Recovery of BMIPP Uptake and Regional Wall Motion in Insulin Resistant Patients Following Angioplasty for Acute Myocardial Infarction

Abstract

The effect of insulin resistance (IR) on the fatty acid metabolism of myocardium, and therefore on the recovery of left ventricular (LV) wall motion, has not been established in patients with acute myocardial infarction (AMI). A total of consecutive 58 non-diabetic AMI patients who had successfully undergone emergency coronary angioplasty were analyzed retrospectively. They were categorized into 2 groups, normal glucose tolerance (NGT) and impaired glucose tolerance (IGT), based on a 75-g oral glucose tolerance test (OGTT). The parameters of OGTT, myocardial scintigraphy (n=58) (thallium-201 (Tl) and iodine-123-beta-methyl-iodophenylpentadecanoic acid (BMIPP)) and left ventriculography (n=24) were compared in the 2 groups after reperfusion (acute phase) and 3-4 weeks after the AMI (chronic phase). The insulin resistance (IR), estimated by the serum concentration of insulin at 120 min (IRI 120') of the OGTT and by the HOMA (the homeostasis model assessment) index, was higher in the IGT group than in NGT group. An inverse correlation was found between the recovery of regional LV wall motion in the ischemic lesion and the IRI 120' and HOMA index. Although the recovery of BMIPP uptake from the acute to the chronic phase was higher in the IGT group, it was only correlated with the degree of IRI 120', not with the HOMA. IR accompanied by IGT can negatively influence the recovery of regional LV wall motion.

Cardiovascular Circulation and Hepatic Perfusion of Pigs in 4-Dimensional Films Evaluated by 256-Slice Cone-Beam Computed Tomography

“…Echocardiography, 12,13 a flow pattern study of magnetic resonance imaging, 14 electron-beam CT, 15,16 conventional left ventriculography 17,18 and aortography have all been used to evaluate of cardiovascular blood flow, but they all use pulsating 2-D images only, which make it difficult to observe the 3-D spatial relationships circulation.…”

Serial Alterations and Prognostic Implications of Myocardial Perfusion and Fatty Acid Metabolism in Patients With Acute Myocardial Infarction

“…This suggests that subclinical deterioration of myocardial perfusion in the at-risk area has etiological and prognostic implications in post-MI patients. Asymptomatic progression or recurrence of myocardial ischemia, deterioration of cardiac function because of sustained impairment of energy metabolism, 1,2,[8][9][10][11] and accelerated remodeling 23 might be responsible for worsening myocardial perfusion.…”

“…[1][2][3][4][5][6][7] Impaired fatty acid uptake relative to myocardial perfusion (ie, perfusion -BMIPP mismatch profile) indicates metabolically damaged, dysfunctional but viable myocardium in the risk area, such as stunned myocardium, following coronary revascularization in the acute stage. 2,[8][9][10][11] However, the size of both the BMIPP defect and the perfusion -BMIPP mismatch closely correlate with fatal and non-fatal cardiac events in postmyocardial infarction (MI) patients during long-term follow-up. 12,13 Experiments have shown that myocardial fattyacid metabolism is so sensitive to ischemia that fatty acid uptake is rapidly impaired in relation to a decrease in the myocardial content of high-energy phosphate.…”

Prediction of Functional Improvement of Ischemic Myocardium With 123I-BMIPP SPECT and 99mTc-Tetrofosmin SPECT Imaging-A Study of Patients With Large Acute Myocardial Infarction and Receiving Revascularization Therapy-

“…Mean time from onset of infarction to reperfusion was 5±6 h (range 0. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Coronary stents were implanted in all patients (MULTI-LINK in 2 cases, GFX in 1 case, and NIR in 8 cases).…”

“…Semiquantitative visual analysis was performed by assigning regional tracer defect scores using a 4-point scale (defect score; DS; 0= normal uptake, 1= mildly reduced uptake, 2= severely reduced uptake, and 3= defect). 17 Segments were analyzed for systolic wall thickening and endocardial wall motion using QGS, and were graded as dyskinesis (-1) or as showing akinesis (0), severe hypokinesis (1), moderate hypokinesis (2), mild hypokinesis (3), or normokinesis (4) as the wall motion score (WMS). 15,[18][19][20] Improvement of wall motion was defined as an increase of 1 point or more in WMS over the 6 months.…”