Importance of flow/metabolism studies in predicting late recovery of function following reperfusion in patients with acute myocardial infarction

Eur Heart J. 1997 Jun;18(6):954-62. doi: 10.1093/oxfordjournals.eurheartj.a015384.

Abstract

Aims: Positron emission tomographic imaging is known to be a reliable indicator of viable myocardium in chronic heart disease. Its value in acute myocardial infarction has not been studied extensively.

Methods and results: Sixty-two patients receiving thrombolytic therapy were studied. Myocardial tissue flow and metabolism were measured at 5 days and 3 months. Recovery of left ventricular function was investigated with echocardiography or radionuclide ventriculography. In eight patients, normal flow was found in the infarct area at 5 days with no significant changes in flow, metabolism or function over the next 3 months. In 54 patients, impaired regional myocardial blood flow in the infarct zone was observed at 5 days. In 39 patients, there was a matching positron emission tomographic pattern, while in 15 the pattern was mismatched. None of the patients with a TIMI flow grade < 3 revealed recovery of left ventricular function. In seven out of 11 patients with TIMI 3 flow and a mismatching pattern, additional angioplasty was performed with functional improvement in six.

Conclusions: Recovery of ventricular function is exclusively found in patients with a TIMI flow grade 3. Patients with a positron emission tomographic mismatching pattern reveal functional recovery only after subsequent angioplasty.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Analysis of Variance
  • Coronary Angiography
  • Coronary Vessels / physiology*
  • Echocardiography
  • Female
  • Glucose / metabolism
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / drug therapy
  • Myocardial Reperfusion
  • Myocardium / metabolism*
  • Predictive Value of Tests
  • Prospective Studies
  • Radionuclide Ventriculography
  • Regional Blood Flow / physiology
  • Sensitivity and Specificity
  • Thrombolytic Therapy*
  • Tomography, Emission-Computed*
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / physiopathology

Substances

  • Glucose