Mismatch of left ventricular function and infarct size demonstrated by technetium-99m isonitrile imaging after reperfusion therapy for acute myocardial infarction: Identification of myocardial stunning and hyperkinesia
Quantitation of perfusion defect size using tomographic imaging with technetium-99m-hexakis-2-methoxy isobutyl isonitrile was performed at the time of hospital discharge in 32 patients with a first myocardial infarction who underwent successful coronary reperfusion within 8 h of the onset of chest p...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1990-12, Vol.16 (7), p.1632-1638 |
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| creator | Christian, Timothy F. Behrenbeck, Thomas Pellikka, Patricia A. Huber, Kenneth C. Chesebro, James H. Gibbons, Raymond J. |
| description | Quantitation of perfusion defect size using tomographic imaging with technetium-99m-hexakis-2-methoxy isobutyl isonitrile was performed at the time of hospital discharge in 32 patients with a first myocardial infarction who underwent successful coronary reperfusion within 8 h of the onset of chest pain. Reperfusion was accomplished with thrombolysis or primary coronary angioplasty. Radionuclide angiography was performed at discharge and 6 weeks later.
There was a close correlation between perfusion defect size and values for ejection fraction and regional wall motion both at discharge (r = −0.80 and −0.75, respectively) and 6 weeks later (r = −0.81 and −0.81, respectively). There was no overall group difference in ejection fraction between the value at discharge and at 6 weeks; however, five patients had a significant increase (≥0.08) and six had a significant decrease (≥0.08) in ejection fraction. In patients with a significant increase at 6 weeks, ejection fraction was significantly lower at discharge than the value predicted from perfusion defect size (0.37 ± 0.09 measured versus 0.47 ± 0.13 predicted, p < 0.05) and it improved at 6 weeks to near predicted values (0.51 ± 0.07). In patients with a significant decrease at 6 weeks, ejection fraction was significantly higher at discharge than the value predicted from perfusion defect size (0.60 ± 0.10 measured versus 0.50 ± 0.10 predicted, p < 0.05) and it decreased at 6 weeks to near predicted levels (0.51 ± 0.09).
Left ventricular ejection fraction at the time of hospital discharge is a potentially misleading index of the efficacy of reperfusion therapy for myocardial infarction. In a significant minority (34%) of patients this index does not accurately reflect perfusion defect size, apparently because of the effects of myocardial stunning and compensatory hyperkinesia. |
| doi_str_mv | 10.1016/0735-1097(90)90313-E |
| format | Article |
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There was a close correlation between perfusion defect size and values for ejection fraction and regional wall motion both at discharge (r = −0.80 and −0.75, respectively) and 6 weeks later (r = −0.81 and −0.81, respectively). There was no overall group difference in ejection fraction between the value at discharge and at 6 weeks; however, five patients had a significant increase (≥0.08) and six had a significant decrease (≥0.08) in ejection fraction. In patients with a significant increase at 6 weeks, ejection fraction was significantly lower at discharge than the value predicted from perfusion defect size (0.37 ± 0.09 measured versus 0.47 ± 0.13 predicted, p < 0.05) and it improved at 6 weeks to near predicted values (0.51 ± 0.07). In patients with a significant decrease at 6 weeks, ejection fraction was significantly higher at discharge than the value predicted from perfusion defect size (0.60 ± 0.10 measured versus 0.50 ± 0.10 predicted, p < 0.05) and it decreased at 6 weeks to near predicted levels (0.51 ± 0.09).
Left ventricular ejection fraction at the time of hospital discharge is a potentially misleading index of the efficacy of reperfusion therapy for myocardial infarction. In a significant minority (34%) of patients this index does not accurately reflect perfusion defect size, apparently because of the effects of myocardial stunning and compensatory hyperkinesia.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/0735-1097(90)90313-E</identifier><identifier>PMID: 2147706</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Biological and medical sciences ; Cardiology. Vascular system ; Coronary heart disease ; Female ; Heart ; Heart - diagnostic imaging ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Infarction - diagnostic imaging ; Myocardial Infarction - drug therapy ; Myocardial Reperfusion Injury - diagnostic imaging ; Nitriles ; Organotechnetium Compounds ; Prospective Studies ; Radionuclide Angiography ; Technetium Tc 99m Sestamibi ; Thrombolytic Therapy ; Time Factors ; Tissue Plasminogen Activator - therapeutic use ; Ventricular Function, Left - physiology</subject><ispartof>Journal of the American College of Cardiology, 1990-12, Vol.16 (7), p.1632-1638</ispartof><rights>1990</rights><rights>1991 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c403t-f73a7c3abb4f70848e04e5b1e32c67b4957034c0665db0b8e74bcda40a6fab733</citedby><cites>FETCH-LOGICAL-c403t-f73a7c3abb4f70848e04e5b1e32c67b4957034c0665db0b8e74bcda40a6fab733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/073510979090313E$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19520547$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/2147706$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christian, Timothy F.</creatorcontrib><creatorcontrib>Behrenbeck, Thomas</creatorcontrib><creatorcontrib>Pellikka, Patricia A.</creatorcontrib><creatorcontrib>Huber, Kenneth C.</creatorcontrib><creatorcontrib>Chesebro, James H.</creatorcontrib><creatorcontrib>Gibbons, Raymond J.</creatorcontrib><title>Mismatch of left ventricular function and infarct size demonstrated by technetium-99m isonitrile imaging after reperfusion therapy for acute myocardial infarction: Identification of myocardial stunning and hyperkinesia</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Quantitation of perfusion defect size using tomographic imaging with technetium-99m-hexakis-2-methoxy isobutyl isonitrile was performed at the time of hospital discharge in 32 patients with a first myocardial infarction who underwent successful coronary reperfusion within 8 h of the onset of chest pain. Reperfusion was accomplished with thrombolysis or primary coronary angioplasty. Radionuclide angiography was performed at discharge and 6 weeks later.
There was a close correlation between perfusion defect size and values for ejection fraction and regional wall motion both at discharge (r = −0.80 and −0.75, respectively) and 6 weeks later (r = −0.81 and −0.81, respectively). There was no overall group difference in ejection fraction between the value at discharge and at 6 weeks; however, five patients had a significant increase (≥0.08) and six had a significant decrease (≥0.08) in ejection fraction. In patients with a significant increase at 6 weeks, ejection fraction was significantly lower at discharge than the value predicted from perfusion defect size (0.37 ± 0.09 measured versus 0.47 ± 0.13 predicted, p < 0.05) and it improved at 6 weeks to near predicted values (0.51 ± 0.07). In patients with a significant decrease at 6 weeks, ejection fraction was significantly higher at discharge than the value predicted from perfusion defect size (0.60 ± 0.10 measured versus 0.50 ± 0.10 predicted, p < 0.05) and it decreased at 6 weeks to near predicted levels (0.51 ± 0.09).
Left ventricular ejection fraction at the time of hospital discharge is a potentially misleading index of the efficacy of reperfusion therapy for myocardial infarction. In a significant minority (34%) of patients this index does not accurately reflect perfusion defect size, apparently because of the effects of myocardial stunning and compensatory hyperkinesia.</description><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Female</subject><subject>Heart</subject><subject>Heart - diagnostic imaging</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnostic imaging</subject><subject>Myocardial Infarction - drug therapy</subject><subject>Myocardial Reperfusion Injury - diagnostic imaging</subject><subject>Nitriles</subject><subject>Organotechnetium Compounds</subject><subject>Prospective Studies</subject><subject>Radionuclide Angiography</subject><subject>Technetium Tc 99m Sestamibi</subject><subject>Thrombolytic Therapy</subject><subject>Time Factors</subject><subject>Tissue Plasminogen Activator - therapeutic use</subject><subject>Ventricular Function, Left - physiology</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1990</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9v1DAQxS0EKtuFbwCSL6ByCNhrJ457QELVApWKuMDZmjjjriFxFtuptHxUPg3ePxROnOYwb37vaR4hzzh7zRlv3jAl6oozrS40e6WZ4KJaPyALXtdtJWqtHpLFveQxOU_pG2Osabk-I2crLpVizYL8-uTTCNlu6OTogC7TOww5ejsPEKmbg81-ChRCT31wEG2myf9E2uM4hZQjZOxpt6MZ7SZg9vNYaT1Sn6bgC2ZA6ke49eGWgssYacQtRjenPTRvMMJ2R90UKdg5Ix13k4XYexj-uBXdJb3uSybvvIVDmJL0H2HKcwgHg5Jxsyv47z5g8vCEPHIwJHx6mkvy9f36y9XH6ubzh-urdzeVlUzkyikBygroOukUa2WLTGLdcRQr26hO6loxIS1rmrrvWNeikp3tQTJoHHRKiCV5eeRu4_RjxpTN6JPFYYCA05xMy3jdNsVrSeRRaOOUUkRntrF8J-4MZ2Zfqdn3ZfZ9Gc3MoVKzLmfPT_y5G7G_Pzp1WPYvTntIFgYXIVif_rJ1vWK1VEX39qjD8ow7j9Ek6zFY7H1Em00_-f8H-Q1CG8TW</recordid><startdate>199012</startdate><enddate>199012</enddate><creator>Christian, Timothy F.</creator><creator>Behrenbeck, Thomas</creator><creator>Pellikka, Patricia A.</creator><creator>Huber, Kenneth C.</creator><creator>Chesebro, James H.</creator><creator>Gibbons, Raymond J.</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199012</creationdate><title>Mismatch of left ventricular function and infarct size demonstrated by technetium-99m isonitrile imaging after reperfusion therapy for acute myocardial infarction: Identification of myocardial stunning and hyperkinesia</title><author>Christian, Timothy F. ; Behrenbeck, Thomas ; Pellikka, Patricia A. ; Huber, Kenneth C. ; Chesebro, James H. ; Gibbons, Raymond J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c403t-f73a7c3abb4f70848e04e5b1e32c67b4957034c0665db0b8e74bcda40a6fab733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1990</creationdate><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Female</topic><topic>Heart</topic><topic>Heart - diagnostic imaging</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnostic imaging</topic><topic>Myocardial Infarction - drug therapy</topic><topic>Myocardial Reperfusion Injury - diagnostic imaging</topic><topic>Nitriles</topic><topic>Organotechnetium Compounds</topic><topic>Prospective Studies</topic><topic>Radionuclide Angiography</topic><topic>Technetium Tc 99m Sestamibi</topic><topic>Thrombolytic Therapy</topic><topic>Time Factors</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Christian, Timothy F.</creatorcontrib><creatorcontrib>Behrenbeck, Thomas</creatorcontrib><creatorcontrib>Pellikka, Patricia A.</creatorcontrib><creatorcontrib>Huber, Kenneth C.</creatorcontrib><creatorcontrib>Chesebro, James H.</creatorcontrib><creatorcontrib>Gibbons, Raymond J.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Christian, Timothy F.</au><au>Behrenbeck, Thomas</au><au>Pellikka, Patricia A.</au><au>Huber, Kenneth C.</au><au>Chesebro, James H.</au><au>Gibbons, Raymond J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mismatch of left ventricular function and infarct size demonstrated by technetium-99m isonitrile imaging after reperfusion therapy for acute myocardial infarction: Identification of myocardial stunning and hyperkinesia</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1990-12</date><risdate>1990</risdate><volume>16</volume><issue>7</issue><spage>1632</spage><epage>1638</epage><pages>1632-1638</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Quantitation of perfusion defect size using tomographic imaging with technetium-99m-hexakis-2-methoxy isobutyl isonitrile was performed at the time of hospital discharge in 32 patients with a first myocardial infarction who underwent successful coronary reperfusion within 8 h of the onset of chest pain. Reperfusion was accomplished with thrombolysis or primary coronary angioplasty. Radionuclide angiography was performed at discharge and 6 weeks later.
There was a close correlation between perfusion defect size and values for ejection fraction and regional wall motion both at discharge (r = −0.80 and −0.75, respectively) and 6 weeks later (r = −0.81 and −0.81, respectively). There was no overall group difference in ejection fraction between the value at discharge and at 6 weeks; however, five patients had a significant increase (≥0.08) and six had a significant decrease (≥0.08) in ejection fraction. In patients with a significant increase at 6 weeks, ejection fraction was significantly lower at discharge than the value predicted from perfusion defect size (0.37 ± 0.09 measured versus 0.47 ± 0.13 predicted, p < 0.05) and it improved at 6 weeks to near predicted values (0.51 ± 0.07). In patients with a significant decrease at 6 weeks, ejection fraction was significantly higher at discharge than the value predicted from perfusion defect size (0.60 ± 0.10 measured versus 0.50 ± 0.10 predicted, p < 0.05) and it decreased at 6 weeks to near predicted levels (0.51 ± 0.09).
Left ventricular ejection fraction at the time of hospital discharge is a potentially misleading index of the efficacy of reperfusion therapy for myocardial infarction. In a significant minority (34%) of patients this index does not accurately reflect perfusion defect size, apparently because of the effects of myocardial stunning and compensatory hyperkinesia.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>2147706</pmid><doi>10.1016/0735-1097(90)90313-E</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Cardiology. Vascular system Coronary heart disease Female Heart Heart - diagnostic imaging Humans Male Medical sciences Middle Aged Myocardial Infarction - diagnostic imaging Myocardial Infarction - drug therapy Myocardial Reperfusion Injury - diagnostic imaging Nitriles Organotechnetium Compounds Prospective Studies Radionuclide Angiography Technetium Tc 99m Sestamibi Thrombolytic Therapy Time Factors Tissue Plasminogen Activator - therapeutic use Ventricular Function, Left - physiology |
| title | Mismatch of left ventricular function and infarct size demonstrated by technetium-99m isonitrile imaging after reperfusion therapy for acute myocardial infarction: Identification of myocardial stunning and hyperkinesia |
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