Analysis of apical remodeling in gated myocardial perfusion SPECT imaging in ischemic cardiomyopathy.
BACKGROUND
A divergent pattern (DP) of the left ventricle (LV) is an expression of apical remodeling in myocardial perfusion gated single-photon emission computed tomography (SPECT) of patients with ischemic cardiomyopathy (ICM).


RESULTS
We consecutively studied 156 patients (mean age, 63 years; 24 women) with ICM (LV ejection fraction, < or =40%) using gated SPECT and technetium-labeled agents. Apical remodeling was considered to exist when a DP was observed. Apical remodeling was noted in 30% of patients, all of whom had a history of anterior myocardial infarction. A divergent pattern was observed more frequently in younger patients and in those with ST-segment elevation on their electrocardiograms. The longer the interval between the infarction and the performance of gated SPECT, the more prevalent were the LV dilatation and DP. A divergent pattern was associated with cardiac death and heart failure only in patients with scintigraphic criteria for myocardial viability.


CONCLUSIONS
A divergent pattern in gated SPECT, as an expression of apical remodeling, can be observed in up to a third of patients with ICM, all with a history of anterior infarction. The longer the time between the infarction and the gated SPECT, the more prevalent the LV dilatation becomes. Apical remodeling is a variable predicts mortality in patients with scintigraphic criteria for viability.
Romero-Farina
Guillermo
G
Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Candell-Riera
Jaume
J
Aguadé-Bruix
Santiago
S
Castell-Conesa
Joan
J
de León
Gustavo
G
D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*; D020257:Ventricular Remodeling