Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Cardiology, The Heart Center, Rigshospitalet University of Copenhagen, Copenhagen, Denmark.
J Nucl Cardiol. 2019 Apr;26(2):471-482. doi: 10.1007/s12350-017-0993-x. Epub 2017 Jul 17.
Assessment of infarct size after myocardial infarction is predictive of subsequent morphological changes and clinical outcome. This study aimed to assess subacute post-intervention Rubidium-82 (Rb)-PET imaging in predicting left ventricle ejection fraction, regional wall motion, and final infarct size by CMR at 3-months after STEMI.
STEMI patients undergoing percutaneous coronary intervention were included prospectively. Rest-only Rb-PET perfusion imaging was performed at median 36 hours [IQR: 22 to 50] after the treatment. The extent of hypoperfusion and absolute blood flow (mL·min·g) were estimated on a global and a 17-segment model with dedicated software. At 3-months follow-up patients completed the CMR functional and late gadolinium enhancement imaging.
42 patients were included, but only 35 had follow-up CMR and constituted the study population. Absolute blood flow was significantly lower in the infarct-related territory compared to remote myocardium, P < .005. Extent of hypoperfusion correlated with final infarct size, r = 0.58, P < .001, while blood flow correlated with ejection fraction, r = 0.41, P < .05. In linear mixed models, higher subacute absolute blood flow (β = 4.6, confidence interval [3.5; 5.2], P < .001, R = 0.67) was associated with greater wall motion. Segmental extent of subacute hypoperfusion (β = 0.43 [0.38; 0.49], P < .001, R = 0.58) was associated with the degree of late gadolinium enhancement at 3-months.
Subacute rest-only Rb-PET is feasible following STEMI and seems predictive of myocardial function and infarct size at 3-months.
心肌梗死后梗死面积的评估可预测后续的形态学改变和临床转归。本研究旨在评估STEMI 后 3 个月经 CMR 评估的亚急性介入后放射性核素 82 铷（Rb）-PET 成像对左心室射血分数、局部壁运动和最终梗死面积的预测价值。
前瞻性纳入接受经皮冠状动脉介入治疗的 STEMI 患者。在治疗后中位数 36 小时[IQR：22 至 50]进行仅行静息期 Rb-PET 灌注成像。使用专用软件在整体和 17 节段模型上估计低灌注程度和绝对血流（mL·min·g）。在 3 个月随访时，患者完成 CMR 功能和晚期钆增强成像。
共纳入 42 例患者，但仅 35 例有随访 CMR，构成研究人群。与远隔心肌相比，梗死相关区域的绝对血流明显较低，P<0.005。低灌注程度与最终梗死面积相关，r=0.58，P<0.001，而血流与射血分数相关，r=0.41，P<0.05。在线性混合模型中，较高的亚急性绝对血流（β=4.6，置信区间[3.5; 5.2]，P<0.001，R=0.67）与更大的壁运动相关。亚急性低灌注的节段程度（β=0.43[0.38; 0.49]，P<0.001，R=0.58）与 3 个月时的晚期钆增强程度相关。
STEMI 后行亚急性仅行静息期 Rb-PET 是可行的，似乎可预测 3 个月时的心肌功能和梗死面积。
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