title: Site of myocardial infarction and severity of perfusion abnormalities impact on post-stress left ventricular function in patients with single-vessel disease: gated single-photon emission computed tomography methoxyisobutylisonitrile study.
abstract: OBJECTIVE
  We used gated single-photon emission computed tomography methoxyisobutylisonitrile (SPECT MIBI) to (i) determine whether location of myocardial infarction (MI) and severity of perfusion abnormalities affect post-stress left ventricular function in patients with single-vessel coronary artery disease, and (ii) correlate changes between post-stress and rest ejection fraction (EF) with the severity of perfusion and regional wall motion abnormalities (RWMAs).
  
  
  METHODS
  Eighty-eight patients with a history (> or =3 months) of anterior MI (n=45) or inferior MI (n=43) underwent a 2-day stress-rest gated SPECT MIBI. 4D-MSPECT software was used to calculate left ventricular end-diastolic volume (EDV), end-systolic volume (ESV), EF, and the difference from post-stress to rest EF (EFs-EFr). Summed stress scores, summed rest scores, and summed difference scores (SDS) were calculated based on the 17-segment model. RWMAs were visually assessed using a 5-point score.
  
  
  RESULTS
  Patients with anterior MI, compared with those with inferior MI, showed significantly greater perfusion abnormalities (summed stress score 11.0+/-5.5 vs. 7.5+/-2.4, P<0.01, summed rest score 7.4+/-4.7 vs. 5.2+/-1.9, P<0.01, SDS 3.3+/-1.0 vs. 1.9+/-1.0, P<0.05) and higher post-stress and rest RWMA (RWMSS 12.2+/-6.0 vs. 8.7+/-4.1, P<0.01, RWMRS 8.7+/-5.4 vs. 5.6+/-3.0, P<0.01). In 22 patients with anterior reversible ischemia in addition to fixed defect, post-stress and rest EDV and ESV were significantly larger and post-stress EF decreased more than in 21 patients with inferior MI (EDV 144.0+/-28.9 ml vs. 108.6+/-36.9 ml, ESV 70.6+/-22.2 ml vs. 53.4+/-20.5 ml, EFs-EFr -4.2+/-3.5% vs. -1.5+/-2.2%, P<0.01). SDS and RWMA were highly correlated with EFs-EFr.
  
  
  CONCLUSIONS
  In patients with single-vessel coronary artery disease, the extent and severity of perfusion and RWMAs assessed by gated SPECT MIBI are greater after anterior MI than inferior MI. Global left ventricular function is significantly more affected after anterior MI only in patients with reversible ischemia in addition to fixed wall defect. Decrease in EF from post-stress to rest is closely associated with the severity of perfusion and RWMAs. Overall results suggest that the extent and severity of perfusion and RWMAs are more prominent in the myocardial region supplied by left anterior descending coronary artery than by right coronary artery, which may explain significantly worse post-stress left ventricular function after anterior MI.
authors.affiliation: aInstitute for Nuclear Medicine bInstitute for Cardiovascular Diseases, Clinical Center of Serbia cInstitute for Medical Statistics and Informatics, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dragana P
authors.initials: DP
authors.lastname: Sobic-Saranovic
authors.forename: Smiljana V
authors.initials: SV
authors.lastname: Pavlovic
authors.forename: Branko D
authors.initials: BD
authors.lastname: Beleslin
authors.forename: Zorica R
authors.initials: ZR
authors.lastname: Petrasinovic
authors.forename: Nebojsa Dj
authors.initials: NDj
authors.lastname: Kozarevic
authors.forename: Mila V
authors.initials: MV
authors.lastname: Todorovic-Tirnanic
authors.forename: Tanja M
authors.initials: TM
authors.lastname: Ille
authors.forename: Emilija D
authors.initials: ED
authors.lastname: Jaksic
authors.forename: Vera M
authors.initials: VM
authors.lastname: Artiko
authors.forename: Vladimir B
authors.initials: VB
authors.lastname: Obradovic
mesh_terms: D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005080:Exercise Test; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi