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CLINICAL RESEARCH

Ischemic and viable myocardium in patients with Non–Q-Wave or Q-Wave myocardial infarction and left ventricular dysfunction

A clinical study using positron emission tomography, echocardiography, and electrocardiography

Hua Yang, MD^*, Min Pu, MD, FACC^*,*, David Rodriguez, MD^*, Donald Underwood, MD, FACC^*, Brian P. Griffin, MD, FACC^*, Vidyasagar Kalahasti, MD^*, James D. Thomas, MD, FACC^* and Richard C. Brunken, MD, FACC

^* Department of Cardiology, Cleveland, Ohio, USA
Department of Nuclear Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received May 21, 2003; revised manuscript received July 17, 2003, accepted July 28, 2003.

^* Reprint requests and correspondence: Dr. Min Pu, Division of Cardiology, H047, Milton S. Hershey Medical Center, Penn State University, 500 University Avenue Drive, P.O. Box 850, Hershey, Pennsylvania 17033-0850, USA.
minpu{at}psu.edu

This study was partially presented at the 2001 Scientific Sessions of the American Heart Association, November 11 to 14, 2001, Anaheim, California.

OBJECTIVES: We investigated whether patients with non–Q-wave myocardial infarction (NQMI) have more ischemic viable myocardium (IVM) than patients with Q-wave myocardial infarction (QMI).

BACKGROUND: Non–Q-wave myocardial infarction is associated with higher incidences of cardiac events than QMI, suggesting more myocardium at risk in NQMI.

METHODS: To identify myocardial ischemia, hibernation, and scar, the resting and stress ⁸²rubidium perfusion and F-18 fluorodeoxyglucose metabolic positron emission tomographic imaging (PET) was performed in 64 consecutive patients with NQMI (n = 21) or QMI (n = 43). Echocardiography was performed for assessment of left ventricular function and wall motion index (WMI). The relationships between PET, echocardiographic, and electrocardiographic findings were analyzed.

RESULTS: There were no significant differences in left ventricular ejection fraction (LVEF) between NQMI and QMI groups (28 ± 10% vs. 25 ± 11%, p > 0.05). Ischemic and viable myocardium was more common in NQMI than in QMI (91% vs. 61%, p < 0.05). The total amount of IVM was significantly higher in NQMI than in QMI (6.5 ± 5.2 vs. 2.9 ± 2.8 segments, p < 0.001). Neither the number of Q waves, residual ST-segment depression of 0.5 mm or elevation of 1 mm, nor LVEF and WMI were significant predictors for IVM. Wall motion index correlated with scar segments (r = 0.54, p < 0.001) and LVEF (r = –0.67, p < 0.001).

CONCLUSIONS: Ischemic and viable myocardium is common in patients with NQMI and left ventricular dysfunction, suggesting that aggressive approaches should be taken to salvage the myocardium at risk in such patients.

Abbreviations and Acronyms   IVM = ischemic viable myocardium   LVEF = left ventricular ejection fraction   MI = myocardial infarction   NQMI = non–Q-wave myocardial infarction   PET = positron emission tomography   QMI = Q-wave myocardial infarction   WMI = wall motion score index   18FDG = fluorodeoxyglucose-18   82Rb = rubidium-82

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