title: Use of ECG-gated SPET to assess the evolution of perfusion after acute myocardial infarction.
abstract: Serial improvement in myocardial perfusion images from the acute or subacute to the chronic stage of acute myocardial infarction (AMI) has been attributed to improved coronary microcirculation or cell function after acute ischaemia and reperfusion. However, conventionally used non-gated imaging cannot eliminate the effect of improved regional contraction. We studied the possibility that such scintigraphic improvement reflects the functional recovery by using ECG-gated myocardial perfusion imaging with technetium-99m sestamibi. Nineteen AMI patients who received acute reperfusion therapy underwent ECG-gated myocardial single-photon emission tomography (SPET) in the subacute and chronic stages. Serial changes in regional image count distributions were analysed on the non-gated, end-diastolic (ED) and end-systolic (ES) images by using segmental mean percent peak activity (MPA) and AMPA (MPA in chronic stage - MPA in subacute stage) on bull's-eye polar maps. These changes were compared with those in regional wall motion on biplane left ventriculography (LVG) from the acute (just after reperfusion) to the chronic stage. During the follow-up, regional wall motion remained the same in 42 (group A) but improved in 17 (group B) of the 59 ischaemically compromised segments. MPA showed no improvement in group A but significant improvement in group B on the non-gated and ES images (P<0.0001 and P<0.001, respectively). However, MPA on the ED images showed no improvement in either group. In the follow-up study of AMI, the scintigraphic improvement documented on the non-gated myocardial images appears to be mainly related to the recovery of wall thickening and not to a real improvement in myocardial perfusion. Therefore, ECG-gated myocardial imaging, which enables simultaneous assessment of changes in perfusion and contraction, is preferable to conventional non-gated imaging for follow-up of AMI.
authors.affiliation: Department of Radiology, National Cardiovascular Center, Osaka, Japan. mtob@nms.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Toba
authors.forename: Y
authors.initials: Y
authors.lastname: Ishida
authors.forename: K
authors.initials: K
authors.lastname: Jukuchi
authors.forename: T
authors.initials: T
authors.lastname: Noguchi
authors.forename: A
authors.initials: A
authors.lastname: Itoh
authors.forename: H
authors.initials: H
authors.lastname: Nonogi
authors.forename: M
authors.initials: M
authors.lastname: Takamiya
mesh_terms: D000208:Acute Disease; D006328:Cardiac Catheterization; D004562:Electrocardiography; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D015425:Myocardial Reperfusion; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi