[Evolution of systolic function and myocardial perfusion, evaluated by gated-SPECT, in the first year after acute
Jaume Candell-Riera1, Osvaldo Pereztol-Valdés, Guillermo Oller-Martínez
1Servicios de Cardiología y de Medicina Nuclear. Hospital Universitari Vall d'Hebron. Barcelona. España. jcandell@hg.vhebron.es
Insights
Systolic function significantly improved in infero-lateral myocardial infarctions within the first year post-discharge. This improvement in ejection fraction was linked to enhanced myocardial perfusion at rest.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Systolic function and myocardial perfusion are critical indicators post-acute myocardial infarction.
- Changes in these parameters can occur during the first year after infarction.
- Gated-Single Photon Emission Computed Tomography (gated-SPECT) is a valuable tool for evaluating cardiac function and perfusion.
Purpose of the Study:
- To assess changes in left ventricular systolic function and myocardial perfusion.
- To evaluate these parameters using gated-SPECT one year after acute myocardial infarction.
- To compare changes between infero-lateral and anterior infarcts.
Main Methods:
- Seventy-four patients with first acute myocardial infarction underwent stress-rest 99mTc-tetrofosmin and rest-gated-SPECT.
- Scans were performed before hospital discharge (6-8 days post-admission) and one year later.
- Patients were categorized into infero-lateral (n=49) and anterior (n=25) infarct groups.
Main Results:
- Ejection fraction (EF) increased by >5% in 51% of infero-lateral infarcts and 28% of anterior infarcts.
- Significant EF improvement (48.4% to 54.6%) and decreased systolic volume were observed in infero-lateral infarcts (p<0.0001).
- Rest perfusion index in the necrotic region improved in infero-lateral infarcts (p=0.004), while ischemia index remained unchanged.
Conclusions:
- Left ventricular systolic function can improve within the first year post-acute myocardial infarction.
- Infero-lateral infarcts showed significant improvement in EF, with over half experiencing >5% increase.
- This functional improvement correlated with enhanced resting myocardial perfusion.
Introduction And Objectives:
Systolic function and myocardial perfusion are evaluated before hospital discharge and can change during follow-up. The purpose of this study was to evaluate these parameters by gated-SPECT in the first year after acute myocardial infarction.
Patients And Method:
We studied 74 consecutive patients with a first uncomplicated acute myocardial infarction (49 infero-lateral and 25 anterior) by stress-rest 99mTc-tetrofosmin and rest-gated-SPECT before hospital discharge (6-8 days after admission) and one year after myocardial infarction.
Results:
The ejection fraction (EF) increased > 5% in 51% of infero-lateral infarcts and 28% of non-revascularized anterior infarcts. EF increased significantly (48.4 8% to 54.6 8.7%; p < 0.0001, mean difference: 6.2; 95% IC, 2.8-9.5) and systolic volume decreased (51.3 19.2 ml to 44.3 19.4 ml; p = 0.001; mean diff.: 7.67; 95% IC, 1.5-13.8) in infero-lateral infarctions. The rest perfusion index in the necrotic region improved (2.3 0.57 to 2.17 0.58; p = 0.004; mean diff.: 0.18; 95% IC, 0.003-0.36) in infero-lateral infarcts and the ischemia index remained unchanged between the first and second studies.
Conclusions:
Left ventricular systolic function can change during the first year of evolution, a significant improvement being seen in infero-lateral infarctions. The ejection fraction increased > 5% in half of these patients, as opposed to only a quarter of anterior infarctions. This improvement was associated to increased myocardial perfusion at rest.
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