Document Detail


Impaired myocardial tissue perfusion early after successful thrombolysis. Impact on myocardial flow, metabolism, and function at late follow-up.
MedLine Citation:
PMID:  7554184     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Impaired tissue reperfusion after successful recanalization of an epicardial coronary artery has been documented both in animals and in patients with acute myocardial infarction. Whether this phenomenon can be demonstrated with positron emission tomography (PET) and whether it has an effect on late recovery of flow, metabolism, and function are unknown. METHODS AND RESULTS: Thirty patients with an acute myocardial infarction and TIMI flow grade 3 of the infarcted vessel at 90 minutes after thrombolytic therapy were studied. Within 24 hours after thrombolysis, at 5 days and at 3 months, myocardial blood flow was measured with 13NH3. 18FDG uptake was measured at 5 days. Radionuclide left ventricular angiograms were acquired at 5 days and at 3 months. In 11 patients (37%), regional myocardial flow was severely impaired (< 50% of normally perfused myocardium) despite successful thrombolysis. No recovery of left ventricular function occurred in any of these patients at 3 months. In 12 patients (40%), intermediate flows (50% to 75% of normal) were found, with functional improvement after angioplasty only in regions with a PET mismatch. Seven patients (23%) had high flow values early after successful thrombolysis (> 75% of normal) and showed preserved regional contractile function at 3 months. CONCLUSIONS: This study is the first demonstration with PET of impaired myocardial tissue perfusion in patients with an acute myocardial infarction after successful thrombolysis. Functional recovery of the reperfused myocardium is observed only when adequate tissue flow is restored. PET may be helpful in selecting patients in whom additional revascularization can improve recovery of left ventricular function.
Authors:
A Maes; F Van de Werf; J Nuyts; G Bormans; W Desmet; L Mortelmans
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  92     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1995 Oct 
Date Detail:
Created Date:  1995-11-14     Completed Date:  1995-11-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2072-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Nuclear Medicine, University of Leuven, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Aged
Case-Control Studies
Coronary Angiography
Coronary Circulation / physiology
Deoxyglucose / analogs & derivatives,  diagnostic use
Female
Fibrinolytic Agents / therapeutic use*
Fluorine Radioisotopes / diagnostic use
Fluorodeoxyglucose F18
Follow-Up Studies
Gated Blood-Pool Imaging
Heart / radionuclide imaging*
Humans
Male
Metalloendopeptidases / therapeutic use
Middle Aged
Myocardial Infarction / drug therapy*,  physiopathology,  radionuclide imaging*
Myocardium / metabolism
Prospective Studies
Recombinant Proteins / therapeutic use
Thrombolytic Therapy*
Time Factors
Tissue Plasminogen Activator / therapeutic use
Tomography, Emission-Computed*
Ventricular Function, Left / physiology
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Fluorine Radioisotopes; 0/Recombinant Proteins; 154-17-6/Deoxyglucose; 63503-12-8/Fluorodeoxyglucose F18; EC 3.4.21.68/Tissue Plasminogen Activator; EC 3.4.24.-/Metalloendopeptidases; EC 3.4.24.29/auR protein, Staphylococcus aureus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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