Dobutamine stress echocardiography (DSE) and PET after ami in the viable myocardium evaluation

S54

Abstracts

JOURNAL OF NUCLEAR CARDIOLOGY

Tuesday morning, April 25, 1995

March/April 1995, Part 2

P08-213

P08-215

T H E NON Q WAVE VERSUS Q WAVE MYOCARDIAL INFARCTION

DEPRESSED REGIONAL FATTY ACIDI METABOLIC ACTIVITY DETECTED BY IODINE-123 p-METHYLIODOPHENYLEPENTADECANOIC ACID IN ACUTE CORONARY SYNDROME

THALLIUM-201 AND CORONARY ANGIOGRAPHY PATTERNS G. C.aatthha. E.M. Coelho, A.I, Santos, M.G, Aires, T. Martins, A. V.Marqaes, B. Costa, F. Godlnho. Iastltuto de Medlclna Nuclear and UCIM/Med I V . Hospital de Santa Maria Llsboa - Portugal

T U E S D A u

Takeshi Tanaka, Tadanori Aizawa, Kzuzo Kato, The Cardiovascular Institute. Tokyo, Japan

Acute myocardial infarction has been electrocardiographically classified according to the presence (QM0 or absence of Q wave (NQM0. This classification is questioned in terms of prognosis and therapeutics, We used thallium-20l SPECT (3"1)to compa~ NQMI and QMI, in order to identify a sub~et of features, regardless of the site and extension of necrosis. We have studied 52 QMI patients (pts), ---58.5+7.4 years, and 23 NQMI I~.s,=60!-_7.7y~a.."s,All pta performed 1"1and enronariography 2-3 months after MI, In 21"1,12 segmants (sg) were oonsidea~din the left ventricle. Analysis was done comparing the number of fixed defects in TI and the steaesis grade of the corresponding corona~ artery, considering:antedor/septal walls (AS) depends of left descendent (LD). lateral (L) of left circumflex (CX) end hfferior (I) of fight cotona~ (PC). In QMI pts, 58% had AS infarction with 48% sg with fixed defect, in 57% ischaemia pefi neonsis (IPN) is present and in 83% distant lesions were found (DL). The =77+28%. 12% pts had lateral QMI in 33% seg, 3 pts with IPN and all with DE. The =61_+34%. NQMI pts: 18% pts had AS TI defects in 17% sg. 2 pts had a moderated fixed hypoperfusion. 3 pta had IPN and all had DL. =88+17%. 91% had I lesions in 70% seg, but 37% had a TI moderate fixed hypoperfusion, 52% had IPN and 57% DL. =67+31%. 24% pls had L lesions in 60% sg, one with'moderate hypoperfnsion, none with IPN and 80% with DL. =75+25%. No important statistical differences were found regarding the extension of IPN or DL and the degree of sWalnsis,the two groups with a high incidence of multiple vessel disease, suggesting a similar long term pregnosis. It w~ possible to identify a pattern of NQMI at TI in 46% pts. which was seen hi only I pt in QMI. This may suggest a distinct pathoghysiologicel entity.

Iodine-123 13-methykiodophentadecanoic acid m y o c a r d i a l i m a g e s ( B M I P P i m a g e s ) was d e v e l o p e d for estimating m y o c a r d i a l fatty acid metabolism. Abnormal fatty acid metabolism in i s c h e m i c region was studied in 50 patients (pts) with acute coronary s y n d r o m e by B M I P P i m a g e s and thallium-201 myocardial i m a g e s (TI-201 i m a g e s ) . In 8(424) hospital days B M I P P and TI-201 were simultaneous infected and i m a g i n g was p e r f o r m e d . Myocardial Perfusion defects w a s not revealed by TI-201 i m a g e s in 21 o f 30 pts with n o n - Q - w a v e infarction, w h e r e a s B M I P P i m a g e s revealed defects corresponding to myocardial ischemic region predicted by coronary angiography in all 30 ptsl N o myocardial perfusion defect w a s detected b y T1-201 i m a g e s in pts with unstable a n g i n a pectoris, w h e r e a s B M I P P i m a g e s revealed defects in 14 or 20 pts. B M I P P defects were noted in the region with normal TI-201 uptake. Fatty acid metabolic activity w a d m o r e vulnerable to i s c h e m i a than m y o c a r d i u m it self. D e p r e s s e d B M I P P uptake d i d not represent i s c h e m i a , but a b n o r m a l fatty acid m e t a b o l i c a c t i v i t y induced by transient ischemia. B M I P P i m a g e s were clinically useful. B M I P P i m a g e s is a sensitive method to detect m y o c a r d i u m exposed to transient ischemia undetected b y T1-201 i m a g e s . T o detect culprit lesion B M I P P i m a g e s were useful.

P08-214

P08-216

P M A P R I L 2 5

DOBUTAMINE STRESS ECHOCARDIOGRAPHY(DSE) AND PET

ELEVATION OF ST SEGMENT IN EXERClCE TEST AFTER AN ANTERIOR INFARCT AND MYOCARDIAL VIABILITY. STUDY WITH SESTAMIBI

AFTER AMI IN THE VIABLE MYOCARDIUMEVALUATION.

J Castell, A Garc(a-Burillo, S Aguad6, P Blanch, H Valenzuela, T Canela, J

G Mobilia,P

Cortadallas, J Csndell. Hospital General Universitari Vail d'Hebron. Barcelona.

Zanco,G Masaro, F Chierichetti,L

Vet-

t o r a t o , F A l i t t o , R B u c h b e r g e r and G F e r l i n . Cardiology-~ntebelluna and N u c l e a r M e d i c i n e Castelfranco To e v a l u a t e the

Veneto, the

Italy.

usefulness

identification

of

of

stunned

low d o s e DSE in but

viable

(VIA)

myocardium after first AMI,IO pts were studied b y DSE l O ~ 2 d a y s , a n d b y DSE and g l u c o s e l o a d FDG PET 3 0 + 4 d a y s a f t e r AMI.Left ventricular w a l l was divided in 16 s e g m e n t s ( s ) . V i a b i l i t y b~' DSE was defined

as n o r m o - o r h y p o k i n e s i a

provement

in w a l l

motion

at

rest

From a k i n e s i a

or

im-

during

do

b u t a m i n e i n f u s i o n . W e c o m p a r e d DSE and PET in t h e corrisponding hypo-(HY)or akinetic s at rest. A F t e r 1 s t DSE we Found 113 n o r m o k i n e t i c , 3 4 notV I A and 13 V I A s ( 8 HY a t r e s t and 5 t h a t improved).After

2nd DSE we Found 113 n o r m o k i n e t i c , 2 9

n o t - V I A and 18 V I A s(9 HY a t r e s t and 9 t h a t improved),By PET, in c o r r i s p o n d i n 9 s , w e Found 24 n o t - V I A and 23 V I A s . ln c o n c l u s i o n , o u r experience suggests

that

the

best

timing

to look for stunned myocardium AMI.Extension of VIA is slightly

to is

perform

DSE

1 month a f t e r g r e a t e r b y PET.

It has been suggested that the elevation of ST segment in the exeroice test (ET) after an anterior infarct can be a sign of myocardial viability in this territory. The aim of this study was to evaluate the amount of viable myocardium in patients with an anterior necrosis, comparing those who elevate ST segment with those with no elevation. 54 consecutive patients who had suffered an anterior infarct as the only coronary history were selected. They underwent a subjective maximum bicycle exercise and a tomographic myocardial perfusion imaging with SESTAMIBI(exercise and resting). Group 1: Elevation of ST:20 patients (mean age: 56 y)(37-69) 4~ Group 2: No elevation of ST:34 patients (mean age:57 y)(24-75) 69 The extension of viable myocardium (uptake higher than 40 % at rest) was calculated upon the bull's eye image, in antero-ssptal, apical territories and total left ventrioular extension. Results: % AS"

% AP"

% TOT"

GROUP 1

5.6•

METS~

69•

22+36

72_+16

GROUP 2

5.7•

91•

63•

89•

%: percentage of viable myocardium (AS: antsroseptal, AP: apical, TOT: total) #: p=ns *: p