Korean J Nucl Med.  2000 Feb;34(1):30-38.

Usefulness of 201Tl Myocardial Perfusion SPECT in Prediction of Left Ventricular Remodeling following an Acute Myocardial Infarction

• Yoon SN
• Park CH
• Hwang KH

Abstract

PURPOSE: We investigated the role of myocardial perfusion SPECT in prediction of ventricular dilatation and the role of revascularization including thrombolytic therapy and PTCA in prevention of ventricular dilatation after an acute myocardial infarction (AMI).
MATERIALS AND METHODS
We performed dipyridamole stress, 4 hour redistribution, and 24 hour reinjection Tl-201 SPECT in 16 patients with AMI two to nine days after attack. Perfusion and wall motion abnormalities were quantified by perfusion index (PI) and wall motion index (WMI). Left ventricular ejection fraction (LVEF), WMI and ventricular volume were measured within 1 week of AMI and after average of 6 months. According to serial changes of left ventricular end-diastolic volume (LVEDV), patients were divided into two groups. We compared WMI, PI and LVEF between the two groups. Relationships among degree of volume, stress-rest PI, WMI, CKMB, Q wave, LVEF and revascularization were analysed using multivariate analysis.
RESULTS
Only initial rest perfusion index was significantly different between the two groups (p<0.05). While initial LVEF, stress PI, CKMB, trial of revascularization procedure, presence of Q wave and WMI were not significantly different between the two groups. Eight of 16 patients (50%) showed LV dilatation on follow-up echocardiography. Three of 3 patients (100%) who did not undergo revascualrization procedure documented LV dilatation. And only 5 (38%) of the remaining 13 patients who underwent revascularization revealed LV dilatation. There was no difference in infarct location between the two groups. By multivariate linear regression analysis in patients only undergoing revascularization, rest perfusion index was the only significant factor.
CONCLUSION
Myocardial perfusion SPECT performed prior to revascularization was useful in prediction of LV dilatation after an AMI. Rest perfusion index on myocardial perfusion plays as a significant predictor of left ventricular dilatation after AMI. And revascularization appears to be a valuable procedure in alleviating LV dilatation after AMI with or without viable myocardium in a limited number of patients studied retrospectively.

Keyword

Tl-201; Acute myocardial infarction; Remodeling; Revascularization

MeSH Terms

Dilatation
Dipyridamole
Echocardiography
Follow-Up Studies
Humans
Linear Models
Multivariate Analysis
Myocardial Infarction*
Myocardium
Perfusion*
Retrospective Studies
Stroke Volume
Thrombolytic Therapy
Tomography, Emission-Computed, Single-Photon*
Ventricular Remodeling*
Dipyridamole