Assessment of the area at risk after acute myocardial infarction using 123I-MIBG SPECT: Comparison with the angiographic APPROACH-score
Assessment of the area at risk (AAR) associated with an acute myocardial infarction is crucial for evaluating prevention and revascularization strategies. The aim of this study was to evaluate whether 123I-metaiodobenzylguanidine (123I-MIBG) single-photon emission computed tomography (SPECT) provides a more widely available assessment of anatomical AAR than the established anatomical angiographic methods.
Seventy patients with ST-segment elevation acute myocardial infarction (STEMI) underwent coronary angiography with percutaneous coronary intervention and subsequent 123I-MIBG myocardial scintigraphy with left myocardial relative radiotracer uptake evaluation 12 ± 10 days after STEMI. Patients were divided into two groups depending on whether the culprit artery was occluded (50 patients) or sub-occluded (20 patients). Two scores were calculated as a percentage of the left ventricular myocardium surface, the first using a standard 17-segment summed rest score derived from the relative quantitative evaluation of 123I-MIBG myocardial uptake (MAR) and the second using the modified APPROACH-score (ApAR).
For the patients with occluded artery, this study showed a high correlation between MAR and the angiographic score (Pearson r = .762 and P < .0001). For the patients with sub-occluded artery, for which the ApAR is not reliable, this study showed no correlation between MAR and the angiographic score (Pearson r = .18 and P = 0.45).
123I-MIBG myocardial scintigraphy provides ARR assessment similar to that of ApAR in patients with a single occluded coronary artery. However, MAR differs from ApAR when angiographic scores are known to be inaccurate (sub-occluded culprit artery) or impossible to use. Further studies are needed to evaluate the potential clinical interest of 123I-MIBG SPECT as an alternative for area at risk assessment after STEMI even when the culprit artery is sub-occluded or when the angiographic scores cannot be used.
KeywordsMyocardial infarction area at risk 123I-MIBG SPECT coronary angiography
Area at risk
Modified APPROACH-score evaluation of the area at risk
123I-MIBG evaluation of the area at risk
Percutaneous coronary intervention
ST-segment elevation acute myocardial infarction
Single-photon emission computed tomography
Mean segmental activity
Magnetic resonance imaging
There is no conflict of interest to declare.
- 10.Carlsson M, Ubachs JF, Hedstrom E, Heiberg E, Jovinge S, Arheden H. Myocardium at risk after acute infarction in humans on cardiac magnetic resonance: quantitative assessment during follow-up and validation with single-photon emission computed tomography. J Am Coll Cardiol Img 2009;2:569-76.CrossRefGoogle Scholar
- 11.Fuernau G, Eitel I, Franke V, Hildebrandt L, Meissner J, De Waha S, et al. Myocardium at risk in ST-segment elevation myocardial infarction. Comparison of T2-weighted edema imaging with the MR-assessed endocardia surface area and validation against angiographic scoring. J Am Coll Cardiol Img 2011;4:967-76.CrossRefGoogle Scholar
- 23.Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. Myocardial iodine-123meta-iodobenzylguanidine imaging and cardiac events in heart failure results of the prospective ADMIRE-HF (AdreViewMyocardial imaging for risk evaluation in heart failure) study. J Am Coll Cardiol 2010;55:2212-21.CrossRefPubMedGoogle Scholar
- 25.Boogersn MJ, Borleffs JW, Henneman MM, Van Bommel RJ, Van Ramshorst J, Boersma E, et al. Cardiac sympathetic denervation assessed with 123-iodine metaiodobenzylguanidine imaging predicts ventricular arrhythmias in implantable cardioverter-defibrillator patients. J Am Coll Cardiol 2010;55:2769-77.CrossRefGoogle Scholar
- 27.Tamaki S, Yamada T, Okuyama Y, Morita T, Sanada S, Tsukamoto Y, et al. Cardiac iodine-123 metaiodobenzylguanidine imaging predicts sudden cardiac death independently of left ventricular ejection fraction in patients with chronic heart failure and left ventricular systolic dysfunction. J Am Coll Cardiol 2009;53:426-35.CrossRefPubMedGoogle Scholar
- 31.D’estanque E, Hedon C, Lattuca B, Bourdon A, Benkiran B, Verd A, et al. Optimization of a simultaneous dual isotope 201Tl/123I-MIBG myocardial SPECT imaging protocol with a CZT camera for trigger zone assessment after myocardial infarction for routine clinical settings: are delayed acquisition and scatter correction necessary? J Nucl Cardiol 2016. doi: 10.1007/s12350-016-0524-1.PubMedGoogle Scholar
- 34.Holls S. Analysis of method comparison studies. JIFCC 1997;9:8-12.Google Scholar
- 36.Jang JS, Spertus JA, Arnold SV, Shafiq A, Grodzinsky A, Fendler TJ, et al. Impact of multivessel revascularization on health status outcomes in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease. J Am Coll Cardiol 2015;66:2104-13.CrossRefPubMedPubMedCentralGoogle Scholar