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Lack of correlation after reperfusion between ventricular function and infarct size estimated by thallium
J Schofer1, R Spielmann, F H Sheehan
1Department of Cardiology, University Hospital Eppendorf, Hamburg, F.R.G.
Insights
Thallium defect size on SPECT scans does not correlate with left ventricular dysfunction after acute myocardial infarction thrombolysis. Early treatment improves wall motion but not thallium defect size.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Acute myocardial infarction (AMI) requires timely intervention to preserve cardiac function.
- Intracoronary thrombolysis is a key treatment for AMI.
- Assessing myocardial viability and function post-treatment is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between regional wall motion and thallium defect size after successful intracoronary thrombolysis in AMI patients.
- To determine if thallium single-photon emission computed tomography (SPECT) can accurately reflect left ventricular dysfunction post-thrombolysis.
Main Methods:
- Contrast cineangiography was used to measure regional wall motion in 32 AMI patients 10-21 days post-thrombolysis.
- Thallium-201 SPECT with dipyridamole was performed to assess thallium defect size.
- Wall motion analysis utilized the centerline method; defect size was compared to a normal cohort.
Main Results:
- No significant correlation was found between ejection fraction or regional wall motion and thallium defect size.
- Earlier treatment (within 3 hours) was associated with less hypokinesis, but thallium defect size did not differ significantly between early and late treatment groups.
- Time from symptom onset to thrombolysis inversely correlated with hypokinesis but not thallium defect size.
Conclusions:
- Thallium defect size, as determined by SPECT, does not accurately reflect the degree of left ventricular dysfunction in patients following thrombolysis for acute myocardial infarction.
- Regional wall motion assessment provides a more sensitive measure of cardiac dysfunction in this patient population.
- Treatment timing impacts regional wall motion, highlighting the importance of prompt reperfusion therapy.
Abstract:
In 32 patients with acute myocardial infarction, who had undergone successful intracoronary thrombolysis, the results of regional wall motion measured from contrast cineangiograms 10 to 21 days after thrombolysis were related to the results of thallium single-photon emission computed tomography (SPECT) after intravenous dipyridamole. Wall motion was measured by means of the centerline method, and thallium defect size was estimated by comparing the patient's circumferential profile with that of 20 normals. No correlation was found between ejection fraction or regional wall motion and thallium defect size. The time from symptom onset to thrombolysis was inversely correlated with the degree of hypokinesis (r = -0.51) but not with thallium defect size. In patients treated within 3 hours, hypokinesis was significantly less than in patients treated later (-1.1 +/- 0.6 SD vs -2.2 +/- 0.8 SD, p less than 0.01) whereas thallium defect size was not significantly different in both groups. It is concluded that, in patients after thrombolysis, thallium defect size determined by SPECT does not reflect the degree of left ventricular dysfunction.