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Published on: December 11, 2016
Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling
Valentina Berti1, Roberto Sciagrà, Wanda Acampa
1Nuclear Medicine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy.
Insights
Infarct severity and size assessed by gated SPECT after acute myocardial infarction (AMI) can predict left ventricular (LV) remodelling. Infarct severity is a stronger predictor than infarct size for long-term LV function changes.
Area of Science:
- Cardiology
- Radiology
- Nuclear Medicine
Background:
- Left ventricular (LV) remodelling can occur after acute myocardial infarction (AMI) even with successful reperfusion.
- Assessing long-term changes in myocardial perfusion and LV function is crucial for patient outcomes.
Purpose of the Study:
- To investigate the long-term evolution of myocardial perfusion and LV function after AMI using gated single photon emission computed tomography (SPECT).
- To identify predictors of LV remodelling following successful primary percutaneous coronary intervention for AMI.
Main Methods:
- Sixty-eight AMI patients underwent (99m)Tc-sestamibi gated SPECT at 1 month and 6-month follow-up.
- LV remodelling was defined as a 20% increase in LV end-diastolic volume.
- Infarct size and severity were assessed as potential predictors.
Main Results:
- Patients who developed LV remodelling had larger and more transmural infarctions at baseline.
- Infarct severity was the strongest predictor of LV remodelling (F = 5.54, p < 0.05).
- Infarct size and severity accurately predicted LV remodelling with 75% accuracy and 95% negative predictive value.
Conclusions:
- Gated SPECT perfusion parameters in the subacute phase correlate with long-term functional changes after AMI.
- Infarct severity is a more effective predictor of LV remodelling than infarct size.
- Both infarct size and severity are valuable for predicting LV remodelling post-AMI.
Purpose:
After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the long-term evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling.
Methods:
Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent (99m)Tc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up.
Results:
At baseline, patients with remodelling (n = 14) showed larger (infarct size 29.3 ± 7.8%) and more transmural (infarct severity 0.28 ± 0.10) infarctions, and reduced LV ejection fraction (35.4 ± 5.6%), but similar LV volume indexes, compared to patients without remodelling (n = 54) (infarct size 20.8 ± 14.4%, p < 0.05, infarct severity 0.40 ± 0.11, p < 0.001, ejection fraction 44.5 ± 9.2, p < 0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (-4.4 ± 8.4%) and without remodelling (-6.8 ± 9.4%) (p = NS).
Conclusion:
Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term follow-up. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling.
