Abstract
Despite the cardioprotective effect of rapid coronary reperfusion, the effects of spontaneous recanalization on myocardial viability and metabolism are unknown. We studied whether preinfarction angina affords cardioprotection when spontaneous coronary reperfusion occurred in acute infarct patients. Myocardial tomographies with thallium and I-123-labeled-β-methyl-p-iodophenyl penta-decanoic acid (BMIPP) were performed in 27 acute myocardial infarct patients treated medically: 15 patients had preexisting angina before infarction (group A) and 12 did not (group B). Thallium and BMIPP abnormalities and regional function were quantified by a polar map and contrast ventriculography, respectively. There was no significant difference between thallium and BMIPP in the severity index in groups A and B (89 ± 97 vs. 85 ± 68, 97 ± 28 vs. 95 ± 27, respectively), and no significant difference between the groups in the thallium or BMIPP severity index. The ratio of the thallium severity index to that of BMIPP and the regional wall-motion abnormality index were identical in groups A and B. Both patient groups were divided into 2 subgroups based on the presence or absence of spontaneous coronary reperfusion: subgroups A1 and A2, and subgroups B1 and B2, respectively. There were no significant differences among the 4 subgroups in severity indexes for both tracers, the thallium/BMIPP ratio, or the asynergy score. The BMIPP severity index correlated significantly with that of thallium in all subgroups, but no significant difference between the regression lines was found. It is therefore unlikely that spontaneous coronary recanalization affords beneficial effects through preservation of myocardial viability in an ischemia-related zone, suggesting that the cardioprotective effect of preinfarction angina is a limited phenomenon in patients undergoing rapid coronary reperfusion.
Similar content being viewed by others
References
Kloner RA, Yellon DM. Does ischemic preconditioning occur in patients?J Am Coll Cardiol 24: 1133–1142, 1994.
Murry CE, Richard VJ, Reimer KA, Jennings RB. Ischemic preconditioning slows energy metabolism and delays ultrastructual damage during a sustained ischemic episode.Circ Res 66: 913–931, 1990.
Cohen MV, Downey JM. Myocardial stunning in dogs: Preconditioning effect and influence of coronary collateral flow.Am Heart J 120: 282–291, 1990.
Cohen MV, Liu GS, Downey JM. Preconditioning causes improved wall motion as well as smaller infarcts after transient coronary occlusion in rabbits.Circulation 84: 341–349, 1991.
Deutsch E, Berger M, Kussmaul WG, Hirshfeld JW, Herrmann HC, Laskey WL. Adaptation to ischemia during percutaneous transluminal coronary angioplasty: clinical, hemodynamic, and metabolic features.Circulation 82: 2044–2051, 1990.
Cribier A, Korsatz L, Koning R, Rath P, Gamra H, Stix G, et al. Improved myocardial ischemic response and enhanced collateral circulation with long repetitive coronary occlusion during angioplasty: a prospective study.J Am Coll Cardiol 20: 578–586, 1992.
Tomai F, Crea F, Gaspardone A, Versaci F, Esposito C, Chiariello L, et al. Mechanisms of cardiac pain during coronary angioplasty.J Am Coll Cardiol 22: 1892–1896, 1993.
Kerensky RA, Kutcher MA, Braden GA, Applegate RJ, Solis GA, Little WC. The effects of intracoronary adenosine on preconditioning during coronary angioplasty.Clin Cardiol 18: 91–96, 1995.
Kloner RA, Shook T, Przyklenk K, Davis VG, Junio L, Matthews RV, et al. Previous angina alters in-hospital outcome in TIMI 4. A clinical correlate to preconditioning?Circulation 91: 37–47, 1995.
Ottani F, Galvani M, Ferrini D, Sorbello F, Limonetti P, Pantoli D, et al. Prodromal angina limits infarct size. A role for ischemic preconditioning.Circulation 91: 291–297, 1995.
Nakagawa Y, Ito H, Kitakaze M, Kusuoka H, Hori M, Kuzuya T, et al. Effect of angina pectoris on myocardial protection in patients with reperfused anterior wall myocardiai infarction: Retrospective clinical evidence of “preconditioning.”J Am Coll Cardiol 25: 1076–1083, 1995.
Anzai T, Yoshikawa T, Asakura Y, Abe S, Akaishi M, Mitamura H, et al. Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave myocardial infarction.J Am Coll Cardiol 26: 319–327, 1995.
Williams DO, Bass TA, Gerwitz H, Most AS. Adaptation to the stress of tachycardia in patients with coronary artery disease: insight into the mechanism of the warm-up phenomenon.Circulation 71: 687–692, 1985.
Okazaki Y, Kodama K, Sato H, Kitakaze M, Hirayama A, Mishima M, et al. Attenuation of increased regional myocardial oxygen consumption during exercise as a major cause of warm-up phenomenon.J Am Coll Cardiol 21: 1597–1604, 1993.
Nakata T, Hashimoto A, Kobayashi H, Miyamoto K, Tsuchihashi K, Miura T, et al. Outcome significance of thallium-201 and iodine-123 BM1PP perfusion-metabolism mismatch in preinfarction angina.J Nucl Med 39: 1492–1499, 1998.
Nakata T, Hashimoto A, Miyamoto K, Fujimori K, Shogase T, Hirasawa K, et al. Clinical implications of mismatched uptakes of beta-methyl fatty acid analogue and thallium in infarcted myocardium: Correlations with coronary stenosis and regional wall motion abnormality.KAKU IGAKU (Jpn J Nucl Med) 32: 1061–1071, 1995.
Rentrop KP, Feit F, Sherman W, Thornton JC. Serial angiographic assessment of coronary artery obstruction and collateral flow in acute myocardial infarction. Report from the second Mount Sinai-New York University Reperfusion Trial.Circulation 80: 1166–1175, 1989.
Topol EJ, Califf RM, Vandormael M, Grines CL, George BS, Sanz ML, et al. A randomized trial of late reperfusion therapy for acute myocardial infarction. Thrombolysis and Angioplasty in Myocardial Infarction-6 Study Group.Circulation 85: 2090–2099, 1992.
Haq A, Morgan CD, Wilson RF, Daly PA, Baigrie RS, White CW, et al. Impact of tissue plasminogen activator and heparin versus heparin alone on quantitative coronary angiographic findings in myocardial infarction. The Toronto Tissue Plasminogen Activator Trial Study Group.Am J Cardiol 12: 379–383, 1993.
Kim S, Yamabe H, Yokoyama M. Impaired coronary circulation in acute myocardial infarction: a dipyridamole-thallium-201 study.Eur J Nucl Med 24: 210–214, 1997.
Akiyama H, Ishikawa K, Kanamasa K, Ogawa I, Koka H, Kamata N, et al. Increased coronary vasomotor tone in acute myocardial infarction patients with spontaneous coronary recanalization.Jpn Circ J 61: 503–509, 1997.
Hashimoto A, Nakata T, Nagao K, Kobayashi H, Hase M, Yoshioka N, et al. Prediction of left ventricular functional recovery in patients with acute myocardial infarction using SPECT with thallium and beta-methyliodophenyl pentadecanoic acid.J Cardiol 26: 35–44, 1995.
Hashimoto A, Nakata T, Tsuchihashi K, Tanaka S, Fujimori K, Iimura O. Postischemic functional recovery and BMIPP uptake after primary percutaneous transluminal coronary angioplasty in acute myocardial infarction.Am J Cardiol 77: 25–30, 1996.
Hase M, Nakata T, Yonekura S, Tsuchihashi K, Kobayashi H, Nagao K, et al. Correlation of regional wall motion and fatty acid metabolism in coronary artery disease, hypertension, and hypertrophic cardiomyopathy: Assessment by dual-isotope SPECT with thallium-201 and iodine-123 β-methyl fatty acid analogue.KAKU IGAKU (Jpn J Nucl Med) 30: 529–539, 1993.
Nishimura T, Uehara T, Strauss HW. Radionuclide assessment of stunned myocardium by alternations in perfusion, metabolic and function.Jpn Circ J 55: 913–918, 1991.
Tamaki N, Kawamoto M, Yonekura Y, Fujibayashi Y, Takahashi N, Konishi J, et al. Regional metabolic abnormality in relation to perfusion and wall motion in patients with myocardial infarction: Assessment with emission tomography using an iodinated branched fatty acid analog.J Nucl Med 33: 659–667, 1992.
Kawamoto M, Tamaki N, Yonekura Y, Tadamura E, Fujibayashi Y, Magata Y, et al. Combined study with I-123 fatty acid and thallium-201 to assess ischemic myocardium: Comparison with thallium redistribution and glucose metabolism.Ann Nucl Med 8: 47–54, 1994.
Takeishi Y, Sukekawa H, Saito H, Nishimura S, Shiba T, Sasaki Y, et al. Impaired myocardial fatty acid metabolism detected by123I-BMIPP in patients with unstable angina pectoris: Comparison with perfusion imaging by99mTc-sestamibi.Ann Nucl Med 9: 125–130, 1995.
Nakajima K, Shimizu K, Taki J, Uetani Y, Konishi S, Tonami N, et al. Utility of iodine-123-BMIPP in the diagnosis and follow-up of vasospastic angina.J Nucl Med 36: 15934–15940, 1995.
Taki J, Nakajima K, Matsunari I, Bunko H, Tanaka S, Kawasuji M, et al. Assessment of improvement of myocardial fatty acid uptake and function after revascularization using iodine-123-BMIPP.J Nucl Med 38: 1503–1510, 1997.
Nakata T, Noto T, Uno K, Wada A, Hikita N, Tanaka S, et al. Quantification of area and percentage of infarcted myocardium by single photon emission computed tomography with thallium-201: A comparison with serial serum CK-MB measurements.Ann Nucl Med 3: 1–8, 1989.
Kloner RA, Shook T, Antman EA, Cannon CP, Przyklenk K, McCabe CH, et al. A prospective analysis on the potential preconditioning effect of preinfarct angina in TIMI 9.Circulation (Suppl) 94: 1–611, 1996. (abstract)
Margaglione M, Grandone E, Di Minno G. Plasma predictors of ischemic complications of atherosclerosis: open issues.Biomed Pliarmacother 47: 445–449, 1993.
Fujibayashi Y, Yonekura Y, Takemura Y, Wada K, Matsumoto K, Tamaki N, et al. Myocardial accumulation of iodinated beta-methyl-branched fatty acid analogue, iodine-125-15-(p-iodophenyl)-3(R,S)methylpentadecanoic acid (BMIPP), in relation to ATP concentration.J Nucl Med 31: 1818–1822, 1990.
Ovize M, Przyklenk K, Hale SL, Kloner RA. Preconditioning does not attenuate myocardial stunning.Circulation 85: 779–789, 1992.
Urabe K, Miura T, Iwamoto T, Ogawa T, Goto M, Sakamoto J, et al. Preconditioning enhances myocardial resistance to postischaemic myocardial stunning via adenosine receptor activation.Cardiovasc Res 27: 657–662, 1993.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hashimoto, A., Nakata, T., Wakabayashi, T. et al. Limitations of spontaneous reperfusion and conventional medical therapy to afford myocardial protection through antecedent angina pectoris in acute myocardial infarction. Ann Nucl Med 13, 337–346 (1999). https://doi.org/10.1007/BF03164873
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03164873