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Evaluation of microvascular obstruction after acute myocardial infarction with cardiac magnetic resonance imaging, 201-thallium and 99 m-technetium pyrophosphate scintigraphy

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Journal of Cardiovascular Magnetic Resonance201012 (Suppl 1) :P170

https://doi.org/10.1186/1532-429X-12-S1-P170

  • Published:

Keywords

  • Acute Myocardial Infarction
  • Wall Motion
  • Cardiac Magnetic Resonance
  • Acute Myocardial Infarction
  • Cardiac Magnetic Resonance Imaging

Introduction

There are few reports about comparison of microvascular obstruction (MO) segments detected by cardiac magnetic resonance (CMR) with scintigraphic findings using 201-thallium (Tl) and 99 m-technetium pyrophosphate (PYP).

Purpose

We examined the relationship between scintigraphic and CMR characteristics of MO after acute myocardial infarction (AMI).

Methods

14 patients(age 69 ± 8 years, 11 males) underwent Tl/PYP SPECT, initial and follow-up cardiac MRI 7 ± 3 days, 16 ± 12 days and 193 ± 20 days after a first reperfused AMI, respectively. Each image was analyzed using 17-segment model. The transmural extent of delayed enhancement (DE) was scored as follows: 0: 0%, 1: 1-25%, 2: 26-50%, 3: 51-75%, 4: 76-100%, and so were wall motion (0: akinesis, 1: severe, 2: moderate, 3: mild hypokinesis, 4: normal) and Tl uptake(0: normal, 1: mildly, 2: moderately, 3: severely reduced, 4: absent).

Results

Of all 91 MI segments detected with DE-CMR, MO was recognized in 22(25%) segments. Comparing MO-positive segments with MO-negative segments, the latter had significantly better wall motion score(1.5 ± 1.1 vs. 2.2 ± 1.2; p = 0.027) and less transmural extent of DE(3.1 ± 0.9 vs. 2.2 ± 0.9; p = 0.0001) in initial CMR. The same results were also seen in the follow-up CMR(1.9 ± 1.1 vs. 2.6 ± 1.3; p = 0.0135, 2.5 ± 1.1 vs. 1.9 ± 1.2; p = 0.026, respectively). Tl uptake was significantly better in MO-negative segments than in MO-positive segments(1.5 ± 1.1 vs. 2.0 ± 0.9; p = 0.045). Focusing on 22 MO segments, 8(36%) segments showed wall motion score improvement at the follow-up CMR. Comparing these segments with the other 14 segments which showed no wall motion improvements at the follow-up CMR, although the CMR parameters and Tl uptake were not significantly different, all of the former segments had PYP uptake while only 3 segments(21%) had PYP uptake in the latter group(p = 0.0039).

Conclusion

After revascularized AMI, MO segments showed worse wall motion score, more transmural extent of DE at the initial CMR and less Tl uptake than MO-negative segments. PYP uptake was significantly more recognized in MO segments with wall motion improvement at the follow-up CMR than those without wall motion improvement.

Authors’ Affiliations

(1)
Hiratsuka Kyosai Hospital, Hiratsuka, Japan

Copyright

© Ohnishi et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd.

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