Early left ventricular dyssynchrony in acute ST elevation myocardial infarction: A gated single photon emission computed tomography study

IF 0.3 Q4 CRITICAL CARE MEDICINE Egyptian Journal of Critical Care Medicine Pub Date : 2016-08-01 DOI:10.1016/j.ejccm.2016.05.002

Akram Abdelbary , Alaa Abdelhay , M.H. Khedr , M. Emam , Khayri Tohamy

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Abstract

Introduction

The resulting left ventricular (LV) dysfunction in acute STEMI is definitely secondary to loss of myocardial muscle mass (Krumholz et al., 2009; Guerchicoff et al., 2014) but may have an additional component of LV dyssynchrony.

Aim

Detection of LV dyssynchrony in acute STEMI patients and its relation to LV dysfunction in these patients.

Patients and methods

60 patients presenting with acute STEMI were injected with 25 mCi of Tc^99m SestaMIBI prior to primary PCI. Acquisition was deferred after the procedure within 6 h of injection. Images were analyzed using QGS Cedars Sinai software to measure the histogram bandwidth, standard deviation and entropy using GSPECT phase analysis. The results were compared to 60 patients with negative perfusion scans upon maximal exercise imaged using the same protocol during rest.

Results

Our study included a total number of 60 acute STEMI patients, 54 males, mean age 54.8 ± 10.38 years, Compared to 60 controls mean age 50.7 + 20.3 years. Risk factors for CAD were smoking in 41 patients, hypertension in 17, dyslipidemia in 7, diabetes in 15, and positive family history of CAD in 21. 30 patients had acute anterior STEMI and 30 had inferior. LVEDV and LVESV were larger compared to controls; 133.0 ± 88.7 vs. 62.0 ± 19.2 ml and 89.7 ± 82.1 vs. 19.9 ± 12.3 ml respectively, p < 0.001, and lower LVEF 39.0 ± 16.8 vs. 71.1 ± 10.4%, p < 0.001. Histogram bandwidth (BW), standard deviation (SD) and entropy (E) values were significantly higher in patients when compared to controls; 76.2 ± 54.7 vs. 17.8 ± 5.3, 20.7 ± 15.2 vs. 4.1 ± 2.0 and 51.1 ± 18.6 vs. 21.8 ± 7.1 degrees respectively, p < 0.001. BW, SD and E significantly negatively correlated with LVEF in acute STEMI cases; r = −.733, p < 0.001, r = −.75, p < 0.001, and r = −.858, p < 0.001 respectively.

Conclusion

LV dyssynchrony may be acquired acutely very early in STEMI and may have a negative impact on LV ejection fraction.

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急性ST段抬高型心肌梗死的早期左室非同步化:门控单光子发射计算机断层扫描研究

急性STEMI导致的左心室功能障碍肯定是继发于心肌质量的损失(Krumholz等，2009;Guerchicoff et al.， 2014)，但可能有左室不同步的额外成分。目的检测急性STEMI患者左室非同步化及其与左室功能障碍的关系。患者和方法60例急性STEMI患者在首次PCI前注射25mci Tc99m SestaMIBI。注射后6小时内延迟采集。采用QGS Cedars Sinai软件对图像进行分析，采用GSPECT相位分析测量直方图带宽、标准差和熵。将结果与60例在最大运动时使用相同方案进行负灌注扫描的患者在休息时进行成像的结果进行比较。结果本研究共纳入急性STEMI患者60例，男性54例，平均年龄54.8±10.38岁，对照组60例，平均年龄50.7±20.3岁。冠心病的危险因素有吸烟41例，高血压17例，血脂异常7例，糖尿病15例，冠心病家族史21例。急性前路STEMI 30例，下路STEMI 30例。与对照组相比，LVEDV和LVESV更大;133.0±88.7和62.0±19.2毫升和89.7±82.1和19.9±12.3毫升分别p & lt;0.001,低LVEF 39.0±16.8和71.1±10.4%,p & lt;0.001. 直方图带宽(BW)、标准差(SD)和熵(E)值显著高于对照组;76.2±54.7和17.8±5.3,20.7±15.2和4.1±2.0,51.1±18.6和21.8±7.1度分别p & lt;0.001. 急性STEMI患者BW、SD、E与LVEF呈显著负相关;r =−。733, p <0.001, r =−。75、p <0.001, r =−。858, p <分别为0.001。结论左室非同步化可能在STEMI患者早期就出现，并可能对左室射血分数产生负面影响。

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来源期刊

Egyptian Journal of Critical Care Medicine

自引率

0.00%

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审稿时长

42 weeks

期刊介绍： The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.