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A Reverse Flow-Metabolism Mismatch Pattern on PET Is Related to Multivessel Disease in Patients with Acute Myocardial Infarction

First Department of Internal Medicine and Division of Nuclear Medicine, Osaka City University Medical School, Osaka, Japan

Correspondence: For correspondence or reprints contact: Hiroyuki Yamagishi, MD, First Department of Internal Medicine, Osaka City University Medical School, 1-5-7 Asahi-Machi, Abeno-Ku, Osaka 545-8586, Japan.

ABSTRACT

Hypoperfused myocardium with increased uptake of ¹⁸F-fluorodeoxyglucose (FDG) is considered to be ischemic but viable myocardium. However, the significanceof a more severe defect of FDG than of ¹³N ammonia (NH3) (i.e., reverse flow-metabolism mismatch) is not well understood. Methods: To study a reverse flow—metabolism mismatch pattern, PET with NH3 and FDG under glucose loading was performed in 35 patients within 2 wk after onset of first acute myocardial infarction (AMI) and in 29 patients with old myocardial infarction (OMI). The left ventricle was divided into nine segments on a bull's eye polar map, and the mean counts of NH3 (%NH3) and FDG (%FDG) were compared for the segment with the least %NH3. Results: Ten patients in the AMI group demonstrated a marked reverse flow—metabolism mismatch pattern (greater than 10% difference between %NH3 and %FDG), whereas only 2 patients in the OMI group demonstrated the mismatch pattern (P < 0.05). Sixteen patients with AMI demonstrated %FDG > %NH3 (group 1), and 19 patients with AMI demonstrated %FDG < %NH3 (group 2). There were no significant differences in age, sex, location of infarction, diameter of stenosis of infarct-related artery or left ventricular ejection fraction between groups 1 and 2. Eleven patients in group 2 and only 3 in group 1 had multivessel disease (P < 0.02). There was no significant relationship between the number of diseased vessels and the flow-metabolism pattern in patients with OMI. Conclusion: The finding of a reverse flow metabolism mismatch on PET in the subacute phase of myocardial infarction was closely related to multivessel disease.

Key Words: PET • myocardial infarction • multivessel disease