pyrophosphate and Angina-Pectoris

Because of recent findings, a reassessment is needed of the concept that rest angina associated with ST-segment depression is due to a spontaneous, transient increase of blood pressure or heart rate, or both, in the presence of critical coronary artery stenosis. Continuous hemodynamic and electrocardiographic recordings done before and during attacks of rest angina and thallium-201 scintigrams done during pain indicate that a transient reduction of flow is the immediate cause of ischemia in most, but not all, instances. Flow reduction, in turn, appears to be due to coronary arterial spasm or platelet aggregation, or both, acting at a site of atherosclerotic narrowing. Therapy for unstable rest angina should include measures to prevent both transient reductions of flow and increases of myocardial oxygen consumption. A combination of long-acting nitrates, a beta-blocker, a calcium-channel blocker, and aspirin or heparin is suggested for this purpose. Intravenous nitroglycerin is useful when angina occurs despite this therapy or when frequent attacks of ischemia are occurring at the time of admission.

Topics: Angina Pectoris; Angina, Unstable; Coronary Angiography; Coronary Disease; Coronary Vasospasm; Diphosphates; Electrocardiography; Hemodynamics; Humans; Krypton; Myocardium; Platelet Aggregation; Radioisotopes; Rest; Rubidium; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Angina Pectoris; Angina, Unstable; Animals; Breast Neoplasms; Cardiomyopathies; Coronary Disease; Diagnosis, Differential; Diphosphates; Dogs; Electric Countershock; Humans; Myocardial Infarction; Radionuclide Imaging; Rats; Rib Fractures; Technetium; Technetium Tc 99m Pyrophosphate

The diagnostic possibilities of myocardial scintigraphy in cardiology are discussed. As an invasive technique the perfusion imaging is described. The valuation of the doubleisotope-scintigraphy for better diagnostic examination during coronary arteriography is accentuated. The 201-Thallium-scintigraphy as a non invasive method is debated. The diagnostic value of the 201-Thallium stress scintigraphy is shown. The similarity of ergometric and pharmacologic provocation with Dipyridamol is represented. In the following the reliability and the specificity of the infarct scintigraphy with 99m-Technetium-pyrophosphate as "hot-spot-technique" is discussed. The follow-up scintigraphy allows to draw prognostic inferences about the further course of a myocardial infarction. The scintigraphic findings were correlated to haemodynamic measurements. Scintigraphic examinations in patients with stable angina pectoris without infarction revealed correlations between the uptake of the tracer in the myocardium and a disturbed left ventricular function. A chronic deficiency in the blood supply of the myocardium is discussed as the cause of the tracer uptake.

Topics: Angina Pectoris; Cardiac Catheterization; Chemotherapy, Cancer, Regional Perfusion; Coronary Vessels; Diphosphates; Dipyridamole; Heart Ventricles; Humans; Iodine Radioisotopes; Methods; Myocardial Infarction; Physical Exertion; Pulmonary Artery; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

The effects of abrupt withdrawal or continuation of beta-blockade therapy during acute myocardial infarction were evaluated in 326 patients participating in the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Thirty-nine patients previously receiving a beta-blocker and randomly selected for withdrawal of beta-blockers and placebo treatment during infarction (group 1) were compared with 272 patients previously untreated with beta-blockers who were also randomly assigned to placebo therapy (group 2). There were no significant differences between the two groups in MB creatine kinase isoenzyme (15.8 +/- 10.9 vs 18.2 +/- 14.4 g-eq/m2, respectively) estimates of infarct size, radionuclide-determined left ventricular ejection fractions within 18 hr of infarction (0.44 +/- 0.15 vs 0.47 +/- 0.16) or 10 days later (0.42 +/- 0.14 vs 0.47 +/- 0.16), creatine kinase-determined incidence of infarct extension (13% vs 6%), congestive heart failure (43% vs 37%), nonfatal ventricular fibrillation (5% vs 7%), or in-hospital mortality (13% vs 9%). Patients in group 1 had more recurrent ischemic chest pain (p = .002) within the first 24 hr after infarction, but not thereafter. However, this did not appear to be related to a rebound increase in systolic blood pressure, heart rate, or double product. In a separate analysis, 20 propranolol-eligible group 1 patients randomly selected for withdrawal of beta-blockade (group 3) were compared with 15 patients randomly selected for continuation of prior beta-blockade therapy (group 4). This comparison yielded similar results. These data indicate that the beta-blockade withdrawal phenomenon is not a major clinical problem in patients with acute myocardial infarction. beta-Blockade therapy can be discontinued abruptly during acute myocardial infarction if clinically indicated.

Topics: Aged; Ambulatory Care; Angina Pectoris; Blood Pressure; Clinical Trials as Topic; Creatine Kinase; Diphosphates; Electrocardiography; Female; Heart Rate; Heart Ventricles; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Propranolol; Radionuclide Imaging; Random Allocation; Substance Withdrawal Syndrome; Technetium; Technetium Tc 99m Pyrophosphate

The possibility of myocardial necrosis occurrence in coronary failure proceeding as atypical myocardial infarction was examined in 176 patients with chronic types of coronary heart disease and in experiments with 16 dogs with reversible coronary failure simulated in chronic tests. 99mTe-labeled pyrophosphate myocardial scintigraphy was used in the clinical studies. Myocardial pyrophosphate accumulation was recorded in 37% of patients with angina pectoris without a history of myocardial infarction and 73% myocardial infarction survivals. Histological evidence for small myocardial necroses at various stages of their development was found in 12 dogs. Recurrent transient myocardial ischemias were shown to be able to lead to myocardial necroses that are not always followed by a typical course of acute myocardial infarction.

Topics: Angina Pectoris; Animals; Chronic Disease; Coronary Disease; Diphosphates; Dogs; Heart; Myocardium; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The incidence of acute myocardial infarction (AMI) complicating coronary artery bypass grafting (CABG) has previously been based on concordance of electrocardiographic, enzymatic and scintigraphic criteria. Technetium-99m pyrophosphate (Tc-PPi) single-photon emission computed tomography now enables detection of AMI with high sensitivity and specificity. Using this technique, perioperative AMI was detected in 12 of 58 patients (21%) undergoing successful elective CABG for stable angina pectoris. Stepwise multivariate logistic regression analysis was performed to compare the predictive value of preoperative (New York Heart Association class, left ventricular ejection fraction and use of beta blockers) and intraoperative (number of grafts constructed, use of internal mammary anastomoses, use of sequential saphenous vein grafts, smallest grafted distal vessel lumen caliber and aortic cross-clamp time) variables. Preoperative New York Association class (p = 0.04) and smallest grafted distal vessel lumen caliber (p = 0.03) were significant multivariate predictors of perioperative AMI. Only 1 perioperative patient with AMI (and 1 pyrophosphate-negative patient) developed new Q waves. Serum creatine kinase-MB was higher in patients with AMI by repeated measures analysis of variance (p = 0.0003). Five AMIs occurred in myocardial segments revascularized using sequential saphenous vein grafts, and 7 in segments perfused by significantly stenosed epicardial vessels with distal lumen diameter and perfusion territory considered too small to warrant CABG. At 6-month follow-up, the mean left ventricular ejection fraction increased from 0.61 to 0.65 in Tc-PPI-negative patients (p = 0.01), but not in perioperative patients with AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Angina Pectoris; Coronary Angiography; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Regression Analysis; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Altogether 106 patients with different types of acute CHD (large and small local MI, unstable angina) and stable angina were investigated. Combined assessment of perfusion disorder permits differentiation of necrotic and ischemic myocardial lesions. A degree and type of RP accumulation corresponds to a size of necrotic myocardial lesion determined by means of biochemical markers of necrosis. Parallelism of myoglobin concentration, isoenzyme activity in the blood serum and the results of scintigraphy was revealed. In focal RP accumulation, myoglobin concentration reached maximum values; a moderate increase and decrease up to normal values in the absence of accumulation were observed in diffuse accumulation. Diffuse RP accumulation in patients with stable and unstable types of angina was indicative of transient perfusion disorders resulting from myocardial ischemia.

Topics: Angina Pectoris; Angina, Unstable; Coronary Disease; Diphosphates; Heart; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Both acute myocarditis and myocardial infarction must be considered in the differential diagnosis of the young patient with angina-like chest pain. Initial assessment may be difficult, since both diseases may produce similar clinical presentations, electrocardiographic changes, and elevations in cardiac enzymes. Early differentiation is important, however, since myocarditis and myocardial infarction differ greatly in their management and prognosis. These difficulties are illustrated by the 2 cases presented, and guidelines for diagnosis and treatment are given.

Topics: Acute Disease; Adult; Angina Pectoris; Diagnosis, Differential; Diphosphates; Echocardiography; Electrocardiography; Heart; Humans; Male; Myocardial Infarction; Myocarditis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Myocardial pyrophosphate accumulation was examined in various forms of coronary heart disease. The status of the coronary reserve in the myocardial lesion foci where pyrophosphate is accumulated has been shown to determine the severity of coronary failure in various uncomplicated forms of the disease, such as angina without prior myocardial infarction, myocardial infarction in the early phase of its healing, and postinfarction cardiosclerosis. In postinfarction cardiosclerosis, the dimensions of such foci are significant in the development of clinical events of coronary failure.

Topics: Aged; Angina Pectoris; Cardiomyopathy, Dilated; Coronary Disease; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Severity of Illness Index; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Angina Pectoris; Angina, Unstable; Bundle-Branch Block; Diphosphates; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Ambulatory Care; Angina Pectoris; Angina, Unstable; Diphosphates; Heart; Humans; Myoglobin; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Myocardial radiocardiography and scintigraphy with 99mTc-pyrophosphate was performed in 58 patients with stable angina and 60 patients with unstable angina. In patients with stable angina, positive scintigrams were mostly recorded after anginal attacks. Their central hemodynamic parameters deteriorated progressively as angina increased in severity. Patients with unstable angina typically showed myocardial accumulation of the label that was unrelated to anginal attacks and recordable by direct-projection scintigraphy. The assessment of myocardial radiocardiographic and scintigraphic data allows one to differentiate between stable and unstable angina.

Topics: Adult; Angina Pectoris; Angina, Unstable; Cardiac Output; Diagnosis, Differential; Diphosphates; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Vascular Resistance

Topics: Adult; Angina Pectoris; Chronic Disease; Coronary Disease; Diphosphates; Evaluation Studies as Topic; Heart; Humans; Male; Middle Aged; Physical Exertion; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Angina Pectoris; Angina, Unstable; Diphosphates; Female; Heart; Humans; Male; Myocardial Infarction; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

The clinical value of myocardial scintigraphy with 99mTc-pyrophosphate in conjunction with bicycle ergometry was assessed through the correlation of the latter's results with the clinical course of coronary heart disease over 1 year in 21 patients with first myocardial infarction during its early healing stage and 17 anginal patients without a history of myocardial infarction. The disease ran a stable course at the time of the testing in all the patients; later on, 11 of those developed various complications associated with coronary heart disease, or died. Three scintigraphic recordings were made: prior to, at the peak of, and after the exercise. Thirteen scintigraphic patterns were identified. They are interpreted on the basis of presumed variation in the degree of myocardial damage and blood supply to affected areas under the effect of exercise; a relation is also noted with predicted risk of complications. The method has proved reliable in identifying patients at low risk for complications. Providing indirect evidence of the quality of blood supply to damaged myocardial areas during rationed exercise, it furnishes additional criteria for the assessment of the patients' working capacity.

Topics: Adult; Aged; Angina Pectoris; Coronary Circulation; Diphosphates; Exercise Test; Female; Heart; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Risk; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

The effect of exercise on the parameters of the scintigraphy of the myocardium with labelled pyrophosphate was studied in 35 patients with coronary heart disease and angina of effort and at rest with regard to the activity of the pituitary-adrenal cortex system. The functional status of this system was evaluated on the basis of data on the blood changes in somatotrophic hormone and cortisol. The use of a scoring system made it possible to identify four types of the pattern of the scintigraphic parameters. Type I and II of the pattern of the scintigraphic parameters indicating the normal ratios between the requirements of the cardiac muscle in oxygen and myocardial perfusion were characteristic of the patients with angina pectoris in the presence of an increased activity of the pituitary-adrenal cortex system. When the coronary heart disease patients with angina had a lower activity of this system, the authors more frequently recorded types III and IV of the pattern of scintigraphy which reflected a decreased perfusion and myocardial damage during exercise.

Topics: Adult; Aged; Angina Pectoris; Diphosphates; Female; Growth Hormone; Heart; Humans; Hydrocortisone; Male; Middle Aged; Oxygen Consumption; Physical Exertion; Pituitary-Adrenal System; Radionuclide Imaging; Rest; Technetium; Technetium Tc 99m Pyrophosphate

Fifty consecutive patients undergoing coronary artery bypass grafting for chronic stable angina were assessed by serial electrocardiography, preoperative and postoperative myocardial scanning with technetium-99m pyrophosphate, gated radionuclide ventriculography, and serial measurement of creatine kinase, aspartate aminotransferase, urea stable lactic dehydrogenase, and creatine kinase isoenzyme (MB) to assess the incidence of perioperative myocardial infarction and identify the most appropriate diagnostic techniques. The correlation between myocardial scanning and the measurement of peak enzyme and isoenzyme activity was excellent in the diagnosis of perioperative infarction, although electrocardiography proved less helpful. There appeared to be no advantage in measuring creatine kinase MB rather than the more routinely measured enzymes. There were two deaths and evidence of myocardial infarction in five other patients, an incidence of 14%. Perioperative infarction was associated with a significant reduction in resting ejection fraction in two cases. In those patients without evidence of perioperative infarction the mean increase in ejection fraction of 7.8% was statistically significant.

Topics: Adult; Aged; Angina Pectoris; Clinical Enzyme Tests; Coronary Artery Bypass; Diphosphates; Electrocardiography; Heart; Heart Ventricles; Humans; Intraoperative Complications; Middle Aged; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To depict the three-dimensional distribution of 99mTc-pyrophosphate in the heart, emission computed tomography (ECT) was performed, following the conventional planar imaging, in 32 cases with suspected acute myocardial infarction (AMI). There were 23 cases with evidence of AMI, 7 with unstable angina (UA), and 2 with dilated cardiomyopathy (DCM). While the planar images showed discrete cardiac activity in only 11 of the 23 cases (48%) with AMI, the ECT images delineated focal myocardial uptake clearly in 20 of them (87%). On the other hand, the ECT images revealed cardiac blood-pool activity without significant myocardial uptake in all cases with UA and DCM in which the planar images showed diffuse activity. Thus, the ECT imaging of 99mTc-pyrophosphate seems to be a valuable technique for assessing the presence and localization of myocardial necrosis, especially in cases showing diffuse cardiac activity in the planar imaging.

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Cardiomyopathies; Diagnosis, Differential; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Tomography, X-Ray

Topics: Angina Pectoris; Coronary Disease; Diphosphates; Humans; Myocardial Infarction; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed

Topics: Angina Pectoris; Arteriosclerosis; Coronary Disease; Diagnosis, Differential; Diphosphates; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In 66 patients suffering on chronic stable angina pectoris myocardial scintigrams with 99mTc-pyrophosphate were evaluated. Patients who had former infarcts or infarct signs in ECG were excluded. 16 normal subjects were used as controls. In all normal subjects and in 35 patients with chronic A.P. a normal myocardial scintigram could be obtained. In the remaining 31 patients a localized myocardial tracer accumulation could be seen. There was a correlation between the tracer accumulation and the limitted left ventricular function. No correlation was found between the severity and the number of involved coronary arteries and a positive scintiphoto. The mechanism of the tracer accumulation is discussed. The results of this investigation show that a positive myocardial scintigram does not prove a myocardial infarction. It is a sign for a insufficiency of the contractility of the left ventricle, probably due to under perfusion.

Topics: Angina Pectoris; Chronic Disease; Diphosphates; Electrocardiography; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Angina Pectoris; Cardiac Output; Cardiac Pacing, Artificial; Diphosphates; Heart Rate; Humans; Lactates; Myocardial Contraction; Pulmonary Wedge Pressure; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Verapamil

Topics: Adult; Aged; Angina Pectoris; Creatine Kinase; Diagnosis, Differential; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A survey is presented of research results of pyrophosphate myocardial scanning in 130 dogs and 150 patients with various myocardial lesions. The results of experiments in animals were immediately applied in clinical practice. The results showed that acute transmural myocardial lesions yielded practically in all instances positive scintigraphic findings. The findings in nontransmural infarctions were less convincing--they were positive in 60% of cases. Positive scintigraphic findings were also obtained in 80% of dogs with experimentally induced temporary ischaemia, and in 80% of dogs with experimentally induced dystrophy of the myocardium. In patients with angina pectoris positive findings were obtained in 1/3 of the cases, and in patients with cardiomyopathies, in 1/3 to 1/4 of the cases (in dependence on the etiology of the cardiomyopathy). It appears that 99mTc-PYP is a highly sensitive, but nonspecific, detector of myocardial lesions.

Topics: Angina Pectoris; Animals; Cardiomyopathies; Coronary Artery Bypass; Coronary Disease; Diphosphates; Dogs; Humans; Myocardial Infarction; Myocardium; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Angina Pectoris; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The authors examined 166 patients with ischemic heart disease and attacks of angina pectoris and 21 healthy individuals. Scintigraphy, electrocardiography and tests for the activity of creatine phosphokinase and its MB fraction were carried out at rest, during physical exercise and 1--3 days after it. It was found that pyrophosphate-99mTc may accumulate in the myocardium both during the attack of angina pectoris and after its cessation. Angina pectoris may occur both with diffuse and with focal pyrophosphate-99mTc accumulation in the myocardium. Positive results of scintigraphy were encountered considerably more often in patients examined during physical exercise than in those examined at rest. Scintigraphic signs of angina pectoris which occurs under the effect of physical exertion develop less frequently, but persisted for a longer time than its electrocardiographic signs.

Topics: Adult; Angina Pectoris; Diphosphates; Exercise Test; Female; Heart; Humans; Hypertension; Male; Middle Aged; Radionuclide Imaging; Technetium

Technetium-99m stannous pyrophosphate myocardial scintigrams were obtained in 138 clinically stable patients 32.7 +/- 47.3 weeks (range 6 to 260) after acute myocardial infarction. Of the 138 patients, 74 (54 percent) had a persistently positive scintigram. Patients with such a scintigram were more likely to have severe angina pectoris, compensated congestive heart failure, anterior location of acute myocardial infarction, Q waves and S-T segment elevation in the electrocardiograms, cardiomegaly, left ventricular dyssynergy (dyskinesia or global dyssynergy), and an ejection fraction of less than 50 percent. During a follow-up period of 11.6 +/- 6.9 months after scintigraphy, 42 percent of the patients with a persistently positive scintigram had either a cardiac death, a nonfatal myocardial infarction, unstable angina pectoris or decompensated congestive heart failure compared with 13 percent of the patients with a negative scintigram (P less than 0.001). Of the 14 patients with cardiac death, 13 (93 percent) had a persistently positive scintigram. A persistently positive scintigram not only was the best single predictor of cardiac death and combined end points, but also added significantly to the predictive ability of the other clinical variables, including age, location of acute myocardial infarct, clinical status, electrocardiographic findings, and chest X-ray findings. It is concluded that technetium-99m stannous pyrophosphate myocardial scintigraphy has prognostic value in patients after acute myocardial infarction.

Topics: Adult; Aged; Angina Pectoris; Cardiac Catheterization; Diphosphates; Electrocardiography; Evaluation Studies as Topic; Female; Follow-Up Studies; Heart; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Regression Analysis; Technetium; Time Factors

The incidence of operative myocardial infarction was assessed by electrocardiogram (ECG) and technetium-99m pyrophosphate (99mTc-PyP) myocardial scintigrams in 89 consecutive patients undergoing coronary artery bypass grafting (CABG). Myocardial scintigrams were performed on the day before operation and repeated 2 to 3 days postoperatively. All patients survived operation, with three in-hospital deaths not related to myocardial infarction (mortality rate 3 percent). Operative infarction was assessed to have occurred in four of 89 patients (4 percent). Two had new Q waves and positive scintigrams; one, major ST-T wave changes and a positive scintigram; and the fourth, new Q waves without a positive scintigram. Three further patients (3 percent) had Q waves and positive scintigrams postoperatively, but myocardial infarction was evolving before anesthesia and operation. Twenty-seven of 89 patients (30 percent) were found to have abnormal scintigrams preoperatively. In two patients, both operated upon with evolving myocardial infarction, the scintigram was worse postoperatively. In 13 patients the scintigram was improved after operation. In 12 patients (13 percent) the abnormal preoperative scintigram was unchanged after operation. Preoperative and postoperative myocardial scintigrams and ECG's must be compared to assess the incidence of operative myocardial infarction in patients undergoing CABG.

Topics: Adult; Aged; Angina Pectoris; Coronary Artery Bypass; Diphosphates; Electrocardiography; Female; Heart; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium

Thirty survivors of acute myocardial infarction with 3+ or 4+ positive technetium-99m pyrophosphate myocardial scintigrams were followed up for 28 +/- 3.1 months (mean +/- standard deviation). Three patient groups were identified from the pattern of radioactive uptake in the scintigram: Group I, 16 patients with focal uptake (anterior in 7, lateral in 2, posterior in 3 and inferior in 4); Group II, 6 patients with anterior myocardial infarction and a doughnut pattern of uptake; Group III, 8 patients with nontransmural myocardial infarction and a diffuse pattern of uptake. Late complications developed in all patients with the doughnut pattern of uptake compared with 43 percent of patients with the focal pattern and 12 percent of patients with the diffuse pattern. After discharge from the hospital, five of six patients with a doughnut pattern of uptake died (mean survival time 9.8 months after the initial myocardial infarction). This mortality rate (83 percent) was significantly greater than that of patients with a focal (mortality rate 6 percent) or diffuse (no mortality) pattern of uptake. The doughnut pattern of technetium-99m pyrophosphate myocardial uptake in patients with acute myocardial infarction appears to identify a subgroup of patients with a very poor long-term prognosis.

Topics: Angina Pectoris; Arrhythmias, Cardiac; Diphosphates; Follow-Up Studies; Heart; Heart Block; Heart Failure; Humans; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Recurrence; Technetium

There is controversy concerning the specificity of myocardial infarct imaging with technetium-99m pyrophosphate due to the high frequency of false positive images, especially in patients with unstable angina. In this study technetium-99m pyrophosphate images were compared with frequent determinations of plasma creatine kinase, MB isoenzyme (MB CK) activity in 116 patients admitted with the diagnosis of unstable angina. It was hypothesized that frequent measurement of MB CK activity, a sensitive and specific marker for myocardial necrosis, using sensitive assay techniques would detect small amounts of myocardial necrosis which might have been unrecognized by conventional clinical methods. The scintigraphic results and isoenzyme determinations agreed in 88 percent of patients; both tests were normal in 69 percent and both were abnormal, indicating acute myocardial infarcation, in 19 percent of patients. In the remaining 14 patients (12 percent), the scans were abnormal, but MB CK activity was normal. In five of these patients (4 percent), abnormal scintigrams presumably reflected persistent scan positivity after previous myocardial infarction. Only the remaining nine patients (8 percent) could be classified as having unexplained false positive scans, a frequency substantially less than that reported by other investigators who based the diagnosis of myocardial infarction on conventional clinical criteria. These results suggest that abnormal technetium-99m pyrophosphate images in patients with unstable angina generally indicate myocardial necrosis.

Topics: Adult; Aged; Angina Pectoris; Coronary Disease; Creatine Kinase; Diagnosis, Differential; Diphosphates; Evaluation Studies as Topic; Female; Heart; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium

Scintigraphy with pyrophosphate 99mTc was performed in 230 patients with various forms of ischemic heart disease and in 15 persons with pain in the region of the heart caused by osteochondrosis of the cervical and thoracic spinal segments or vegetovascular dystonia (control group). It was found that labelled purophosphate accumulated in the myocardium in necrosis of the heart muscle or when coronary insufficiency takes a course in which necrosis of the myocardial cells is quite possible. Positive results of scintigraphy with pyrophosphate 99mTc are not a strict criterion of acute myocardial infarction because they are also encountered in a chronic course of ischemic heart disease and are evidence in this case that "a state of risk" has occurred during the disease.

Topics: Acute Disease; Angina Pectoris; Cervical Vertebrae; Coronary Disease; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Neurocirculatory Asthenia; Osteochondritis; Radionuclide Imaging; Technetium

It has been suggested that diffuse Tc-99m pyrophosphate precordial activity may be due to persistent blood-pool activity in routine delayed views during myocardial imaging. To answer this question, we reviewed myocardial scintigrams recorded 60--90 min following the injection of 12--15 mCi of Tc-99m pyrophosphate for the presence of diffuse precordial activity, and compared these with early images of the blood pool in 265 patients. Diffuse activity in the delayed images was identified in 48 patients: in 20 with acute myocardial infarction and in 28 with no evidence of it. Comparison of these routine delayed images with early views of the blood pool revealed two types of patterns. In patients with acute infarction, 95% had delayed images that were distinguishable from blood pool either because the activity was smaller than the early blood pool, or by the presence of localized activity superimposed on diffuse activity identical to blood pool. In those without infarction, 93% had activity distribution in routine delayed views matching that in the early blood-pool images. The usefulness of the diffuse TcPPi precordial activity in myocardial infarction is improved when early blood-pool imaging is used to exclude persistence of blood-pool activity as its cause. Moreover, it does not require additional amounts of radioactivity nor complex computer processing, a feature that may be of value in the community hospital using the technique to "rule out" infarction 24--72 hr after onset of suggestive symptoms.

Topics: Angina Pectoris; Diphosphates; Heart Ventricles; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium

The interpretations of 156 99mtechnetium pyrophosphate myocardial scintigrams by four observers were analyzed in order to determine the reliability and reproducibility of the subjective process of reading scintigrams. The scintigrams were scored on an integral scale from 0 to 4, depending upon the degree of myocardial radionuclide accumulation, and the site and nature of uptake were specified. Exact agreement upon score was generally poor but approximate concurrence of interpretation was good (90.4 and 92.5% inter- and intra-observer agreement, respectively). There was somewhat less agreement on scintigrams with the higher scores of 3 and 4 (83.3 and 78.0%, respectively). A high level of concurrence upon the differentiation between diffuse and localized uptake, and upon the site of uptake, was found. We conclude that only approximate rather than exact agreement of individual readers' interpretations can be expected in this subjective technique, that scintigrams with higher degrees of radionuclide accumulation produce slightly greater observer disagreement, and that variability of interpretation could account for some of the diagnostic inaccuracy of 99mtechnetium pyrophosphate myocardial scintigraphy.

Topics: Angina Pectoris; Diphosphates; Heart; Heart Diseases; Humans; Radionuclide Imaging; Technetium

To determine the sensitivity of myocardial scintigraphy with technetium-99m pyrophosphate during the early phase of acute myocardial infarction, 31 patients admitted to the coronary care unit with prolonged ischemic pain underwent imaging within 4 to 8 hours and again at 24 hours after the onset of symptoms. In 11 of 15 patients with documented acute myocardial infarction, increased focal myocardial uptake was demonstrated on early myocardial scintigraphy. Focal uptake was observed in only 2 of 16 patients with unstable angina pectoris. Three or four patients with normal early scintigrams had massive transmural myocardial infarction. Normal early scintigrams in these three patients may have reflected poor perfusion because the images were abnormal at 24 hours. In four patients the extent of technetium-99m pyrophosphate uptake increased more than 20 percent at 24 hours without other evidence of infarct extension. In the other seven patients, there was no significant change in the area of the abnormal radioactive uptake between early and delayed scintiscans. This study suggests that technetium-99m pyrophosphate scintigraphy can defect acute myocardial infarction as early as 4 hours after the onset of symptoms although the sensitivity rate (73 percent) is less than that at 24 hours.

Topics: Acute Disease; Angina Pectoris; Diphosphates; Humans; Methods; Myocardial Infarction; Radionuclide Imaging; Technetium; Time Factors

A total of 400 patients, aged 25-82 years, admitted to the Coronary Care Unit due to clinical suspicion of acute myocardial infarction, were examined with 10 mCi 99mTc labelled to pyrophosphate. The examinations were carried out 4-120 hours post onset of symptoms, with a mobile gamma camera. Scintigrams were evaluated with regard to presence, localization and intensity of an uptake. Among 249 patients with a verified acute myocardial infarction, uptake was found in 237. Sixty-two of 85 patients with unstable angina showed a diffuse uptake with low intensity. Scintigraphy could not be used as a prognostic index of which patients would later develop an infarct. However, the scintigraphic pattern was useful as an aid in the differential diagnosis between acute myocardial infarction and unstable angina.

Topics: Adult; Aged; Angina Pectoris; Diagnosis, Differential; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium

Technetium-99m-stannous pyrophosphate (99mTc-PYP) accumulates in acutely infarcted myocardium and can be detected by scintiscanning. The clinical value of 99mTc-PYP scintiscanning was studied in 83 patients 6 hours to 21 days after the onset of acute chest pain. In 12 patients with normal electrocardiograms and serum enzyme values no uptake of 99mTc-PYP was detected on the scintigrams. Of 44 patients with electrocardiographic or enzyme evidence, or both, of acute myocardial infarction the scintigrams were positive in 31, "questionable" in 2 and negative in 11; no positive scan was obtained within 12 hours of the onset of pain, and the scans generally remained positive for up to 5 days. In 24 patients with evidence of prolonged myocardial ischemia the scans were positive in 2, questionable in 4 and negative in 18. The scans were negative in each of three patients with acute or constrictive pericarditis. Localization by electrocardiography and scintiscanning correlated nearly perfectly for transmural infarcts but subendocardial infarcts could not always be localized precisely by scintiscanning. The infarct area (total area of 99mTc-PYP uptake) correlated well with the peak serum value of creatine phosphokinase.

Topics: Angina Pectoris; Diphosphates; Humans; Myocardial Infarction; Pericarditis; Radionuclide Imaging; Technetium

Pyrophosphate-99m Tc injected intravenously is almost invariably fixed in the infarcted zone in transmural infarctions less than 8 days old. Fixation occurs in only 2/3 of cases of rudimentary infarction. The degree of fixation is more or less proportional to the size of the peak of creatine phosphokinase. After the 8th day following infarction, fixation is slight or nil. It is inconstant in pre-infarction syndrome or simple angina. This examination complements clinical, electrocardiographic and enzyme findings, in particular in the case of difficult diagnosis.

Topics: Angina Pectoris; Diphosphates; Humans; Injections, Intravenous; Myocardial Infarction; Radionuclide Imaging; Technetium

Myocardial imaging using technetium 99m stannous pyrophosphate (99mTc-PYP) has been utilized preoperatively and three to five days postoperatively to detect myocardial infarction in 48 patients undergoing aortocoronary bypass grafting, including 7 having valve replacement (5 aortic, 2 mitral) in addition to revascularization. In the total group of patients operated on there were 3 deaths (6%). Preoperatively, 26 patients had unstable angina and 10 had severe left main coronary artery disease. Eleven of the 48 (23%) were women. ECG and enzyme-proved infarctions occurred in 6 of the 48 patients (12%), but the addition of 99mTc-PYP myocardial imaging demonstrated scintigraphic evidence of infarction in 15 patients (31%), including 2 who died in the operating room. The 99mTc-PYP myocardial imaging technique, which has proved safe, simple, and relatively inexpensive in these patients, suggests that the incidence of infarction after coronary bypass operations is somewhat higher than has been previously recognized from just ECG and enzyme changes. This technique also has been of value in helping to exclude myocardial infarction in difficult clinical situations such as postoperative arrhythmias and the postpericardiotomy syndrome.

Topics: Adult; Angina Pectoris; Coronary Artery Bypass; Coronary Disease; Diphosphates; Electrocardiography; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium; Tin

Topics: Angina Pectoris; Angina Pectoris, Variant; Aspartate Aminotransferases; Coronary Angiography; Coronary Disease; Creatine Kinase; Diphosphates; Electrocardiography; Exercise Test; Heart Sounds; Humans; Myocardial Infarction; Myocardium; Myoglobin; Radionuclide Imaging; Technetium

150 patients, admitted to the coronary care unit with suspicion of acute myocardial infarction, received pyrophosphate labelled with 99mTc, 6-120 h after onset of symptoms, mean 24 h, and were examined in the anterior posterior position and in the left anterior oblique position with a mobile gamma camera. Scintigrams were obtained initially at the injection, and then every 15th min during 1h. The scintigrams were evaluated with regard to presence and localization of radionuclide uptake in myocardial area. In 98 patients with a clinical diagnosis of acute myocardial infarction, uptake was found in 95, with good correlation between ECG and scintigraphic localization. 2. patients with myocardial infarction, verified at autopsy, did not show any uptake and 1 patient, surviving the myocardial infarction, also showed negative result. 19 of 26 patients with unstable angina pectoris also exhibited an uptake in the myocardium. 25 of 26 patients with other diagnoses showed no uptake, while in 1 patient an uptake was recorded. It is concluded that with 99mTc-pyrophosphate scintigraphy it is possible to separate ischemic heart disease from other diseases in patients with chest pain.

Topics: Adult; Aged; Angina Pectoris; Coronary Care Units; Diagnosis, Differential; Diphosphates; Electrocardiography; Female; Heart Diseases; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium

Technetium-99m stannous pyrophosphate was utilized for myocardial imaging in 202 patients admitted to the hospital with chest pain of uncertain etiology. One hundred and one patients had clinical and evolved electrocardiographic and enzymatic evidence of acute myocardial infarction. Ninety-six of these 101 patients had increased myocardial uptake of the technetium stannous pyrophosphate and positive myocardial scintigrams; there was nearly precise correlation between the ECG and myocardial imaging localization of the area of infarction for acute transmural myocardial infarctions. In the five patients with negative myocardial images the scintigrams were obtained after seven or more days had elapsed following the myocardial infarction. In the remaining 101 patients no clinical, ECG, or enzymatic evidence of infarction developed; 92 of these patients had negative myocardial scintigrams. Seven of the remaining nine patients were admitted with "unstable angina pectoris", and despite the absence of diagnostic ECG and enzyme evolution each of these patients had faintly and diffusely positive myocardial scintigrams. The remaining two patients had positive myocardial scintigrams but no definite ECG or enzymatic evidence of acute myocardial infarction. Thus the technetium pyrophosphate imaging technique appears safe, inexpensive and to correlate well with ECG and enzyme identification of the presence of infarction and with ECG localization of myocardial infarction. In addition the positive myocardial scintigrams in some patients with "unstable angina" suggest that there may be limited myocardial necrosis that is ordinarily undetected by ECG and enzymes in these patients. The incidence of false positive and false negative scintigrams appears to be small.

Topics: Angina Pectoris; Clinical Enzyme Tests; Collateral Circulation; Diagnosis, Computer-Assisted; Diagnostic Errors; Diphosphates; Electrocardiography; Evaluation Studies as Topic; Injections, Intravenous; Myocardial Infarction; Radionuclide Imaging; Technetium; Tin