Dual Nuclide Myocardial Imaging Combined With SST2 And Galectin-3 For Guidance And Prognosis Of Delayed PCI In Patients With AMI

Objective To investigate the survival myocardium condition of patients with acute myocardial infarction whose onset is more than 24 hours.Before receiving delayed PCI treatment,iradioisotopes myocardial imaging is used to detect the survival myocardium condition in the infarction area,and sST2 and Galectin-3 serum concentrations are combined to guide further treatment and predict the outcome.Methods 10 AMI patients with onset over 24 hours who received delayed PCI were collected（killip grade 1-2）.Two days before PCI,^{99m T}c-MIBI/¹⁸F-FDG dual radionuclide myocardial imaging was performed in turn.The percentage of the metabolic defect area of imaging agent in the overall area was processed by computer software to obtain the percentage of the surviving myocardium in the infarction area,which was accessed to decect the survival situation of myocardial infarction area within AMI patients and guide the PCI treatment.The changes in cardiac function（ejection fraction,left ventricle end-systolic volume,left ventricle end-diastolic volume）and their correlation with cardiovascular adverse events were compared before PCI and one-month follow-up).Meanwhile,blood samples were collected and ELISA method was used to measure the serum concentrations of sST2 and galectin-3in the patients as the experimental group,and 20 healthy patients aged 18-65 years who underwent physical examination in our hospital at the same time were used as the control group.Predict prognosis.The serum concentrations of sST2 and galectin-3in patients with AMI and healthy subjects were statistically analyzed to guide further treatment,assess the correlation with changes in cardiac function and cardiovascular events,and predict the outcome.Results 1.Dual-nuclide myocardial imaging can be used to assess the area percentage of the surviving myocardium after AMI.2.After 1 month follow-up,patients with viable myocardium in the infarcted area,the left ventricular ejection fraction（53.50±9.44%vs 58.20±10.82%,P=0.011）and the left ventricular end-systolic volume（73.50±26.74ml vs 63.50±25.10ml,P<0.001）and the left ventricular end-diastolic volume（118.70±29.32ml vs 108.60±30.93ml,P<0.001）were improved with reascularization and the recovery of blood flow.The percentage of viable myocardium obtained was positively correlated with LVEF（r=0.767,P=0.010）,and negatively correlated with LVESV（r=-0.847,P=0.002）and LVEDV（r=-0.799,P=0.010）.The changes of cardiac function in MACE event occurs or not there was no statistically significant difference in the two groups（LVEF,P=0.078,LVESV:P=0.700,LVEDV:P=0.309）.3.After 1 month follow-up,dual nuclide myocardial manifestations of patients survive scope and MACE or not the events was statistically significant difference in the two groups（P=0.023）.4.The concentrations of sST₂（22.84±1.12ng/ml vs 7.71±1.24,P=0.002）and Gelactin-3（7.65±3.87ng/ml vs 1.21±0.38ng/ml,P=0.001）in the experimental group were higher than those in the control group,and the concentrations of sST₂and Gelactin-3 were negatively correlated with the change of LVEF（sST2:r=-0.733,P=0.016,Gelactin-3:R=-0.800,P=0.005）,was positively correlated with the change of LVESV（sST₂:r=0.866,P=0.001 Gelactin-3:r=0.689,P=0.028）,and LVEDV（sST₂:r=0.755,P=0.012Gelactin-3:r=0.640,P=0.046）.There was no significant correlation between sST₂and Gelactin-3 concentrations and the occurrence of MACE events（sST₂:0R=1.378,90%CI:0.970-2.121 Gelactin-3:0R=1.127,90%CI:0.779-1.631）.Conclusion For AMI patients with onset over 24 hours,dual-nuclide myocardial imaging can decect the status of the viable myocardium in the infarction area,which is of guiding significance for further PCI treatment.The concentration of sST2 and galectin-3 in AMI patients can provide more information for determining the stage of pre-heart failure,and independent biomarker for predicting the adverse prognosis of heart failure.