Clinical investigations: imaging and diagnostic testingQuantitative regional wall motion analysis with early contrast ventriculography for the assessment of myocardium at risk in acute myocardial infarction☆
Section snippets
Methods
The study group consisted of a series of consecutive acute myocardial infarction patients who were enrolled in an institutional review board-approved study of technetium-99m sestamibi after giving informed consent to participate in that study. Forty patients met the inclusion criteria for the sestamibi study: 1) chest pain >30 minutes and <12 hours duration; 2) electrocardiographic (ECG) ST-segment elevation ≥0.1 mV in at least 2 contiguous leads; 3) acute angiography documenting coronary
Comparison for infarct locations
Myocardium-at-risk assessed with quantitative tomographic imaging was significantly greater for anterior infarctions than for inferior infarctions (40% ± 18% vs 14.0% ± 8.5%, P = .0001). Of the regional wall motion parameters, only the global circumferential extent of hypokinesis revealed a significant difference between the 2 infarct locations (43% ± 25% vs 22% ± 15%, P = .02). The other regional parameters did not distinguish between anterior and inferior myocardial infarctions (Table I).
Correlation of 30° right anterior oblique regional wall motion parameter with technetium-99m imaging
The
Discussion
The determination of the amount of myocardium salvaged, the difference between the area at risk and the final area of permanent damage, is an important end point in the evaluation of a reperfusion therapy. Measurement of the amount of myocardium at risk during an acute ischemic event is critical to this determination. The location of the coronary occlusion is not sufficient for this purpose. Feiring et al demonstrated that the amount of myocardium at “risk” during an acute myocardial
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Supported in part by a grant from E.I. Dupont de Nemours and Company.
Guest Editor for this manuscript was Leslee J. Shaw, PhD, Atlanta Cardiovascular Research Institute, Atlanta, Ga.