Fatty acid metabolism and myocardial perfusion imaging for the evaluation of global left ventricular dysfunction following acute myocardial infarction: comparisons with echocardiography.

Background: Myocardial fatty acid metabolic imaging with beta-methyl iodophenyl pentadecanoic acid (BMIPP) and perfusion imaging with tetrofosmin (TF) combined can predict post ischemic salvageable myocardium and persistent left ventricular (LV) dysfunction. This study was designed for the first time to assess systolic, diastolic and global LV dysfunction considering BMIPP and TF mismatched defect score (MMDS), and comparing this approach with the conventional Doppler echocardiography.

Methods: Thirty four patients with first acute myocardial infarction (AMI) were enrolled, and all of them underwent percutaneous coronary intervention (PCI). BMIPP and Tetrofosmin (TF) scans were performed at 7+/-3.5 days of admission. Echocardiography was performed within 24 h of admission, at an interval of 1 and 3 months. MMDS was compared with systolic: ejection fraction (EF), wall motion score index (WMSI), fractional shortening (FS); diastolic: mitral valve deceleration time (MVDT), E/E', left atrial volume index (LAVI); combined systolic and diastolic parameter: left ventricular myocardial performance index (LVMPI).

Results: A good correlation was observed between BMIPP and TF defect score (p<0.00001), and in 31 (91%) patients BMIPP defect score was higher than that of TF. The MMDS showed significant correlation with EF (r=-0.64, p=<0.00001), WMSI (r=0.61, p<0.0001), and FS(r=-0.65, p<0.00001), LAVI (r=-0.32, p<0.05), and LVMPI (r=0.37, p<0.02) during follow up echocardiography at 1 month. MVDT and E/E' did not correlate with MMDS.

Conclusion: Perfusion-metabolism mismatched defect score was well correlated with the evolution of global left ventricular dysfunction following AMI evidenced from conventional Doppler echocardiography.