Influence of infarct-zone viability detected by rest Tc-99m sestamibi gated SPECT on left ventricular remodeling after acute myocardial infarction treated by percutaneous transluminal coronary angioplasty in the acute phase

Abstract

Despite successful PTCA in the acute phase of MI, an increase in end-systolic volume was observed at 6 months in 28% of patients. Tc-99m sestamibi ECG-gated SPECT performed 3 weeks after the acute phase could predict this enlargement with a high accuracy.

Relationship between infarct size and severity measured by gated SPECT and long-term left ventricular remodelling after acute myocardial infarction

“…We observed that infarct size and severity could be significant predictors of LV remodelling. Several clinical studies demonstrated that various parameters are predictive of remodelling, including anterior infarct location, patency of the infarctrelated artery, perfusion and functional parameters [4][5][6][7][8][9][10][11][12][13]. In agreement with these previous findings, the present study showed a number of baseline parameters predictive of remodelling, infarct severity demonstrating the best predictive value.…”

“…In agreement with these previous findings, the present study showed a number of baseline parameters predictive of remodelling, infarct severity demonstrating the best predictive value. Our results are in disagreement with the studies showing infarct size as the single significant predictor of LV remodelling after AMI [5,7], but are consistent with previous studies demonstrating that the severity of the infarction might be the best predictor of subsequent changes in LV geometry and performance and is associated with LV volume enlargement at follow-up [12,13]. Because infarct severity, assessed by SPECT, might be considered an estimate of infarct transmurality, as demonstrated also by several studies [28], our findings indirectly confirm that the presence of residual viability in the infarct territory could favourably influence LV remodelling in long-term follow-up.…”

“…The relation between infarct severity and LV functional outcome was also confirmed in gated SPECT studies, showing that infarct severity was more effective than infarct size for predicting subsequent LV remodelling [12,13].…”

“…To the best of our knowledge, the present study is possibly the first in which both myocardial perfusion and LV function have been evaluated with gated SPECT 1 month after AMI as well as at long-term follow-up, differently from most prior reports in which functional data were derived from other techniques, or gated SPECT data were collected over a short time interval [5,6,12,13]. 99m Tc-Sestamibi gated SPECT combines an accurate evaluation of both infarct size and infarct severity with reliable measures of LV function and volumes [30][31][32][33].…”

Prediction of left ventricular remodelling by radionuclide imaging

“…A progressive reduction in infarct size was observed and this was associated with a favourable shortterm evolution of LV function [18]. The relation between infarct severity and LV changes has also been investigated using ECG-gated SPECT, and it was shown that infarct severity was more effective than infarct size for predicting subsequent LV remodelling [19,20].…”