pyrophosphate and Cardiomyopathies

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Diphosphonates; Humans; Prealbumin; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Idiopathic infantile arterial calcification (IIAC) is a rare, but important, cause of rapidly progressive ischemic heart disease in children. In this paper, we report two recent cases of IIAC seen at tertiary referral hospitals. Both cases presented in infancy with signs of heart failure and, ultimately, died with the diagnosis of IIAC confirmed at postmortem examination. A thorough review of the literature reveals approximately 160 reported cases of IIAC. The clinical outcomes, radiographic findings and pathologic details are summarized. Proposed etiologic mechanisms are reviewed, including promising research into the role of inorganic pyrophosphate as a regulatory factor in the development of IIAC. Because of the typically fatal outcome of IIAC and the lack of proven therapies, the potential role for cardiac transplantation is discussed.

Topics: Arteries; Basement Membrane; Calcinosis; Cardiomyopathies; Coronary Vessels; Diphosphates; Disease Progression; Fatal Outcome; Female; Heart Transplantation; Humans; Infant; Myocardial Ischemia; Myocardium; Tunica Intima; Vascular Diseases

Topics: Age Factors; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

Pyrophosphate (PYP) imaging has a high diagnostic accuracy for transthyretin cardiac amyloidosis (ATTR-CA). Indeterminate findings are often reported due to persistent blood pool activity, presumed to be from low cardiac output. We evaluated the relationship between blood pool activity on PYP imaging and echocardiographic indices of cardiac function.. Clinical and imaging data of 189 patients referred for PYP scintigraphy were evaluated. All patients underwent planar imaging and SPECT (diagnostic standard). Among those with a negative PYP SPECT, persistent left ventricular blood pool activity on planar images was inferred by a visual score ≥2 or a heart-to-contralateral (HCL) ratio ≥ 1.5. Absence of blood pool activity was inferred when both visual score was < 2 and HCL was < 1.5. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), stroke volume index (SVi), and left atrial pressure (LAP) were calculated from standard transthoracic echocardiograms.. ATTR-CA was present in 43 (23%) patients. Among those with a negative PYP SPECT, 11 patients had significant blood pool activity. Patients with ATTR-CA had a lower LVEF, SVi, and GLS, with a higher LAP, compared to those without ATTR-CA. Among those without ATTR-CA, there were no significant differences in these parameters.. Approximately 8% of patients with a negative PYP SPECT have significant blood pool activity. Measures of cardiac function are not different among those with and without blood pool activity. PYP SPECT should be routinely performed in all patients to avoid false image interpretation.

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Echocardiography; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

Transthyretin amyloidosis (ATTR) proteins can infiltrate skeletal muscle and infrequently cause a myopathy.. Radioisotope uptake in the deltoid muscles of patients with ATTR was compared to uptake in control subjects without amyloidosis in a retrospective study.. Tracer uptake was significantly higher over the deltoids and heart but not the CC, in patients with ATTR than in control subjects. MC values were 120.1 ± 43.7 (mean ± SD) in ATTR patients and 78.9 ± 20.4 in control subjects over the heart (p = 0.005), 73.3± 21.0 and 63.5 ± 14.4 over CC (p = 0.09), and 37.0 ± 11.7 and 26.0 ± 7.1 averaged over both deltoid muscles (p = 0.014).

Topics: Amyloid Neuropathies, Familial; Biomarkers; Cardiomyopathies; Diphosphates; Humans; Muscle, Skeletal; Prealbumin; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Data were reviewed for 318 patients with suspected ATTR who underwent PYP SPECT/CT. Myocardial-to-blood pool count (MBP) ratios were computed and repeated independently > 1 month later. A physician independently scored LV myocardial-to-rib uptake on SPECT/CT as: 0 (negative), 1 < rib (equivocal), 2 = rib (positive) or 3 > rib (positive), and the image quality as: 1 (poor), 2 (adequate), and 3 (good). SPECT-only MBP ratios and visual scores were assessed separately for a subgroup of the first sequential 191 patients.. 25% of patients had positive myocardial uptake (myocardial-to-rib uptake score of ≥ 2). SPECT/CT MBP ratios were reproducible (1.35 ± .68 vs 1.33 ± .74, p = .09) and corresponded with visual scores ≥ 2 (ROC AUC = 99 ± 1%) more accurately than SPECT-only MBPs (93 ± 3%, p = .02). SPECT/CT image quality was better than that of SPECT-only (2.7 ± .5 vs 2.1 ± .5, p < .0001) with fewer equivocal results (2.6% vs 22.5%, p < .0001).. SPECT/CT produces MBP ratios that are reproducible and accurately identify a positive scan, with better image quality and fewer equivocal cases than SPECT-only.

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Humans; Reproducibility of Results; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to examine the diagnostic value of planar. PYP images of 109 consecutive patients with suspected ATTR-CA were retrospectively reviewed. The myocardial PYP uptake was visually graded on a scale of 0 to 3 and quantified with the heart-to-contralateral (H/CL) ratio in accordance with the current expert consensus recommendations. The diagnostic value of planar images for identifying positive PYP SPECT was assessed by a receiver-operating characteristic curve analysis with the area under the curve (AUC). The uptake ratios of the ascending and descending aorta, left atrium, and trapezius muscle divided by the liver uptake were measured on SPECT images and compared to the renal function.. A total of 41 patients (38%) had myocardial PYP uptake on SPECT images. In comparison with the visual scores on 1-h anterior planar images, those on 3-h anterior planar images had lower sensitivity (80.5% vs. 97.6%) and higher specificity (86.8% vs. 55.9%) for identifying positive PYP SPECT. The ROC analysis showed that the combination of visual scores on both 1-h and 3-h anterior planar images had significantly higher AUC values in comparison with 1-h anterior planar images alone (0.90 [95% CI 0.83-0.94] vs. 0.83 [95% CI 0.75-0.88]; P < 0.001), which was comparable to the AUC values on 3-h anterior planar images alone (0.88 [95% CI 0.80-0.92]; P = 0.071). In comparison with visual scores on 1-h or 3-h anterior planar images alone, the combination of visual scores and H/CL ratio did not significantly improve the diagnostic value for identifying positive PYP SPECT (P = 0.73 and P = 0.50, respectively). The uptake ratios of ascending aorta/liver, descending aorta/liver, left atrium/liver, and trapezius muscle/liver were not significantly associated with the serum creatinine level or estimated glomerular filtration rate (P > 0.05 for all).. In the assessment of ATTR-CA using PYP imaging, visual scores on 3-h anterior planar images for identifying positive PYP SPECT had lower sensitivity and higher specificity in comparison with those on 1-h anterior planar images. The diagnostic value of the visual scores on 1-h and 3-h anterior planar images was not improved by adding the H/CL ratio. Blood pool activity of PYP was not significantly associated with renal dysfunction.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Kidney Diseases; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium

Transthyretin (ATTR) amyloidosis is a debilitating systemic disease often associated with symptomatic cardiac involvement. Diagnosis has dramatically changed with the advent of Technetium-99 m pyrophosphate (Tc-PYP) single-photon emission computed tomography (SPECT). With the ability to diagnose ATTR amyloidosis noninvasively and offer newer therapies, it is increasingly important to identify which patients should be referred for this testing. Relative apical sparing of longitudinal strain on echocardiogram can be potentially used to screen such patients. We sought to describe electrocardiogram (ECG) and echocardiogram (TTE) findings, including relative apical sparing of longitudinal strain, in ATTR amyloidosis patients diagnosed non-invasively with

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Cardiomyopathies; Diphosphates; Heart; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloidosis; Calcinosis; Cardiomyopathies; Diphosphates; Humans; Immunoglobulin Light-chain Amyloidosis; Prealbumin; Radiopharmaceuticals

The optimal heart-to-contralateral chest (H/CL) ratio threshold for non-invasive diagnosis of transthyretin cardiac amyloidosis (ATTR-CA) using Tc. Using myocardial PYP retention by SPECT as the reference standard, we evaluated the diagnostic performance of different semi-quantitative and quantitative (H/CL chest ratio) planar parameters obtained from 3-hour PYP imaging in a prospectively recruited cohort of minority older adults with heart failure and increased LV wall thickness.. Of 229 patients, 14 were found to have ATTR-CA (6.1%). No PYP uptake (grade 0) was observed in 77% of scans, all grade 3 scans were ATTR-CA, and only 4 of 11 (36%) grade 2 scans were ATTR-CA. An H/CL threshold of ≥ 1.4 maximized specificity (99%) and positive predictive value (93%) but resulted in decreased sensitivity (93%), compared to the ≥ 1.3 threshold which had 100% sensitivity.. Among patients with a low pretest likelihood of ATTR-CA, planar interpretation, while useful to exclude disease, must be interpreted with caution. H/CL ratio threshold of ≥ 1.3 resulted in clinically important misclassifications. These data suggest that quantitative planar imaging thresholds may not be appropriate to apply in low pretest likelihood populations being evaluated for ATTR-CA.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Predictive Value of Tests

Tafamidis has been used for treatment of transthyretin cardiac amyloidosis (ATTR-CA). However, Tc-99 m pyrophosphate (PYP) cardiac scan for follow-up after tafamidis therapy has not been reported.. From May 2017 to March 2022, five patients with or without tafamidis therapy had received two Tc-99 m PYP cardiac scans. Tc-99 m PYP cardiac scan was performed with planar image and single photon emission computed tomography/computed tomography (SPECT/CT) 3 h after administration of Tc-99 m PYP. Perugini grading system was applied to determine positive or negative result of the scan. Heart to contralateral lung (H/CL) ratio as well as the difference of H/CL ratio between first and second Tc-99 m PYP cardiac scans (ΔH/CL ratio) was calculated.. In the five patients participated in this study, three received tafamidis therapy and H/CL ratio was significantly decreased (p = 0.02) after tafamidis therapy. Besides, the ΔH/CL ratio was larger in patients with tafamidis therapy than that in those without tafamidis therapy, albeit not reaching statistical significance (p = 0.2).. A decrease in H/CL ratio was found after tafamidis therapy in patients with ATTR-CA, albeit the magnitude of changes in the H/CL ratio (ΔH/CL ratio) was not significantly different from that of patients without tafamidis therapy. Future study with larger population might be required to further clarify the effect of tafamidis therapy on myocardial uptake of Tc-99 m PYP.. No clinical trial was conducted in our retrospective study.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Follow-Up Studies; Humans; Prealbumin; Retrospective Studies; Technetium Tc 99m Pyrophosphate

SPECT improves diagnostic specificity of Technetium-99m pyrophosphate (PYP) scintigraphy. Diagnostic performance of PYP data, reconstructed as either chest or cardio-focal SPECT is not known.. In this quality assurance study, blinded evaluation of PYP SPECT/CT data from 102 Caucasian patients (mean age 76 ± 11 years, 67% men) was performed by two readers. Reader 1 reviewed planar and PYP chest SPECT, while reader 2 reviewed planar and cardio-focal PYP SPECT. Demographic, clinical, and other testing data were obtained from the electronic medical records.. A total of 41 patients (40%) were considered positive based on myocardial uptake on chest PYP SPECT. Of these, 98% of the patients had a Perugini score ≥ 2 on planar imaging. There was good agreement between the two readers for visual score ≥ 2 (k = .88, P < .001) and excellent agreement for myocardial uptake on tomographic imaging (98%, P < .001). Only one study was categorized as false negative by cardio-focal SPECT reconstruction. Non-diffuse myocardial uptake was identified in 22% of those with a positive PYP SPECT.. When read by experienced readers, chest and cardio-focal reconstruction of PYP SPECT have comparable diagnostic performance. A substantial proportion of patients with a positive PYP SPECT have a non-diffuse distribution of PYP. Given the possibility of misclassification of non-diffuse myocardial uptake on cardio-focal reconstruction alone, chest reconstruction of PYP scintigraphy should be strongly considered.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Prealbumin; Quality Assurance, Health Care; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Gastrointestinal Tract; Humans; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Cardiac amyloidosis was thought to be rare, undiagnosable, and incurable. However, recently it has been discovered to be common, diagnosable, and treatable. This knowledge has led to a resurgence in nuclear imaging with

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Humans; Radionuclide Imaging; Radiopharmaceuticals

Technetium-labeled bone-avid radiotracers can be used to diagnose transthyretin cardiac amyloidosis (ATTR-CA). Extracardiac uptake of technetium pyrophosphate (Tc-99m PYP) in this context has not been extensively explored and its significance is not well characterized. We assessed extracardiac Tc-99m PYP uptake in individuals undergoing nuclear scintigraphy and the extent of clinically actionable findings.. The Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study utilizes Tc-99m PYP imaging to identify ATTR-CA in self-identified Black and Caribbean Hispanic participants ≥ 60 years old with heart failure. We characterized the distribution of extracardiac uptake, including stratification of findings by timing of scan (1 hour vs 3 hours after Tc-99m PYP administration) and noted any additional testing in these subjects.. Of 379 participants, 195 (51%) were male, 306 (81%) Black race, and 120 (32%) Hispanic ethnicity; mean age was 73 years. Extracardiac Tc-99m PYP uptake was found in 42 subjects (11.1%): 21 with renal uptake only, 14 with bone uptake only, 4 with both renal and bone uptake, 2 with breast uptake, and 1 with thyroid uptake. Extracardiac uptake was more common in subjects with Tc-99m PYP scans at 1 hour (23.8%) than at 3 hours (6.2%). Overall, four individuals (1.1%) had clinically actionable findings.. Extracardiac Tc-99m PYP uptake manifested in about 1 in 9 SCAN-MP subjects but was clinically actionable in only 1.1% of cases.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Middle Aged; Prealbumin; Prevalence; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed

Topics: Amyloid Neuropathies, Familial; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radionuclide Imaging

Technetium-99mm pyrophosphate (Tc-PYP) scintigraphy is a highly accurate non-invasive method for the diagnosis of transthyretin (ATTR) cardiac amyloidosis. Prognosis for this disease is improved following treatment with the transthyretin (TTR) stabilizer tafamidis. Although tafamidis slows disease progression, its effects on myocardial amyloid and Tc-PYP uptake remain unclear. We present a patient with ATTR cardiac amyloidosis who had a strongly positive initial Tc-PYP scan, with a dramatic decrease in Tc-PYP uptake on repeat scan after 3 years of tafamidis treatment. However, myocardial biopsy showed persistent diffuse amyloid deposits. This case highlights the need for further studies regarding the utility of serial Tc-PYP scans in monitoring the progress of ATTR cardiomyopathy.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diphosphates; Heart; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

With documented high specificity, 99m Tc-pyrophosphate (PYP) scan enables the diagnosis of transthyretin cardiomyopathy to be made reliably without endomyocardial biopsy in patients who do not have monoclonal gammopathy. We report a case with extensive myocardial uptake of Perugini 3 score in the 3-hour 99m Tc-PYP myocardial SPECT that suggested transthyretin cardiac amyloidosis. However, a followed endomyocardial biopsy revealed no amyloid deposition. In this case, hyperphosphatemia was the most likely and presumptive cause of the false-positive 99m Tc-PYP scan. With this case, our experiences of the potential causes of false-positive results of 99m Tc-PYP are further expanded.

Topics: Biopsy; Cardiomyopathies; Diphosphates; Humans; Hyperphosphatemia; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diphosphates; Heart; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Quantitation of myocardial. Consecutive patients who underwent. Seventy patients were identified, mean age 70.4 ± 11.4 years, with ATTR-CM and AL-CM diagnosed in 22 (31%) and 11 (16%) patients, respectively. In patients with ATTR-CM, there were significant correlations between CPA (r. CPA and VOI were correlated with CMR measures of myocardial fibrosis in patients with ATTR-CM.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Magnetic Resonance Spectroscopy; Middle Aged; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Stroke Volume; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

There are limited data on the head-to-head comparison of

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Male; Middle Aged; Prealbumin; Radiopharmaceuticals; Retrospective Studies

Radionuclide imaging using bone-avid tracers plays a critical role in diagnosing transthyretin cardiac amyloidosis (ATTR-CA), but technetium-99m-pyrophosphate (PYP) rarely allows the detection of extracardiac amyloid infiltration. We retrospectively investigated the frequency of PYP uptake in the subcutaneous abdominal fat of patients with ATTR-CA and its relevance to the results of fine-needle aspiration biopsy (FNAB) of this tissue.. Chest-centered images of PYP scintigraphy were obtained 2 h after the intravenous injection of the tracer (20 mCi), and the frequency of PYP uptake in the subcutaneous abdominal fat was evaluated. Amyloid deposits of fat smears taken by subcutaneous abdominal fat FNAB were assessed by Congo red staining.. Twenty-four patients with ATTR-CA were included. Ten (41.7%) patients showed some PYP uptake in the subcutaneous abdominal fat (positive PYP group), and 14 patients did not (negative PYP group). Amyloid deposits were detected by subcutaneous abdominal fat FNAB in 7/10 patients (70.0%) of the positive PYP group versus 0/14 patients (0%) of the negative PYP group, and the difference was significant.. In patients with ATTR-CA, abnormal PYP uptake in the subcutaneous abdominal fat could reflect the regional amyloid deposition confirmed by FNAB of this tissue.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Plaque, Amyloid; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Transthyretin cardiac amyloidosis (ATTR and ATTRv) is an underrecognized cause of heart failure that results from myocardial deposition of misfolded protein (TTR or prealbumin). The diagnosis can be confirmed by uptake of 99m Tc-pyrophosphate ( 99m Tc-PYP) in the heart with serologic studies to rule out light chain disease. We present the case of a 70-year-old woman who underwent a 99m Tc-PYP scan. The patient had a large right-sided pleural effusion that lowered counts in the right chest on planar imaging, interfered with ratio-based grading of PYP uptake, and highlighted the importance of obtaining SPECT/CT for problem-solving in cases where uptake ratios may be spurious.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Pleural Effusion; Prealbumin; Technetium; Technetium Tc 99m Pyrophosphate

Transthyretin cardiac amyloidosis (ATTR-CA) is an increasingly recognized disease, in which atrial fibrillation (AF) has been shown to be prevalent. Cardiac scintigraphy with technetium-99m-pyrophosphate (99mTc-PyP) labeled bone-seeking tracers is used to noninvasively make the diagnosis of ATTR-CA, based on ventricular myocardial uptake. Assessment of atrial wall uptake (AU) on 99mTc-PyP is currently not used in the clinical setting Methods: We analyzed a cohort of patients referred for 99mTc-PyP scan at a tertiary center to explore AU and associations between any and incident AF, ATTR-CA, and all-cause mortality.. Among 580 patients included, 296 patients (51%) had a diagnosis of AF; 164 patients (28%) had scans consistent with ATTR-CA while 117 patients (20%) had AU. Of 117 patients with AU, 107 (91%) had any AF. In contrast, of 463 patients without AU 191(41%) had any AF. Of those with AU, 59/117(50%) patients had a 99mTc-PyP diagnosis of ATTR-CA while 58/117(50%) patients did not have such a diagnosis (. In a consecutive cohort of patients undergoing 99mTc-PyP scans, 20% had AU, which was statistically associated with any AF, independently of ATTR-CA diagnosis and sex. AU was associated with significantly lower freedom from incident AF at 1-year. Overlooking AU on 99mTc-PyP scans could potentially miss an earlier disease manifestation, or an additional risk factor for any/incident AF.

Topics: Atrial Fibrillation; Cardiomyopathies; Diphosphates; Heart Atria; Humans; Prealbumin; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

Subcutaneous tissue and gastrointestinal tract biopsy sensitivity are inadequate, especially in patients with ATTRwt; however, the combination of these extracardiac biopsies contributes to increased sensitivity in patients with positive

Topics: Amyloid Neuropathies, Familial; Biopsy; Cardiomyopathies; Diphosphates; Humans; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Pyrophosphate

We included 318 patients in the analysis (n = 86 patients +ATTR-CM; n = 232 patients -ATTR-CM). The median follow-up time was 20.1 months. During the study period, 67% of +ATTR-CM patients received tafamidis (median treatment duration, 17 months). The median H/CL ratio was 1.58 (interquartile range, 1.40-1.75). An H/CL ratio of more than 1.6 or less than 1.6 did not seem to have an impact on survival probability in +ATTR-CM patients (P = .30; hazard ratio, 0.65; 95% confidence interval, 0.31-1.41). Cardiac biomarkers were poorly correlated with H/CL (troponin T, R

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Natriuretic Peptide, Brain; Prealbumin; Retrospective Studies; Technetium Tc 99m Pyrophosphate; Troponin T

Myocardial scintigraphy with technetium-99m pyrophosphate is a minimally invasive technique that can distinguish between transthyretin amyloidosis (ATTR) and light-chain amyloidosis. We present a case in which it helped determine the amyloidosis type in a 74-year-old man with cardiac amyloidosis and multiple previous admissions for acute decompensated heart failure. The patient presented with increasing abdominal girth and bilateral lower extremity edema. His medical history also included atrial fibrillation, liver cirrhosis, hypertension, stage 3 chronic kidney disease, and peripheral vascular disease. We prescribed guideline-directed medical therapy for his acute decompensated heart failure with cardiorenal syndrome and his decompensated cirrhosis. Two years previously, a presumptive diagnosis of ATTR cardiomyopathy had been made on the basis of the patient's age, predominantly cardiac involvement, an unremarkable serum protein electrophoresis result, and an abnormal free κ/λ light-chain ratio of 2.24. Over the next year, the patient's clinical condition had worsened with the development of liver cirrhosis and peripheral neuropathy, and his free κ/λ light-chain ratio had become even more abnormal. At the current presentation, a technetium-99m pyrophosphate nuclear scintigram revealed a free κ/λ light-chain ratio of 1.52. This, combined with the patient's age and slow progression of primarily cardiac disease, supported the diagnosis of ATTR, and we prescribed tafamadis. This case suggests that technetium-99m pyrophosphate scintigraphy is valuable in definitively diagnosing ATTR cardiomyopathy and selecting patients who may benefit from disease-modifying therapy.

Topics: Aged; Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Liver Cirrhosis; Male; Myocardial Perfusion Imaging; Technetium

Clinical algorithms stipulate that transthyretin amyloid cardiomyopathy (ATTR-CM) can be diagnosed noninvasively by technetium-99m pyrophosphate (PYP) imaging when light chain (AL) amyloidosis has been excluded. We sought to define the distribution of light chain abnormalities and final diagnosis of ATTR-CM among patients referred for PYP imaging. We conducted a retrospective cohort study of 378 sequential patients with suspected ATTR-CM, referred for PYP imaging from October 2014 to January 2019. PYP scans were adjudicated as per guidelines. We found that 97 patients (26%) had abnormal plasma cell dyscrasia (PCD) markers, including serum free light chain (FLC) and/or urine/serum immunofixation electrophoresis (IFE). After exclusions for incomplete data or known AL amyloidosis, the final study population with abnormal PCD testing was n = 82. Final adjudication of amyloidosis was determined by multidisciplinary clinical assessment and/or tissue biopsy. The median age of cohort was 75 (68 to 81) years, 88% were men, and 33% were Black. Of the 82 patients, 62 had positive PYP scans (76%) and 20 had negative PYP scans (24%). A total of 64 patients had adjudicated ATTR-CM, confirmed by tissue biopsy in 41 (64%). Of those with confirmed ATTR-CM, 44 (69%) had abnormal FLC ratio between 1.65 and 3.1 and normal IFE. In conclusion, among patients referred for technetium-99m-PYP imaging for suspected ATTR-CM, 26% exhibited abnormalities of PCD markers. An FLC ratio 1.65 to 3.1, with normal IFE was noted in 69% of those with ATTR-CM, suggesting that ATTR-CM can be diagnosed noninvasively without cardiac biopsy in patients with positive PYP scan and similar plasma cell testing results.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Immunoglobulin Light-chain Amyloidosis; Male; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Prealbumin; Technetium

Transthyretin cardiomyopathy (ATTR-CM) is an under-recognized cause of heart failure, but it has received increasing attention due to the availability of treatment options. We present a case of hereditary transthyretin cardiomyopathy (A97S, an under-represented variant in current clinical studies) who presented with heart failure. Timely diagnosis and intervention with tafamidis demonstrated reversed cardiac remodelling via multiple imaging techniques (echocardiography, cardiac magnetic resonance imaging and technetium-99m pyrophosphate scintigraphy). The echocardiography and cardiac magnetic resonance imaging demonstrated improved global strain. Cardiac magnetic resonance imaging showed decreased extracellular volume. The technetium-99m pyrophosphate scintigraphy demonstrated decreased heart-to-contralateral ratio. This case highlights the potential reversible effect of tafamidis on A97S amyloidosis cardiomyopathy.

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Heart Failure; Humans; Prealbumin; Technetium; Ventricular Remodeling

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.. В статье суммируется текущий опыт отдела радионуклидной диагностики и позитронно-эмиссионной томографии ФГБУ НМИЦ кардиологии им. акад. Е.И. Чазова в выполнении сцинтиграфии миокарда с 99mTc-пирофосфатом при дифференциальной диагностике типов амилоидоза сердца. Проанализированы возможные причины ложноположительных, сомнительных и недиагностических результатов исследования, предложены способы их устранения, в том числе путем модификации протоколов планарного и томографического исследований и оптимизации диагностического алгоритма амилоидоза сердца в целом.

Topics: Algorithms; Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Myocardial Perfusion Imaging; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Echocardiographic deformation-based ratios and novel multi-parametric scores have been suggested to discriminate transthyretin cardiac amyloidosis (ATTR-CM) from other causes of increased left ventricular wall thickness among patients referred for ATTR-CM evaluation. Their relative predictive accuracy has not been well studied. We sought to (1) identify echocardiographic parameters predictive of ATTR-CM and (2) compare the diagnostic accuracy of these parameters in patients with suspected ATTR-CM referred for technetium-99m-pyrophosphate scintigraphy.. Echocardiograms from 598 patients referred to 3 major amyloidosis centers for technetium-99m-pyrophosphate to detect ATTR-CM were analyzed, including longitudinal strain (LS) analysis. Deformation ratios (septal apex to base ratio, relative apical sparing, ejection fraction to global LS), a multi-center European increased wall thickness score, and Mayo Clinic derived ATTR score (transthyretin cardiac amyloidosis score) were calculated. A logistic regression model was used to identify the parameters that best associated with a diagnosis of ATTR-CM. Comparison of the diagnostic capacity of the parameters was performed by receiver operating characteristic curves and the area under the curve (AUC).. Over half of the subjects (54.2%) were diagnosed with ATTR-CM (78% were men, median age of 76 years). Age, inferolateral wall thickness, and basal LS were the strongest predictors of ATTR-CM, AUC of 0.87 (95% CI: 0.83, 0.90), superior to the increased wall thickness score AUC of 0.78 (95% CI: 0.73, 0.83;. Inferolateral wall thickness and average basal LS performed as well as or better than more complex echo ratios and multiparametric scores to predict ATTR-CM.

Topics: Aged; Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Prealbumin; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Amyloidosis; Atrial Fibrillation; Cardiomyopathies; Diphosphates; Heart; Humans; Technetium Tc 99m Pyrophosphate

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Humans; Prealbumin; Technetium Tc 99m Pyrophosphate

Quantitative assessment of myocardial radiotracer activity with CPA or VOI have high diagnostic accuracy for ATTR-CM. Both measures are potential non-invasive markers to follow progression of disease or response to therapy.. La evaluación cuantitativa de la actividad del radiotrazador en miocárdico con CPA o VOI tiene una alta certeza diagnóstica para ATTR-CM. Ambas medidas son potenciales marcadores no invasivos para seguir la progresión de la enfermedad o la respuesta a terapia.. 背景:. L’imagerie au 99mTc-pyrophosphate est devenue une méthode non invasive importante pour le diagnostic de l’amyloidose cardiaque à transthyrétine (ATTR-CM). La quantification de l’activité du 99mTc-pyrophosphate sur les images SPECT, pourrait être un marqueur de l’intensité de la maladie. Dans cette étude, nous avons évalué la précision diagnostique et la signification clinique de la quantification au 99mTc-pyrophosphate. MéTHODES ET RéSULTATS: Les patients ayant bénéficié d’une imagerie au 99mTc-pyrophosphate pour suspicion d’ATTR-CM ont été inclus. Nous avons calculé l’activité (CPA) et le volume (VOI) du 99mTc-pyrophosphate (CPA) au niveau du myocarde sur les images SPECT en rapport à l’activité sanguine au niveau de la cavité ventriculaire gauche. La précision du test a été évaluée en utilisant la surface (AUC) sous la courbe ROC. Au total, 124 patients ont été étudiés (âge moyen de 73,9 ± 11,4). Quarante trois de ces patients (34.7%) furent diagnostiqués positivement pour l’ ATTR-CM. La précision diagnostique de la CPA s’est révélée la plus élevée (AUC 0,996, IC à 95% 0,987 - 1,00), et s’est avérée significativement plus élevée que le score de Perugini (AUC 0,952, p = 0,016). Chez les patients avec ATTR-CM, la CPA est associée à une fraction d’éjection ventriculaire gauche réduite (odds ratio ajusté de 1,28, p = 0,035) et une augmentation d’ hospitalisation pour insuffisance cardiaque (hazard ratio ajusté de 1,29, p = 0,006).. L’évaluation quantitative de l’activité du 99mTc-pyrophosphate est d’une grande précision diagnostique pour l’ ATTR-CM. Les mesures CAP et VOI sont des marqueurs non invasifs potentiels pour le suivi de la progression de la maladie ou réponse au traitement.

Topics: Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Diphosphates; Female; Humans; Male; Middle Aged; Observer Variation; Predictive Value of Tests; Prognosis; Radiopharmaceuticals; Retrospective Studies; ROC Curve; Stroke Volume; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Heart; Heart Murmurs; Humans; Immunoglobulin Light-chain Amyloidosis; Male; Middle Aged; Multimodal Imaging; Prognosis; Systole

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Humans; Prealbumin; Radionuclide Imaging

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Humans; Neoplasms; Prealbumin; Technetium Tc 99m Pyrophosphate

Mammalian tissues calcify with age and injury. Analogous to bone formation, osteogenic cells are thought to be recruited to the affected tissue and induce mineralization. In the heart, calcification of cardiac muscle leads to conduction system disturbances and is one of the most common pathologies underlying heart blocks. However the cell identity and mechanisms contributing to pathological heart muscle calcification remain unknown. Using lineage tracing, murine models of heart calcification and in vivo transplantation assays, we show that cardiac fibroblasts (CFs) adopt an osteoblast cell-like fate and contribute directly to heart muscle calcification. Small-molecule inhibition of ENPP1, an enzyme that is induced upon injury and regulates bone mineralization, significantly attenuated cardiac calcification. Inhibitors of bone mineralization completely prevented ectopic cardiac calcification and improved post injury heart function. Taken together, these findings highlight the plasticity of fibroblasts in contributing to ectopic calcification and identify pharmacological targets for therapeutic development.

Topics: Animals; Basic Helix-Loop-Helix Transcription Factors; Biomarkers; Calcification, Physiologic; Calcinosis; Cardiomyopathies; Cell Differentiation; Cell Lineage; Cell Separation; Diphosphates; Disease Models, Animal; Female; Fibroblasts; Humans; Male; Mice, Inbred C57BL; Myocardial Infarction; Myocardium; Osteogenesis; Phosphates; Phosphoric Diester Hydrolases; Pyrophosphatases

Transthyretin cardiac amyloidosis (also known as ATTR cardiac amyloidosis) is an increasingly recognized cause of heart failure with preserved ejection fraction. In single-center studies, technetium 99m pyrophosphate (Tc 99m PYP) cardiac imaging noninvasively detects ATTR cardiac amyloidosis, but the accuracy of this technique in a multicenter study and the association of Tc 99m PYP myocardial uptake with survival are unknown.. To assess Tc 99m PYP cardiac imaging as a diagnostic tool for ATTR cardiac amyloidosis and its association with survival in a multicenter study.. Retrospective cohort study performed at 3 academic specialty centers for cardiac amyloidosis in the United States in which 229 participants were evaluated for cardiac amyloidosis and also underwent Tc 99m PYP cardiac imaging. The date of analysis and final confirmation from the statistician was May 4, 2016.. Tc 99m PYP cardiac imaging for detection of ATTR cardiac amyloidosis.. Retention of Tc 99m PYP in the heart was assessed using both a semiquantitative visual score (range, 0 [no uptake] to 3 [uptake greater than bone]) and a quantitative heart to contralateral (H/CL) ratio. The H/CL ratio was calculated as total counts in a region of interest over the heart divided by background counts in an identical size region of interest over the contralateral chest. The outcome measured was time to death after Tc 99m PYP imaging.. Tc 99m PYP imaging of 171 participants (121 with ATTR cardiac amyloidosis and 50 with non-ATTR cardiac amyloidosis [34 with AL amyloidosis and 16 with nonamyloid heart failure with preserved ejection fraction]; 86% male; median [IQR] age, 73 years [65-79 years]) demonstrated 91% sensitivity and 92% specificity for detecting ATTR cardiac amyloidosis with an area under the curve of 0.960 (95% CI, 0.930-0.981). Univariable and multivariable Cox proportional hazards regression analyses among participants with ATTR cardiac amyloidosis showed that an H/CL ratio of 1.6 or greater predicted worse survival (hazard ratio, 3.911 [95% CI, 1.155-13.247]; P = .03 for univariable analysis and 7.913 [95% CI, 1.679-37.296]; P = .01 for multivariable analysis). In Kaplan-Meier analysis over a 5-year follow-up period, survival was significantly worse if the H/CL ratio was 1.6 or greater rather than less than 1.6 (log-rank P = .02).. In this multicenter study, Tc 99m PYP cardiac imaging conferred a high level of sensitivity and specificity for differentiation of patients with ATTR cardiac amyloidosis (irrespective of genotype) from patients with AL cardiac amyloidosis and patients with nonamyloid heart failure with preserved ejection fraction. An H/CL ratio of 1.6 or greater was associated with worse survival among patients with ATTR cardiac amyloidosis. Among patients for whom there is a high clinical suspicion of cardiac amyloidosis, Tc 99m PYP may be of diagnostic and prognostic importance.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Heart; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium

Topics: Arterial Occlusive Diseases; Calcinosis; Cardiomegaly; Cardiomyopathies; Carpal Bones; Child, Preschool; Consanguinity; Developmental Disabilities; Diphosphates; Humans; Infant; Infant, Newborn; Male; Radiography; Treatment Outcome

Immobilisation stress-induced heart damage in rats. Pretreatment with guanethidine decreases myocardial catecholamine level and completely reverses cardiac injury induced by stress. Bretylium eliminates norepinephrine release from sympathetic nerve terminals in myocardium and decreases stress-induced heart damage. Activation of peripheral mu-opioid receptors abolishes the stress-induced cardiac injury and increases endogenous myocardial and adrenal catecholamine level). The findings suggest that the stress-induced cardiac lesions depend on activation of the sympatho-adrenomedullary system whereas the endogenous mu-receptors agonists modulate heart resistance against stress-induced damages).

Topics: Adrenal Glands; Adrenergic Agents; Animals; Brain; Cardiomyopathies; Catecholamines; Diphosphates; Enkephalin, Ala(2)-MePhe(4)-Gly(5)-; Enkephalins; Guanethidine; Injections, Intraventricular; Male; Myocardium; Oligopeptides; Rats; Rats, Wistar; Receptors, Opioid, mu; Stress, Physiological; Sympathetic Nervous System

The possible myocardial injury induced by electrical cardioversion in the treatment of supraventricular arrhythmias was analyzed after 45 countershocks of 200 joules and after 6 of 600 joules (total accumulated energy). In all patients myocardial injury was evaluated by serial CK, CK-Mb, and myoglobin determinations and in 48 cases a cardiac gammagraphy with technetium pyrophosphate was also performed. Significant increases in total CK and myoglobin were observed in 2 (4%) patients treated with 200 joules and in 3 (50%) patients receiving 600 joules. CK-Mb was also increased in one patient receiving 200 joules (13.5 U/I) and in one patient treated with 600 joules (27.8 U/I). In all cases technetium gammagraphy was negative.

Topics: Adult; Arrhythmias, Cardiac; Cardiomyopathies; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Electric Countershock; Female; Heart; Humans; Isoenzymes; Male; Middle Aged; Myoglobin; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

A case report of patient with cardiac sarcoidosis is presented. Advanced atrioventricular (AV) block and abnormalities of radionuclide imaging were improved by steroid therapy. We stress the effectiveness of steroid therapy together with usefulness of radionuclide techniques.

Topics: Cardiomyopathies; Diphosphates; Female; Heart Block; Humans; Middle Aged; Pacemaker, Artificial; Prednisone; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

This study was aimed to determine whether nuclear methods were useful for examining cardiac pathology and for making a decision of corticosteroid therapy in patients with sarcoidosis. Thirty six patients were divided into two groups; GpA consisted of 19 patients with cardiac sarcoidosis and abnormal ECG findings, and GpB of 17 patients with sarcoidosis without ECG abnormalities. Cardiac uptake of 67Ga-citrate in 2 and 99mTc-PYP in one of GpA was observed and steroid therapy resulted in the disappearance of the uptake. 201Tl-CL cardiac tomograms disclosed perfusion defects in 10 of 14 patients (71%) in GpA, including defects with redistribution in 8 of the 10 pts, but only one case in GpB. Radionuclide ventriculography using 99mTc-RBC revealed abnormal response of left ventricular (LV) function to exercise and LV dysfunction in GpA. These data suggest that nuclear study is a useful tool for diagnosing cardiac sarcoidosis, evaluating therapeutic effectiveness and long-term follow-up in patients with sarcoidosis.

Topics: Adult; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Heart; Humans; Male; Middle Aged; Myocardium; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

This study describes the results of scintigraphy with 99mTc-labeled methylene-diphosphonate (99mTc-MDP) and pyrophosphate (99mTc-PYP) as a noninvasive test for the distribution of organ involvement in five different types of amyloidosis. Scintigraphy with 99mTc-labeled phosphates appeared to be a sensitive noninvasive screening test for the extent and the distribution of organ involvement in systemic AA and systemic AL amyloidosis as well as in local bronchial amyloid, local dermal amyloid, and familial amyloidotic polyneuropathy. Echocardiography, however, was more sensitive for demonstrating cardiac involvement in systemic amyloidosis than 99mTc-MDP or 99mTc-PYP scintigraphy. 99mTc-MDP images showed a better contrast than 99mTc-PYP images, although there was no difference in the extent or the intensity of soft-tissue uptake.

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Connective Tissue; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Amyloidosis is a systemic disease frequently involving the myocardium and leading to functional disturbances of the heart. Amyloidosis can mimic other cardiac diseases. A conclusive clinical diagnosis of cardiac involvement can only be made by a combination of different diagnostic methods. In 7 patients with myocardial amyloidosis we used a combined first-pass and static scintigraphy with technetium-99 m-pyrophosphate. There was only insignificant myocardial uptake of the tracer. The first-pass studies however revealed reduced systolic function in 4/7 patients and impaired diastolic function in 6/7 patients. Therefore, although cardiac amyloid could not be demonstrated in the static scintigraphy due to amyloid fibril amount and composition, myocardial functional abnormalities were seen in the first-pass study.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; Humans; Technetium; Technetium Tc 99m Pyrophosphate; Ventriculography, First-Pass

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Heart; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To validate the significance of technetium-99m-pyrophosphate (Tc-99m PYP) myocardial scintigraphy in diagnosing cardiac amyloidosis, 2 patients with familial amyloid polyneuropathy (FAP) and 1 patient with amyloidosis secondary to chronic rheumatic arthritis were studied. All three patients had echocardiographic abnormalities, which were increased wall thickness of the interventricular septum and the left ventricular posterior wall, and granular sparkling appearance in the septum. In 2 patients with FAP, abnormal myocardial uptake of Tc-99m PYP was diffusely detected in Tc-99m PYP SPECT. In the remaining 1 patient with secondary amyloidosis, however, Tc-99m PYP SPECT showed no abnormality, although we had confirmed the presence of myocardial amyloid deposits (type AA amyloid protein) with high amount in the histological examination. Thus, these results indicate that Tc-99m PYP scintigraphy may have a limitation in detecting cardiac involvement in secondary amyloidosis although it is useful in FAP.

Topics: Adult; Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Male; Middle Aged; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Marked clinical or electrocardiographic changes, suggestive of heart disease, were only detected in 14 (7%) of 190 patients with sarcoidosis. Diffuse myocardial accumulation of 99mTc pyrophosphate (2+ or 3+) was seen in 12 (43%) of 28 patients with active sarcoidosis. Repeated scintigraphy showed normal values in 3 patients after a course of corticosteroid therapy. Echocardiographic signs of heart disease were found in 33 (37%) of 89 patients, including left-ventricular contractility disorders in 21, thinning (5) or thickening (7) of left-ventricular wall and ventricular septum, mitral prolapse in 3 and limited pericardial exudate in 5. Signs of pulmonary heart were detected in 17 patients. Clinical and electrocardiographic symptoms of cardiac sarcoidosis were significantly more frequent in patients with myocardial Tc-pyrophosphate accumulation and echocardiographic changes. It is suggested that myocardial Tc-pyrophosphate scintigraphy and echocardiography may be used for the diagnosis of cardiac sarcoidosis, including its latent forms.

Topics: Adult; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; False Negative Reactions; Heart; Humans; Middle Aged; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Heart; Humans; Male; Middle Aged; Peripheral Nervous System Diseases; Predictive Value of Tests; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

Topics: Adult; Cardiomyopathies; Climacteric; Diagnosis, Differential; Diphosphates; Electrocardiography; Female; Heart; Humans; Middle Aged; Neurocirculatory Asthenia; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Cardiomyopathies; Diphosphates; Electrocardiography; Female; Heart; Humans; Myositis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Experimental cardiomyopathy was provoked in 24 dogs with high intravenous doses of adrenaline and theophylline. These lesions were studied by means of the new agent 99mTc-AHDP and 99mTc-PYP in comparison. Cardiomyopathy could be imaged as early as 4 h after the onset of involvement but not later than 7 days. A maximum accumulation occurred in lesions 24 h old. 99mTc uptake in the myocardium was graded scintigraphically. 99mTc-AHDP was accumulated in the altered myocardium to a greater extent than 99mTc-PYP. Scintigraphic findings were in good agreement with plasma levels of creatine-kinase. A comparison with histology demonstrated that the maximum accumulation of radiopharmaceuticals occurred at the time when the development of myocardium involvement reached the stage of myocytolysis.

Topics: Animals; Cardiomyopathies; Diphosphates; Diphosphonates; Dogs; Epinephrine; Organometallic Compounds; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Theophylline

Topics: Adult; Cardiomyopathies; Diphosphates; Echocardiography; Humans; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate

To determine whether technetium-99m-pyrophosphate (Tc-99m-PYP) scanning or two-dimensional echocardiography can detect amyloid heart disease in an earlier stage of familial amyloid polyneuropathy, 15 patients were examined. Although 10 of the 15 patients had no clinical evidence of congestive heart failure, as well as normal ventricular wall thickness and normal values for left ventricular systolic function, five (50%) of them showed mild or moderate myocardial uptake. On the other hand, none had characteristic highly refractile myocardial echoes on the two-dimensional echocardiographic images (p less than 0.01), and values for diastolic function were reduced in four of the five and normal in the remaining one. In 85 control subjects, diffuse positive pyrophosphate scans of the heart were found in four (5%) of them (three with dilated cardiomyopathy and one with sarcoidosis), and highly refractile granular sparkling echoes were observed in nine (11%) (five with hypertrophic cardiomyopathy, three with aortic stenosis, and one with hypereosinophilic syndrome). We conclude that Tc-99m-PYP scanning is a more sensitive and specific method and may have the potential ability to detect amyloid heart disease in the earlier stage of familial amyloid polyneuropathy than two-dimensional echocardiography.

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Polyneuropathies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Thirteen patients with systemic lupus erythematosus, 8 patients with polymyositis, and 6 patients with spondylitis ankylopoetica (Bechterew's disease) underwent clinical cardiologic examination and scintigraphy of the myocardium (99mTc-pyrophosphate), ECG, echocardiography, polygraphy, and their blood pressure was taken. The aim of the study was to ascertain how such a combination of non-invasive examinations can help in recognizing a cardiac involvement. In systemic lupus erythematosus cases one or more positive findings were revealed in 9 patients (69%), in 4 patients all examinations were negative (31%). Four patients (50%) with polymyositis had positive findings. In patients with spondylitis ankylopoetica positive findings occurred in 2 cases (33%). The study has shown that a combination of non-invasive cardiologic methods increases the probability of detecting cardiac involvement in systemic connective tissue diseases.

Topics: Cardiomyopathies; Connective Tissue Diseases; Diphosphates; Electrocardiography; Humans; Lupus Erythematosus, Systemic; Myositis; Radionuclide Imaging; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Pyrophosphate

Thirty-four patients with amyloidosis proved by biopsy specimen were studied using technetium Tc 99m pyrophosphate scintigraphy to assess its utility in the diagnosis of amyloid heart involvement. Of 14 patients studied retrospectively, only three had intense uptake judged to be diagnostic of cardiac amyloidosis. In a prospective analysis of 20 patients with amyloidosis, all of whom had evidence of cardiac involvement by two-dimensional echocardiography, 17 had abnormal scans. Fourteen of the 17 scans had only 1+ or 2+ uptake, a finding that also was present in 15 of the 20 control patients (without amyloid heart disease). Only three of the 20 patients with cardiac amyloidosis had intense uptake that was considered unequivocal and diagnostic of amyloidosis. Of the five patients with biopsy specimen proof of endomyocardial amyloidosis, only one had intense uptake and one had no uptake. When intense uptake of technetium Tc 99m pyrophosphate is found in the heart of a patient, amyloidosis is highly likely. The technique, however, is not sufficiently sensitive to warrant routine screening of patients with amyloidosis or cardiomyopathies. Cross-sectional echocardiography is superior to pyrophosphate scintigraphy for recognition of cardiac amyloidosis.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Polyneuropathies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

This report describes the unusual presentation of a patient with primary cardiac amyloidosis. Initial clinical symptoms and hemodynamic studies, including Technetium-99m-pyrophosphate scintigraphy, suggested hypertrophic obstructive cardiomyopathy, but endomyocardial biopsy revealed diffuse amyloid infiltration. Only two other cases of left ventricular outflow tract obstruction due to cardiac amyloidosis have been reported. The false-negative technetium-99m-pyrophosphate scintigram in this patient argues for the use of endomyocardial biopsy to aid in the diagnosis of left ventricular hypertrophy.

Topics: Amyloidosis; Biopsy; Cardiac Catheterization; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Diagnosis, Differential; Diphosphates; Echocardiography; Endocardium; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Amyloidosis is an important entity in the differential diagnosis of cardiac failure of undetermined etiology. In this case report, the typical pattern of combined systolic and diastolic impairment in amyloid cardiomyopathy was demonstrated by analysis of the cardiac blood pool study. In addition, the patient described had mild uptake of Ga-67 citrate, as well as the characteristically intense myocardial uptake of Tc-99m pyrophosphate. Scintigraphic assessment may be particularly helpful when the diagnosis of amyloidosis is being considered in a patient with unexplained cardiac failure.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Heart Ventricles; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Methods for evaluating cardiac myocyte necrosis utilizing antibodies specific for the heavy or light chains of cardiac myosin are reviewed. Cell death, associated with sarcolemmal disruption, results in the leakage of myosin light chains from the cytoplasm as well as the accessibility of myosin heavy chains to exogenous specific antibodies. Measurement of plasma light chain concentration has been useful in the diagnosis of myocardial infarction, though more recently, patients with congestive cardiomyopathy associated with an inflammatory infiltrate have been identified by an elevated plasma light chain concentration. The binding of myosin heavy chains to necrotic myocytes has been useful in the study of mechanisms of ischemic cell death in cell culture, in the diagnosis and quantification of myocardial infarction, both experimentally and clinically, and more recently in the study of experimental myocarditis and cardiac transplantation. It is hoped that these methods may evolve as useful clinical tools in the identification of those cardiomyopathy patients whose course is characterized by rapid myocyte loss.

Topics: Animals; Antibodies; Biopsy; Cardiomyopathies; Cell Survival; Creatine Kinase; Diphosphates; Heart; Heart Failure; Heart Transplantation; Humans; Immunoglobulin Fab Fragments; Indium; Isoenzymes; Mice; Myocardial Infarction; Myocardium; Myosins; Necrosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

We describe herein the case of a 62-year-old man affected by congestive heart failure of obscure origin, in which the clinical history, the electrocardiographic and echocardiographic findings were compatible with the diagnosis of amyloid cardiomyopathy. Cardiac catheterization disclosed a restrictive physiology. Tc-99m-pyrophosphate myocardial scintiscan was negative despite the markedly increased left ventricular wall thickness on echocardiographic examination. A definite diagnosis was obtained by means of endomyocardial biopsy.

Topics: Amyloidosis; Biopsy; Cardiomyopathies; Diphosphates; Echocardiography; False Negative Reactions; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Humans; Middle Aged; 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

This report describes an American family with a high incidence of symptomatic cardiac amyloidosis among four siblings, and explores the role of echocardiography and technetium pyrophosphate myocardial scintigraphy in the detection of this infiltrative cardiomyopathy within the involved family.

Topics: Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Heart; Heart Failure; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A patient had severe congestive cardiomyopathy secondary to myocardial sarcoidosis. The clinical diagnosis was confirmed by radionuclide ventriculography, thallium 201 (201Tl), gallium-67 (67Ga), and technetium-99m (99mTc) pyrophosphate (TcPYP) scintigraphy. Myocardial TcPYP uptake has not been reported previously in sarcoidosis. In this patient, TcPYP was as useful as gallium scanning and thallium imaging in documenting the myocardial process.

Topics: Adult; Cardiomyopathies; Diphosphates; Female; Gallium Radioisotopes; Heart; Humans; Radioisotopes; Radionuclide Imaging; Sarcoidosis; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

To determine the value of technetium-99m-pyrophosphate myocardial scintigraphy in the diagnosis of amyloid heart disease this procedure was prospectively performed in 20 consecutive patients with biopsy-proven primary amyloidosis. Eleven patients had echocardiographic abnormalities compatible with amyloid cardiomyopathy, 9 of whom had congestive heart failure. Diffuse myocardial pyrophosphate uptake was of equal or greater intensity than that of the ribs in 9 of the 11 patients with echocardiograms suggestive of amyloidosis, but in only 2 of the 9 with normal echocardiograms, despite abnormal electrocardiograms (p less than 0.01). Increased wall thickness measured by M-mode echocardiography correlated with myocardial pyrophosphate uptake (r = 0.68, p less than 0.01). None of 10 control patients with nonamyloid, nonischemic heart disease had a strongly positive myocardial pyrophosphate uptake. Thus, myocardial technetium-99m-pyrophosphate scanning is a sensitive and specific test for the diagnosis of cardiac amyloidosis in patients with congestive heart failure of obscure origin. It does not appear to be of value for the early detection of cardiac involvement in patients with known primary amyloidosis without echocardiographic abnormalities.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Cardiomyopathies; Diphosphates; Dogs; Gluconates; Heart; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Ten consecutive patients with tissue-proven amyloidosis, seven of whom presented with congestive heart failure, were found to exhibit intense diffuse uptake of technetium-99m-pyrophosphate (Tc-99m-PYP) on cardiac radionuclide imaging. The patients exhibited echocardiographic and systolic time interval abnormalities suggesting combined restrictive and congestive cardiomyopathic changes. On M-mode echocardiograms, there was symmetrically increased thickness of the interventricular septum and left ventricular (LV) posterior wall in diastole (10 of 10), decreased fractional shortening of the LV minor axis diameter in systole (eight of nine), and decreased percent thickening of the LV minor axis diameter in systole (eight of nine) and LV posterior wall (10 of 10) in systole. Three patients demonstrated enlarged LV end-diastolic diameter. All 10 patients had abnormal PEP/LVET and eight had shortened LVETI. When combined with noninvasive tests of LV performance, positive myocardial pyrophosphate (PYP) scanning provides a new and useful adjunct in the diagnosis of amyloid heart disease.

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Echocardiography; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Systole; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Amyloidosis; Cardiomyopathies; Diphosphates; Electrocardiography; Heart Ventricles; Humans; Male; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adolescent; Adult; Aged; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Child; Diphosphates; Heart; Humans; Middle Aged; Muscular Dystrophies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diphosphates; Heart; Heart Injuries; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Cardiomyopathies; Diphosphates; Female; Humans; Lupus Erythematosus, Systemic; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Scleroderma, Systemic; Sugar Acids; Technetium; Technetium Tc 99m Pyrophosphate

The spontaneous occurrence of perimyocardial calcification localized in the right ventricle has been reported in an inbred strain of DBA/2 mice. In this paper we examined the correlation between the myocardial uptake ratio of technetium-99m pyrophosphate (99mTc-PYP) and pathological findings in these mice ranging in age from one to 12 months and became lower with age, while calcification and fibrosis in the perimyocardium of the right ventricle became more prominent in aged mice. This may be due to an insidious onset of degeneration with calcification and fibrosis in spontaneously occurring perimyocardial lesions in these mice. Persistent abnormal uptake of 99mTc-PYP observed in the present study suggests the usefulness of such scintigrams in the diagnosis of chronic perimyocardial disease.

Topics: Animals; Calcinosis; Cardiomyopathies; Diphosphates; Heart; Mice; Mice, Inbred DBA; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In long-term daunorubicin treated rabbits increased myocardial accumulation of 99Tcm-pyrophosphate and 99Tcm-gluconate of a varying degree were recorded, visible at gamma camera examination in more than half of the animals. Chronic cardiomyopathy morphologically and topographically different from the ischemic myocardial injury was demonstrated in most animals at light microscopic examination. The myocardial abnormalities were classified in qualitative and quantitative scores and compared with the degree of isotope accumulation. The rabbits receiving a large single dose of daunorubicin had slightly increased isotope accumulation in the myocardium but no histopathologic changes.

Topics: Animals; Cardiomyopathies; Daunorubicin; Diphosphates; Drug Administration Schedule; Female; Gluconates; Heart; Male; Myocardium; Organ Size; Organotechnetium Compounds; Rabbits; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Radioactive imaging agents are chemically designed for selective distribution. Another approach to selectivity is to find stable compounds that favorably influence this distribution. Using a rat model of myocardial necrosis, we studied effects of various stable compounds (as a single, large dose or fractionated into short series) on the ratio, uptake of Tc-99m pyrophosphate (PPi) by the target lesion/uptake by the principal nontarget, bone (L/B). Vitamin D3s ability to increase L/B was mediated by the hypercalcemia and hyperphosphatemia that it caused. The hypercalcemia was accompanied by increased [Ca] in the lesion. In contrast, pulse doses of desoxycorticosterone acetate (DOCA) at 7 and 6 hr before killing increased uptake by lesion, increasing L/B from 0.19 +/- 0.03 to 0.45 +/- 0.08 (p less than 0.01), with no change in serum [Ca] and minimal changes in serum [P], [Na], and [K]. DOCA also increased the lesion-to-blood ratio from 6.5 +/- 0.07 to 15.4 +/- 3.9 (p less than 0.05). These results encourage further study of DOCA's effect and investigation of other stable drugs that may influence distribution of other imaging agents.

Topics: Animals; Calcium; Cardiomyopathies; Cholecalciferol; Desoxycorticosterone; Diphosphates; Drug Interactions; Etidronic Acid; Phosphorus; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Pyrophosphate; Tissue Distribution

Topics: Animals; Blood Flow Velocity; Body Burden; Bone and Bones; Bone Resorption; Calcium; Cardiomyopathies; Diphosphates; Dogs; Drug Interactions; Humans; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tissue Distribution

Scintigraphic examination of the myocardium using 99mTc-labelled pyrophosphate was carried out in 10 dogs with experimentally produced cardiomyopathy. This was brought about by intravenous administration of high doses of adrenalin and theophylline. The scan was positive in 8 out of 10 dogs. "Hot" foci were very extensive. The degree of accumulation was however low (2+). Histological examination of the myocardium using the light microscope showed only scarcely distinguishable damage to the tissue without the presence of necrosis. ECG examinations were normal in all cases. By means of 99mTc-labelled pyrophosphate even very small myocardial disorders can thus be detected. This fact may be of clinical importance for an early diagnosis of heart lesions.

Topics: Animals; Cardiomyopathies; Diphosphates; Dogs; Heart; 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; Calcinosis; Cardiomyopathies; Diphosphates; Humans; Male; Radiography; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Topics: Animals; Cardiomyopathies; Diphosphates; Heart; Hypoxia; In Vitro Techniques; Male; Myocardium; Oxygen Consumption; Radionuclide Imaging; Rats; Technetium

Technetium-99m stannous pyrophosphate scintiscanning was performed in 22 patients with radiographically detected calcification within the cardiac silhouette. All but one of these scintigrams showed a localised area of increased activity similar to that ordinarily seen in acute myocardial infarction. Scintiscans in 3 patients after removal of the calcified aortic valve reverted to negative. It was concluded that this technique for acute infarct detection may yield false positive results in the presence of cardiac calcification.

Topics: Calcinosis; Cardiomyopathies; Diphosphates; False Positive Reactions; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Adult; Calcinosis; Cardiomyopathies; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphates; Humans; Kidney Transplantation; Lung Diseases; Male; Parathyroid Glands; Radionuclide Imaging; Technetium; Transplantation, Homologous

Myocardial studies with 99mTc-labeled phosphate agents were obtained in 20 patients without demonstrable cardiovascular disease, 24 patients with unstable arteriosclerotic heart disease (ASHD) without acute infarction, and six patients with myocardiopathy. The patients without cardiovascular disease showed no localization or tracer; the patients with unstable ASHD and without acute infarction showed nonfocal ill-defined accumulation of tracer; and the patients with myocardiopathy showed diffuse accummulation of tracer throughout the confines of an enlarged cardiac outline. Careful evaluation of both the distribution and intensity of the activity, in conjunction with the clinical picture, allows differentiation among these disease processes. Since ischemic areas around infarcted tissue may show increased activity, the value of this technique for sizing acute myocardial infarction may be limited.

Topics: Adult; Aged; Alcoholism; Cardiomyopathies; Coronary Disease; Diphosphates; Humans; Male; Middle Aged; Phosphates; Radionuclide Imaging; Technetium

Topics: Cardiomyopathies; Diphosphates; Doxorubicin; Humans; Myocardium; Neoplasms; Radionuclide Imaging; Technetium