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Predictors of post-stress LVEF drop 6 months after reperfused myocardial infarction: a gated myocardial perfusion SPECT study

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Abstract

Objective

To identify the predictive factors of myocardial stunning as assessed by the drop in post-stress Left Ventricular Ejection Fraction (LVEF) in patients with a recent history of myocardial infarction (MI).

Methods

We prospectively included 215 consecutive patients admitted for acute MI who underwent percutaneous coronary intervention with a greater than or equal to grade-3 TIMI flow in the culprit vessel. Six months after discharge, a post-stress/rest 99mTc-sestamibi gated SPECT was performed. The perfusion score was evaluated visually using a 17-segment model. The LVEF drop was considered significant if the post-stress LVEF was ≥5 % below the rest LVEF (QGS® software).

Results

A post-stress LVEF drop was observed in 51 (24 %) patients. Patients with an LVEF drop were more likely than patients with a stable post-stress LVEF to have diabetes (22 % vs. 10 %, p = 0.048), significant ischemia (SDS > 2) (51 % vs. 28 % p = 0.003) and higher rest LVEF [62 % (56–69) vs. 56 % (49–63) p < 0.001]. In contrast, summed rest score, related to infarct size, did not differ between the groups. Multivariate logistic regression analysis identified SDS > 2 (OR 3.78, 95 % CI 1.8–7.92, p < 0.001), diabetes (OR 3.35, 95 % CI 1.33–8.49; p = 0.011) and rest LVEF (OR 1.08, 95 % CI 1.04–1.12, p < 0.001) as independent explanatory variables of an LVEF drop.

Conclusion

In patients with recent MI and post-procedural grade-3 TIMI flow, ischemia and diabetes were independent predictive factors of myocardial stunning. The higher incidence of reversible perfusion abnormalities validates the model of myocardial stunning in the post-MI period, and excludes the potential involvement of myocardial necrosis.

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Abbreviations

APMHR:

Age-predicted maximal heart rate

CAD:

Coronary artery disease

CMRI:

Cardiac magnetic resonance imaging

EDV:

End-diastolic volume

ESV:

End-systolic volume

gSPECT:

Gated single photon emission computed tomography

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

RICO:

obseRvatoire des Infarctus de Côte d’Or

SDS:

Summed difference score

SRS:

Summed rest score

SSS:

Summed stress score

SEV:

Systolic ejection volume

TIMI:

Thrombolysis in myocardial infarction

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Acknowledgments

We thank Philip Bastable for English assistance and Olivier Hachet for data collection.

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Authors and Affiliations

  1. Cardiology Department, CHU Dijon, 14 rue P. Gaffarel, 21000, Dijon, France

    C. Guenancia, L. Lorgis, M. Zeller, K. Stamboul & Y. Cottin

  2. LPPCM, Faculté de Médecine de Dijon, UMR INSERM 866, 2 Boulevard Jeanne d’Arc, 21000, Dijon, France

    C. Guenancia, L. Lorgis, M. Zeller, K. Stamboul & Y. Cottin

  3. Nuclear Medicine Department, CGFL, Dijon, France

    A. Cochet, I. Dygai-Cochet & F. Brunotte

  4. Le2i UMR CNRS, 5158, Dijon, France

    A. Cochet & F. Brunotte

  5. Spectroscopy NMR Department, University Hospital, Dijon, France

    O. Humbert

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  1. C. Guenancia
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Correspondence to C. Guenancia.

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Guenancia, C., Cochet, A., Humbert, O. et al. Predictors of post-stress LVEF drop 6 months after reperfused myocardial infarction: a gated myocardial perfusion SPECT study. Ann Nucl Med 27, 112–122 (2013). https://doi.org/10.1007/s12149-012-0661-9

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  • DOI: https://doi.org/10.1007/s12149-012-0661-9

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