The purpose of the present study was to assess the accuracy of non-invasive estimates of the rate of myocardial fatty acid esterification (MFAE) obtained using positron emission tomography (PET).Methods-Sixteen dogs were studied after an overnight fast (FAST), during a euglycemic hyperinsulinemic clamp (CLAMP), or during infusion of Intralipid (IL) or IL plus dobutamine (IL/ DOB) (n=4/group). The rate of MFAE was quantified using a bolus injection of [1-11 C]palmitate and compartmental modeling as described by Bergmann et al. 3 and compared to the rate of triglyceride (TG) synthesis measured directly using a continuous infusion of [1-13 C]palmitate and tissue sampling.Results-Across groups, mean plasma free fatty acid (FFA) concentration varied ~20-fold, with this variation in FFA availability accompanied by a ~20-fold range in directly-measured TG synthesis (i.e., from 7±1 nmol/min/g in CLAMP to 128±75 nmol/min/g in IL). PET-based estimates of MFAE varied to a similar degree (i.e., from 22±9 nmol/min/g in CLAMP to 543±551 nmol/min/g in IL), and were significantly correlated with TG synthesis (i.e., R=0.77, P<0.001). MFAE, however, was 3-to 4-fold higher than TG synthesis in FAST, CLAMP, and IL, but comparable when cardiac work was increased in IL/DOB, suggesting that MFAE reflects, in part, the incorporation of label into amino acids via TCA cycle exchange reactions (e.g., α-ketoglutarate ↔ glutamate) as well as the synthesis of TG and other lipids.Conclusions-Changes in the rate of MFAE as determined using PET and the compartmental model of Bergmann et al. 3 parallel changes in the rate of TG synthesis, at least in the basal state. Although such measurements are not as robust as rates of myocardial FFA uptake and oxidation as estimated by the model, this method should still be useful for quantifying acute changes in FFA storage by the heart in various pathophysiological states.