Abstract
Purpose
After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the long-term evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling.
Methods
Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent 99mTc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up.
Results
At baseline, patients with remodelling (n = 14) showed larger (infarct size 29.3 ± 7.8%) and more transmural (infarct severity 0.28 ± 0.10) infarctions, and reduced LV ejection fraction (35.4 ± 5.6%), but similar LV volume indexes, compared to patients without remodelling (n = 54) (infarct size 20.8 ± 14.4%, p < 0.05, infarct severity 0.40 ± 0.11, p < 0.001, ejection fraction 44.5 ± 9.2, p < 0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (−4.4 ± 8.4%) and without remodelling (−6.8 ± 9.4%) (p = NS).
Conclusion
Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term follow-up. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling.
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References
Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol 2000;35:569–82.
Touboul P, Andre-Fouët X, Leizorovicz A, Itti R, Lopez M, Sayegh Y, et al. Risk stratification after myocardial infarction. A reappraisal in the era of thrombolysis. The Groupe d’Etude du Pronostic de l’Infarctus du Myocarde (GREPI). Eur Heart J 1997;18:99–107.
Bax JJ, Schinkel AF, Boersma E, Elhendy A, Rizzello V, Maat A, et al. Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis. Circulation 2004;110(11 Suppl 1):II18–22.
Gaudron P, Eilles C, Kugler I, Ertl G. Progressive left ventricular dysfunction and remodeling after myocardial infarction. Potential mechanisms and early predictors. Circulation 1993;87:755–63.
Chareonthaitawee P, Christian TF, Hirose K, Gibbons RJ, Rumberger JA. Relation of initial infarct size to extent of left ventricular remodeling in the year after acute myocardial infarction. J Am Coll Cardiol 1995;25:567–73.
Castro PF, Corbalan R, Baeza R, Nazzal C, Greig DP, Miranda FP, et al. Effect of primary coronary angioplasty on left ventricular function and myocardial perfusion as determined by Tc-99m sestamibi scintigraphy. Am J Cardiol 2001;87:1181–4.
Orn S, Manhenke C, Anand IS, Squire I, Nagel E, Edvardsen T, et al. Effect of left ventricular scar size, location, and transmurality on left ventricular remodeling with healed myocardial infarction. Am J Cardiol 2007;99:1109–14.
Lund GK, Stork A, Muellerleile K, Barmeyer AA, Bansmann MP, Knefel M, et al. Prediction of left ventricular remodeling and analysis of infarct resorption in patients with reperfused myocardial infarcts by using contrast-enhanced MR imaging. Radiology 2007;245:95–102.
Bolognese L, Buonamici P, Cerisano G, Santini A, Carrabba N, Santoro GM, et al. Early dobutamine echocardiography predicts improvement in regional and global left ventricular function after reperfused acute myocardial infarction without residual stenosis of the infarct-related artery. Am Heart J 2000;139(1 Pt 1):153–63.
Bolognese L, Neskovic AN, Parodi G, Cerisano G, Buonamici P, Santoro GM, et al. Left ventricular remodeling after primary coronary angioplasty: patterns of left ventricular dilation and long-term prognostic implications. Circulation 2002;106:2351–7.
Irimpen AM, Tenaglia AN, Shin DJ, Buda AJ. Lack of ventricular remodeling in non-Q-wave myocardial infarction. Am Heart J 1996;131:466–71.
Lipiecki J, Cachin F, Durel N, de Tauriac O, Ponsonnaille J, Maublant J. Influence of infarct-zone viability detected by rest Tc-99m sestamibi gated SPECT on left ventricular remodeling after acute myocardial infarction treated by percutaneous transluminal coronary angioplasty in the acute phase. J Nucl Cardiol 2004;11:673–81.
Ernande L, Cachin F, Chabrot P, Durel N, Morand D, Boyer L, et al. Rest and low-dose dobutamine Tc-99m-mibi gated-SPECT for early prediction of left ventricular remodeling after a first reperfused myocardial infarction. J Nucl Cardiol 2009;16:597–604.
The TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 1985;312:932–6.
O’Connor MK, Hammel T, Gibbons RJ. In vitro validation of a simple tomographic technique for estimation of percentage myocardium at risk using methoxyisobutyl isonitrile technetium 99m (sestamibi). Eur J Nucl Med 1990;17:69–76.
Christian TF, Schwartz RS, Gibbons RJ. Determinants of infarct size in reperfusion therapy for acute myocardial infarction. Circulation 1992;86:81–90.
Christian TF, O’Connor MK, Schwartz RS, Gibbons RJ, Ritman EL. Technetium-99m MIBI to assess coronary collateral flow during acute myocardial infarction in two closed-chest animal models. J Nucl Med 1997;38:1840–6.
Germano G, Kiat H, Kavanagh PB, Moriel M, Mazzanti M, Su HT, et al. Automatic quantification of ejection fraction from gated myocardial perfusion SPECT. J Nucl Med 1995;36:2138–47.
Bolognese L, Cerisano G, Buonamici P, Santini A, Santoro GM, Antoniucci D, et al. Influence of infarct-zone viability on left ventricular remodeling after acute myocardial infarction. Circulation 1997;96:3353–9.
Gibson WS, Christian TF, Pellikka PA, Behrenbeck T, Gibbons RJ. Serial tomographic imaging with technetium-99m-sestamibi for the assessment of infarct-related artery patency following reperfusion therapy. J Nucl Med 1992;33:2080–5.
Gibbons RJ, Miller TD, Christian TF. Infarct size measured by single photon emission computed tomographic imaging with (99m)Tc-sestamibi: a measure of the efficacy of therapy in acute myocardial infarction. Circulation 2000;101:101–8.
Gibbons RJ, Miller TD. Tc-99m sestamibi infarct size as a surrogate endpoint. J Nucl Cardiol 2005;12:12–9.
Miller TD, Hodge DO, Sutton JM, Grines CL, O’Keefe JH, DeWood MA, et al. Usefulness of technetium-99m sestamibi infarct size in predicting posthospital mortality following acute myocardial infarction. Am J Cardiol 1998;81:1491–3.
Galli M, Marcassa C, Bolli R, Giannuzzi P, Temporelli PL, Imparato A, et al. Spontaneous delayed recovery of perfusion and contraction after the first 5 weeks after anterior infarction. Evidence for the presence of hibernating myocardium in the infarcted area. Circulation 1994;90:1386–97.
Ndrepepa G, Mehilli J, Martinoff S, Schwaiger M, Schömig A, Kastrati A. Evolution of left ventricular ejection fraction and its relationship to infarct size after acute myocardial infarction. J Am Coll Cardiol 2007;50:149–56.
Uren NG, Crake T, Lefroy DC, de Silva R, Davies GJ, Maseri A. Delayed recovery of coronary resistive vessel function after coronary angioplasty. J Am Coll Cardiol 1993;21:612–21.
Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 1977;56:786–94.
Hayat SA, Janardhanan R, Moon JCC, Pennell DJ, Senior R. Comparison between myocardial contrast echocardiography and single-photon emission computed tomography for predicting transmurality of acute myocardial infarction. Am J Cardiol 2006;97:1718–21.
Kaul S. There may be more to myocardial viability than meets the eye! Circulation 1995;92:2790–3.
Verberne HJ, Dijkgraaf MG, Somsen GA, van Eck-Smit BL. Stress-related variations in left ventricular function as assessed with gated myocardial perfusion SPECT. J Nucl Cardiol 2003;10:456–63.
De Winter O, De Bondt P, Van De Wiele C, De Backer G, Dierckx RA, De Sutter J. Day-to-day variability of global left ventricular functional and perfusional measurements by quantitative gated SPECT using Tc-99m tetrofosmin in patients with heart failure due to coronary artery disease. J Nucl Cardiol 2004;11:47–52.
Sciagrà R, Imperiale A, Antoniucci D, Migliorini A, Parodi G, Comis G, et al. Relationship of infarct size and severity versus left ventricular ejection fraction and volumes obtained from 99mTc-sestamibi gated single-photon emission computed tomography in patients treated with primary percutaneous coronary intervention. Eur J Nucl Med Mol Imaging 2004;31:969–74.
Sciagrà R, Parodi G, Pupi A, Migliorini A, Valenti R, Moschi G, et al. Gated SPECT evaluation of outcome after abciximab-supported primary infarct artery stenting for acute myocardial infarction: the scintigraphic data of the abciximab and carbostent evaluation (ACE) randomized trial. J Nucl Med 2005;46:722–7.
Acampa W, Caprio MG, Nicolai E, Liuzzi R, De Luca S, Capasso E, et al. Assessment of poststress left ventricular ejection fraction by gated SPECT: comparison with equilibrium radionuclide angiocardiography. Eur J Nucl Med Mol Imaging 2010;37:349–56.
Sciagrà R, Berti V, Genovese S, Pupi A. Reliability of myocardial perfusion gated SPECT for the reproducible evaluation of resting left ventricular functional parameters in long-term follow-up. Eur J Nucl Med Mol Imaging 2010;37:1722–9.
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Berti, V., Sciagrà, R., Acampa, W. et al. Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction. Eur J Nucl Med Mol Imaging 38, 1124–1131 (2011). https://doi.org/10.1007/s00259-011-1739-7
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DOI: https://doi.org/10.1007/s00259-011-1739-7