Peculiarities of acute myocardial infarction course and distribution of the somatostatin receptor analogue 99mTc-octreotide in the heart

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Aim. To study the relationship between the clinical course of myocardial infarction (MI) with changes in left ventricular (LV) geometry and myocardial accumulation of the somatostatin analogue 99mTc-octreotide according to cardiac single-photon emission computed tomography (SPECT). Material and methods. This pilot, cohort, prospective study included 14 patients aged 37 to 72 years with primary anterior ST-segment elevation MI. Patients underwent a general clinical examination, 3-fold determination of high-sensitivity C-reactive protein (hsCRP), echocardiography on days 1-3, cardiac SPECT with 99mTc-octreotide on days 6-7 from MI onset. Statistical analysis was performed using STATISTICA 10.0, StatSoft, USA. Results. In 10 of 14 patients, 99mTc-octreotide accumulation in LV involvement area was recorded. The accumulation analysis showed varying intensity. This made it possible to form two subgroups with high and low accumulation of 99mTc-octreotide (heart-to-cavity LV ratio more and less than 1,5, respectively). Clinical characteristics and MI course, length of hospital stay did not differ between the subgroups. Occlusion of the infarct-related coronary artery (in 5 (62,5%) vs 0 (0%) patients, p=0,016) was more common in the group with increased versus decreased accumulation of 99mTc-octreotide, respectively. Laboratory analysis showed a significant increase in hsCRP upon admission in patients with increased vs decreased accumulation of 99mTc-octreotide — 31,6 mg/l (10,45-42,05) vs 6,5 mg/l (3,2-11,8), p=0,043, respectively. A significant increase in end-diastolic and end-systolic LV volumes was established. There were an increase in LV sphericity index and local contractility disruption index along with a decrease in LV ejection fraction in the subgroup with high vs reduced accumulation of 99mTc-octreotide (47,5% (45,5-51,5) vs 57,5% (54-59), p=0,020) in the damage zone, respectively. In addition, a predictive relationship between the increase in LV end-diastolic volume and the severity of 99mTc-octreotide accumulation was found (R2=0,601, F-ratio=16,562, p=0,002). Conclusion. An increase in hsCRP and early initiation of LV remodeling after primary anterior ST-segment elevation MI is accompanied by a pronounced accumulation of 99mTc-octreotide in the damage zone, detected using cardiac SPECT, as a result of systemic and local, in our opinion, macrophage-mediated post-infarction inflammation.

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