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Relation between wall thickening on gated perfusion SPECT and functional recovery after coronary revascularization in
Mario Petretta1, Giovanni Storto, Wanda Acampa
1Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Naples, Italy.
Insights
Gated perfusion SPECT wall thickening analysis offers additional insights into predicting myocardial functional recovery after revascularization. Perfusion imaging alone is more valuable for patient-level predictions of recovery post-myocardial infarction.
Area of Science:
- Cardiovascular imaging
- Nuclear cardiology
- Myocardial perfusion imaging
Background:
- Left ventricular (LV) dysfunction post-myocardial infarction (MI) impacts prognosis.
- Revascularization aims to restore myocardial function.
- Predicting functional recovery is crucial for guiding treatment decisions.
Purpose of the Study:
- To assess the utility of wall thickening analysis using gated perfusion single-photon emission computed tomography (SPECT) in predicting functional recovery after revascularization.
- To compare the predictive value of wall thickening versus perfusion imaging for myocardial recovery.
Main Methods:
- 41 patients with prior MI and LV dysfunction underwent rest 99mTc-sestamibi gated SPECT.
- Echocardiography assessed baseline wall motion abnormalities.
- Wall thickening and perfusion data were correlated with functional recovery post-revascularization.
Main Results:
- Perfusion imaging demonstrated higher sensitivity and specificity than wall thickening analysis for predicting recovery of akinetic/dyskinetic segments.
- Segments with viable myocardium (≥55% sestamibi uptake) and detectable wall thickening showed higher functional recovery rates.
- Perfusion imaging was more sensitive for predicting improvement in ejection fraction (EF) on a patient basis.
Conclusions:
- Wall thickening analysis by gated perfusion SPECT provides supplementary information for predicting segmental functional recovery in coronary artery disease.
- Perfusion status alone appears more valuable for predicting overall patient functional recovery after revascularization.
Purpose:
This study aimed to evaluate whether wall thickening analysis by gated perfusion single-photon emission computed tomography (SPECT) is useful in predicting functional recovery after revascularization.
Methods:
Forty-one patients with previous myocardial infarction and left ventricular (LV) dysfunction (ejection fraction, EF, 36+/-6%) who were scheduled for revascularization underwent rest 99mTc-sestamibi gated SPECT.
Results:
Of 131 akinetic or dyskinetic segments at baseline echocardiography, 82 (63%) recovered after revascularization. Compared with wall thickening analysis, perfusion imaging provided higher sensitivity (78% vs 50%, P<0.0001) and specificity (80% vs 71%, P<0.0005). Among segments with > or =55% sestamibi uptake (viable), those with detectable wall thickening had a higher likelihood of functional recovery than those with absent wall thickening (95% vs 77%, P<0.05). In segments with improved function, the absence of wall thickening was associated with lower sestamibi activity than was observed when detectable wall thickening was present (58+/-14% vs 71+/-13%, P<0.0005). An increase in EF of > or =5% was detectable in 22 (54%) patients. For the prediction of EF improvement, perfusion imaging provided a higher sensitivity than wall thickening analysis (68% vs 41%, P<0.05), while specificity was not significantly different (68% vs 74%). The prevalence of patients with functional recovery did not change when wall thickening analysis was considered in addition to perfusion status (73% in patients with detectable wall thickening and 70% in those without; P=NS).
Conclusion:
In patients with coronary artery disease, wall thickening analysis by gated perfusion SPECT provides additional information compared with perfusion data for the prediction of segmental functional recovery. However, on a patient basis, wall thickening assessment seems to be of more limited value than perfusion status.
