Advertisement

Journal of Nuclear Cardiology

, Volume 25, Issue 3, pp 742–753 | Cite as

Summed thickening score by myocardial perfusion imaging: A risk factor of left ventricular remodeling in patients with myocardial infarction

  • Wei Yang
  • Feifei Zhang
  • Haipeng Tang
  • Xiaoliang Shao
  • Jianfeng Wang
  • Xiaosong Wang
  • Xiaonan Shao
  • Wenchong Xin
  • Ling Yang
  • Weihua Zhou
  • Yuetao Wang
Original Article

Abstract

Background

Left ventricular (LV) remodeling has adverse effects on the prognosis of patients with myocardial infarction (MI). The aim of this study is to identify the risk factors of LV remodeling in MI patients by radionuclide myocardial imaging.

Methods and Results

This retrospective study consisted of 92 patients who had a history of definite prior MI on ECG and underwent both resting gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) and positron emission tomography (PET) myocardial metabolism imaging. LV remodeling was defined as > mean + 2SD of LV end-diastolic volume index (LVEDVi) in the normal database. LV enlargement, cardiac dysfunction, wall thickening abnormalities expressed as summed thickening score (STS) were more severe in the old MI patients as compared to those with subacute MI. STS (Odds ratio, 1.296; P = .004) and the proportion of segments with reduced wall thickening in segments with normal perfusion (Odds ratio, 1.110; P = .001) were identified as the independent factors of LV remodeling in subacute and old MI patients in the multivariate binary regression model. Total perfusion deficit (TPD), viable myocardium, scar, and the proportion of segments with reduced wall thickening in segments with decreased perfusion showed strong correlation with LV remodeling in the univariate regression model as well.

Conclusions

LV remodeling in old MI patients is more extensive and severe than that in subacute MI patients. LV wall thickening abnormalities as expressed by STS and the proportion of segments with reduced wall thickening in segments with normal perfusion are the independent risk factors of LV remodeling in MI patients.

Keywords

SPECT PET myocardial infarction left ventricular remodeling summed thickening score 

Abbreviations

LV

Left ventricular

LVEF

Left ventricular ejection fraction

CMR

Cardiac magnetic resonance

MI

Myocardial infarction

SPECT

Single photon emission computed tomography

MPI

Myocardial perfusion imaging

ECG

Electrocardiogram

18F-FDG

18F-fluorodeoxyglucose

PET

Positron emission tomography

STS

Summed thickening score

TPD

Total perfusion deficit

99mTc-MIBI

99mTc-sestamibi

LVEDV

Left ventricular end-diastolic volume

LVESV

Left ventricular end-systolic volume

CCS

Canadian class classification of angina pectoris

NYHA

New York Heart Association classification of heart failure

COPD

Chronic obstructive pulmonary disease

Notes

Acknowledgements

This research was supported by grants from National Natural Science Foundation of China (Project Number: 81471690, PI: Yuetao Wang), Key Research Foundation of Jiangsu Province (Project Number: BE2015635, PI: Yuetao Wang), Major Project of Changzhou City Health Bureau (Project Number: ZD201409, PI: Xiaosong Wang), and Application and Basic Research Funds of Changzhou Science and Technology Bureau ((Project Number: J20160030, PI: Ling Yang). This research was also supported by a grant from the American Heart Association (Project Number: 17AIREA33700016, PI: Weihua Zhou) and a New Faculty startup grant from the University of Southern Mississippi (Project Number: DE01791, PI: Weihua Zhou).

Disclosures

None of the authors have any relevant conflicts of interest.

Supplementary material

12350_2018_1200_MOESM1_ESM.pptx (874 kb)
Supplementary material 1 (PPT 868 kb)
12350_2018_1200_MOESM2_ESM.mp3 (6.5 mb)
Supplementary material 2 (MP3 6681 kb)

References

  1. 1.
    Verma A, Meris A, Skali H, Ghali JK, Arnold JM, Bourgoun M, et al. Prognostic implications of left ventricular mass and geometry following myocardial infarction: the VALIANT (VALsartan In Acute myocardial iNfarcTion) Echocardiographic Study. JACC Cardiovasc Imaging 2008;1:582-91.CrossRefPubMedGoogle Scholar
  2. 2.
    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;110:18-22.Google Scholar
  3. 3.
    Bonow RO, Castelvecchio S, Panza J, Berman D, Velazquez E, Michler R, et al. Does severity of left ventricular remodeling influence the relation between myocardial viability and survival with medical or surgical therapy in patients with coronary artery disease and left ventricular dysfunction? J Am Coll Cardiol 2014;63:A1625.CrossRefGoogle Scholar
  4. 4.
    Anagnostopoulos CD, Cokkinos DV. Prediction of left ventricular remodelling by radionuclide imaging. Eur J Nucl Med Mol Imaging 2011;38:1120-3.CrossRefPubMedGoogle Scholar
  5. 5.
    Konstam MA, Kramer DG, Patel AR, Maron MS, Udelson JE. Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment. JACC Cardiovasc Imaging 2011;4:98-108.CrossRefPubMedGoogle Scholar
  6. 6.
    Wei H, Tian C, Schindler TH, Qiu M, Lu M, Shen R, et al. The impacts of severe perfusion defects, akinetic/dyskinetic segments, and viable myocardium on the accuracy of volumes and LVEF measured by gated (99m)Tc-MIBI SPECT and gated (18)F-FDG PET in patients with left ventricular aneurysm: cardiac magnetic reson. J Nucl Cardiol 2015;22:785.CrossRefPubMedGoogle Scholar
  7. 7.
    Berti V, Sciagra R, Acampa W, Ricci F, Cerisano G, Gallicchio R, 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 2011;38:1124-31.CrossRefPubMedGoogle Scholar
  8. 8.
    Nijland F, Kamp O, Verhorst PMJ, Voogt WGD, Bosch HG, Visser CA. Myocardial viability: impact on left ventricular dilatation after acute myocardial infarction. Heart (British Cardiac Society) 2002;87:17-22.CrossRefGoogle Scholar
  9. 9.
    Götte MJW, van Rossum AC, Twisk JWR, Kuijer JPA, Marcus JT, Visser CA. Quantification of regional contractile function after infarction: strain analysis superior to wall thickening analysis in discriminating infarct from remote myocardium. J Am Coll Cardiol 2001;37:808-17.CrossRefPubMedGoogle Scholar
  10. 10.
    Uebleis C, Hoyer X, Van Kriekinge SD, Schuessler F, Laubender RP, Becker A, et al. Association between left ventricular mechanical dyssynchrony with myocardial perfusion and functional parameters in patients with left bundle branch block. J Nucl Cardiol 2013;20:253-61.CrossRefPubMedGoogle Scholar
  11. 11.
    Tilkemeier PL. ASNC imaging guidelines for nuclear cardiology procedures standardized reporting of myocardial perfusion images. J Nucl Cardiol 2009;16:651.CrossRefGoogle Scholar
  12. 12.
    Xu Y, Fish M, Gerlach J, Lemley M, Berman DS, Germano G, et al. Combined quantitative analysis of attenuation corrected and non-corrected myocardial perfusion SPECT: Method development and clinical validation. J Nucl Cardiol 2010;17:591.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Sharir T, Berman DS, Waechter PB, Areeda J, Kavanagh PB, Gerlach J, Sharir T, Berman DS, Waechter PB, et al. Quantitative analysis of regional motion and thickening by gated myocardial perfusion SPECT: Normal heterogeneity and criteria for abnormality. J Nucl Med 2001;42:1630-8.PubMedGoogle Scholar
  14. 14.
    Akincioglu C, Berman DS, Nishina H, Kavanagh PB, Slomka PJ, Abidov A, et al. Assessment of diastolic function using 16-frame 99mTc-sestamibi gated myocardial perfusion SPECT: normal values. J Nucl Med 2005;46:1102-8.PubMedGoogle Scholar
  15. 15.
    Zhang X, Liu XJ, Wu Q, Shi R, Gao R, Liu Y, et al. Clinical outcome of patients with previous myocardial infarction and left ventricular dysfunction assessed with myocardial (99m)Tc-MIBI SPECT and (18)F-FDG PET. J Nucl Med 2001;42:1166.PubMedGoogle Scholar
  16. 16.
    Beanlands RSB, Ruddy TD, Dekemp RA, Iwanochko RM, Coates G, Freeman M, et al. Positron emission tomography and recovery following revascularization (PARR-1): the importance of scar and the development of a prediction rule for the degree of recovery of left ventricular function. J Am Coll Cardiol 2002;40:1735-43.CrossRefPubMedGoogle Scholar
  17. 17.
    Gajarsa JJ, Kloner RA. Left ventricular remodeling in the post-infarction heart: a review of cellular, molecular mechanisms, and therapeutic modalities. Heart Fail Rev 2011;16:13-21.CrossRefPubMedGoogle Scholar
  18. 18.
    Westman PC, Lipinski MJ, Luger D, Waksman R, Bonow RO, Wu E, et al. Inflammation as a driver of adverse left ventricular remodeling after acute myocardial infarction. J Am Coll Cardiol 2016;67:2050.CrossRefPubMedGoogle Scholar
  19. 19.
    Bhatt AS, Ambrosy AP, Velazquez EJ. Adverse remodeling and reverse remodeling after myocardial infarction. Curr Cardiol Rep 2017;19:71.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    O’Regan DP, Shi W, Ariff B, Baksi AJ, Durighel G, Rueckert D, et al. Remodeling after acute myocardial infarction: mapping ventricular dilatation using three dimensional CMR image registration. J Cardiovasc Magn Reson 2012;14:1-9.CrossRefGoogle Scholar
  22. 22.
    Vatner SF. Correlation between acute reductions in myocardial blood flow and function in conscious dogs. Circ Res 1980;47:201.CrossRefPubMedGoogle Scholar
  23. 23.
    Chan W, Duffy SJ, White DA, Gao XM, Du XJ, Ellims AH, et al. Acute Left ventricular remodeling following myocardial infarction: Coupling of regional healing with remote extracellular matrix expansion. Jacc Cardiovasc Imaging 2012;5:884-93.CrossRefPubMedGoogle Scholar
  24. 24.
    Ishizu T, Seo Y, Baba M, Machino T, Higuchi H, Shiotsuka J, et al. Impaired subendocardial wall thickening and post-systolic shortening are signs of critical myocardial ischemia in patients with flow-limiting coronary stenosis. Circ J 2011;75:1934-41.CrossRefPubMedGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  • Wei Yang
    • 1
  • Feifei Zhang
    • 1
  • Haipeng Tang
    • 2
  • Xiaoliang Shao
    • 1
  • Jianfeng Wang
    • 1
  • Xiaosong Wang
    • 1
  • Xiaonan Shao
    • 1
  • Wenchong Xin
    • 1
  • Ling Yang
    • 3
  • Weihua Zhou
    • 2
  • Yuetao Wang
    • 1
  1. 1.Department of Nuclear MedicineThe Third Affiliated Hospital of Soochow UniversityChangzhouChina
  2. 2.School of ComputingUniversity of Southern MississippiLong BeachUSA
  3. 3.Department of CardiologyThe Third Affiliated Hospital of Soochow UniversityChangzhouChina

Personalised recommendations