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Myocardial perfusion reserve in spared myocardium: correlation with infarct size and left ventricular ejection fraction
Authors:Luis Eduardo Juárez-Orozco  Julius Glauche  Erick Alexanderson  Clark J. Zeebregts  Hendrikus H. Boersma  Andor W. J. M. Glaudemans  Rudi A. Dierckx  Dirk J. van Veldhuisen  René A. Tio  Riemer H. J. A. Slart
Affiliation:1. Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands
2. Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
7. Cardiovascular Imaging and Nuclear Medicine Department, National Institute of Cardiology “Ignacio Chavez”, Mexico City, Mexico
3. Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
4. Department of Clinical and Hospital Pharmacy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
6. Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
5. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Abstract:

Purpose

Left ventricular ejection fraction (LVEF) after myocardial infarction is considered to be determined by the size of the infarction and residual function of the spared myocardium. Myocardial perfusion reserve (MPR) has been shown to be a strong prognostic factor in patients with ischaemic heart failure, even stronger than LVEF. In the present study, the interrelationship between MPR, LVEF and infarct size was investigated.

Methods

In total, 102 patients with a prior history of myocardial infarction were included. All underwent rest and stress 13N-ammonia and gated 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for evaluation of myocardial ischaemia and viability. FDG polar maps were used to determine the size of the infarction. The LVEF was obtained by gated 18F-FDG PET or another available method within 3 months of the PET scan. MPR was obtained per segment in the spared myocardium.

Results

The mean age of the subjects was 68?±?12 years. Global MPR was 1.63?±?0.51. The mean LVEF was 36?±?10 % and mean infarct size 23.72?±?14.8 %. A linear regression model was applied for the analysis considering the LVEF as a dependent variable. All risk factors, mean stress flow, infarct size and MPR were entered as variables. The infarct size (p?p?=?0.04) reached statistical significance. In a multivariate model MPR had a stronger correlation with LVEF than infarct size.

Conclusion

In patients with a prior history of myocardial infarction, LVEF is not just related to infarct size but also to MPR in the spared myocardium.
Keywords:
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