| Prospective identification of myocardial stunning using technetium-99m sestamibi-based measurements of infarct size. | |
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MedLine Citation:
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PMID: 9385887 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to prospectively identify patients with stunning and hyperkinesia at hospital discharge on the basis of mismatches between left ventricular (LV) function and infarct size as assessed by technetium-99m (Tc-99m) sestamibi perfusion tomographic imaging. BACKGROUND: Mechanical indexes of LV function may not accurately reflect myocardial damage after acute myocardial infarction (MI) because of myocardial stunning and compensatory hyperkinesia in noninfarct-related territories. Myocardial perfusion techniques are unaffected by these variables. METHODS: Eighty-four patients with acute MI underwent hospital admission and discharge Tc-99m-sestamibi tomographic imaging. Global LV ejection fraction (LVEF) was measured at hospital discharge and 6 weeks later. The perfusion defect size was quantified and expressed as a percentage of the LV. The discharge perfusion defect, which is a measure of infarct size, was used to predict the 6-week LVEF for each patient based on a previously reported regression equation. Patients were classified into one of three groups depending on whether their LVEF at hospital discharge fell within, above or below one standard error (6.8 LVEF points) of the predicted 6-week LVEF. RESULTS: There were 48 patients classified as having a "match" between function and infarct size; these patients demonstrated no significant change in LVEF at 6 weeks. There were 21 patients (25%) classified as "mismatch stunned" who had discharge LVEFs lower than those predicted by infarct size. These patients demonstrated a significant improvement in mean LVEF at 6 weeks (mean [+/-SD] discharge LVEF 0.41 +/- 0.08, 6-week LVEF 0.47 +/- 0.10; p = 0.003). Fifteen patients (18%) were classified as "mismatch-hyperkinetic." The mean LVEF for these patients significantly declined at 6 weeks (discharge LVEF 0.64 +/- 0.06, 6-week LVEF 0.58 +/- 0.09; p = 0.002). There was a marked increase in LVEF within the infarct zone (8 +/- 15 LVEF points; p = 0.03) for patients predicted to have stunning and a marked decline in LVEF outside the infarct zone (9 +/- 15 LVEF points; p = 0.06) in patients predicted to have hyperkinesia. Both discharge LVEF (p < 0.0001) and group classification (p = 0.005) were independent predictors of LVEF 6 weeks later. CONCLUSIONS: Perfusion imaging with Tc-99m-sestamibi can identify post-MI patients at hospital discharge in whom LV function is discordant with the measured infarct size. Patients with stunning have late increases in LVEF; patients with hyperkinesia have late decreases. This methodology, performed at discharge, is predictive of late changes in LV function. |
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Authors:
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T F Christian; M J Gitter; T D Miller; R J Gibbons |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 30 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1997 Dec |
Date Detail:
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Created Date: 1997-12-19 Completed Date: 1997-12-19 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1633-40 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. christian.timothy@mayo.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Case-Control Studies Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction / complications, physiopathology, therapy Myocardial Reperfusion Myocardial Stunning / physiopathology, radionuclide imaging* Prospective Studies Radiopharmaceuticals / diagnostic use* Technetium Tc 99m Sestamibi / diagnostic use* Thrombolytic Therapy Time Factors Ventricular Function, Left / physiology |
| Chemical | |
Reg. No./Substance:
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0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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