Predictors of post-stress LVEF drop 6 months after reperfused myocardial infarction: a gated myocardial perfusion
C Guenancia1, A Cochet, O Humbert
1Cardiology Department, CHU Dijon, 14 rue P. Gaffarel, 21000, Dijon, France. charles.guenancia@gmail.com
Insights
Myocardial stunning after myocardial infarction (MI) is predicted by significant ischemia and diabetes. These factors, along with higher resting Left Ventricular Ejection Fraction (LVEF), indicate a drop in post-stress LVEF.
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiovascular Imaging
Background:
- Myocardial stunning, characterized by a drop in Left Ventricular Ejection Fraction (LVEF), can occur after myocardial infarction (MI).
- Identifying predictive factors for myocardial stunning is crucial for patient management and risk stratification post-MI.
Purpose of the Study:
- To determine the independent predictors of myocardial stunning, assessed by a decrease in post-stress LVEF.
- To investigate the relationship between ischemia, diabetes, and myocardial stunning in patients with recent MI.
Main Methods:
- Prospective study of 215 patients with acute MI undergoing percutaneous coronary intervention.
- Post-stress/rest 99mTc-sestamibi gated SPECT performed six months post-discharge to assess myocardial perfusion and LVEF.
- Significant LVEF drop defined as post-stress LVEF ≥ 5% below rest LVEF.
Main Results:
- Myocardial stunning (LVEF drop) observed in 24% of patients.
- Diabetes, significant ischemia (SDS > 2), and higher rest LVEF were associated with LVEF drop.
- Independent predictors identified: significant ischemia (OR 3.78), diabetes (OR 3.35), and rest LVEF (OR 1.08).
Conclusions:
- Ischemia and diabetes are independent predictors of myocardial stunning in post-MI patients with successful reperfusion.
- Findings support the concept of myocardial stunning as a reversible phenomenon, distinct from myocardial necrosis, in the post-MI setting.
Objective:
To identify the predictive factors of myocardial stunning as assessed by the drop in post-stress Left Ventricular Ejection Fraction (LVEF) in patients with a recent history of myocardial infarction (MI).
Methods:
We prospectively included 215 consecutive patients admitted for acute MI who underwent percutaneous coronary intervention with a greater than or equal to grade-3 TIMI flow in the culprit vessel. Six months after discharge, a post-stress/rest 99mTc-sestamibi gated SPECT was performed. The perfusion score was evaluated visually using a 17-segment model. The LVEF drop was considered significant if the post-stress LVEF was ≥ 5% below the rest LVEF (QGS® software).
Results:
A post-stress LVEF drop was observed in 51 (24%) patients. Patients with an LVEF drop were more likely than patients with a stable post-stress LVEF to have diabetes (22% vs. 10%, p = 0.048), significant ischemia (SDS > 2) (51% vs. 28% p = 0.003) and higher rest LVEF [62% (56-69) vs. 56% (49-63) p < 0.001]. In contrast, summed rest score, related to infarct size, did not differ between the groups. Multivariate logistic regression analysis identified SDS > 2 (OR 3.78, 95% CI 1.8-7.92, p < 0.001), diabetes (OR 3.35, 95% CI 1.33-8.49; p = 0.011) and rest LVEF (OR 1.08, 95% CI 1.04-1.12, p < 0.001) as independent explanatory variables of an LVEF drop.
Conclusion:
In patients with recent MI and post-procedural grade-3 TIMI flow, ischemia and diabetes were independent predictive factors of myocardial stunning. The higher incidence of reversible perfusion abnormalities validates the model of myocardial stunning in the post-MI period, and excludes the potential involvement of myocardial necrosis.
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