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(429 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
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Tilkemeyer, P. L., Guiney, T. E., LaRaia, P. J., Boucher, C. A., Prognostic value of pre-discharge low-level exercise thallium testing after thrombolytic treatment of acute myocardial infarction (1990) Am J Cardiol, 66, pp. 1203-1207
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Bavelaar-Croon, C. D., Pauwels, E. K., Van Der Wall, E. E., Gated single-photon emission computed tomographic myocardial imaging: A new tool in clinical cardiology (2001) Am Heart J, 141, pp. 383-390
Hambye, A. S., Dobbeleir, A., Derveaux, M., Vandevivere, J., Van Der Heuvel, P., Determination of systolic thickening index with gated Tc-99m sestamibi SPECT: A new parameter of myocardial viability? (1997) Clin Nucl Med, 22, pp. 172-175
Harrell, F. E., Lee, K. L., Califf, R. M., Pryor, D. B., Rosati, R. A., Regression modelling strategies for improved prognostic prediction (1984) Stat Med, 3, pp. 143-152
Pierard, L. A., Landsheere, C. M., Berthe, C., Rigo, F., Kulbertus, H. E., Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy, comparison with positron emission tomography (1990) J Am Coll Cardiol, 15, pp. 1021-1031
Carlos, M. E., Smart, S. C., Wynsen, J. C., Sagar, K. B., Dobutamine stress echocardiography for risk stratification after myocardial infarction (1997) Circulation, 95, pp. 1402-1410
Wackers, F. J. Th., Radionuclide detection of myocardial ischemia and myocardial viability: Is the glass half empty or half full? (1996) J Am Coll Cardiol, 27, pp. 1598-1600
Christian, T. F., Gitter, M. J., Miller, T. D., Gibbons, R. J., Prospective identification of myocardial stunning using technetium-99m sestamibi-based measurements of infarct size (1997) J Am Coll Cardiol, 30, pp. 1633-1640
Gibbons, R. J., Miller, T. D., Christian, T. F., Infarct size measured by single photon emission computed tomographic imaging with Tc-99m sestamibi: A measure of the efficacy of therapy in acute myocardial infarction (2000) Circulation, 101, pp. 101-108
Maes, A. F., Borgers, M., Flameng, W., Assessment of myocardial viability in chronic coronary artery disease using lechnetium-99m sestamibi SPECT (1997) J Am Coll Cardiol, 29, pp. 62-68
Dakik, H. A., Howell, J. F., Lawrie, G. M., Espada, R., Weibaecher, D. G., Assessment of myocardial viability with Tc-99m sestamibi tomography before coronary bypass graft surgery: Correlation with histopathology and postoperative improvement in cardiac function (1997) Circulation, 96, pp. 2892-2898
Meyers, D. G., Bendon, K. A., Hankins, J. H., Stratbucker, R. A., The effect of baseline electrocardiographic abnormalities on the diagnostic accuracy of exercise-induced ST segment changes (1990) Am Heart J, 119, pp. 272-276
Burger, A. J., Al-Sergani, H., Wrobleski, D., False positive ST segment elevation during dobutamine stress echocardiography due to left ventricular hypertrophy (2002) Echocardiography, 19, pp. 103-108
Amanullah, A. M., Berman, D. S., Kang, X., Cohen, I., Germano, G., Friedman, J. D., Enhanced prognostic stratification of patients with left ventricular hypertrophy with the use of single-photon emission computed tomography (2000) Am Heart J, 140, pp. 456-462
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