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Nitrate-enhanced gated SPECT in patients with primary angioplasty for acute myocardial infarction: evidence of a reversible and nitrate-sensitive impairment of myocardial perfusion

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Reperfusion of myocardial infarction (MI) leads to a reversible dysfunction of coronary vessels. We hypothesised that vasodilating drugs such as nitrates might improve sestamibi uptake within viable areas of recently reperfused MI, thereby enhancing prediction of subsequent improvements in perfusion and contractility. This study was aimed at assessing nitrate-enhanced sestamibi gated SPECT after MI reperfusion.

Methods

Twenty-nine patients underwent rest followed by nitrate sestamibi gated SPECT at 9 ± 3 days after primary angioplasty for acute MI and at follow-up, 4–10 months later. Four MBq/kg of 99mTc-sestamibi was injected at rest, and 12 MBq/kg after nitroglycerin spray.

Results

Follow-up improvements were documented for both perfusion (P+) and contractility (C+) in 18% of the 180 initially abnormal segments, in neither perfusion (P−) nor contractility (C−) in 44%, in contractility only (C+P−) in 16% and in perfusion only (C−P+) in 22%. Perfusion improvement was related to lower sestamibi uptake on baseline rest SPECT (P+: 42 ± 15% vs P−: 50 ± 15%, p = 0.001) and, moreover, to a higher increase between rest and nitrate uptake (P+: +9.5 ± 6.5% vs P−: +2.0 ± 5.9%, p < 0.001). Contractility improvement was related to sestamibi uptake on baseline nitrate SPECT (C+: 58 ± 15% vs C−: 38 ± 16%, p < 0.001), a variable enhancing the prediction provided by sestamibi uptake at rest (p < 0.05).

Conclusion

The improvement in perfusion which is documented in the months following MI reperfusion is predicted by initial nitrate enhancement of sestamibi uptake, suggesting a mechanism of reversible vascular injury. In this particular setting, sestamibi uptake is a better predictor of contractility recovery when determined after nitrate administration rather than under conventional resting conditions.

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Acknowledgements

The authors thank: the association ARISC (Association de Recherche et Information Scientifique en Cardiologie, CHU Nancy) for financial support, Sylvain Poussier and Henri Boutley for their help in the quantitative analysis of SPECT images, Alain Manrique and Vincent Richard (University Hospital of Rouen, France) for there help in data interpretation, Renaud Fay from the Centre of Clinical Investigation (CIC) of Nancy for his help in statistical analysis and Dominique Marlier (SMV-General Electric, France) for technical support.

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Correspondence to Wassila Djaballah.

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Djaballah, W., Muller, M.A., Angioï, M. et al. Nitrate-enhanced gated SPECT in patients with primary angioplasty for acute myocardial infarction: evidence of a reversible and nitrate-sensitive impairment of myocardial perfusion. Eur J Nucl Med Mol Imaging 34, 1981–1990 (2007). https://doi.org/10.1007/s00259-007-0423-4

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  • DOI: https://doi.org/10.1007/s00259-007-0423-4

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