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Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Purpose

In gated myocardial perfusion SPECT, apical remodeling may be identified by the presence of a divergent pattern (DP) of the left ventricle (LV).

Methods and Results

We examined 150 anterior ST-elevation myocardial infarction (STEMI) patients, all successfully treated with primary percutaneous coronary interventions (PCI). Perfusion gated-SPECT to measure infarct size, LV end-diastolic (ED) and end-systolic (ES) volumes and ejection fraction (EF) was acquired before hospital discharge and repeated at 6-month follow-up. DP was observed in 26 patients, who had larger infarct size (28 ± 19% vs. 15.7 ± 17%, P < 0.02), and lower EF (33 ± 7% vs. 41 ± 10%, P < 0.001) than patients without DP. At follow-up, DP patients had significantly larger EDV (156 ± 54 vs. 107 ± 44 mL, P < 0.0001), ESV (104 ± 47 vs. 59 ± 36 mL, P < 0.0001) and lower EF (35 ± 12% vs. 48 ± 13%, P < 0.0001). 54% of DP patients developed remodeling at follow-up vs. 12% of those without DP (P < 0.001). During follow up, 7 events in the DP group (27%) and 11 events in patients without DP (9%; P < 0.02) occurred. Kaplan–Meier survival curves showed a worse prognosis for DP patients.

Conclusion

In patients with anterior AMI, early DP detection is related to subsequent LV dysfunction, larger infarct size, and worse severity. It is helpful for predicting LV remodeling at short-term follow-up and has prognostic implications.

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Abbreviations

AMI:

Acute myocardial infarction

DP:

Divergent pattern

EF:

Ejection fraction

EDV:

End-diastolic volume

ESV:

End-systolic volume

LV:

Left ventricle

PCI:

Percutaneous coronary interventions

SPECT:

Single-photon emission computed tomography

STEMI:

ST-elevation myocardial infarction

References

  1. Romero-Farina G, Candell-Riera J, Aguadé-Bruix S, Castell-Conesa J, de León G. Analysis of apical remodeling in gated myocardial perfusion SPECT imaging in ischemic cardiomyopathy. J Nucl Cardiol 2008;15:225‐31.

    Article  Google Scholar 

  2. Burns RJ, Gibbons RJ, Yi Q, Roberts RS, Miller TD, Schaer GL. CORE Study Investigators. The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis. J Am Coll Cardiol 2002;39:30‐6.

    Article  Google Scholar 

  3. Savoye C, Equine O, Tricot O, Nugue O, Segrestin B, Sautière K, et al. Left ventricular remodeling after anterior wall acute myocardial infarction in modern clinical practice (from the REmodelage VEntriculaire [REVE] Study Group). Am J Cardiol 2006;98:1144‐9.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. 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.

    Article  Google Scholar 

  6. Miller TD, Sciagrà R, Gibbons JJ. Application of technetium-99m sestamibi single photon emission computed tomography in acute myocardial infarction: Measuring the efficacy of therapy. Q J Nucl Med Mol Imaging 2010;54:213‐29.

    CAS  Google Scholar 

  7. Cerisano G, Buonamici P, Valenti R, Sciagrà R, Raspanti S, Santini A, et al. Early short-term doxycycline therapy in patients with acute myocardial infarction and left ventricular dysfunction to prevent the ominous progression to adverse remodeling: The TIPTOP trial. Eur Heart J 2014;35:184‐91.

    Article  CAS  Google Scholar 

  8. Giglioli C, Cecchi E, Sciagrá R, Baldereschi GJ, Meucci F, Valente S, et al. COmparison between COronary THrombus aspiration with Angiojet® or Export® catheter in patients with ST-elevation myocardial infarction submitted to primary angioplasty: The COCOTH Study. Int J Cardiol 2016;203:757‐62.

    Article  Google Scholar 

  9. Parodi G, Valenti R, Carrabba N, Memisha G, Moschi G, Migliorini A, et al. Long-term prognostic implications of non-optimal primary angioplasty for acute myocardial infarction. Catheter Cardiovasc Interv 2006;68:50‐5.

    Article  Google Scholar 

  10. 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.

    Article  Google Scholar 

  11. Miller TD, Christian TF, Hopfenspirger MR, Hodge DO, Gersh BJ, Gibbons RJ. Infarct size after acute myocardial infarction measured by quantitative tomographic 99mTc-sestamibi imaging predicts subsequent mortality. Circulation 1995;92:334‐41.

    Article  CAS  Google Scholar 

  12. Christian TF, Schwartz RS, Gibbons RJ. Determinants of infarct size in reperfusion therapy for acute myocardial infarction. Circulation 1992;96:81‐90.

    Article  Google Scholar 

  13. Christian TF, Berger PB, O’Connor MK, Hodge DO, Gibbons RJ. Threshold values for preserved viability with a noninvasive measurement of collateral blood flow during acute myocardial infarction treated by direct coronary angioplasty. Circulation 1999;100:2392‐5.

    Article  CAS  Google Scholar 

  14. 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.

    CAS  Google Scholar 

  15. Bolognese L. Left ventricular remodeling after primary coronary angioplasty: Patterns of left ventricular dilation and long-term prognostic implications. Circulation 2002;106:2351‐7.

    Article  Google Scholar 

  16. Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J 2012;33:2569‐619.

    Article  CAS  Google Scholar 

  17. Flachskampf FA, Schmid M, Rost C, Achenbach S, DeMaria AN, Daniel WG. Cardiac imaging after myocardial infarction. Eur Heart J 2011;32:272‐83.

    Article  Google Scholar 

  18. Heusch G, Libby P, Gersh B, Yellon D, Böhm M, Lopaschuk G, et al. Cardiovascular remodelling in coronary artery disease and heart failure. Lancet 2014;383:1933‐43.

    Article  Google Scholar 

  19. Prasad A, Stone GW, Holmes DR, Gersh B. Reperfusion injury, microvascular dysfunction, and cardioprotection: The “dark side” of reperfusion. Circulation 2009;120:2105‐12.

    Article  Google Scholar 

  20. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation 2002;105:656‐62.

    Article  Google Scholar 

  21. Seiler C. The human coronary collateral circulation. Eur J Clin Investig 2010;40:465‐76.

    Article  Google Scholar 

  22. Piérard LA, Lancellotti P. Risk stratification after myocardial infarction: Toward novel quantitative assessment of left ventricular mechanics? J Am Coll Cardiol 2010;56:1823‐5.

    Article  Google Scholar 

  23. Mollema SA, Nucifora G, Bax JJ. Prognostic value of echocardiography after acute myocardial infarction. Heart 2009;95:1732‐45.

    Article  CAS  Google Scholar 

  24. Dionisopoulos P, Smart SC, Sagar KB. Dobutamine stress echocardiography predicts left ventricular remodelling after acute myocardial infarction. J Am Soc Echocardiogr 1999;12:777‐84.

    Article  CAS  Google Scholar 

  25. Li F, Chen YG, Yao GH, Li L, Ge ZM, Zhang M, et al. Usefulness of left ventricular conic index measured by real-time three-dimensional echocardiography to predict left ventricular remodelling after acute myocardial infarction. Am J Cardiol 2008;102:1433‐7.

    Article  Google Scholar 

  26. Di Cesare E, Cademartiri F, Carbone I, Carriero A, Centonze M, De Cobelli F, et al. Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging. Radiol Med 2013;118:752‐98.

    Article  Google Scholar 

  27. Larsen TH, Stugaard M, Rotevatn S, Nygård O, Nordrehaug JE, et al. Clinical significance of late enhancement and regional wall remodeling assessed by 3T magnetic resonance imaging. Clin Med Insights Cardiol. 2015;9:17‐24.

    Article  Google Scholar 

  28. Wu E, Judd R, Vargas JD, Klocke FJ, Bonow RO, Kim RJ. Visualisation of presence, location, and transmural extent of healed Q-wave and non-Q-wave myocardial infarction. Lancet 2001;357:21‐8.

    Article  CAS  Google Scholar 

  29. Krittayaphong R, Boonyasirinant T, Chaithiraphan V, Maneesai A, Saiviroonporn P, Nakyen S, et al. Prognostic value of late gadolinium enhancement in hypertensive patients with known or suspected coronary artery disease. Int J Cardiovasc Imaging 2010;26:123‐31.

    Article  Google Scholar 

  30. Catalano O, Moro G, Perotti M, Frascaroli M, Ceresa M, Antonaci S, et al. Late gadolinium enhancement by cardiovascular magnetic resonance is complementary to left ventricle ejection fraction in predicting prognosis of patients with stable coronary artery disease. J Cardiovasc Magn Reson 2012;14:29.

    Article  Google Scholar 

  31. Petriz JL, Gomes BF, Rua BS, Azevedo CF, Hadlich MS, Mussi HT, et al. Assessment of myocardial infarction by cardiac magnetic resonance imaging and long-term mortality. Arq Bras Cardiol 2015;104:159‐68.

    Google Scholar 

  32. van der Wall EE, van Rugge FP, Vliegen HW, Reiber JH, de Roos A, Bruschke AV. Ischemic heart disease: Value of MR techniques. Int J Card Imaging 1997;13:179‐89.

    Article  Google Scholar 

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Disclosures

Raffaella Calabretta, MD; Angelo Castello, MD; Cristina Giglioli, MD; Emanuele Cecchi, MD; Giampaolo Cerisano, MD; Marcus Hacker, MD; Roberto Sciagrà, MD: Disclosures: none.

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Authors and Affiliations

  1. Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy

    R. Calabretta MD, A. Castello MD & R. Sciagrà MD

  2. Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    R. Calabretta MD & M. Hacker MD

  3. Division of Nuclear Medicine, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy

    A. Castello MD

  4. Intensive Cardiac Coronary Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    C. Giglioli MD & E. Cecchi MD

  5. Division of Cardiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    G. Cerisano MD

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  1. R. Calabretta MD
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Raffaella Calabretta, MD; Angelo Castello, MD; Cristina Giglioli, MD; Emanuele Cecchi, MD; Giampaolo Cerisano, MD; Marcus Hacker, MD; Roberto Sciagrà, MD: Not applicable.

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Calabretta, R., Castello, A., Giglioli, C. et al. Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction. J. Nucl. Cardiol. 29, 3115–3122 (2022). https://doi.org/10.1007/s12350-021-02874-6

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