Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction.
Gated SPECT allows combined assessment of regional myocardial perfusion and left ventricular function. The aim of this study was to address the prognostic value of gated SPECT performed during dobutamine stress testing and during rest on patients with acute myocardial infarction treated with thrombolysis.


METHODS
Eighty-eight consecutive patients with uncomplicated acute myocardial infarction who underwent predischarge (3-7 d after admission) dobutamine (5-40 microg/kg of body weight per minute in 3-min dose increments) and rest gated (99m)Tc-sestamibi SPECT were followed for a mean of 48 mo (range, 4-64 mo).


RESULTS
Eighteen cardiac events (8 cardiac deaths and 10 nonfatal myocardial infarctions) occurred. Ischemia at dobutamine SPECT imaging (summed difference score or=>or= 1) was present in 60% of the patients. In patients without ischemia, there was a lower event rate (11%), compared with patients with mild ischemia (18%) and moderate-to-severe ischemia (40%) (P < 0.05). Patients with events showed also a higher summed difference score, compared with patients without events (2.3 +/- 1.6 vs. 1.3 +/- 1.6, P < 0.05). Independent predictors of events were the number of segments with preserved (99m)Tc-sestamibi uptake at rest and the number of akinetic or dyskinetic segments with preserved (99m)Tc-sestamibi uptake and preserved wall thickening (global chi(2) of the model, 13.6; P < 0.01). The assessment of the incremental prognostic value of variables added sequentially showed that the addition of the summed difference score added information to perfusion status at rest (P < 0.05). Combined assessment of regional myocardial perfusion and left ventricular function at rest further improved the model (P < 0.05).


CONCLUSIONS
The present study indicated that predischarge (99m)Tc-sestamibi gated SPECT gives prognostic information on patients recovering from acute myocardial infarction. Patients with preserved systolic wall thickening should be regarded as a high-risk subgroup, requiring closer follow-up for appropriate treatment.
Spinelli
Letizia
L
Institute of Internal Medicine, Cardiology and Heart Surgery, University Federico II, Naples, Italy.
Petretta
Mario
M
Acampa
Wanda
W
He
Wei
W
Petretta
Andrea
A
Bonaduce
Domenico
D
Cuocolo
Alberto
A
D004280:Dobutamine; D005260:Female; D005500:Follow-Up Studies; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012146:Rest; D018570:Risk Assessment / Q000379:methods; D016037:Single-Blind Method; D013223:Statistics as Topic; D017256:Technetium Tc 99m Sestamibi; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology
D019275:Radiopharmaceuticals; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi