Elsevier

American Heart Journal

Volume 145, Issue 6, June 2003, Pages 1051-1057
American Heart Journal

Clinical investigations: imaging and diagnostic testing
Quantitative regional wall motion analysis with early contrast ventriculography for the assessment of myocardium at risk in acute myocardial infarction

https://doi.org/10.1016/S0002-8703(03)00112-1Get rights and content

Abstract

Background

Several techniques have been used to quantify the myocardium at risk, including measurement of regional ventricular function with contrast ventriculography and measurement of perfusion defect size with tomographic technetium-99m-sestamibi imaging. This study evaluates the correlation between these 2 techniques.

Methods

Twenty-three patients with angiographically documented coronary occlusion and acute myocardial infarctions (10 anterior, 13 inferior) were studied. All patients had contrast left ventriculography at the time of their acute angiogram before any revascularization therapy. Regional wall motion parameters measured with the centerline method were the severity, circumferential extent, and global circumferential extent of hypokinesis and the mean standardized motion in predefined areas. Technetium-99m-sestamibi was injected before reperfusion therapy with measurement of the myocardium at risk using single photon emission computed tomography imaging.

Results

The tomographic sestamibi-measured myocardium at risk was significantly greater for anterior infarctions compared with inferior infarctions (40% ± 18% vs 14.0 ± 8.5%, P = .0001). The only parameter of regional wall motion to show a significant difference by infarct location was global circumferential extent of hypokinesis (43% ± 25% vs 22% ± 15%, P = .02). The other parameters were not significantly different between anterior and inferior myocardial infarctions. For anterior infarctions, these parameters of regional wall motion correlated with myocardium at risk assessed with sestamibi: global circumferential extent of hypokinesis (r = .88, P < .01), circumferential extent of hypokinesis (r = .78, P < .01), mean standardized motion in predefined areas (r = –.74, P < .05), and severity of hypokinesis (r = –.70, P < .05). For inferior infarctions, there was no significant correlation between any of these parameters of regional wall motion and myocardium at risk assessed with sestamibi imaging.

Conclusion

The assessment of regional ventricular function with contrast ventriculography correlates with the area of myocardium at risk measured with tomographic technetium-99m-sestamibi for anterior, but not for inferior, myocardial infarctions. Therefore, these parameters of regional wall motion are a poor measure of the efficacy of reperfusion therapies.

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

References (42)

  • T.D Miller et al.

    Usefulness of technetium-99m Sestamibi infarct size in predicting posthospital mortality following acute myocardial infarction

    Am J Cardiol

    (1998)
  • R.J Burns et al.

    The relationships of left ventricular ejection fraction, end-systolic volume index and infarct size to six-month mortality after hospital discharge following myocardial infarction treated by thrombolysis

    J Am Coll Cardiol

    (2002)
  • P.J Ahrens et al.

    Extension of hypokinesia into angiographically perfused myocardium in patients with acute infarction

    J Am Coll Cardiol

    (1993)
  • T.F Christian et al.

    The influence of gating on measurements of myocardium at risk and infarct size during acute myocardial infarction by tomographic technetium-99m sestamibi imaging

    J Nucl Cardiol

    (1995)
  • A.J Feiring et al.

    The importance of the determination of the myocardial area at risk in the evaluation of the outcome of acute myocardial infarction in patients

    Circulati

    (1987)
  • P.M De Costa et al.

    Area at-risk determination by technetium-99m-hexakis-2-methoxyisobutyl isonitrile in experimental reperfused myocardial infarction

    Circulation

    (1990)
  • Q.S Li et al.

    Technetium 99m methoxyisobutyl isonitirle (RP30) for quantification of myocardial ischemia and reperfusion in dogs

    J Nucl Med

    (1988)
  • M.S Verani et al.

    Quantification of myocardial infarction during coronary occlusion and myocardial salvage after reperfusion using cardiac imaging with technetium-99m hexakis 2-methoxyisobutyl isonitrile

    J Am Coll Cardiol

    (1988)
  • R.J Gibbons et al.

    Feasibility of tomographic 99mTc-hexakis-2-methoxy-2-methylpropyl-isonitrile imaging for the assessment of myocardial area at risk and the effect of treatment in acute myocardial infarction

    Circulation

    (1989)
  • G.M Santoro et al.

    Single photon emisssion computed tomography with technetium-99m hexakis 2-methoxyisobutyl isonitrile in acute myocardial infarction before and after thrombolytic treatment: assessment of salvaged myocardium and prediction of late functional recovery

    J Am Coll Cardiol

    (1990)
  • T.F Christian et al.

    Noninvasive identification of myocardium at risk in patients with actue myocardial infarction and nondiagnostic electrocardiograms with technetium-99m-Sestamibi

    Circulation

    (1991)
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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.

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