The persistence of hibernating myocardium after acute myocardial infarction

OBJECTIVE: To establish the persistence of hibernating myocardium initially detected after myocardial infarction treated with thrombolysis. METHODS AND RESULTS: Fourteen patients underwent gated positron emission tomography with 18-fluoro-deoxyglucose and N13-ammonia at a median of 8 days after first myocardial infarction. Repeat scans were performed at a median of 13 weeks post-infarction. A total of 148 (30.9%) myocardial segments showed reduced N13-ammonia uptake at the time of the first scan compared with 154.5 (32.2%) segments at the time of repeat imaging. The median change in the number of segments with reduced perfusion was -1.0. Initially 13 subjects had hibernating myocardium, seven patients had large areas and six had smaller regions. Six (46.2%) subjects had repeat scans showing unchanged areas of hibernating tissue and seven had second scans demonstrating changes in the size of the region of hibernating myocardium. One patient had no hibernating myocardium on either scan. CONCLUSIONS: Positron emission tomography performed several months after myocardial infarction demonstrates significant changes in myocardial perfusion. However, a reduction in the number of segments with reduced perfusion does not always result in an improvement in myocardial metabolism and contraction. Whilst most regions of hibernating myocardium were still present several months after infarction, in only approximately half was the size of the mismatched region unchanged. Therefore it is not possible to predict the fate of hibernating myocardium which is present after infarction.