An assessment of wall motion, perfusion and glucose metabolism in recent myocardial infarction: a comparison in patients with and without revascularization.

The aim of this study was to compare the extent and severity of wall motion abnormalities, perfusion and glucose metabolism, in recent myocardial infarction in patients with and without revascularization. Forty-nine patients were studied (82% men; mean age 58 years) by using echocardiography, 201 Tl single photon emission computed tomography (SPECT) rest and redistribution, and 2-[18F]fluoro-2-deoxy-D-glucose ( 18 F-FDG) SPECT at a mean of 9.2 days (range, 1-24 days) after myocardial infarction. Twenty-seven of the 49 patients underwent revascularization while the other 22 received medical therapy before echocardiography and studies using radionuclides. A contrast angiogram was obtained for each patient. A follow-up echocardiogram at 3 months was obtained for 44 patients. Images were read blindly, using a 17 segment model, with semi-quantitative analysis. In the whole group, the extent of hypokinesia was 15%±14 (mean±SD); the extent of mild defects was determined as 5%±6 by using 201 Tl at rest, 6%±9 by using 201 Tl redistribution, and 4%±6 by using 18 F-FDG (P<0.0005, echocardiogram/radionuclides). Echocardiography showed that the extent of akinesia-dyskinesia was 16%±18 in revascularized patients and 28%±18 in non-revascularized patients (P=0.017). With regard to moderate and severe defects, 201 Tl rest showed 19%±16 and 28%±17, respectively (P=0.047); 201 Tl redistribution 17%±15 and 26%±15, respectively (P= 0.043); and 18 F-FOG 17%±13 and 24%±15, respectively (NS). In echocardiography, the extent of hypokinetic segments decreased from 16%±15 at baseline to 10%±11 at 3 months (P=0.045), in revascularized patients. It is concluded that, in recent myocardial infarction, hypokinesia extent on echocardiogram is greater than mild perfusion or metabolic defect extent, reflecting stunning and so the use of radionuclide techniques appear more accurate for defining the extent of myocardial infarction. Non-revascularized patients showed a significantly greater extent of akinesia-dyskinesia and moderate-severe perfusion defects than did revascularized patients, which can be considered a result of therapy. It is suggested that 201 Tl rest perfusion be used for the assessment of myocardial infarction soon after revascularization.