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.
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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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