Rest and low-dose dobutamine Tc-99m-mibi gated-SPECT for early prediction of left ventricular remodeling after a first reperfused myocardial infarction

Ernande, Laura; Cachin, F.; Chabrot, P.; Durel, Nicolas; Morand, Dominique; Boyer, L.; Maublant, J.; Lipiecki, Janusz

doi:10.1007/s12350-009-9098-5

Cited by 8 publications

(11 citation statements)

References 23 publications

(19 reference statements)

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“…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.…”

Section: Discussionsupporting

confidence: 90%

“…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.…”

Section: Discussioncontrasting

confidence: 53%

“…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].…”

Section: Introductionmentioning

confidence: 70%

“…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].…”

Section: Discussionmentioning

confidence: 98%

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

Berti

Sciagrà

Acampa

et al. 2011

Eur J Nucl Med Mol Imaging

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Purpose After acute myocardial infarction (AMI), left ventricular (LV) remodelling may occur despite successful reperfusion. This study aimed to investigate by gated single photon emission computed tomography (SPECT) the longterm evolution of myocardial perfusion and LV function after AMI and to identify the predictors of LV remodelling. Methods Sixty-eight AMI patients successfully treated by primary percutaneous coronary intervention underwent 99m Tc-sestamibi gated SPECT at 1 month (baseline) and over 6-month follow-up after the acute event. LV remodelling was defined as 20% increase in LV end-diastolic volume at follow-up. Results At baseline, patients with remodelling (n=14) showed larger (infarct size 29.3±7.8%) and more transmural (infarct severity 0.28±0.10) infarctions, and reduced LV ejection fraction (35.4±5.6%), but similar LV volume indexes, compared to patients without remodelling (n=54) (infarct size 20.8±14.4%, p<0.05, infarct severity 0.40± 0.11, p<0.001, ejection fraction 44.5±9.2, p<0.001). At stepwise multivariate regression analysis, infarct severity showed the best predictive value for predicting LV remodelling (F = 5.54, p < 0.05). Using the thresholds identified by receiver-operating characteristic curve analysis, infarct size and severity detected patients with remodelling with 75% accuracy and 95% negative predictive value. Infarct resorption (defined as the defect size difference between follow-up and baseline) was comparable between patients with (−4.4±8.4%) and without remodelling (−6.8±9.4%) (p=NS). Conclusion Perfusion parameters assessed by gated SPECT in the subacute phase after successfully treated AMI correlate with changes in functional parameters at long-term followup. Infarct severity is more effective than infarct size, but both are helpful for predicting LV remodelling.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 98%

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

Berti

Sciagrà

Acampa

et al. 2011

Eur J Nucl Med Mol Imaging

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“…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].…”

mentioning

confidence: 99%

Prediction of left ventricular remodelling by radionuclide imaging

Anagnostopoulos

Cokkinos

2011

Eur J Nucl Med Mol Imaging

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Left ventricular remodelling is a complex process by which mechanical, neurohormonal and genetic factors alter ventricular structure and function leading to reduced mechanical performance, electrical instability and sudden death [1]. It is an important aspect of heart failure progression, characterized by dilatation and change of shape of the left ventricle (LV) as well as alterations in the ventricular wall which include hypertrophy, loss of myocytes and increased interstitial fibrosis [2]. At the molecular level, it is characterized by a regression to the fetal pattern, i.e. increase of β-myosin heavy chain, α-actin, atrial natriuretic peptide overexpression, sarco/endoplasmic reticulum Ca 2+ -ATPase activity decrease and a shift of myocardial metabolism towards glucose utilization [3,4]. Acute myocardial infarction (MI) is a common cause of LV remodelling. It is estimated that despite primary percutaneous coronary intervention (PCI) and standard current therapy, around 30% of anterior MIs will develop remodelling. The three major biomechanical mechanisms contributing to the increase of LV volumes over time after MI are: (1) expansion of the infarct in the subacute phase [5], (2) subsequent non-ischaemic infarct extension into the adjacent non-infarcted region [6,7] and (3) hypertrophy and dilatation of non-infarcted myocardium in the chronic phase [8][9][10]. The main factors associated with remodelling are size of infarction, anterior location and late or unsuccessful (or absence of) reperfusion therapy both at the epicardial vessel level and at the microvasculature level. LV remodelling, however, is a potentially reversible or even possibly preventable process. Regression is manifested as a return to a more normal ventricular size and shape and appears to be a good predictor of a reduction in morbidity and mortality [2,11]. Several trials on post acute MI patients have demonstrated that this can be achieved by a combination of treatment regimes [12]. This is understandable considering that the three aforementioned mechanisms operate in different regions of the LV and during different time frames after MI, thus making it unlikely for any single drug to be completely effective in addressing all three mechanisms [12]. A major determinant to the selection of the appropriate treatment is the propensity of the underlying MI to result in LV remodelling. Therefore, accurate monitoring of post acute MI patients to identify those who are likely to develop LV remodelling is of great importance.Based on the mechanistic rationale described above, monitoring is performed with non-invasive imaging and usually includes assessment of heart size, shape and mass, ejection fraction (EF), end-diastolic and end-systolic volumes and regional contractility. Cardiac magnetic resonance (CMR) is the gold standard to assess these parameters as well microvascular obstruction and infarct size. A consistent finding from the CMR literature in the post acute MI setting is that scar size is a key determinant of long-term LV remodelling. Mor...

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Correspondence between gated SPECT and cardiac magnetic resonance quantified myocardial wall thickening

Nichols

Tosh

Wang

et al. 2010

Int J Cardiovasc Imaging

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Left ventricular (LV) wall thickening (WT) assessed from myocardial perfusion (MP) gated SPECT data has been reported to be a marker of functional recovery following myocardial damage. However, the accuracy of WT measurements obtained in the clinical setting rarely has been validated against an independent quantitative reference standard. The purpose of this investigation was to assess the degree to which quantified MP WT agrees with cardiac magnetic resonance (CMR) WT measurements, and to determine whether quantitation is as accurate as visual analysis in detecting abnormal regional WT. MP and ECG-gated True-FISP CMR data were analyzed for 20 patients evaluated after myocardial infarction (age 60 ± 11 years; 95% males). An experienced observer visually graded MP WT on a 5-point scale while viewing MP cines. MP WT was quantified using "Emory Cardiac Toolbox" (ECTb) algorithms. MP algorithms isolated myocardial counts and generated polar maps of WT. CMR data were analyzed by Medis "MASS" software. Manually drawn endocardial and epicardial contours were used to compute WT on CMR. CMR data also were processed for 10 age-matched normal volunteers to define the CMR WT threshold of abnormality. All computations were sampled into conventional 17 ACC/AHA LV wall segments. Receiver operating characteristics (ROC) curve analysis provided discrimination thresholds for optimal accuracy, which subsequently were used to dichotomize the MP methods. WT abnormalities also were assessed for the 3 major arterial territories, and for total numbers of abnormal segments per patient. 25% of all segments had abnormally low WT by CMR. While MP quantitation underestimated CMR WT values for segments with normal WT (26 ± 13% vs. 56 ± 28%, P < 0.0001), measurements were similar for segments with abnormal WT (4 ± 12% vs. 5 ± 9%, P = 0.45). On a segment-by-segment basis, detection of abnormal WT was more accurate by quantitative than visual analysis both for continuous variables (ROC area = 88 ± 2% vs. 80 ± 3%, P < 0.0001) and for dichotomized methods (83% vs. 76%, P = 0.04). Agreement of MP versus CMR for discriminating segments with normal from abnormal WT was significantly better for quantitative than visual analysis (κ = 0.59 vs. 0.40, P < 0.0001), with strongest agreement for left anterior descending artery territories (κ = 0.72). Total numbers of segments with abnormal WT per patient demonstrated significant correlation with CMR (r = 0.83, P < 0.0001). MP quantified LV ejection fractions and volumes also correlated well with CMR (r = 0.87 and 0.90, respectively). Quantified MP WT measurements correlated significantly with CMR values, and discriminated segments with abnormal WT from segments with normal WT more accurately than visual analysis. Therefore, quantification should be performed when analyzing regional WT by scintigraphy.

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Rest and low-dose dobutamine Tc-99m-mibi gated-SPECT for early prediction of left ventricular remodeling after a first reperfused myocardial infarction

Cited by 8 publications

References 23 publications

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

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

Prediction of left ventricular remodelling by radionuclide imaging

Correspondence between gated SPECT and cardiac magnetic resonance quantified myocardial wall thickening

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