Prognostic Value of Gated SPECT after Reperfusion for Acute Myocardial Infarction
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| Format: | Artículo científico |
| Langue: | en |
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Medical Education Cooperation with Cuba
2013
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| author | Lázaro O. Cabrera-Rodríguez |
| author_facet | Lázaro O. Cabrera-Rodríguez |
| contents | Prognostic Value of Gated SPECT after Reperfusion for Acute Myocardial Infarction Lázaro O. Cabrera-Rodríguez Amalia T. Peix Kenia M. Padrón Deilys Chacón Regla Carrillo Yoel Fernández Erick Mena Medicina myo Cuba single cardiac prognosis INTRODUCTION Myocardial reperfusion during the course of an acute myocardial infarction improves patients’ short- and long-term prognosis; coronary blood fl ow is successfully re-established while preserving a large amount of at-risk muscle. Clinical evolution, howev-er, varies. Presence of residual ischemia or viable myocardial tissue affects a patient’s prognosis. Assessment by noninvasive methods allows better prognostic stratifi cation. Cardiac-gated SPECT provides appropriate parameters to support treatment selection and monitoring of these patients. OBJECTIVES Assess the prognostic value—ability to predict occur-rence of major cardiac events—of perfusion and cardiac function obtained by myocardial perfusion scintigraphy in myocardial infarc-tion patients treated by any myocardial reperfusion method, whether pharmacological or surgical.METHODS Forty patients were included, mean age 58.8±9 years, diagnosed with myocardial infarction. Participants were divided into two groups: primary percutaneous transluminal coronary angioplasty (15) or thrombolysis (25). All received myocardial perfusion scintigra-phy with cardiac-gated SPECT to assess perfusion and left ventricular function, and were followed for six months with telephone interviews and review of clinical records.RESULTS In the 11patients who had major cardiac events within six months of followup, a nonsignifi cant increase in perfusion defect extent was seen post reperfusion. Six (54.5%) of those with major car-diac events had anterior perfusion defects. In functional parameters, a signifi cant increase in end-diastolic and end-systolic volumes and decrease in left ventricular ejection fraction were observed post stress (p = 0.006) and at rest (p = 0.001). Post-stress end-diastolic volume of ≥70 mL had a higher prognostic value for major cardiac events [sensitivity 100%; specifi city 89%, area under ROC curve 0.835 (CI 0.702–0.969), p = 0.001].CONCLUSIONS Cardiac-gated SPECT is useful to identify variables (including left ventricular systolic dysfunction and dilation of left cavities, particularly left end-systolic volume of >70 mL) predictive of major car-diac events in reperfused patients, independent of treatment modality. 2013 artículo científico 1555-7960 https://www.redalyc.org/articulo.oa?id=437542093005 en http://www.redalyc.org/revista.oa?id=4375 MEDICC Review application/pdf Medical Education Cooperation with Cuba MEDICC Review (Estados Unidos de América) Num.2 Vol.15 |
| format | Artículo científico |
| id | redalyc_437542093005 |
| institution | Redalyc |
| language | en |
| publishDate | 2013 |
| publisher | Medical Education Cooperation with Cuba |
| spellingShingle | Prognostic Value of Gated SPECT after Reperfusion for Acute Myocardial Infarction Lázaro O. Cabrera-Rodríguez Medicina myo Cuba single cardiac prognosis Prognostic Value of Gated SPECT after Reperfusion for Acute Myocardial Infarction Lázaro O. Cabrera-Rodríguez Amalia T. Peix Kenia M. Padrón Deilys Chacón Regla Carrillo Yoel Fernández Erick Mena Medicina myo Cuba single cardiac prognosis INTRODUCTION Myocardial reperfusion during the course of an acute myocardial infarction improves patients’ short- and long-term prognosis; coronary blood fl ow is successfully re-established while preserving a large amount of at-risk muscle. Clinical evolution, howev-er, varies. Presence of residual ischemia or viable myocardial tissue affects a patient’s prognosis. Assessment by noninvasive methods allows better prognostic stratifi cation. Cardiac-gated SPECT provides appropriate parameters to support treatment selection and monitoring of these patients. OBJECTIVES Assess the prognostic value—ability to predict occur-rence of major cardiac events—of perfusion and cardiac function obtained by myocardial perfusion scintigraphy in myocardial infarc-tion patients treated by any myocardial reperfusion method, whether pharmacological or surgical.METHODS Forty patients were included, mean age 58.8±9 years, diagnosed with myocardial infarction. Participants were divided into two groups: primary percutaneous transluminal coronary angioplasty (15) or thrombolysis (25). All received myocardial perfusion scintigra-phy with cardiac-gated SPECT to assess perfusion and left ventricular function, and were followed for six months with telephone interviews and review of clinical records.RESULTS In the 11patients who had major cardiac events within six months of followup, a nonsignifi cant increase in perfusion defect extent was seen post reperfusion. Six (54.5%) of those with major car-diac events had anterior perfusion defects. In functional parameters, a signifi cant increase in end-diastolic and end-systolic volumes and decrease in left ventricular ejection fraction were observed post stress (p = 0.006) and at rest (p = 0.001). Post-stress end-diastolic volume of ≥70 mL had a higher prognostic value for major cardiac events [sensitivity 100%; specifi city 89%, area under ROC curve 0.835 (CI 0.702–0.969), p = 0.001].CONCLUSIONS Cardiac-gated SPECT is useful to identify variables (including left ventricular systolic dysfunction and dilation of left cavities, particularly left end-systolic volume of >70 mL) predictive of major car-diac events in reperfused patients, independent of treatment modality. 2013 artículo científico 1555-7960 https://www.redalyc.org/articulo.oa?id=437542093005 en http://www.redalyc.org/revista.oa?id=4375 MEDICC Review application/pdf Medical Education Cooperation with Cuba MEDICC Review (Estados Unidos de América) Num.2 Vol.15 |
| title | Prognostic Value of Gated SPECT after Reperfusion for Acute Myocardial Infarction |
| topic | Medicina myo Cuba single cardiac prognosis |
| url | https://www.redalyc.org/articulo.oa?id=437542093005 |