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13.56 Correlation between infarct size and LV ejection fraction in acute myocardial infarct
Journal
of Nuclear
Volume
8, Number
Cardiology
Abstracts
1
Saturday,
May
13.53
13.55
Comparison of different diagnostic strategies in patients with multivessel coronary artery disease: the 'ILIAS' study.
1231-BM[PP and 201-1"1cardiac imaging for detecting transient myocardial vasospastic ischaemia induced by acetylcholine.
SAJ Chamuleau, MGW Dijkgraaf1, JJ Piek2, JGP Tijssen2, BLF Van Eck-Smit 3. On behalf of the [LIAS-investigators Amsterdam, lClininal Epidemiology & Biostat. Dept. Academic Med. Center, 2Cardiology Academic Med. Center, 3Nuclear Medicine Dept. Academic Med. Center Amsterdam Netherlands. Background: For clinical decision making in patients with multivessel coronary artery disease it is of importance to determine the functional significance of intermediate lesions as detected by coronary angingraphy. This can be determined non invasively (reversible perfusion defect on myocardial perfusion scintigraphy) and invasively (intraeoronary Doppler flow velocity assessment). Different diagnostic strategies for the intermediate lesion were evaluated in a Dutch multi-center trial: the ILIAS study (Intermediate Lesions: Intracoronary flow Assessment versus 99mTc MIBI SPECT). Methods: In total 191 patients with multivessel disease with 1 severe lesion (>70% diameter stenosis, DS) 1 lesion of intermediate severity (40-70% DS/ were evaluated. Both dipyridamole perfusion scintigraphy (SPECT) and intracoronary flow measurements (coronary flow velocity reserve, CFR) were performed to determine the functional significance of the intermediate lesion. A CFR of >= 2.0 was considered 'normal'. Alter dichotomization of the test results, 4 grps of patients were identified: grp A (both test results were normal; ~ 1 2 4 ) , grp B (SPECT normal, CFR abnormal; n-37), grp C (SPECT abnormal, CFR normal; n-21), and gtp D (both test results were abnormal; n-9h Only patients in grp D were treated with angioplasty (PTCA) of the intermediate lesion; PTCA was performed of all severe lesions. Patients were followed for one year to observe the occurrence of major cardiac events. The medical costs were calculated for the diagnostic strategies and for the 1 year follow up period. The most cost effective strategy (CFR alone, SPECT alone, or restrictive or extensive combination of CFR and SPECT) was determined by decision modeling. Results: In total, 18 events were observed, related to the intermediate lesion. ]'he results on costs and probabilities of cardiac events indicated the dominance of a 'restrictive combined strategy'. This strategy starts with the performance of perfusion seintigraphy in all patients; intracoronary flow velocity measurements should only be performed if the scintigrapltic result is abnormal. If both test results are abnormal, PTCA should be performed. The choice of strategy is most sensitive for the probability of a cardiac event after PTCA. Conclusion: The ILIAS study provides useful information for the comparison of diagnostic strategies in this patient cohort. After decision modeling based on the clinical outcome results and cost calculations, we favor a restrictive combined strategy for clinical decision making in this grp of patients.
$91
5, 2001
A Sfi(o, K AonuI~, M Korenaga, H Haga, H Okada, Y Sekiguchi, M HiroeI. Cardiovascular Center Yokosuka Kyosai General Hospital Yokosuka, ICardiovascular Center Oume City Hospital Oume Japan. There are few data regarding the kinetics and the metabolism of 1231-BMIPP (BM) and 201-TI (TL) m stunned myocardium acutely caused by vasospasm. The aim of this study is to clarify whether fatty acid metabolism and myocardial pcrfusion are damaged by transient myocardial ischemia induced by acetylcholine provocation (Acb). We evaluated 23 patients tpts) with total or subtotal spasm of left anterior descending artery (LAD) induced by Ach. Left venlriculographywas performed before and 5 ram after Ach. and early and delayed BM/TL SPECT was performed immediately and 4 hours aiter Ach. For the evaluation of BM/TL uptake, we divided myocardial area of the LAD lesion into 9 segments, and visually classified into 4 grades of defect scores (DS: 0-normal to 3-severe defect). A sumw~tional point of DS of more than 3 was defined as decreased uptake. The left ventricle was divided into seven segments. The wall motion score tWMS) was also classified into 4 grades (0:normal to 3:alonesis). Reduced wall motion was observed in 9 (A group) of 23 ptstEF 60 ± 6.7, 55 ± 6.3, WMS 1.1 ± 1.1, 3.1 ± 1.0: p< 0.05), conversely the rest of the 14 pts(B group) had no change. Fifteen of 23 pts(65%) had decreased TI uptake on early imaging in eomparision to 3 of 23 pts(13%) on BM t p< 0.05). TI uptake was decreased in S of 9 pts (89%) in group A and hi ordy 7 of 14 pts(50%) in group n (p< 0.05), however, BM uptake was decreased only 2 of 9 pts(22%) in group A and I of 14 pts (7%) in group B (N.S). These results demonstrated that I) Ach induced spasm disturbed relatively large coronary blood flow. and the damage continued for more than few hours ahhough vasospasrn was already resolved. 2) Fatty acid metabolism was not necessarily damaged by short period of myocardial vasospastic ischemia.
1oht~at~ ~,a~t,~ vs LV~
mot~ fin
"fl
4o zo!
....
~ ...........
myocardial imaging vs LV wall motion
13.54 Positron emission tomography with s o d i u m - l l - l l C ] - b u t i r a t e for estimating the free fatty acid metabolism rate after surgical revascularisation in patients with C A D . D Ryjkova. P E T department C R I R R St-Petersburg Russian Federation. The a i m o f this study was to evaluate the myocardial oxydative m e t a b o l i s m rate after surgical revascutarisation by positron emission tomography ( P E T ) with n e w tracer S o d i u m - [ l - I 1C]Butyrate (1 IC-butyrate) in patients with coronary artery disease(CAD). Methods: It w e r e studied 10 patients (male, m e a n age 4 2 + 5 y r s ) w i t h C A D , who were undergone surgical revascularisation. The myocardial fi:ee fatty acid metabolism rate w a s assessed by P E T and 11C-butyrate twice (before and a i t e r surgical revascularisation). P E T - s c a n s (Ecat Exact 47) with 1 IC-Butyrate w e r e performed after transmission in fasted (6-8 hours) patients twice: at 1-7 min (first scan) and 2 3 - 3 0 min (second scan) after i.v. injection o f 3 0 0 - 4 5 0 M B q 11CButyrate. Intensity o f free fatty acid extraction was assessed by the tracer uptake ( % U p t a k e ) at first scan and intensity o f beta-oxidation was determined by decreasing the uptake level from the first scan to the second scan ( % U p t a k e ) . Results: M y o c a r d i a l segments w i t h normal oxidative metabolism demonstrated fast elimination o f radioactivity (% U p t a k e = 2 0 - 5 0 % ) . Whereas decreased or almost normal uptake in ischemic segments presented at the first scan diminished rate o f agent elimination (% U p t a k e - 6 0 - 8 0 % ) caused by depressed betaoxidation was r e v e a l e d at the second scan. Fixed defects w e r e seen in the scarred segments both at the first and second scans. 6 months later after surgical revascularisation the intensity o f free fatty acid extraction increased in ischemical regions on 5 8 % , in normal regions on 10%. Intensity o f beta-oxidation was increased ischemical regions on 6 8 % , in normal regions on 2 0 % . In scarred myocardium the intensity o f free fatty acid extraction and beta-oxidation rate w e r e not changed. Conclusion: The intensity o f free fatty acid extraction and beta-oxidation rate increased in ischemical regions more, than in normal one after surgical revascularisation. It pointed out on improvement o f oxygen delivery to ischemical zones. P E T and 1 l C - B u t y r a t e a l l o w e d to assess myocardial metabolic activity in patients with C A D and to estimate the results o f surgical revascularisation.
13.56 Correlation between myocardial infarct.
infarct
size
and
LV
ejection
fraction
in acute
S Canclini, A Terzi, C Cuccia l, M Panteghini 2, PL Rossini, C Pizzocaro, G C Magri, R Giubbini. N u c l e a r M e d i c i n e Spedali Civili di Brescia Brescia, ICardiology Spedali Civili di Brescia Brescia, 2Clinical Pathology Spedali Civili di Brescia Brescia Italy. Background: Both infarct size and L V dysfunction have prognostic implications after uncomplicated MI. Gated S P E C T permits simultaneous evaluation o f perfusion and function by a single acquisition. Methods: 29 consecutive pts (5F, 2 4 M ) w e r e analyzed at rest, early (76=25 h) after acute MI, by T c 9 9 m Sestamibi ( 1 1 0 0 M B q ) gated S P E C T . The presence o f myocardial infarction was determined by clinical. E K G and enzymatic criteria ( W H O criteria). The majority o f pts ( 6 5 % ) w e r e reperfused either by thrombolysis or by direct P T C A and all o f them w e r e in stable conditions. Infarct size was quantified by comparison with a gender matched polar map and LV function according to the Q G S protocol. Results: A significant EF difference w a s observed b e t w e e n pts with infarct size o v e r or b e l o w 2 0 % o f the LV surface (p < 0.003). 9 / 1 0 ( 9 0 % ) with infarct size o v e r 2 0 % had a E F b e l o w 4 5 % , whereas 13/19 ( 6 8 % ) with infhrct size < 20°6 had normal EF values. The correlations between infarct size and EF and b e t w e e n infarct size and end systolic volume w e r e respectively: y = - 0 , 8 1 5 8 x + 5 1 , 8 1 5 R2 0,5205 and y = 1,823x + 39,01 R2 0,6355. In conclusion: an infarct size > 2 0 % determines a significant LV functional impairment in the early phase after uncomplicated MI. There is a closer relationship b e t w e e n infarct size and L V end systolic volume in comparison to L V EF.
of Nuclear
Volume
8, Number
Cardiology
Abstracts
1
Saturday,
May
13.53
13.55
Comparison of different diagnostic strategies in patients with multivessel coronary artery disease: the 'ILIAS' study.
1231-BM[PP and 201-1"1cardiac imaging for detecting transient myocardial vasospastic ischaemia induced by acetylcholine.
SAJ Chamuleau, MGW Dijkgraaf1, JJ Piek2, JGP Tijssen2, BLF Van Eck-Smit 3. On behalf of the [LIAS-investigators Amsterdam, lClininal Epidemiology & Biostat. Dept. Academic Med. Center, 2Cardiology Academic Med. Center, 3Nuclear Medicine Dept. Academic Med. Center Amsterdam Netherlands. Background: For clinical decision making in patients with multivessel coronary artery disease it is of importance to determine the functional significance of intermediate lesions as detected by coronary angingraphy. This can be determined non invasively (reversible perfusion defect on myocardial perfusion scintigraphy) and invasively (intraeoronary Doppler flow velocity assessment). Different diagnostic strategies for the intermediate lesion were evaluated in a Dutch multi-center trial: the ILIAS study (Intermediate Lesions: Intracoronary flow Assessment versus 99mTc MIBI SPECT). Methods: In total 191 patients with multivessel disease with 1 severe lesion (>70% diameter stenosis, DS) 1 lesion of intermediate severity (40-70% DS/ were evaluated. Both dipyridamole perfusion scintigraphy (SPECT) and intracoronary flow measurements (coronary flow velocity reserve, CFR) were performed to determine the functional significance of the intermediate lesion. A CFR of >= 2.0 was considered 'normal'. Alter dichotomization of the test results, 4 grps of patients were identified: grp A (both test results were normal; ~ 1 2 4 ) , grp B (SPECT normal, CFR abnormal; n-37), grp C (SPECT abnormal, CFR normal; n-21), and gtp D (both test results were abnormal; n-9h Only patients in grp D were treated with angioplasty (PTCA) of the intermediate lesion; PTCA was performed of all severe lesions. Patients were followed for one year to observe the occurrence of major cardiac events. The medical costs were calculated for the diagnostic strategies and for the 1 year follow up period. The most cost effective strategy (CFR alone, SPECT alone, or restrictive or extensive combination of CFR and SPECT) was determined by decision modeling. Results: In total, 18 events were observed, related to the intermediate lesion. ]'he results on costs and probabilities of cardiac events indicated the dominance of a 'restrictive combined strategy'. This strategy starts with the performance of perfusion seintigraphy in all patients; intracoronary flow velocity measurements should only be performed if the scintigrapltic result is abnormal. If both test results are abnormal, PTCA should be performed. The choice of strategy is most sensitive for the probability of a cardiac event after PTCA. Conclusion: The ILIAS study provides useful information for the comparison of diagnostic strategies in this patient cohort. After decision modeling based on the clinical outcome results and cost calculations, we favor a restrictive combined strategy for clinical decision making in this grp of patients.
$91
5, 2001
A Sfi(o, K AonuI~, M Korenaga, H Haga, H Okada, Y Sekiguchi, M HiroeI. Cardiovascular Center Yokosuka Kyosai General Hospital Yokosuka, ICardiovascular Center Oume City Hospital Oume Japan. There are few data regarding the kinetics and the metabolism of 1231-BMIPP (BM) and 201-TI (TL) m stunned myocardium acutely caused by vasospasm. The aim of this study is to clarify whether fatty acid metabolism and myocardial pcrfusion are damaged by transient myocardial ischemia induced by acetylcholine provocation (Acb). We evaluated 23 patients tpts) with total or subtotal spasm of left anterior descending artery (LAD) induced by Ach. Left venlriculographywas performed before and 5 ram after Ach. and early and delayed BM/TL SPECT was performed immediately and 4 hours aiter Ach. For the evaluation of BM/TL uptake, we divided myocardial area of the LAD lesion into 9 segments, and visually classified into 4 grades of defect scores (DS: 0-normal to 3-severe defect). A sumw~tional point of DS of more than 3 was defined as decreased uptake. The left ventricle was divided into seven segments. The wall motion score tWMS) was also classified into 4 grades (0:normal to 3:alonesis). Reduced wall motion was observed in 9 (A group) of 23 ptstEF 60 ± 6.7, 55 ± 6.3, WMS 1.1 ± 1.1, 3.1 ± 1.0: p< 0.05), conversely the rest of the 14 pts(B group) had no change. Fifteen of 23 pts(65%) had decreased TI uptake on early imaging in eomparision to 3 of 23 pts(13%) on BM t p< 0.05). TI uptake was decreased in S of 9 pts (89%) in group A and hi ordy 7 of 14 pts(50%) in group n (p< 0.05), however, BM uptake was decreased only 2 of 9 pts(22%) in group A and I of 14 pts (7%) in group B (N.S). These results demonstrated that I) Ach induced spasm disturbed relatively large coronary blood flow. and the damage continued for more than few hours ahhough vasospasrn was already resolved. 2) Fatty acid metabolism was not necessarily damaged by short period of myocardial vasospastic ischemia.
1oht~at~ ~,a~t,~ vs LV~
mot~ fin
"fl
4o zo!
....
~ ...........
myocardial imaging vs LV wall motion
13.54 Positron emission tomography with s o d i u m - l l - l l C ] - b u t i r a t e for estimating the free fatty acid metabolism rate after surgical revascularisation in patients with C A D . D Ryjkova. P E T department C R I R R St-Petersburg Russian Federation. The a i m o f this study was to evaluate the myocardial oxydative m e t a b o l i s m rate after surgical revascutarisation by positron emission tomography ( P E T ) with n e w tracer S o d i u m - [ l - I 1C]Butyrate (1 IC-butyrate) in patients with coronary artery disease(CAD). Methods: It w e r e studied 10 patients (male, m e a n age 4 2 + 5 y r s ) w i t h C A D , who were undergone surgical revascularisation. The myocardial fi:ee fatty acid metabolism rate w a s assessed by P E T and 11C-butyrate twice (before and a i t e r surgical revascularisation). P E T - s c a n s (Ecat Exact 47) with 1 IC-Butyrate w e r e performed after transmission in fasted (6-8 hours) patients twice: at 1-7 min (first scan) and 2 3 - 3 0 min (second scan) after i.v. injection o f 3 0 0 - 4 5 0 M B q 11CButyrate. Intensity o f free fatty acid extraction was assessed by the tracer uptake ( % U p t a k e ) at first scan and intensity o f beta-oxidation was determined by decreasing the uptake level from the first scan to the second scan ( % U p t a k e ) . Results: M y o c a r d i a l segments w i t h normal oxidative metabolism demonstrated fast elimination o f radioactivity (% U p t a k e = 2 0 - 5 0 % ) . Whereas decreased or almost normal uptake in ischemic segments presented at the first scan diminished rate o f agent elimination (% U p t a k e - 6 0 - 8 0 % ) caused by depressed betaoxidation was r e v e a l e d at the second scan. Fixed defects w e r e seen in the scarred segments both at the first and second scans. 6 months later after surgical revascularisation the intensity o f free fatty acid extraction increased in ischemical regions on 5 8 % , in normal regions on 10%. Intensity o f beta-oxidation was increased ischemical regions on 6 8 % , in normal regions on 2 0 % . In scarred myocardium the intensity o f free fatty acid extraction and beta-oxidation rate w e r e not changed. Conclusion: The intensity o f free fatty acid extraction and beta-oxidation rate increased in ischemical regions more, than in normal one after surgical revascularisation. It pointed out on improvement o f oxygen delivery to ischemical zones. P E T and 1 l C - B u t y r a t e a l l o w e d to assess myocardial metabolic activity in patients with C A D and to estimate the results o f surgical revascularisation.
13.56 Correlation between myocardial infarct.
infarct
size
and
LV
ejection
fraction
in acute
S Canclini, A Terzi, C Cuccia l, M Panteghini 2, PL Rossini, C Pizzocaro, G C Magri, R Giubbini. N u c l e a r M e d i c i n e Spedali Civili di Brescia Brescia, ICardiology Spedali Civili di Brescia Brescia, 2Clinical Pathology Spedali Civili di Brescia Brescia Italy. Background: Both infarct size and L V dysfunction have prognostic implications after uncomplicated MI. Gated S P E C T permits simultaneous evaluation o f perfusion and function by a single acquisition. Methods: 29 consecutive pts (5F, 2 4 M ) w e r e analyzed at rest, early (76=25 h) after acute MI, by T c 9 9 m Sestamibi ( 1 1 0 0 M B q ) gated S P E C T . The presence o f myocardial infarction was determined by clinical. E K G and enzymatic criteria ( W H O criteria). The majority o f pts ( 6 5 % ) w e r e reperfused either by thrombolysis or by direct P T C A and all o f them w e r e in stable conditions. Infarct size was quantified by comparison with a gender matched polar map and LV function according to the Q G S protocol. Results: A significant EF difference w a s observed b e t w e e n pts with infarct size o v e r or b e l o w 2 0 % o f the LV surface (p < 0.003). 9 / 1 0 ( 9 0 % ) with infarct size o v e r 2 0 % had a E F b e l o w 4 5 % , whereas 13/19 ( 6 8 % ) with infhrct size < 20°6 had normal EF values. The correlations between infarct size and EF and b e t w e e n infarct size and end systolic volume w e r e respectively: y = - 0 , 8 1 5 8 x + 5 1 , 8 1 5 R2 0,5205 and y = 1,823x + 39,01 R2 0,6355. In conclusion: an infarct size > 2 0 % determines a significant LV functional impairment in the early phase after uncomplicated MI. There is a closer relationship b e t w e e n infarct size and L V end systolic volume in comparison to L V EF.