Early risk stratification using Rubidium-82 positron emission tomography in STEMI patients
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology(2017)
摘要
Background Assessment of infarct size after myocardial infarction is predictive of subsequent morphological changes and clinical outcome. This study aimed to assess subacute post-intervention Rubidium-82 ( 82 Rb)-PET imaging in predicting left ventricle ejection fraction, regional wall motion, and final infarct size by CMR at 3-months after STEMI. Methods STEMI patients undergoing percutaneous coronary intervention were included prospectively. Rest-only 82 Rb-PET perfusion imaging was performed at median 36 hours [IQR: 22 to 50] after the treatment. The extent of hypoperfusion and absolute blood flow (mL·min·g) were estimated on a global and a 17-segment model with dedicated software. At 3-months follow-up patients completed the CMR functional and late gadolinium enhancement imaging. Results 42 patients were included, but only 35 had follow-up CMR and constituted the study population. Absolute blood flow was significantly lower in the infarct-related territory compared to remote myocardium, P < .005. Extent of hypoperfusion correlated with final infarct size, r = 0.58, P < .001, while blood flow correlated with ejection fraction, r = 0.41, P < .05. In linear mixed models, higher subacute absolute blood flow ( β = 4.6, confidence interval [3.5; 5.2], P < .001, R 2 = 0.67) was associated with greater wall motion. Segmental extent of subacute hypoperfusion ( β = 0.43 [0.38; 0.49], P < .001, R 2 = 0.58) was associated with the degree of late gadolinium enhancement at 3-months. Conclusions Subacute rest-only 82 Rb-PET is feasible following STEMI and seems predictive of myocardial function and infarct size at 3-months.
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关键词
Positron emission tomography,Rubidium-82,ST-segment elevation myocardial infarction,cardiac magnetic resonance,final infarct size,myocardial blood flow
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