Journal of Nuclear Cardiology

, Volume 17, Issue 5, pp 817–824

Fractional flow reserve and myocardial viability as assessed by SPECT perfusion scintigraphy in patients with prior myocardial infarction

  • Branko Beleslin
  • Milan Dobric
  • Dragana Sobic-Saranovic
  • Vojislav Giga
  • Jelena Stepanovic
  • Ana Djordjevic-Dikic
  • Milan Nedeljkovic
  • Sinisa Stojkovic
  • Vladan Vukcevic
  • Goran Stankovic
  • Dejan Orlic
  • Zorica Petrasinovic
  • Smiljana Pavlovic
  • Vladimir Obradovic
  • Miodrag Ostojic
Original Article

DOI: 10.1007/s12350-010-9251-1

Cite this article as:
Beleslin, B., Dobric, M., Sobic-Saranovic, D. et al. J. Nucl. Cardiol. (2010) 17: 817. doi:10.1007/s12350-010-9251-1
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Abstract

Background

In patients with previous myocardial infarction (MI), assessment of myocardial viability and physiological significance of coronary artery stenoses are essential for appropriate guidance of revascularization. The aim of the study was to evaluate the relation between fractional flow reserve (FFR) and myocardial viability as assessed by gated SPECT MIBI perfusion scintigraphy in patients with previous MI undergoing elective PCI.

Methods

The study population consisted of 26 patients (mean age 55 ± 7 years; 21 male) with a previous MI and a significant coronary stenosis in a single infarct-related coronary vessel for which PCI was being performed. In all patients, FFR was evaluated before and immediately after PCI. SPECT imaging was done before and 3 ± 1 months after PCI. A region representing the MI was considered viable if MIBI uptake was ≥55% of the normal region. Improvement in perfusion after revascularization was considered achieved if perfusion abnormalities decreased by 5% or more and there was a decrease in segmental score of ≥1 in three segments in PCI-related vascular territory.

Results

Extent of perfusion abnormalities decreased from 32 ± 16% to 27 ± 19% after PCI (P < .001). In patients with myocardial viability in comparison to patients with no viability, there was significant difference in FFR before PCI (.57 ± .14 vs .76 ± .12, P = .002), despite almost the same values of diameter stenosis of infarct-related artery (63 ± 8% vs 64 ± 3%, respectively, P = .572). In addition, FFR prior to PCI was related to improvement in perfusion abnormalities after revascularization (P = .047), as well as with peak activity of creatine-kinase measured during previous MI (r = .56, P = .005).

Conclusion

Lower values of FFR before angioplasty are associated with myocardial viability and functional improvement as assessed by SPECT perfusion scintigraphy.

Keywords

Myocardial infarctionfractional flow reserveperfusion imagingangioplasty

Copyright information

© American Society of Nuclear Cardiology 2010

Authors and Affiliations

  • Branko Beleslin
    • 1
    • 2
  • Milan Dobric
    • 1
  • Dragana Sobic-Saranovic
    • 2
    • 3
  • Vojislav Giga
    • 1
  • Jelena Stepanovic
    • 1
    • 2
  • Ana Djordjevic-Dikic
    • 1
    • 2
  • Milan Nedeljkovic
    • 1
    • 2
  • Sinisa Stojkovic
    • 1
    • 2
  • Vladan Vukcevic
    • 1
    • 2
  • Goran Stankovic
    • 1
    • 2
  • Dejan Orlic
    • 1
    • 2
  • Zorica Petrasinovic
    • 1
  • Smiljana Pavlovic
    • 2
    • 3
  • Vladimir Obradovic
    • 2
    • 3
  • Miodrag Ostojic
    • 1
    • 2
  1. 1.Clinic for Cardiology, Department for Diagnostic and Catheterization LaboratoriesClinical Center of SerbiaBelgradeSerbia
  2. 2.Medical School of BelgradeUniversity of BelgradeBelgradeSerbia
  3. 3.Institute for Nuclear Medicine, Clinical Center of SerbiaBelgradeSerbia