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The Association between Hypoperfused Myocardium and Systolic Function in Patients With AMI Undergoing Complete
Jin Si1, Chong Zheng2, Jinghao Sun1
1Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China.
Insights
Myocardial hypoperfusion can persist after acute myocardial infarction (AMI) treatment. Reversal of this hypoperfusion is linked to better left ventricular (LV) systolic function recovery in AMI patients.
Area of Science:
- Cardiology
- Medical Imaging
- Myocardial Reperfusion Injury
Background:
- Restoring coronary blood flow in acute myocardial infarction (AMI) is crucial for reducing mortality.
- Epicardial blood flow restoration does not always parallel myocardial reperfusion.
- This study investigates myocardial perfusion dynamics and left ventricular (LV) function post-revascularization.
Purpose of the Study:
- To examine temporal changes in myocardial perfusion after complete revascularization in AMI patients.
- To assess the association between myocardial perfusion and LV systolic function.
- To identify predictors of persistent hypoperfusion and its impact on cardiac function.
Main Methods:
- Prospective study of 55 AMI patients treated with complete revascularization.
- Hybrid positron emission tomography/magnetic resonance imaging (PET/MR) performed at 2 months and 1 year post-procedure.
- Hypoperfused myocardium defined as reduced perfusion with preserved metabolism.
Main Results:
- 45.5% of patients had hypoperfused myocardium at 2 months post-AMI.
- Higher hs-CRP and lower T2 values predicted baseline hypoperfusion.
- At 1 year, hypoperfusion reversal in some patients correlated with female sex, lower diabetes/overweight prevalence, and better baseline global longitudinal strain (GLS).
- Significant LV ejection fraction improvement observed in patients with hypoperfusion reversal (Group A), but not in those without (Group B).
Conclusions:
- Myocardial hypoperfusion can persist and evolve over time even after complete revascularization in AMI patients.
- Reversal of myocardial hypoperfusion is associated with improved LV systolic function.
- These findings highlight the importance of assessing myocardial perfusion beyond epicardial flow restoration.
Background:
Timely restoring coronary blood flow reduces mortality in acute myocardial infarction (AMI), while epicardial flow restoration is non-parallel to myocardial reperfusion. This prospective study examined temporal changes in myocardial perfusion and their association with left ventricular (LV) systolic function after complete revascularization.
Methods:
AMI patients treated with complete revascularization underwent hybrid positron emission tomography/magnetic resonance imaging (PET/MR) at 2 months and 1 year after the index procedure. Hypoperfused myocardium was defined as reduced perfusion with preserved metabolism.
Results:
Fifty-five patients (60.42 ± 11.47 years, 80.0% male) were enrolled, and hypoperfused myocardium (median: 12% of LV) was detected in 25 (45.5%) patients 2 months post-AMI. Patients with and without hypoperfused myocardium were classified as Group A and Group B, respectively. Higher high-sensitivity C-reactive protein (hs-CRP) and lower T2 values were observed in Group A and independently predicted baseline hypoperfused myocardium. At 1-year PET/MR follow-up, six (31.6%) patients in Group A showed perfusion recovery; these patients were more frequently female (p = 0.025), less frequently diabetic (p = 0.044) or overweight (p = 0.035), and had better baseline global longitudinal strain (GLS) (p = 0.005). Significant LV ejection fraction improvement was observed in Group A (56.39% ± 9.76% vs. 54.58% ± 10.39%, p = 0.016) but not in Group B (51.63% ± 13.09% vs. 50.79% ± 16.95%, p = 0.615).
Conclusions:
Even after complete revascularization, myocardial hypoperfusion may persistently exist and evolve over time in AMI patients. The reversal of myocardial hypoperfusion is possibly associated with improved LV systolic function.
Trial Registration:
The study was retrospectively registered on 2022-11-24 under the name Evaluation of short-and long-term cardiac structure and function in patients with acute coronary syndrome and made publicly available in the China Medical Research Registration Information System (https://www.medicalresearch.org.cn/), with the registration number MR.-11-23-000090.
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