Prognostic value of combined assessment of regional left ventricular function and myocardial perfusion by dobutamine and rest gated SPECT in patients with uncomplicated acute myocardial infarction

Gated SPECT allows combined assessment of regional myocardial perfusion and left ventricular function. The aim of this study was to address the prognostic value of gated SPECT performed during dobutamine stress testing and during rest on patients with acute myocardial infarction treated with thrombolysis. Methods: Eighty-eight consecutive patients with uncomplicated acute myocardial infarction who underwent predischarge (3-7 d after admission) dobutamine (5-40 mug/kg of body weight per minute in 3-min dose increments) and rest gated Tc-99m-sestamibi SPECT were followed for a mean of 48 mo (range, 4-64 mo). Results: Eighteen cardiac events (8 cardiac deaths and 10 nonfatal myocardial infarctions) occurred. Ischemia at dobutamine SPECT imaging (summed difference score 1) was present in 60% of the patients. In patients without ischemia, there was a lower event rate (11%), compared with patients with mild ischemia (18%) and moderate-to-severe ischemia (40%) (P < 0.05). Patients with events showed also a higher summed difference score, compared with patients without events (2.3 +/- 1.6 vs. 1.3 +/- 1.6, P < 0.05). Independent predictors of events were the number of segments with preserved 99mTc-sestamibi uptake at rest and the number of akinetic or clyskinetic segments with preserved Tc-99m-sestamibi uptake and preserved wall thickening (global chi(2) of the model, 13.6; P < 0.01). The assessment of the incremental prognostic value of variables added sequentially showed that the addition of the summed difference score added information to perfusion status at rest (P < 0.05). Combined assessment of regional myocardial perfusion and left ventricular function at rest further improved the model (P < 0.05). Conclusion: The present study indicated that predischarge Tc-99m-sestamibi gated SPECT gives prognostic information on patients recovering from acute myocardial infarction. Patients with preserved systolic wall thickening should be regarded as a high-risk subgroup, requiring closer follow-up for appropriate treatment.