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CLINICAL STUDY: PERCUTANEOUS CORONARY INTERVENTION

Coronary vasodilator reserve: a clue to the explanation of ²⁰¹Tl redistribution patterns early after successful primary stenting for acute myocardial infarction

^* Adult Cardiology and Nuclear Cardiology Departments, Necker University Hospital, Paris, France

Manuscript received December 28, 2001; revised manuscript received April 22, 2002, accepted May 24, 2002.

^* Reprint requests and correspondence: Dr. Farzin Beygui, Institut de Cardiologie, Département de Cardiologie Médicale, La Pitié-Salpêtrière University Hospital, 47-83, Bd de l’Hôpital, 75013, Paris, France.
fbeygui{at}medscape.com

OBJECTIVES: We sought to assess the mechanism and significance of different ²⁰¹Tl redistribution patterns after successful primary stenting following acute myocardial infarction (AMI).

BACKGROUND: The mechanism of ²⁰¹Tl reverse redistribution and the impact of different redistribution patterns on the recovery of contractility after successful reperfusion therapy for AMI remain unclear.

METHODS: We studied 41 consecutive patients with successful primary stenting for a first AMI. Patients underwent predischarge and six-month follow-up dipyridamole stress-reinjection single photon emission tomography (SPECT), coronary and left ventricular angiography. Intracoronary Doppler assessment of coronary flow reserve (CFR) was performed before discharge.

RESULTS: Four patient groups were identified according to predischarge SPECT: patients with I: nonreversible defects (n = 8), II: redistribution (n = 7), III: reverse redistribution (n = 21), IV: no defect (n = 5). At follow-up contractility recovery increased in a stepwise fashion from groups I to IV (19 ± 41%, 40 ± 53%, 70 ± 28%, 78 ± 33%, p = 0.01). Compared with patients with redistribution, those with reverse redistribution had lower infarct-related artery (IRA) CFR (2.2 ± 0.5 vs. 2.8 ± 0.9, p = 0.03) but higher contractility recovery.

CONCLUSIONS: Variable ²⁰¹Tl redistribution patterns, early after successful stenting for AMI, may predict different degrees of late contractility recovery. The lower IRA CFR and the higher contractility recovery in areas with reverse redistribution suggest more severe microvascular dysfunction and less severe myocardial injury in such areas compared with those with redistribution.

Abbreviations and Acronyms   AMI   acute myocardial infarction   CFR   coronary flow reserve   EF   ejection fraction   IRA   infarct-related artery   SPECT   single photon emission computed tomography