal was founded by the Servier Research Group with the educational aim to impart information and create awareness among cardiologists of basic myocardial metabolism, metabolic imaging and metabolic therapy. This remains an excellent goal since over the last 10 years cardiac metabolic imaging has become a valuable clinical tool with the use of positron emission tomography (PET) and single photon emission computed tomography (SPECT). Also, metabolic interventions specifically aimed at the heart are now a clinical reality. Because of these new applications we need to upgrade our knowledge of cardiac metabolism. Therefore, the editorial board has opted for a systematic coverage of all major aspects of each issue.
The main article will discuss an important clinical problem and will involve review articles and guidelines on diagnosis, prevention, treatment and epidemiology; in short, on the state of cardiology today. The remaining articles will highlight various metabolic aspects related to the subject of the main clinical article. The basic metabolism section aims to give more insight into the basic aspects of metabolism; the section on new therapeutic strategies will discuss potential and existing metabolic therapy in relation to the clinical topic covered in the main article. Finally, each issue will contain an article on cardiac metabolic imaging, and, if space permits, case reports will also be presented. In this way we hope to present you with new and challenging data on the clinical implications of cardiac metabolism. We hope that our new-look journal will receive a positive response from you.
In this issue the potential beneficial effects of metabolic therapy using glucose-insulin-potassium (GIK) infusion in the acute stage of myocardial infarction are discussed by one of the ECLA authors, Dr Rafael Díaz. The ECLA authors showed that GIK intervention, especially with a high dose of glucose and insulin in the acute stage of myocardial infarction, is feasible and safe. More importantly, this metabolic therapy may be beneficial for acute infarction patients.
In the section on new therapeutic strategies, Dr Carl Apstein looks critically at the ECLA data and compares them with previous data, in particular the meta-analysis of acute infarction interventions by Fath-Ordoubadi. The clinically most important question of whether we are ready for routine GIK use is answered in the negative by both contributors. However, the ECLA study was merely a pilot study and the ECLA II study is currently underway with adequate power to definitively prove whether this simple and cheap metabolic intervention is indeed beneficial for patients with acute myocardial infarction. Other international studies are also being planned or performed to support the preliminary data, so keep an eye out for future developments.
The basic metabolism article by Dr Michael Allard and colleagues gives some background for understanding the uptake and oxidation of glucose in normal and ischaemic myocardium and how very important insulin is for this process. Also the mechanisms by which GIK is beneficial following ischaemia are discussed. The evidence for GIK in both the basic research and the clinical setting shows the importance of metabolic changes in cardiac function and the interest of the metabolic approach to ischemic heart diesease.
The importance of insulin for glucose imaging is shown on the front cover images provided by Dr Lucas Klein. One fluorodeoxyglucose (FDG) PET image is from a patient without insulin resistance, the second is from a patient with insulin resistance. Clearly, FDG uptake is better in the patient without insulin resistance, with a ‘sharper’ myocardial delineation and a better heart: background ratio.
In the cardiac metabolic imaging section, Professor Paolo Camici describes the myocardial uptake patterns of FDG under normal and ischaemic conditions. These patterns are important for optimizing metabolic conditions during FDG imaging and for the clinical interpretation of these images.
In summary, this issue gives an overview of the clinical applications of glucose in the diagnosis and treatment of ischaemic heart disease. I hope you will enjoy reading it as much as I did.