title: Location of myocardium at risk in patients with first-time ST-elevation infarction: comparison among single photon emission computed tomography, magnetic resonance imaging, and electrocardiography.
abstract: BACKGROUND
  The amount of myocardium at risk (MaR) during acute coronary occlusion and the duration of occlusion are important determinants of final infarct size. The main goal of early reperfusion therapy is to salvage ischemic myocardium, thereby preserving left ventricular function. The aims of the present study were to test the feasibility of developing polar plot representations of MaR, for perfusion single photon emission computed tomography (SPECT), regional wall thickening by magnetic resonance imaging (MRI), and distribution of ST-segment changes. A second aim was to test the hypothesis that these different modalities display similar localization of the MaR in patients with reperfused first-time myocardial infarction.
  
  
  METHODS
  Eleven patients with first-time myocardial infarction with ST-elevation received (99m)Tc tetrofosmin before primary percutaneous coronary intervention, SPECT imaging within 3 hours, and cardiac MRI of the left ventricle within 24 hours. The results for SPECT, MRI, and electrocardiogram (ECG) were developed into polar plots, and two expert observers designated the culprit coronary artery as assessed by angiography.
  
  
  RESULTS
  The perfusion SPECT, MRI wall thickening, and ST changes are presented in side-by-side polar plots. In total, the culprit artery, based on the location of the MaR, was correctly designated in 91%, 82%, and 91% of cases by SPECT, MRI, and ECG, respectively.
  
  
  CONCLUSIONS
  Polar representation for localization of the MaR by SPECT perfusion, MRI wall thickening, and ECG ST-segment deviation is feasible. All 3 modalities have the potential to be used for indirect visual designation of the culprit artery in patients with first-time acute coronary occlusion.
authors.affiliation: Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands.
authors.forename: Joey F A
authors.initials: JF
authors.lastname: Ubachs
authors.forename: Henrik
authors.initials: H
authors.lastname: Engblom
authors.forename: Erik
authors.initials: E
authors.lastname: Hedström
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Selvester
authors.forename: Stephanie A M
authors.initials: SA
authors.lastname: Knippenberg
authors.forename: Galen S
authors.initials: GS
authors.lastname: Wagner
authors.forename: Anton P M
authors.initials: AP
authors.lastname: Gorgels
authors.forename: Håkan
authors.initials: H
authors.lastname: Arheden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis*; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000209:etiology*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*