Prediction Of Improvement Of Regional Ventricular Function After PCI In AMI Using ～(18)F-FDG-SPECT: Comparison With Dobutamine Stress Echocardiography

Objective:The goals of this study were to compare the diagnostic accuracy of18F-FDG-SPECT and low-dose dobutamine echocardiography (LDDSE) in detecting myocardial viability and to predict functional improvement of dysfunctional but viable myocardium at 3 months in early stage of reperfused acute myocardial infarction. Methods:1.Fourteen patients with a first AMI successfully treated with percutaneous coronary intervention were studied . 18F-FDG/99mTc-MIBI-SPECT were performed at a mean of two weeks after AMI, Myocardialviability was defined by normal perfusion or a 7% increse in 18F-FDG uptake in perfusion defect ( mismatch ) .2. LDDSE were performed 1 day before the SPECT study, wall motion was graded semiquantitatively using the follow scoring system: 0 = normal, 1= hypokinesia, 2 = akinesia, 3 = dyskinesia. The dysfunctional segments were defined as viable if they exhibited improvement by at least 1 grade and biphasic response during dobutamine infusion . Resting echocardiography was performed at 3 months to evaluate the effective recovery of regional wall motion.The dysfunctional segments were defined as improvment if hypokinetic segments were normokinetic or if segements that wereakinetic or dyskinetic became hypokinetic or normokinetic after 3 month. Results:1.18F-FDG-SPECT detected viable myocardium and predicted the improve -ment of dysfunctional with a sensitivity, specificity, positive predictive value and negative predictive value of 86.8%, 50.0%, 69.1 % 72.7%, respectively. The sensitivity specificity positive predictive value and negative predictive value for hypokinetic segments were 85.7%, 66.6%, 90.0%, 56.1%, respectively; and for akinetic segments were 88.2%, 45.0%, 57.6%, 81.8%, respectively.2. LDDSE detected the viable myocardium with a sensitivity, specificity, positive predictive value and negative predictive value of 84.2%, 73.0% 82.1% 76.0%, respectively. The sensitivity specificity, positive predictive value and negative predictive value of LDDSE for hypokinetic segments were 95.2%, 83.3%,95.2%, 83.3%; and for akinetic segments were 70.5%, 70.0% 66.6%, 73.6%, respectively.3. The value between I8F-FDG-SPECT ,LDDSE and the result of improvement of regional wall motion after 3 months were0.380( P>0.05 ) , 0.517 ( P>0.05 ) .respectively. The K value between 18F-FDG-SPECT and LDDSE was 0.304, (P<0.05 =.4 . The function of all segements with normal perfusion can improvement;Myocardial perfusion defect and WMS1 correlated well after PCI in patient with AMI. Conclusions:Both 18F-FDG-SPECT and LDDSE can predict the improvement of dysfunctional but viable myocardium in patients with a first AMI revasculized by PCI. But LDDSE is more accurate.The presence of normal perfusionafter PCI in patient with AMI showed good functional improvement. Myocardial perfusion defect and WMSI correlated well .