Document Detail


Site of myocardial infarction and severity of perfusion abnormalities impact on post-stress left ventricular function in patients with single-vessel disease: gated single-photon emission computed tomography methoxyisobutylisonitrile study.
MedLine Citation:
PMID:  19077915     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We used gated single-photon emission computed tomography methoxyisobutylisonitrile (SPECT MIBI) to (i) determine whether location of myocardial infarction (MI) and severity of perfusion abnormalities affect post-stress left ventricular function in patients with single-vessel coronary artery disease, and (ii) correlate changes between post-stress and rest ejection fraction (EF) with the severity of perfusion and regional wall motion abnormalities (RWMAs). METHODS: Eighty-eight patients with a history (> or =3 months) of anterior MI (n=45) or inferior MI (n=43) underwent a 2-day stress-rest gated SPECT MIBI. 4D-MSPECT software was used to calculate left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), EF, and the difference from post-stress to rest EF (EFs-EFr). Summed stress scores, summed rest scores, and summed difference scores (SDS) were calculated based on the 17-segment model. RWMAs were visually assessed using a 5-point score. RESULTS: Patients with anterior MI, compared with those with inferior MI, showed significantly greater perfusion abnormalities (summed stress score 11.0+/-5.5 vs. 7.5+/-2.4, P<0.01, summed rest score 7.4+/-4.7 vs. 5.2+/-1.9, P<0.01, SDS 3.3+/-1.0 vs. 1.9+/-1.0, P<0.05) and higher post-stress and rest RWMA (RWMSS 12.2+/-6.0 vs. 8.7+/-4.1, P<0.01, RWMRS 8.7+/-5.4 vs. 5.6+/-3.0, P<0.01). In 22 patients with anterior reversible ischemia in addition to fixed defect, post-stress and rest EDV and ESV were significantly larger and post-stress EF decreased more than in 21 patients with inferior MI (EDV 144.0+/-28.9 ml vs. 108.6+/-36.9 ml, ESV 70.6+/-22.2 ml vs. 53.4+/-20.5 ml, EFs-EFr -4.2+/-3.5% vs. -1.5+/-2.2%, P<0.01). SDS and RWMA were highly correlated with EFs-EFr. CONCLUSION: In patients with single-vessel coronary artery disease, the extent and severity of perfusion and RWMAs assessed by gated SPECT MIBI are greater after anterior MI than inferior MI. Global left ventricular function is significantly more affected after anterior MI only in patients with reversible ischemia in addition to fixed wall defect. Decrease in EF from post-stress to rest is closely associated with the severity of perfusion and RWMAs. Overall results suggest that the extent and severity of perfusion and RWMAs are more prominent in the myocardial region supplied by left anterior descending coronary artery than by right coronary artery, which may explain significantly worse post-stress left ventricular function after anterior MI.
Authors:
Dragana P Sobic-Saranovic; Smiljana V Pavlovic; Branko D Beleslin; Zorica R Petrasinovic; Nebojsa Dj Kozarevic; Mila V Todorovic-Tirnanic; Tanja M Ille; Emilija D Jaksic; Vera M Artiko; Vladimir B Obradovic
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Nuclear medicine communications     Volume:  30     ISSN:  0143-3636     ISO Abbreviation:  Nucl Med Commun     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-05     Completed Date:  2009-03-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8201017     Medline TA:  Nucl Med Commun     Country:  England    
Other Details:
Languages:  eng     Pagination:  148-54     Citation Subset:  IM    
Affiliation:
aInstitute for Nuclear Medicine bInstitute for Cardiovascular Diseases, Clinical Center of Serbia cInstitute for Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia.
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MeSH Terms
Descriptor/Qualifier:
Coronary Artery Disease / complications,  radionuclide imaging*
Exercise Test
Female
Gated Blood-Pool Imaging / methods*
Humans
Male
Middle Aged
Myocardial Infarction / complications,  radionuclide imaging*
Radiopharmaceuticals / diagnostic use
Reproducibility of Results
Sensitivity and Specificity
Severity of Illness Index
Technetium Tc 99m Sestamibi / diagnostic use*
Tomography, Emission-Computed, Single-Photon / methods*
Ventricular Dysfunction, Left / complications,  radionuclide imaging*
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi

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