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Abstracts
Monday morning, April 24, 1995
JOURNAL OF NUCLEARCARDIOLOGY
March/April 1995, Part 2
S03-O05
S03-007
O
DIPYRIDAMOLE THALLIUM-201 VERY EARLY AFI'ER ACUTE
MYOCARDIALINFARCTIONTREATEDWITH THROMBOLYSIS
N
D
A
Rest Fatty
Acid and
Stress-RD-RI
Thallium
S P E C T M y o c a r d i a l I m a g i n g in p r e d i c t i o n of left
S. Pirelli, A. Moreo, G. Piecalo', D. Massa, A. Corato, R. Sara, G.
Danzi, L. Ruffini, C. DeVita. Niguarda Hospital, Milan, Italy
ventricular recovery following revascularisation
after an acute m y o c a r d i a l infarction.
The aim of this study was to assess the safety and the prognostic
value of dipyridamole thallium-201 imaging (DipTl) very early after
AM/in lots treated with thrombolytic therapy. 52 consecutive pts with
uncomplicated clinical course underwent DipTl 2-5 days after AMI
and were followed for a mean of 14:t:7 months.Quantitative analysis
of planar images, obtained after dipyridamole infusion(0.56 mg/kg)
and 3-4 hours later, was performed. No major complications occurred
during the test. Minor side effects of dipyridamole(mild ipotension,
flushing, headache) were observed in 12 pts(23%).Chest pain, ST
segment depression or both developed during the test in 15 pts(29%).
The perfusion defects within the infarct zone were observed in all 52
pts.Redistribution was seen in 30 of 52 pts(57.6%). No death nor
reinfarction occurred during hospitalization. 5 of the 30 pts with
redistribution (9.6%) developed in-hospital unstable angina compared
to 0 of the 22 pts without redistribution. During the follow-up a total
of 5 late cardiac events were observed: 2 deaths and 2 cases of
unstable angina in the group with reversible defect and 1 reinfarction
in the group with fixed defect. Two-year actuarial probability free of
cardiac events was 55% and 94% 'in the pts with or without
redistribution respectively. In conclusions in pts treated with
thrombolysis DipTl very early after uncomplicated AMI is a feasible
and safe test. The test allows a early stratification of pts with different
degrees of risk for in-hospital and late cardiac events. The pts with
negative DipTl appear to be at low risk and may be candidates for
early discharge. The presence of redistribution identifies a subgroup
of pts who may benefit from further careful clinical evaluation.
Stress-RD-RI-T1 S P E C T is p e r f o r m e d for the a s s e s m e n t o f
residual viability. Fatty acid (FA) h a v e also been proposed.
W e c o m p a r e d the a c c u r a c y o f t h e s e 2 t r a c e r s for t h e
prediction o f regional L V recovery a s s e s s e d b y quantitative
L V a n g l o (Slager m e t h o d ) 18+12 d a y s before a n d 151+51
days after systematic revascularization. 60 pts were included
after a first acute t r a n s m u r a l MI. 35 pts u n d e r w e n t a P T C A ,
17 pts a C A B G , and 8 pts h a d no significant stenosis on the
I R A . A s t r e s s - R D - R I - T 1 S P E C T w a s p e r f o r m e d 18+14
d a y s after ]VII, followed 24 h o u r s later by a rest F A SPECT.
Images were visually analysed by two independant
o b s e r v e r s a c c o r d i n g to t h e C e d a r s S i n a i p r o g r a m . A
s e g m e n t w a s defined as viable w h e n R D - R I T1 u p t a k e w a s
5 0 % or m o r e , or w h e n F A u p t a k e w a s 75% or m o r e , w h e n
c o m p a r e d to the reference area. Results : Positive Predictive
Value, Negative Predictive Value and Accuracy were
r e s p e c t i v e l y : for R D - R I - T 1 . 5 1 , .65, .59, a n d for r e s t - F A
.54, . 6 2 , . 55.
C o n c l u s i o n : W h e n p e r f o r m e d i m m e d i a t l y after the acute
p h a s e o f MI, T1 a n d F A S P E C T s e e m to be p o o r predictors
o f L V i m p r o v e m e n t . Either u s u a l tresholds are n o t accurate
in such pts, or L V angio is n o t the optimal gold standart for
the a s s e s s e m e n t o f regional wall motion after MI.
S03-006
S03-008
SERIAL ASSESSMENT OF METABOLIC AND FUNCTIONAL
CHANGES AFTER ACUTE MYOCARDIAL INFARCTION WITH
PLANAR 201TL/FDG IMAGING AND ECHOCARDIOGRAPHY.
JM Huitink, FC Visser, JJ Bax, A v Lingen, GJJ Teule, CA Visser.
Free University Hospital, Amsterdam, NL
THE LOCATIONOF ISCHEMICPERFUSIONDEFECTSON STRESSTc99m SESTAMIBISPECT SCINTIGRAPHYDOES NOT PREDICTTHE
LOCATIONOF A SUBSEQUENTMYOCARDIALINFARCTION
M
Y
P
M
A
P
R
I
L
2
4
Planar rest myocardial 201T1/FDG imaging has been shown to
distinguish between viable and non-viable myocardium. Using this
technique 25 patients (20 males, 60 +_ 9 yrs) with acute myocardial
infarction were studied within 6 + 2 days of onset of symptoms and 42
+ 4 days thereafter. Serial assessmentof wall motion with 2D-echo
was performed to determine the prognostic value of metabolic indexes
for functional tissue recovery. No revascularization procedure was
performed. Segmental 201TI and FDG uptake was evaluated using
circumferential profiles. Wall motion was scored as normal, hypokinetic
or akinetic. Results: 201T1 uptake was reduced in 71 segments. Twenty
six segments showed a match (FDG-201TI < 20%) consistent with the
presence of scarred tissue. Regional function improved in only 10% of
these segments. In 27 segments a mismatch was present (FDG-20IT1 _>
20 %) of which 25 % showed spontaneous improvement in function,
although recovery varied considerably among patients. In 18 flow
defects FDG was normal of which 27% had improved function after 6
weeks. All segments with functional improvement in time were also
viable by scintJgraphic criteria. Also 56 % of akinetic segments without
improvement showed still a mismatch or normal FDG after 6 weeks,
indicating the presence of hibernation. Conclusions: absence of residual
tissue metabolism shortly after infarction is associated with irreversible
injury, while preservation of metabolic activity identifies segments with
variable outcome. Planar 201T1/FDG imaging allows early identification
of viable but jeopardized tissue and may help select patients who will
benefit from aggressive therapy to salvage endangered myocardium.
Noirclerc M, V a n z e t t o G, M a c h e c o u r t J, F a g r e t D, C o m e t
M, D e n i s B. University Hospital - Grenoble' - France
Gregory L. Miller, Steven D. Herman, Sunil Kalla, Gary V. Heller,
William A. Levin, Kira Stillwell, Mark I. Travin. Roger Williams
Medical Center, Providence, Memorial Hospital, Pawtucket, and
Brown University School of Medicine, Providence, RI.
The location of isehemia on stress Tc-99m sestamibi (MIBI)
SPECT scintigraphy for 26 patients(pts) who had a subsequent MI (85% male, mean age: 66 _+ 13 yrs, 58% pharmacologic stress) was correlated with the location o f infarction.
For each patient's SPECT images, two territories - anterior
(including anterolateral and anteroseptal) and inferior
(including inferolateral and inferoseptal) - were assessed for
the presence of MIBI defects. MI location was determined
from available ECG, eehocardiographic and catheterization
data, blinded to SPECT image results. In 6 pts, MI location
was indeterminate. O f 19 territories with a reversible MIBI
defect, an MI occurred in 9 (47%); of 8 territories with a fixed
defect, an MI occurred in 4 (50%); of 13 territories with no
defect, an MI occurred in 6 (46%) (p=NS). The remaining pt.
had a lateral MI after MIBI images had shown a reversible
apical defect. Thus, 11/20 (55%) infarctions occurred in
territories that had not shown ischemia on prior MIBI imaging.
CONCLUSION: The location o f ischemia on a stress Tc-99m
sestamibi SPECT imaging study does not consistently
correlate with the location o f a future myocardial infarction.
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Soma Jyothula
The University of Texas Health Science Center at Houston
Lucia Florio
Universidad de la República (Uruguay)
Ildiko Toma
Sanguine BioSciences, Inc.
Hassan Djavadzadegan
Tabriz University Of Medical Sciences
