Association of coronary microvascular dysfunction and cardiac muscle injury in acute myocardial infarction: results of comparison of dynamic SPECT and cardiac MRI

Aim      To study the interrelation of changes in coronary microcirculation by data of dynamic single photon emission computed tomography (SPECT) and myocardial injury by data of magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).

Material and methods  The study included patients admitted to the emergency cardiology department with new-onset AMI. Contrast-enhanced cardiac MRI was performed for all patients on day 2-7 of admission. Dynamic SPECT of the myocardium with evaluation of semiquantitative and quantitative parameters of perfusion was performed on day 7-10.

Results All patients were divided into two groups based on the type of MR contrast agent accumulation: 1) patients with the ischemic type of contrast enhancement (n=34; 62 %); 2) patients with the non-ischemic type of contrast enhancement (n=21; 38 %). According to data of myocardial perfusion scintigraphy (MPS), the group of ischemic MR pattern had larger perfusion defects at rest and during a stress test. Moreover, this group was characterized by lower global stress-induced blood flow and absolute and relative myocardial flow reserve (MFR). When the study group was divided into patients with transmural (n=32; 58 %) and non-transmural (n=23; 42 %) accumulation of the MR-contrast agent, lower values of global stress-induced blood flow and of absolute and relative MFR were observed in the group of transmural MR-enhancement pattern. A moderate inverse correlation was found between the stress-induced myocardial blood flow and the volume of myocardial edema (r= –0.47), infarct area (r= –0.48) and microvascular obstruction area (r= –0.38).

Conclusion      The variables of dynamic SPECT characterizing microcirculatory disorders that are independent on or due to injuries of the epicardial coronary vasculature reflect the severity and depth of structural changes of the myocardium in AMI. In this process, quantitative variables of myocardial perfusion are interrelated with the myocardial injury more closely than semiquantitative MPS indexes. The findings of the present study can also contribute to the heterogenicity of a patient group with acute coronary syndrome and AMI. Further study is required for understanding the prognostic significance of dynamic SPECT parameters.

1. Staroverov I.I., Shakhnovich R.M., Gilyarov M.Yu., Komarov A.L., Konstantinova E.V., Panchenko E.P. et al. Eurasian clinical guidelines on diagnosis and treatment of acute coronary syndrome with st segment elevation (STEMI). Eurasian heart journal. 2020;1(30):4–77. DOI: 10.38109/2225-1685-2020-1-4-77

2. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2021;42(14):1289–367. DOI: 10.1093/eurheartj/ehaa575

3. Del Buono MG, Montone RA, Camilli M, Carbone S, Narula J, Lavie CJ et al. Coronary Microvascular Dysfunction Across the Spectrum of Cardiovascular Diseases. Journal of the American College of Cardiology. 2021;78(13):1352–71. DOI: 10.1016/j.jacc.2021.07.042

4. Rigo F, Sicari R, Gherardi S, Djordjevic-Dikic A, Cortigiani L, Picano E. The additive prognostic value of wall motion abnormalities and coronary flow reserve during dipyridamole stress echo. European Heart Journal. 2007;29(1):79–88. DOI: 10.1093/eurheartj/ehm527

5. Fukuoka Y, Nakano A, Tama N, Hasegawa K, Ikeda H, Morishita T et al. Impaired myocardial microcirculation in the flow-glucose metabolism mismatch regions in revascularized acute myocardial infarction. Journal of Nuclear Cardiology. 2017;24(5):1641–50. DOI: 10.1007/s12350-016-0526-z

6. Xu J, Cai F, Geng C, Wang Z, Tang X. Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis. Frontiers in Cardiovascular Medicine. 2021;8:621389. DOI: 10.3389/fcvm.2021.621389

7. Zavadovsky KV, Mochula AV, Maltseva AN, Boshchenko AA, Baev AE, Andreev SL et al. The diagnostic value of SPECT CZT quantitative myocardial blood flow in high-risk patients. Journal of Nuclear Cardiology. 2022;29(3):1051–63. DOI: 10.1007/s12350-020-02395-8

8. Maltseva A.N., Mochula A.V., Kopyeva K.V., Grakova E.V., Zavadovsky K.V. Radionuclide imaging methods in the diagnosis of microvascular dysfunction in non-obstructive coronary artery disease. Russian Journal of Cardiology. 2021;26(12):181–8. DOI: 10.15829/1560-4071-2021-4746

9. Pan J, Yuan M, Yu M, Gao Y, Shen C, Wang Y et al. 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. Korean Journal of Radiology. 2019;20(5):709–18. DOI: 10.3348/kjr.2018.0729

10. Terenicheva M.A., Shakhnovich R.M., Stukalova O.V., Pevzner D.V., Arutyunyan G.K., Demchenkova A.Yu. et al. Correlations between clinical and laboratory findings and prognostically unfavorable CMRbased characteristics of acute ST-elevation myocardial infarction. Kardiologiia. 2021;61(1):44–51. DOI: 10.18087/cardio.2021.1.n1373

11. Mochula O.V., Sulejmanova A.S., Sukhareva A.E., Ryabov V.V., Zavadovsky K.V. Relationship between the degree of myocardial damage according to contrast-enhanced cardiac magnetic resonance imaging and laboratory data in patients with acute myocardial infarction. Russian Journal of Cardiology. 2022;27(11):30–8. DOI: 10.15829/1560-4071-2022-5226

12. Stukalova O.V., Gupalo E.M., Chumachenko P.V., Samko A.N., Butorova E.A., Shakhnovich R.M. et al. The value of cardiovascular magnetic resonance in myocarditis with different clinical presentation. Therapeutic Archive. 2019;91(4):28–36. DOI: 10.26442/00403660.2019.04.000078

13. Pershina E.S., Shchekochikhin D.Yu., Shaginyan G.M., Shilova A.S., Sherashov A.V., Poltavskaya M.G. et al. Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries. Therapeutic Archive. 2021;93(4):376–80. DOI: 10.26442/00403660.2021.04.200676

14. Kim HW, Farzaneh-Far A, Kim RJ. Cardiovascular Magnetic Resonance in Patients With Myocardial Infarction. Journal of the American College of Cardiology. 2009;55(1):1–16. DOI: 10.1016/j.jacc.2009.06.059

15. Zavadovsky KV, Vorobyeva DA, Mochula OV, Mochula AV, Maltseva AN, Bayev AE et al. Myocardial Blood Flow and Flow Reserve in Patients With Acute Myocardial Infarction and Obstructive and Non-Obstructive Coronary Arteries: CZT SPECT Study. Frontiers in Nuclear Medicine. 2022;2:935539. DOI: 10.3389/fnume.2022.935539

16. Everaars H, van Diemen PA, Biesbroek PS, Hopman LHGA, Bom MJ, Schumacher SP et al. Comparison between cardiac magnetic resonance stress T1 mapping and [15O]H2O positron emission tomography in patients with suspected obstructive coronary artery disease. European Heart Journal - Cardiovascular Imaging. 2022;23(2):229–37. DOI: 10.1093/ehjci/jeab073