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The Association between Hypoperfused Myocardium and Systolic Function in Patients with Ami Undergoing Complete Revascularization
Background: Timely restoring coronary blood flow reduces mortality in acute myocardial infarction (AMI), while epicardial flow restoration is non-parallel to myocardial reperfusion. This study investigates the dynamic of myocardial perfusion and its association with left ventricular (LV) systolic function in AMI patients undergoing complete revascularization.
Methods: AMI patients undergoing complete revascularization were prospectively enrolled, and hybrid positron emission tomography/magnetic resonance (PET/MR) was performed 2 months and 1 year after the indexed procedure. Hypoperfused myocardium was defined as myocardium with reduced perfusion and normal metabolism.
Findings: Fifty-five patients (60.42 ± 11.47 years, 80.0% male) were enrolled, and hypoperfused myocardium (median: 12% of LV) was detected in 25 (45.5%) patients 2 months post-AMI. Patients with hypoperfused myocardium (Group A) had significantly higher hypersensitive C-reactive protein (hs-CRP) (p = 0.020) and lower T2 value (p = 0.010) than those without (Group B). In the follow-up PET/MR at 1 year, six (31.6%) patients in Group A showed recovery of perfusion, of which there were more females (p = 0.025), fewer diabetics (p = 0.044), or overweight (p = 0.035), with better baseline global longitudinal strain (GLS) (p = 0.005). Significant LV ejection fraction improvement was observed in Group A (56.39 ± 9.76% vs. 54.58 ± 10.39%, p = 0.016) but not in Group B (51.63 ± 13.09% vs. 50.79 ± 16.95%, p = 0.615).
Interpretation: Even after complete revascularization, myocardial hypoperfusion may persistently exist, and evolve over time in AMI patients. The reversal of myocardial hypoperfusion is possibly associated with improved LV systolic function.
Si, Jin and Zheng, Chong and Xiao, Keling and Cui, Yadong and Cui, Bixiao and Yi, Ming and Sun, Lijie and Zhang, Haoyu and Gu, Shanshan and Lu, Jie and Li, Jing, The Association between Hypoperfused Myocardium and Systolic Function in Patients with Ami Undergoing Complete Revascularization. Available at SSRN: https://ssrn.com/abstract=5105519 or http://dx.doi.org/10.2139/ssrn.5105519
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