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Prognostic value of adenosine thallium-201 spect after acute myocardial infarction: A prospective trial
Journal of Nuclear Cardiology V o l u m e 4, N u m b e r
Abstracts
1, Part 2
$27
M o n d a y a f t e r n o o n , A p r i l 7, 1997
23.2
23.4
PROGNOSTIC VALUE OF ADENOSINE THALLIUM201 SPECT AFTER ACUTE MYOCARDIAL INFARCTION: A PROSPECTIVE TRIAL. Habib A. Dakik, J'ohn A. Farmer, Mario S. Verani, ZuoXiang He, Juliet A. Wendt, John J. Mahraarian.Baylor College of Medicine, Houston, Texas, USA
EXERCISE TOLERANCE AND LEFT VENTRICULAR FUNCTION IN PATIENTS WITH MYOCARDIAL INFARCTION FOLLOWING REPERFUStON THERAPY AND ANGIOTENSIN CONVERTfNG ENZYME INHIBITION L.H.B. Baur, E.E. van der Wall, B.L.F. van Eck-Smit, E. van der Velde, J.J. Schipperheyn, A.V.G. Bruschke. Leiden University Hospital, Leiden, The Netherlands
We have previously shown in a retrospective study that the total and ischemic perfusion defect size (PDS) quantified by adenosine TI-201 SPECT predicts cardiac events in pts after myocardial infarction (MI). In this prospective study, we performed adenosine SPECT in 86 consecutive pts 4,54" 2.9 days after MI. Over 8.54-5 months, cardiac events occurred in 25 pts: death (N=6), MI (N=I0), unstable angina ~=5), CHF (N=4). Predictors of cardiac events were: Cardiac Event No Cardiac p ] 0 =25) Event (N=61) Value Total PDS (%LV) 36~-19 [schemic PDS (%LV) 154"12 LV EF (%) 40-2:15 494"12 1012 I Diabetes (%) 54 2l .oo3 I Cardiac events occurred in 80% of pts with vs only 36% ofpts without a large (_>20%) PDS (p<.0()l). Of note, 5 of 6 pts who died had PDS _>40%. Conclusion: This prospective trial confirms the important role of adenosine SPECT in risk stratification after acute MI.
I
I
23.3 PREDICTION OF FUNCTIONAL RECOVERY AND PROGNOSIS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION USING 1231-BMIPP AND THALLIUM-201 SPECT : A MULTI CENTER TRIAL BY 14 INSTITUIONS, *T.Nishimura, S,Nishimura, T.Kajiya, H.Sugihara, K.Kitahara, K.Imai, T.Matsumura, N.Takahashi, H.Yoshida, T.Osada, K.Terada, T.Ito, H.Naruse. N.Iwabuchi. *Tracer kinetics, Osaka University Medical School. Osaka, Japan. The purpose of this study was to determine whether 6-methyl-p-(~2al) iodophenylpentadecanoic acid (~I-BMIPP) and thallium-201 single-photon emission computed tomography during subacute stage were useful for prediction of functional recovery and prognosis in patients with acute myocardial infarction (AMI). We retrospectively evaluated left ventrisular ejection fraction (EF) at discharge and at 3 months or more, improvement of EF from admission to discharge (±EF), o c c u r r e n c e of severe cardiac events (cardiac death or heart failure) and recurrent ischemia (non-fatal myocardial infarction or angina pain) in 201 cases followed for more than 3 months by means of ~231-BMIPP and thallium-201 during subacute stage. The best predictor of EF after AMI was tmI-BMIPP severity scores (SS) and _¢EFcorrelated well with thallium-201 defect size and the degree of difference in thallium-201 and ~I-BMIPP SS (mismatch). ImI-BMIPP SS tended to be large in patients with severe cardiac events. Occurrence of recurrent ischemia was high in the cases with small thallium-201 SS during the chronic stage and no improvement of mismatch from subacute to chronic stage. In conclusion, ~231-BMIPP and thallium-201 SPECT during subacute stage were extremely useful for patient management after AMI.
Left ventrtcular remodelling can be attenuated by reperfusion of the infarct related artery and by treatment with an angiotensin converting enzyme inhibitor. The purpose of this study was to assess the additional value of the angiotensin converting enzyme inhibitor enalapril on exercise tolerance and ventricular remodelling in patients treated with thrombolysis or coronary angioplasty. Methods: Seventy-one patients with an anterior wall infarction received in a double blind fashion 20 mg o.d. enalapril (E, n=36) or placebo (C, n=35), starting within 48 hrs after hospital admission. Trial medication was continued for one year. The influence of E on exercise tolerance and left ventricular enddiastolic volume (LVEDV), ejection fraction and diastolic function was assessed with exercise radionuclide angiography. Results: Exercise level of pts treated with C increased from 87.9=~.2.6.9 Watts 3 weeks after infarction to 104.5+33.6 Watts after one year (p<0.05). Enalapdl treated pts increased exercise level from 105.7+43.6 Watts to 114.3+38.5 Watts (p<0.05; E vs. C pNS). LVEDV increased during follow-up from 106.7:-z-46.4ml/m2 to 121.3+55.5 ml/m2in C pts and from 99.3:t:38.9 mVm2 to 120.4~55.9 ml/m2 for E treated pts (p<0.05). No difference between E and C was observed. Left ventricular ejection fraction was similar in both groups. Three weeks after infarction, peak filling rate was 2.5=l:0.8 EDV.s ~ for C pts and 2.4+1.1 EDV?s for E treated pts. After one year peak filling values were 2.2~0.8 and 2.3+0.8 EDV.s"~ (respectively, pNS). Conclusion: In pts with acute myocardial infarction, treatment with an angiotensin converting enzyme inhibitor following reperfusion therapy had no significant influence on exercise tolerance, left ventricular remodelling or diastolic function during one year follow-up.
23.5 Early Prediction of High Risk Patients With Multivessel Disease Role of Acute Imaging in Recen¢ MI Alia Ahd EI-Fnitah, MD; Molumted EI-Shafle; Helmy EI-Ghawaby; Ayman EI-Naggar and SherifMokhtar, MD, Critical Care Department, Cairo University, E=ypt To identify patients (pts) who need early intervention in the acute phase of myocardial infarction (MI), 15 pts (12 M, mean age 55:~5 yrs) with 1st acute MI were subjected to acute imaging, using Technedutw99 sestemibi injected immediately after admission, 3 planar images were acquired within 6 hours, A second set of images was acquired 72 hours later. Myocardiure at risk was quantified by s~niquantitative analysis technique via dividing the myacasdiurn into 15 segments and application of a ~oring system(0-3). Aseoreof0was assigned to segments with 70-100% of MCA, mild defect was asigned a more of 1, moderate defect a scoreof2, severedefectascoveof3. AIIptsweresubj¢ctedto coronary angiography one week after acute MI, and pts wereclassifiedinto 2 groups: single vessel disease (4 pts), mutlivessel disease (11 pts). Perfusinn defects outside segments of the infarct related a~ety (indicating iscbemia at distance) were looked for and the extent of myocardial salvage was assessed via estimating the score difference (SD) betwecothe2 setsnfireages. Reversibility index (RI) was estimated (RI= SD/initial score).
Out of the 11 pts with multivessel disease, 9 showed evidence of iscbemia at a distance in the 1st set of images with subsequent partial reperfusinn in the 2nd set of images. The mean scores in the infarct related segment~ in file 2 sets of images, PA were 1!.6~4.4, 7.1--L3.2, 29.4%d:11.2%. The corresponding mean scores, 17,I in non-infarct related segments were 2.4±2.1, 0.17±0.2, 90.6% .+.37.6% respectively, Then=was complete resolution ofischemla at distance in 7 pts (out of 9). None of the 4 pts with single vessel disease showed pcrfi~inn defects outside the infarct-related artery distribution.
Conclusion: In the setting ofacuteML earlypredictionof high risk pts with mnitiv~sal disease can be achieved non-invasively via acute ireaging, The high RI points to the presence of remote ischemia and multiplicity ofcerousry artery disease.
M O N D A Y P M A P R I L 7
Abstracts
1, Part 2
$27
M o n d a y a f t e r n o o n , A p r i l 7, 1997
23.2
23.4
PROGNOSTIC VALUE OF ADENOSINE THALLIUM201 SPECT AFTER ACUTE MYOCARDIAL INFARCTION: A PROSPECTIVE TRIAL. Habib A. Dakik, J'ohn A. Farmer, Mario S. Verani, ZuoXiang He, Juliet A. Wendt, John J. Mahraarian.Baylor College of Medicine, Houston, Texas, USA
EXERCISE TOLERANCE AND LEFT VENTRICULAR FUNCTION IN PATIENTS WITH MYOCARDIAL INFARCTION FOLLOWING REPERFUStON THERAPY AND ANGIOTENSIN CONVERTfNG ENZYME INHIBITION L.H.B. Baur, E.E. van der Wall, B.L.F. van Eck-Smit, E. van der Velde, J.J. Schipperheyn, A.V.G. Bruschke. Leiden University Hospital, Leiden, The Netherlands
We have previously shown in a retrospective study that the total and ischemic perfusion defect size (PDS) quantified by adenosine TI-201 SPECT predicts cardiac events in pts after myocardial infarction (MI). In this prospective study, we performed adenosine SPECT in 86 consecutive pts 4,54" 2.9 days after MI. Over 8.54-5 months, cardiac events occurred in 25 pts: death (N=6), MI (N=I0), unstable angina ~=5), CHF (N=4). Predictors of cardiac events were: Cardiac Event No Cardiac p ] 0 =25) Event (N=61) Value Total PDS (%LV) 36~-19 [schemic PDS (%LV) 154"12 LV EF (%) 40-2:15 494"12 1012 I Diabetes (%) 54 2l .oo3 I Cardiac events occurred in 80% of pts with vs only 36% ofpts without a large (_>20%) PDS (p<.0()l). Of note, 5 of 6 pts who died had PDS _>40%. Conclusion: This prospective trial confirms the important role of adenosine SPECT in risk stratification after acute MI.
I
I
23.3 PREDICTION OF FUNCTIONAL RECOVERY AND PROGNOSIS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION USING 1231-BMIPP AND THALLIUM-201 SPECT : A MULTI CENTER TRIAL BY 14 INSTITUIONS, *T.Nishimura, S,Nishimura, T.Kajiya, H.Sugihara, K.Kitahara, K.Imai, T.Matsumura, N.Takahashi, H.Yoshida, T.Osada, K.Terada, T.Ito, H.Naruse. N.Iwabuchi. *Tracer kinetics, Osaka University Medical School. Osaka, Japan. The purpose of this study was to determine whether 6-methyl-p-(~2al) iodophenylpentadecanoic acid (~I-BMIPP) and thallium-201 single-photon emission computed tomography during subacute stage were useful for prediction of functional recovery and prognosis in patients with acute myocardial infarction (AMI). We retrospectively evaluated left ventrisular ejection fraction (EF) at discharge and at 3 months or more, improvement of EF from admission to discharge (±EF), o c c u r r e n c e of severe cardiac events (cardiac death or heart failure) and recurrent ischemia (non-fatal myocardial infarction or angina pain) in 201 cases followed for more than 3 months by means of ~231-BMIPP and thallium-201 during subacute stage. The best predictor of EF after AMI was tmI-BMIPP severity scores (SS) and _¢EFcorrelated well with thallium-201 defect size and the degree of difference in thallium-201 and ~I-BMIPP SS (mismatch). ImI-BMIPP SS tended to be large in patients with severe cardiac events. Occurrence of recurrent ischemia was high in the cases with small thallium-201 SS during the chronic stage and no improvement of mismatch from subacute to chronic stage. In conclusion, ~231-BMIPP and thallium-201 SPECT during subacute stage were extremely useful for patient management after AMI.
Left ventrtcular remodelling can be attenuated by reperfusion of the infarct related artery and by treatment with an angiotensin converting enzyme inhibitor. The purpose of this study was to assess the additional value of the angiotensin converting enzyme inhibitor enalapril on exercise tolerance and ventricular remodelling in patients treated with thrombolysis or coronary angioplasty. Methods: Seventy-one patients with an anterior wall infarction received in a double blind fashion 20 mg o.d. enalapril (E, n=36) or placebo (C, n=35), starting within 48 hrs after hospital admission. Trial medication was continued for one year. The influence of E on exercise tolerance and left ventricular enddiastolic volume (LVEDV), ejection fraction and diastolic function was assessed with exercise radionuclide angiography. Results: Exercise level of pts treated with C increased from 87.9=~.2.6.9 Watts 3 weeks after infarction to 104.5+33.6 Watts after one year (p<0.05). Enalapdl treated pts increased exercise level from 105.7+43.6 Watts to 114.3+38.5 Watts (p<0.05; E vs. C pNS). LVEDV increased during follow-up from 106.7:-z-46.4ml/m2 to 121.3+55.5 ml/m2in C pts and from 99.3:t:38.9 mVm2 to 120.4~55.9 ml/m2 for E treated pts (p<0.05). No difference between E and C was observed. Left ventricular ejection fraction was similar in both groups. Three weeks after infarction, peak filling rate was 2.5=l:0.8 EDV.s ~ for C pts and 2.4+1.1 EDV?s for E treated pts. After one year peak filling values were 2.2~0.8 and 2.3+0.8 EDV.s"~ (respectively, pNS). Conclusion: In pts with acute myocardial infarction, treatment with an angiotensin converting enzyme inhibitor following reperfusion therapy had no significant influence on exercise tolerance, left ventricular remodelling or diastolic function during one year follow-up.
23.5 Early Prediction of High Risk Patients With Multivessel Disease Role of Acute Imaging in Recen¢ MI Alia Ahd EI-Fnitah, MD; Molumted EI-Shafle; Helmy EI-Ghawaby; Ayman EI-Naggar and SherifMokhtar, MD, Critical Care Department, Cairo University, E=ypt To identify patients (pts) who need early intervention in the acute phase of myocardial infarction (MI), 15 pts (12 M, mean age 55:~5 yrs) with 1st acute MI were subjected to acute imaging, using Technedutw99 sestemibi injected immediately after admission, 3 planar images were acquired within 6 hours, A second set of images was acquired 72 hours later. Myocardiure at risk was quantified by s~niquantitative analysis technique via dividing the myacasdiurn into 15 segments and application of a ~oring system(0-3). Aseoreof0was assigned to segments with 70-100% of MCA, mild defect was asigned a more of 1, moderate defect a scoreof2, severedefectascoveof3. AIIptsweresubj¢ctedto coronary angiography one week after acute MI, and pts wereclassifiedinto 2 groups: single vessel disease (4 pts), mutlivessel disease (11 pts). Perfusinn defects outside segments of the infarct related a~ety (indicating iscbemia at distance) were looked for and the extent of myocardial salvage was assessed via estimating the score difference (SD) betwecothe2 setsnfireages. Reversibility index (RI) was estimated (RI= SD/initial score).
Out of the 11 pts with multivessel disease, 9 showed evidence of iscbemia at a distance in the 1st set of images with subsequent partial reperfusinn in the 2nd set of images. The mean scores in the infarct related segment~ in file 2 sets of images, PA were 1!.6~4.4, 7.1--L3.2, 29.4%d:11.2%. The corresponding mean scores, 17,I in non-infarct related segments were 2.4±2.1, 0.17±0.2, 90.6% .+.37.6% respectively, Then=was complete resolution ofischemla at distance in 7 pts (out of 9). None of the 4 pts with single vessel disease showed pcrfi~inn defects outside the infarct-related artery distribution.
Conclusion: In the setting ofacuteML earlypredictionof high risk pts with mnitiv~sal disease can be achieved non-invasively via acute ireaging, The high RI points to the presence of remote ischemia and multiplicity ofcerousry artery disease.
M O N D A Y P M A P R I L 7