Calabretta R, Castello A, Giglioli C, Cecchi E, Cerisano G, Hacker M, Sciagrà R
Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
J Nucl Cardiol. 2022 Dec;29(6):3115-3122. doi: 10.1007/s12350-021-02874-6. Epub 2021 Dec 16.
In gated myocardial perfusion SPECT, apical remodeling may be identified by the presence of a divergent pattern (DP) of the left ventricle (LV).
We examined 150 anterior ST-elevation myocardial infarction (STEMI) patients, all successfully treated with primary percutaneous coronary interventions (PCI). Perfusion gated-SPECT to measure infarct size, LV end-diastolic (ED) and end-systolic (ES) volumes and ejection fraction (EF) was acquired before hospital discharge and repeated at 6-month follow-up. DP was observed in 26 patients, who had larger infarct size (28 ± 19% vs. 15.7 ± 17%, P < 0.02), and lower EF (33 ± 7% vs. 41 ± 10%, P < 0.001) than patients without DP. At follow-up, DP patients had significantly larger EDV (156 ± 54 vs. 107 ± 44 mL, P < 0.0001), ESV (104 ± 47 vs. 59 ± 36 mL, P < 0.0001) and lower EF (35 ± 12% vs. 48 ± 13%, P < 0.0001). 54% of DP patients developed remodeling at follow-up vs. 12% of those without DP (P < 0.001). During follow up, 7 events in the DP group (27%) and 11 events in patients without DP (9%; P < 0.02) occurred. Kaplan-Meier survival curves showed a worse prognosis for DP patients.
In patients with anterior AMI, early DP detection is related to subsequent LV dysfunction, larger infarct size, and worse severity. It is helpful for predicting LV remodeling at short-term follow-up and has prognostic implications.
在门控心肌灌注单光子发射计算机断层显像（SPECT）中，可通过左心室（LV）发散模式（DP）的存在来识别心尖重塑。
我们检查了150例前壁ST段抬高型心肌梗死（STEMI）患者，所有患者均成功接受了直接经皮冠状动脉介入治疗（PCI）。在出院前进行灌注门控SPECT以测量梗死面积、左心室舒张末期（ED）和收缩末期（ES）容积以及射血分数（EF），并在6个月随访时重复进行。在26例患者中观察到DP，这些患者的梗死面积比无DP的患者更大（28±19%对15.7±17%，P<0.02），EF更低（33±7%对41±10%，P<0.001）。在随访时，有DP的患者的舒张末期容积（EDV）显著更大（156±54对107±44 mL，P<0.0001），收缩末期容积（ESV）更大（104±47对59±36 mL，P<0.0001），EF更低（35±12%对48±13%，P<0.0001）。54%有DP的患者在随访时发生重塑，而无DP的患者为12%（P<0.001）。在随访期间，DP组发生7例事件（27%），无DP的患者发生11例事件（9%；P<0.02）。Kaplan-Meier生存曲线显示有DP的患者预后更差。
在前壁急性心肌梗死患者中，早期检测到DP与随后的左心室功能障碍、更大的梗死面积以及更严重的病情相关。这有助于预测短期随访时的左心室重塑并具有预后意义。
