Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction
Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction(469 views) Spinelli L, Petretta M, Acampa W, He W, Petretta A, Bonaduce D, Cuocolo A
Keywords: Acute Myocardial Infarction, Gated Tomography, Left Ventricular Function, Myocardial Perfusion, Dobutamine, Methoxy Isobutyl Isonitrile Technetium Tc 99m, Diagnostic Agent, Radiopharmaceutical Agent, Acute Heart Infarction, Adult, Akinesia, Article, Controlled Study, Dyskinesia, Exercise Test, Follow Up, Gated Imaging, Heart Death, Heart Left Ventricle Function, Heart Muscle Ischemia, Heart Muscle Perfusion, Heart Ventricle Wall, High Risk Patient, Human, Major Clinical Study, Medical Assessment, Medical Information, Prediction, Priority Journal, Prognosis, Scoring System, Single Photon Emission Computer Tomography, Clinical Trial, Female, Italy, Methodology, Middle Aged, Mortality, Prediction And Forecasting, Reproducibility, Risk Assessment, Scintiscanning, Single Blind Procedure, Statistics, Follow-Up Studies, Gated Blood-Pool Imaging, Predictive Value Of Tests, Reproducibility Of Results, Single-Blind Method, Technetium Tc 99m Sestamibi, Ventricular Dysfunction,
Affiliations: *** IBB - CNR ***
Inst. Int. Med. Cardiol. Heart Surg., University Federico II, Naples, Italy
Inst. Biostructures and Bioimaging, National Council of Research, Naples, Italy
IRCCS Neuromed., Pozzilli, Italy
Dept. Biomorphological Funct. Sci., University Federico II, Naples, Italy
Dipto. Sci. Biomorfologiche F., Università Federico II, Via Pansini, 5, 80131 Napoli, Italy
References: Not available.
Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction
Gated SPECT allows combined assessment of regional myocardial perfusion and left ventricular function. The aim of this study was to address the prognostic value of gated SPECT performed during dobutamine stress testing and during rest on patients with acute myocardial infarction treated with thrombolysis. Methods: Eighty-eight consecutive patients with uncomplicated acute myocardial infarction who underwent predischarge (3-7 d after admission) dobutamine (5-40 μ/kg of body weight per minute in 3-min dose increments) and rest gated 99mTc-sestamibi SPECT were followed for a mean of 48 mo (range, 4-64 mo). Results: Eighteen cardiac events (8 cardiac deaths and 10 nonfatal myocardial infarctions) occurred. Ischemia at dobutamine SPECT imaging (summed difference score ≥ 1) was present in 60% of the patients. In patients without ischemia, there was a lower event rate (11%), compared with patients with mild ischemia (18%) and moderate-to-severe ischemia (40%) (P < 0.05). Patients with events showed also a higher summed difference score, compared with patients without events (2.3 ± 1.6 vs. 1.3 ± 1.6, P < 0.05). Independent predictors of events were the number of segments with preserved 99mTc-sestamibi uptake at rest and the number of akinetic or dyskinetic segments with preserved 99mTc-sestamibi uptake and preserved wall thickening (global χ2 of the model, 13.6; P < 0.01). The assessment of the incremental prognostic value of variables added sequentially showed that the addition of the summed difference score added information to perfusion status at rest (P < 0.05). Combined assessment of regional myocardial perfusion and left ventricular function at rest further improved the model (P < 0.05). Conclusion: The present study indicated that predischarge 99mTc-sestamibi gated SPECT gives prognostic information on patients recovering from acute myocardial infarction. Patients with preserved systolic wall thickening should be regarded as a high-risk subgroup, requiring closer follow-up for appropriate treatment.
Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction
Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction