Prognostic value of divergent pattern detection by 99mTc-sestamibi gated SPECT in patients with anterior acute myocardial infarction

Abstract

Purpose. In gated myocardial perfusion SPECT, apical remodeling may be identified by the presence of a divergent pattern (DP) of the left ventricle (LV).Methods and Results. 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.Conclusion. 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. (J Nucl Cardiol 2021

Stand der Technik in der Radiopharmazie

“…1 Physikalische Eigenschaften von häufig verwendeten Radionukliden für die Einzelphotonen-Emissions-Computertomografie (SPECT) und die Positronen-Emissions-Tomografie (PET). 111 In SPECT 13 N 1 0 m β + (100) 16 O(p,α) 13 N P E T 99 m Tc-Kern enthalten, in dem das koordinativ gesättigte 99 m Technetium(VII) in 99 m TcO -4 auf einen Oxidationszustand reduziert wurde, der für die Herstellung stabiler Komplexe für die Koordinationschemie besser geeignet ist. Am leichtesten zugänglich ist Technetium(V), wie die zahlreichen zugelassenen 99 m Technetium(V)-Radiotracer zeigen, darunter 99 m Tc-Sestamibi, 99 m Tc-Tetrofosmin, 99 m Tc-Teboroxim, 99 m Tc-Bicisat, 99 m Tc-Pentetat, 99 m Tc-Oxidronat (CH5O7P2Tc), bekannt unter den Handelsnamen Cardiolite, Myoview, Cardiotec, Neurolite, Technescan MAG3, Osteoscan HDP [13][14][15][16][17][18].…”

“…111 In SPECT 13 N 1 0 m β + (100) 16 O(p,α) 13 N P E T 99 m Tc-Kern enthalten, in dem das koordinativ gesättigte 99 m Technetium(VII) in 99 m TcO -4 auf einen Oxidationszustand reduziert wurde, der für die Herstellung stabiler Komplexe für die Koordinationschemie besser geeignet ist. Am leichtesten zugänglich ist Technetium(V), wie die zahlreichen zugelassenen 99 m Technetium(V)-Radiotracer zeigen, darunter 99 m Tc-Sestamibi, 99 m Tc-Tetrofosmin, 99 m Tc-Teboroxim, 99 m Tc-Bicisat, 99 m Tc-Pentetat, 99 m Tc-Oxidronat (CH5O7P2Tc), bekannt unter den Handelsnamen Cardiolite, Myoview, Cardiotec, Neurolite, Technescan MAG3, Osteoscan HDP [13][14][15][16][17][18]. Die ersten 3 Komplexe sind als Mittel zur Durchblutung des Herzmuskels zugelassen, während die anderen für die zerebrale Perfusion, die Nierenfunktion bzw.…”

Divergent pattern: Pattern recognition or marker for adverse events

“…In this edition of the Journal, Dr. Calabretta and colleagues 5 explore the prognostic value of Divergent Pattern (DP) detection by SPECT among patients with Acute anterior Myocardial Infarction. Traditionally, divergent pattern recognition has been applied in the evaluation and management of ischemic cardiomyopathy but not in the setting of post-AMI patients.…”