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[Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute
G Romero-Farina1, S Aguadé-Bruix, M N Pizzi
1Unidad de Cardiología Nuclear, Hospital Universitario Vall d'Hebron, Institut de Recerca, Universidad Autónoma de Barcelona, Barcelona, España. guirom@telefonica.net
Insights
Percutaneous coronary revascularization (PCR) improves diastolic function after acute myocardial infarction (AMI). Myocardial perfusion gated SPECT shows this improvement is linked to salvaged myocardium (SM).
Area of Science:
- Cardiology
- Nuclear Medicine
- Cardiac Imaging
Background:
- Acute myocardial infarction (AMI) can impair left ventricular diastolic function.
- Percutaneous coronary revascularization (PCR) is a common treatment for AMI.
- Assessing diastolic function changes post-PCI is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the changes in diastolic function after PCR in patients with AMI.
- To assess the role of myocardial perfusion gated SPECT in measuring these changes.
- To correlate diastolic function improvements with myocardial salvage and ventricular remodeling.
Main Methods:
- Thirty-two patients with AMI underwent gated SPECT before and 4-5 weeks after PCR.
- Diastolic function parameters, including peak filling rate (PFR) and time to peak filling rate (TTPF), were measured.
- Changes in diastolic function were correlated with salvaged myocardium (SM), end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (LVEF).
Main Results:
- Diastolic function significantly improved post-PCR, with increased PFR (P=0.011).
- Improvement in PFR was significantly associated with greater SM, increased LVEF, and reduced ESV.
- Improvement in TTPF was significantly related to the percentage of SM.
Conclusions:
- Myocardial perfusion gated SPECT effectively assesses diastolic function recovery after PCR in AMI.
- The extent of salvaged myocardium is a key determinant of diastolic function improvement post-revascularization.
- These findings highlight the importance of myocardial salvage in cardiac recovery after AMI.
Objective:
To evaluate the evolutive changes in diastolic function after percutaneous coronary revascularization (PCR) in acute myocardial infarction (AMI), using myocardial perfusion gated SPECT.
Methods:
Thirty-two patients (mean 61.9±9.7 years, 7 women) were studied by two at rest gated SPECT: the first gated-SPECT-1 was performed with an injection of a dose of (99m)Tc-tetrofosmin prior to PCR and the second gated-SPECT-2 between the fourth and fifth weeks after AMI. Changes of peak filling rate (PFR) and the time to peak filling rate (TTPF) were assessed between both studies, and were related to the extent of salvaged myocardium (SM), end-diastolic (EDV) and end-systolic (ESV) volumes, and left ventricular ejection fraction (LVEF) changes.
Results:
An improvement was observed in diastolic function parameters Gated-SPECT-2: PFR increased significantly (P=0.011) while the TTPF decreased without reaching statistical significance (P=0.288). In multivariate analysis, adjusted by clinical and coronary variables, improvement of PFR was significantly associated with percentage of SM (P=0.030), increase in LVEF (P=0.004) and with ESV volume reduction (P=0.005). Improvement of TTPF was only related significantly to the percentage of SM (P=0.046). PFR increased 0.01 EDV/sec. and TTPF decreased 1.14ms for each cm(2) increase of the area of SM.
Conclusions:
After PCR in AMI, the myocardial perfusion gated SPECT makes it possible to assess the significant improvement in diastolic function mainly related to the amount of MS.
