Korean J Radiol.  2019 May;20(5):709-718. 10.3348/kjr.2018.0729.

Myocardial Blood Flow Quantified by Low-Dose Dynamic CT Myocardial Perfusion Imaging Is Associated with Peak Troponin Level and Impaired Left Ventricle Function in Patients with ST-Elevated Myocardial Infarction

Affiliations
  • 1Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
  • 2Department of Radiology, Affiliated Zhoupu Hospital, Shanghai University of Medicine and Health Science, Shanghai, China.
  • 3Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. andrewssmu@msn.com
  • 4Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
  • 5Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract


OBJECTIVE
To investigate the association of myocardial blood flow (MBF) quantified by dynamic computed tomography (CT) myocardial perfusion imaging (MPI) with troponin level and left ventricle (LV) function in patients with ST-segment elevated myocardial infarction (STEMI).
MATERIALS AND METHODS
Thirty-five STEMI patients who successfully had undergone reperfusion treatment within 1 week of their infarction were consecutively enrolled. All patients were referred for dynamic CT-MPI. Serial high-sensitivity troponin T (hs-TnT) levels and left ventricular ejection fraction (LVEF) measured by echocardiography were recorded. Twenty-six patients with 427 segments were included for analysis. Various quantitative parameters derived from dynamic CT-MPI were analyzed to determine if there was a correlation between hs-TnT levels and LVEF on admission and again at the 6-month mark.
RESULTS
The mean radiation dose for dynamic CT-MPI was 3.2 ± 1.1 mSv. Infarcted territories had significantly lower MBF (30.5 ± 7.4 mL/min/100 mL versus 73.4 ± 8.1 mL/min/100 mL, p < 0.001) and myocardial blood volume (MBV) (2.8 ± 0.9 mL/100 mL versus 4.2 ± 1.1 mL/100 mL, p = 0.044) compared with those of reference territories. MBF showed the best correlation with the level of peak hs-TnT (r = −0.682, p < 0.001), and MBV showed a moderate correlation with the level of peak hs-TnT (r = −0.437, p = 0.026); however, the other parameters did not show any significant correlation with hs-TnT levels. As for the association with LV function, only MBF was significantly correlated with LVEF at the time of admission (r = 0.469, p = 0.016) and at 6 months (r = 0.585, p = 0.001).
CONCLUSION
MBF quantified by dynamic CT-MPI is significantly inversely correlated with the level of peak hs-TnT. In addition, patients with lower MBF tended to have impaired LV function at the time of their admission and at 6 months.

Keyword

Acute myocardial infarction; Troponin; Myocardial perfusion imaging; Computed tomography; Myocardial blood flow

MeSH Terms

Blood Volume
Echocardiography
Heart Ventricles*
Humans
Infarction
Myocardial Infarction*
Myocardial Perfusion Imaging*
Reperfusion
Stroke Volume
Troponin T
Troponin*
Troponin
Troponin T

Figure

  • Fig. 1 Flow chart of patient inclusion and exclusion.CT = computed tomography, MPI = myocardial perfusion imaging, STEMI = ST-segment elevated myocardial infarction

  • Fig. 2 Representative case of severely reduced MBF and high peak hs-TnT level in 62-year-old male STEMI patient.A. ICA showed occlusion of proximal LAD (arrow). B. PCI was performed to restore patency to lumen (arrow). C. Color-coded fusion image of short-axis view derived from dynamic CT-MPI showed dramatically reduced MBF of middle anterior and middle anteroseptal segment (mean MBF = 21 mL/100 mL/min) (arrows). Mean MBF of reference territory was 68 mL/100 mL/min. Peak hs-TnT level was 32.6 µg/L. hs-TnT = high-sensitivity troponin T, ICA = invasive coronary angiography, LAD = left anterior descending artery, MBF = myocardial blood flow, PCI = percutaneous coronary intervention

  • Fig. 3 Representative case of mildly reduced MBF and low peak hs-TnT level in 67-year-old male STEMI patient.A. ICA showed occlusion of distal RCA (arrow). B. PCI was performed to restore patency to lumen (arrow). C. Color-coded fusion image of short-axis view derived from dynamic CT-MPI showed mildly reduced MBF of mid inferior segment (mean MBF = 45 mL/100 mL/min) (arrows). Mean MBF of reference territory was 74 mL/100 mL/min. Peak hs-TnT level was 5.4 µg/L. RCA = right coronary artery

  • Fig. 4 Correlation of peak hs-TnT level and LVEF (at time of admission and at 6 months) with MBF and MBFinfarct/MBFreference.Both MBF and MBFinfarct/MBFreference were shown to inversely correlate with peak hs-TnT level and proportionally correlate with LVEF. LVEF = left ventricular ejection fraction


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