Abstract
With the emergence of therapeutic modalities to re-establish regional blood flow to jeopardized myocardium in patients with acute myocardial infarction, there is increased interest in the pathophysiology of tissue reperfusion [1–4]. Experimental and clinical studies in humans suggest a transition from reversible ischemic injury to necrosis within 3 to 6 hours which indicates the temporal dependence of beneficial effects of thrombolytic therapy [5–8]. However, early spontaneous recanalization and the individual degree of residual collateral blood flow might significantly influence the time course of infarct development [8]. In addition, energy demand during the acute phase also affects the evolution of tissue infarction [9, 10]. Consequently, the assessment of the extent and stage of the infarction process from the time elapsed from onset of symptoms is difficult but crucial in a given patient [11]. Clinical and histologic evidence indicates the presence of a mixture of necrotic and ischemic but viable myocytes even in late stages. The clinically important task is to identify “incomplete necrosis” which would benefit from therapeutic interventions. Evaluation of blood flow and regional function cannot distinguish between viable but “stunned” from necrotic myocardium. Based on experimental studies that have revealed enhanced glucose utilization relative to blood flow in ischemic but viable tissue [12, 13], the purpose of this study is
-
a)
to assess regional myocardial glucose metabolism in acute myocardial infarction to define the stage of the infarction process, and
-
b)
to compare regional metabolic activity with the outcome of regional function.
Keywords
- Acute Myocardial Infarction
- Positron Emission Tomography Study
- Myocardial Viability
- Regional Wall Motion
- Ischemic Cell Death
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Rentrop P, Blanke H, Karsch KR, Kaiser H, Kostering H, Leitz K (1981) Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation 63:307–317.
Mathey DG, Kuck KH, Tilsner V, Krebber HJ, Bleifeld W (1981) Nonsurgical coronary artery recanalization in acute transmural myocardial infarction. Circulation 63:489–497.
Reduto LA, Freund GC, Gaeta JM, Smalling RW, Lewis B, Bould KL (1981) Coronary artery reperfusion in acute myocardial infarction: Beneficial effects of intracoronary streptokinase on left ventricular salvage and performance. Am Heart J 102:1168–1175.
Ganz W, Buchbinder N, Marcus H, et al (1981) Intracoronary thrombolysis in evolving myocardial infarction. Am Heart J 101:4–15.
Reimer KA, Lowe JE, Rasmussen MM, Jennings RE (1977) The wavefront phenomenon of ischemic cell death. I. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 56:786–794.
Vokonas PS, Malsky PM, Paul SJ, Robbins SL, Hood WB (1978) Radioautographic studies in experimental myocardial infarction: Profiles of ischemic blood flow and quantification of infarct size of ischemic zone. Am J Cardiol 42:62–72.
Mathey DG, Sheehan FH, Schofer J, et al (1985) Time from onset of symptoms to thrombolytic therapy: A major determinant of myocardial salvage in patients with acute transmural infarction. J Am Coll Cardiol 6:518–525.
Nienaber C, Gottwik M, Winkler B, Schaper W (1983) The relationship between the perfusion deficit, infarct size and time after experimental coronary occlusion. Basic Res Cardiol 78:210–216.
Ong L, Reiser P, Coromilas J, Scherr L, Morrison J (1983) Left ventricular function and rapid release of creatine kinase-MB in acute myocardial infarction — evidence for spontaneous reperfusion. N Engl J Med 309:1–6.
Nienaber CA, Spielmann RP, Rozza A, Montz R, Bleifeld W, Mathey DG (1985) Prevalence of spontaneous coronary thrombolysis and its relation to left ventricular function. Eur Heart J E6:145–153.
Sniderman AD, Beaudry JP, Rahal DP (1983) Early recognition of the patient at late high risk: incomplete infarction and vulnerable myocardium. Am J Cardiol 52:669–673.
Bergmann SR, Lerch RA, Fox KAA, et al (1982) Temporal dependence of beneficial effects of coronary thombolysis characterized by positron tomography. Am J Med 73:573–581.
Schwaiger M, Schelbert HR, Ellison D, et al (1985) Sustained regional abnormalities in cardiac metabolism after transient ischemia in the chronic dog model. J Am Coll Cardiol 6:336–347.
Marshall RC, Tillisch JH, Phelps ME, et al (1983) Identification and differentiation of resting myocardial ischemia and infarction in man with positron computed tomography, 18Flabeled fluorodeoxyglucose and N-13 ammonia. Circulation 64:766–778.
Hoffman EJ, Huang SC, Phelps ME (1979) Quantitation in positron emission computed tomography. I. Effects of object size. J Comput Assist Tomogr 3:299–308.
Schelbert HR, Phelps ME, Huang SC, et al (1981) N-13 ammonia as an indicator of myocardial blood flow. Circulation 63:1259–1272.
Tillisch J, Brunken R, Marshal R, Schwaiger M, Phelps M, Schelbert HR (1986) Prediction of the reversibility of cardiac wall motion abnormalities using positron tomography, 18fluorodeoxyglucose and 13N-ammonia. N Engl J Med 314:884–888.
Geltman EM, Biello D, Welch MJ, Terr-Pogossian MM, Roberts R, Sobel BE (1982) Characterization of nontransmural myocardial infarction by positron-emission tomography. Circulation 65:747–755.
Meyer J, Merx W, Schmitz H, et al (1982) Percutaneous transluminal coronary angioplasty immediately after intracoronary streptolysis of transmural myocardial infarction. Circulation 66:905–913.
DeWood MA, Spores J, Notske RN, et al (1979) Medical and surgical management of myocardial infarction. Am J Cardiol 44:1356–1368.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1988 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Nienaber, C., Schwaiger, M., Schelbert, H.R. (1988). Positron Emission Tomography for the Assessment of Myocardial Viability in Acute Myocardial Infarction. In: Vincent, J.L. (eds) Update 1988. Update in Intensive Care and Emergency Medicine, vol 5. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-83392-2_38
Download citation
DOI: https://doi.org/10.1007/978-3-642-83392-2_38
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-18981-7
Online ISBN: 978-3-642-83392-2
eBook Packages: Springer Book Archive