Toba M, Ishida Y, Fukuchi K, Shimotsu Y, Kume N, Hayashida K, Takamiya M, Noguchi T, Itoh A, Nonogi H
Department of Radiology, National Cardiovascular Center.
Kaku Igaku. 1998 Apr;35(4):219-27.
To clarify the background of the scintigraphic improvement in non-gated myocardial perfusion imaging for patients with acute myocardial infarction, we performed serial ECG-gated 99mTc-MIBI myocardial SPECT in 17 patients with acute myocardial infarction (AMI) receiving successful reperfusion therapy. ECG-gated myocardial SPECT and left ventriculography were performed at 1 week (acute phase) and 1 month (subacute phase) after the onset of AMI. Regional %uptake (regional count x 100/maximal count) was determined for each of 8 myocardial segments of the Bull's eye map. We analyzed the data in 53 AMI segments out of total 136 myocardial segments, on the non-gated (NG), end-diastolic (ED), and end-systolic (ES) images. In addition, the delta %uptake (%uptake in subacute phase--%uptake in acute phase) was also determined as an index representing the improvement of myocardial tracer uptake on each image. In 17 segments (group A) with wall motion recovery assessed by serial left ventriculography, the %uptake on the NG image was significantly improved (61.6 +/- 10.0 to 75.7 +/- 10.1, p < 0.0001). However, in 36 segments (group B) without wall motion recovery, the change of %uptake on the NG image was small. There was no significant change in the %uptake on the ED image in groups A and B. On the contrary, the %uptake on the ES image showed a significant increase in group A (58.4 +/- 11.8 to 68.9 +/- 11.8, p < 0.001), but did not in group B. Thus, this change on the ES image reflects the wall motion recovery. Furthermore, in group A, there was a significant correlation between the delta %uptake on the NG image and those on the ES image (p < 0.02), but was not between those on the NG and the ED images. Thus, the change in the %uptake on the NG image was more related to those on the ES image which is more affected by the change in regional wall motion than those on the ED image which reflects improved myocardial perfusion. These results suggest that ECG-gated myocardial 99mTc-MIBI SPECT is more useful to assess the serial change in myocardial perfusion and contraction than the conventional non-gated SPECT in the follow-up study of patients with AMI.
