pyrophosphate and Coronary-Disease

The major value of hot-spot imaging of the myocardium is its ability to define areas of necrosis rather than areas of diminished blood flow or cellular function. Applications of hot-spot imaging include the diagnosis and quantitation of myocardial infarction, myocarditis, and cardiac transplant rejection. The two agents in clinical use, 99mTc-Pyrophosphate and radiolabeled antimyosin, are discussed.

Topics: Animals; Antibodies; Coronary Disease; Diphosphates; Graft Rejection; Heart Transplantation; Humans; Myocardial Infarction; Myocarditis; Myocardium; Myosins; Necrosis; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Invasive techniques of cardiac catheterization and angiography have become the gold standard for the diagnosis and management of patients with ischemic heart disease. More recently there has been a remarkable development of noninvasive imaging techniques which has resulted in improved ability to select patients in need of invasive investigations and in a more complete understanding of the physiological and clinical significance of information obtained from such invasive investigations. The value and limitations of the 3 most common techniques, radionuclide ventriculography, myocardial perfusion scintigraphy and acute myocardial infarction scintigraphy, are discussed in this review in relation to the assessment of patients with proven or suspected ischemic heart disease. These nuclear cardiology techniques are now available in most hospitals with nuclear medicine equipment; a good understanding of the strengths and weaknesses of each technique is essential for optimal clinical use.

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

Topics: Coronary Disease; Diphosphates; Emergencies; Erythrocytes; Heart; Humans; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed

Topics: Coronary Disease; Diphosphates; Heart; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Adolescent; Arrhythmias, Cardiac; Cardiac Catheterization; Coronary Angiography; Coronary Disease; Diphosphates; Electrocardiography; Exercise Test; Female; Heart; Heart Diseases; Heart Failure; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, X-Ray Computed; Ultrasonography

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: Adrenal Glands; Cardiology; Coronary Disease; Diphosphates; Exercise Test; Heart; Heart Diseases; Hemodynamics; Humans; Kidney; Radioisotopes; Serum Albumin, Radio-Iodinated; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed; USSR

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

Topics: Antibodies; Coronary Disease; Diphosphates; Dipyridamole; Gallium Radioisotopes; Heart; Humans; Indium; Methods; Myocardial Infarction; Myocardium; Myosins; Physical Exertion; Radioisotopes; Rest; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed

Reports have indicated that myocardial accumulation of 99mTc-pyrophosphate occurs in the absence of a recent myocardial infarction. An attempt was made to determine if myocardial accumulation, in the absence of a recent infarction, may be associated with left ventricular wall motion abnormalities. 51 patients undergoing elective left ventriculography had 99mTc-pyrophosphate cardiac scans 24-28 h prior to the procedure. 33 (33/51) patients had myocardial accumulation; all 33 had left ventrcular wall motion abnormalities. Localized myocardial accumulation occurred in 21 (21/33) patients; 19 of the 21 had localized left ventricular wall motion abnormalities corresponding to the area of myocardial accumulation. 12 (12/33) patients had diffuse myocardial accumulation; 4 had diffuse left ventricular hypokinesis and 8 had localized myocardial dysfunction. 18 (18/51) patients had no myocardial accumulation of the radionuclide; 9 had normal wall motion in all areas and 9 had localized dysfunction. The data strongly suggest that myocardial accumulation of 99mTc-pyrophosphate in the absence of a recent myocardial infarction is associated with a left ventricular wall motion abnormality.

Topics: Adult; Aged; Coronary Disease; Diphosphates; Female; Heart; Heart Aneurysm; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Prospective Studies; Radiography; Radionuclide Imaging; Technetium

Topics: Coronary Disease; Diphosphates; Evaluation Studies as Topic; Heart; Humans; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Static radionuclide imaging procedures are now available for evaluating regional myocardial perfusion and for detecting acute myocardial infarction. Thallium-201, a radiopharmaceutical that possesses many of the characteristics of potassium analogues, at present is receiving the greatest attention as a regional blood flow indicator. Ischemic lesions appear as areas of decreased tracer uptake. Unfortunately, this agent is expensive, is in limited supply, and has a photopeak that is low for optimum imaging. Positive infarct images can be obtained with various Technetium-99m chelates. Pyrophosphate appears to be the best of the technetium compounds studied to date, although the mechanism of uptake of the chelates has not yet been fully elucidated. Therefore, quantitative measurements of infract size are not justified. As perfusion imaging and infarct imaging provide useful, complementary data, a dual tracer approach to evaluating patients with suspected coronary artery disease and/or myocardial infarction, is probably justifiable.

Topics: Ammonia; Animals; Carbon Radioisotopes; Cesium Radioisotopes; Coronary Circulation; Coronary Disease; Diphosphates; Dogs; Fatty Acids; Heart Rate; Humans; Microspheres; Nitrogen Radioisotopes; Potassium Radioisotopes; Radioisotopes; Radionuclide Imaging; Rubidium; Sugar Acids; Technetium; Tetracycline; Thallium

Topics: Calcium; Coronary Disease; Diphosphates; Electrocardiography; Humans; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Contusions; Coronary Artery Bypass; Coronary Disease; Diagnosis, Differential; Diphosphates; Heart Injuries; Humans; Myocardial Infarction; Myocardium; Necrosis; Radionuclide Imaging; Technetium; Time Factors

Due to the fact that there were difficulties in interpreting the cardiac scintigrams after 99mTC pyrophosphate had been given to patients with coronary heart disease without acute myocardial infarction, an experimental study was undertaken. The scintigraphic characteristics were examined in 10 cats following ligation of the interventricular artery at its middle third for more than 20 min, followed by myocardial reperfusion, histochemical and electron microscopic studies. Cat interventricular artery occlusion for a more than 20 min was found to be followed by specific ischemic changes in ECG and myocardial accumulation of 99mTc pyrophosphate. The histochemical and electron microscopic studies indicated that there were both reversible and irreversible cardiomyocyte lesions. Reversible myocardial changes were detected not only in the ischemic area, but in the other myocardial regions away from the basin of the ligated artery. If occlusion was short, the rate of myocardial tracer accumulation rapidly became lower; with long-term occlusion or profound myocardial damage caused by reperfusion, tracer accumulation became higher. There is experimental evidence for applying 99mTc-pyrophosphate scintigraphy in the clinical setting to reveal reversible myocardial changes that are most common in chronic coronary heart disease.

Topics: Animals; Cats; Coronary Disease; Diphosphates; Disease Models, Animal; Heart; Microscopy, Electron; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The time course of myocardial 99mTc-pyrophosphate accumulation 1 hour after a bicycle ergometric test versus the resting scintigraphic findings was correlated with the severity of chronic coronary heart disease (CHD) and long-term prognosis. A group of the patients who had higher radiotracer accumulation following the exercise showed the most severe disease and unfavorable prognosis (in this group 19.4% deaths were observed during a three-year follow-up). A single administration of 99mTc-pyrophosphate followed by scintigraphy 2 hours after bicycle ergometry and repeated scintigraphy 1 hour later allows one to assess the time course of myocardial radiotracer accumulation and to judge how the myocardium is supplied by blood.

Topics: Adult; Chronic Disease; Coronary Disease; Diphosphates; Exercise Test; Heart; Humans; Male; Middle Aged; Prognosis; Radionuclide Imaging; Severity of Illness Index; Technetium; Technetium Tc 99m Pyrophosphate

Assessment of myocardial contractility function and its diastolic features (according to the results of radionuclide ventriculography with 99mTc-pertechnetate) in patients with dilatory cardiomyopathy (DCMP) revealed a significant decrease in the total ejection fraction, regional ejection fractions, cardiomegaly (an increase in the end-diastolic volume combined with an increase in end-systolic volume and a decrease in the stroke volume) and a decrease in ejection rate indices. Differential criteria for the diagnosis of DCMP and CHD were a greater degree of cardiodynamic indices and a diffuse decrease in myocardial regional contractility function in the former and heterogeneity of changes in regional contractility in the latter pathology. The process of diastolic filling in DCMP patients was characterized by a marked decrease in a filling rate at reduced time of its achievement, and in CHD patients by a decrease in a maximum filling rate in combination with increased time of its achievement.

Topics: Adult; Cardiomyopathy, Dilated; Coronary Disease; Diagnosis, Differential; Diphosphates; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Ventriculography; Sodium Pertechnetate Tc 99m; 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

Topics: Coronary Circulation; Coronary Disease; Diphosphates; Energy Metabolism; Erythrocytes; Heart; Humans; Myocardium; Radionuclide Angiography; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; 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

Topics: Adult; Coronary Disease; Diagnosis, Differential; Diphosphates; Humans; Male; Pectoralis Muscles; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The aim of this prospective study was to document postoperative myocardial infarction (PMI) by technetium pyrophosphate scan using single-photon emission computed tomography (TcPPi-SPECT) in 28 patients undergoing elective coronary bypass grafting (CABG). The relationships of intraoperative electrocardiographic myocardial ischemia, hemodynamic responses, and pharmacological requirements to this incidence of PMI were correlated. Radionuclide cardioangiography and TcPPi-SPECT were performed 24 h preoperatively and 48 h postoperatively. A standard high-dose fentanyl anesthetic protocol was used. Twenty-five percent of elective CABG patients were complicated with PMI, as documented by TcPPi-SPECT with an infarcted mass of 38.0 +/- 5.5 g. No significant difference in demographic, preoperative right and left ventricular function, number of coronary vessels grafted, or aortic cross-clamp time was observed between the PMI and non-PMI groups. The distribution of patients using preoperative beta-adrenergic blocking drugs or calcium channel blocking drugs was found to have no correlation with the outcome of PMI. As well, no significant differences in hemodynamic changes or pharmacological requirements were observed in the PMI and non-PMI groups during prebypass or postbypass periods, indicating careful intraoperative control of hemodynamic indices did not prevent the outcome of PMI in these patients. However, the incidence of prebypass ischemia was 39.3% and significantly correlated with the outcome of positive TcPPi-SPECT, denoting a 3.9-fold increased risk of developing PMI. Prebypass ischemic changes in leads II and V5 were shown to correlate with increased CPK-MB release (P less than 0.05) and tends to occur more frequently with lateral myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Coronary Artery Bypass; Coronary Disease; Diphosphates; Female; Hemodynamics; Humans; Intraoperative Period; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Ventriculography; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

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: Adult; Coronary Disease; Diphosphates; Exercise Test; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Topics: Coronary Circulation; Coronary Disease; Diphosphates; Heart; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

This study compared the accuracy of rest and exercise gated equilibrium technetium ventriculography with exercise thallium imaging in 50 consecutive male patients undergoing routine coronary angiography for the evaluation of chest pain. No patients were excluded on the basis of prior myocardial infarction, nature of angiographically defined coronary disease or symptoms. Antianginal therapy was continued in all patients. Eight patients had normal coronary arteries, 9 had single vessel, disease, 20 had double vessel disease and 13 had triple vessel disease. Sixteen patients had previously documented myocardial infarction. Using exercise radionuclide ventriculography, 34 patients with coronary disease were detected resulting in a sensitivity of 81%; 6 patients with normal coronary arteries had normal scans, a specificity of 75%, with a predictive accuracy of 80%. In comparison, thallium imaging detected 42 patients with coronary disease resulting in a sensitivity of 100%. Six patients with normal coronary arteries had normal thallium images resulting in a specificity of 75% and a predictive accuracy of 96%. These results suggest that exercise thallium imaging is a more accurate investigation than exercise equilibrium radio-nuclide ventriculography and is the investigation of choice in the noninvasive detection of coronary artery disease.

Topics: Adult; Angiography; Coronary Disease; Diphosphates; Electrocardiography; Exercise Test; Heart; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Coronary Disease; Diphosphates; Electrocardiography; False Negative Reactions; Heart; Humans; Myocardium; Myoglobin; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To evaluate the contribution of myocardial contractility and preload to increase cardiac output during supine bicycle exercise, quantitative radionuclide ventriculography was performed at rest (R) and during peak exercise (Ex) in 43 patients with coronary artery disease (CAD) and 13 normal subjects. Myocardial contractility was estimated from the ratio of peak systolic pressure to end-systolic volume index (P/V index). During Ex in normal subjects, P/V index invariably increased and its percent change from R to Ex averaged 98 +/- 46 percent. Stroke index (SI) in normal subjects increased from 48 +/- 9 to 57 +/- 7 ml/m2 during Ex (p less than 0.001) without an increase in end-diastolic volume index (EDVI) (76 +/- 11 vs 78 +/- 11 ml/m2, NS). Ten of 43 patients with CAD, whose percent increase in P/V index was more than 40 percent, showed a significant increase in SI during Ex (44 +/- 5 vs 51 +/- 12 ml/m2, p +/- 0.05) without an increase in EDVI (86 +/- 14 vs 87 +/- 15 ml/m2, NS). In 16 of 43 patients with CAD whose percent increase in P/V index was less than 40 percent, SI increased from 44 +/- 10 to 51 +/- 15 ml/m2 (p less than 0.01) during Ex with an increase in EDVI (102 +/- 24 vs 117 +/- 29 ml/m2, p less than 0.001). In the remaining 17 patients with CAD whose P/V index decreased during Ex, SI did not increase during Ex (48 +/- 14 vs 44 +/- 12 ml/m2, NS) despite an increase in EDVI (80 +/- 19 vs 94 +/- 18 ml/m2, p less than 0.01). These results indicate that the Frank-Starling mechanism operates under limited augmentation in myocardial contractility, and that its compensatory function may have limitations under the severely depressed reserve of myocardial contractility.

Topics: Aged; Cardiac Output; Cardiac Volume; Coronary Disease; Diphosphates; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Coronary Artery Bypass; Coronary Disease; Diphosphates; Heart; Humans; Myocardial Contraction; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Coronary Disease; Diphosphates; Heart; Humans; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Combined infarction scintigraphy with 201Tl-chloride and 99mTc-pyrophosphate (PPi) by simultaneous seven-pinhole tomography was investigated with a phantom as well as in patients. No artificial defects occurred when the collimator was centered correctly in axial position, but a very high standard of image uniformity and linearity of the gamma camera was required. Artefacts by overlying activity from the skeleton or cardiac blood pool were not observed. All 11 controls showed normal results. Despite a poor depth resolution due to limitations of the system even small areas of partially damaged myocardium could be recognized and correlated three-dimensionally. Of 24 patients with proven myocardial infarction, in 16 both a positive (99mTc-PPi) and a negative (201Tl) image was obtained in congruence with the necrosis. 8 patients (33%) showed discordant results providing however additional information on the nature and extent of the necrosis. 4 out of 6 non-transmural infarctions seen by tomography had been suspected clinically.

Topics: Adult; Aged; Coronary Disease; Diphosphates; Female; Humans; Male; Middle Aged; Models, Anatomic; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed

One hundred and twenty eight patients with suspected or proven CAD were investigated using both X-ray ventriculography and equilibrium gated radionuclide angiography. In order to diagnose regional wall motion abnormalities, the parametric images obtained by Fourier analysis of the radionuclide images were analysed by different automated methods based on the measurement of the homogeneity of the phase values within the LV ROI. The effect of a diastolic frames exclusion, smoothing the original data, weighting the phase histogram, using Bacharach's error corrected phase distribution functions, using different descriptors of the spread of the phase histograms or distribution functions were tested. Using the results of the X-ray examination as the gold standard, ROC curves were plotted for each method. The ROC curves were modelled by a binormal model using the maximum likelihood method. Statistical tests were applied on the area under the ROC curves. The results show that the diagnostic value of the automated methods depends mainly on the way the histograms or distribution functions are described and to a lesser extent on the type of histograms or distribution functions used. The best result is obtained after smoothing, diastolic frames exclusion, weighting the phase histogram by the amplitude and describing it by its standard deviation. Nevertheless, this result is not significantly different from the result obtained by visual analysis of the phase and amplitude images.

Topics: Adult; Aged; Coronary Angiography; Coronary Disease; Coronary Vessels; Diphosphates; Evaluation Studies as Topic; Female; Heart Ventricles; Humans; Male; Methods; Middle Aged; Radionuclide Imaging; Statistics as Topic; Technetium; Technetium Tc 99m Pyrophosphate

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

Radionuclide (99mTc) ventriculography demonstrated a tendency to reduced ejection fraction, mean normalized systolic expulsion rate and myocardial circular fibre shortening rate of coronary patients that was proportionate to the severity of their condition. Myocardial lesion was shown to be heterogeneous and typically involve asynergic areas. As the disease progresses, the disturbance of myocardial contractility grows more severe, and the number of hypokinetic areas increases while that of normo- and hyperkinetic areas declines.

Topics: Adult; Aged; Coronary Disease; Diphosphates; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

The internal mammary artery, when used as a conduit for coronary artery bypass, offers a better long-term patency rate and survival rate than the saphenous vein; however, its utility has been limited. Among other factors, the availability of only two internal mammary arteries for anastomosis has been a major limitation. In an attempt to overcome this limitation, we constructed sequential internal mammary artery grafts in 87 patients. In 49 patients (Group I), only one internal mammary artery was used for sequential anastomosis. In another 31 patients (Group II), one internal mammary artery was used for sequential anastomosis and the other was used for single end-to-side anastomosis. Both internal mammary arteries were used in seven patients (Group III) for the construction of sequential anastomoses. Postoperatively, 64 patients were evaluated by exercise stress tests. None of these patients had a positive stress test although seven patients (11%) had electrocardiographic changes that were considered equivocal. Coronary angiography was performed in 35 of the 87 patients, with 92 vein grafts and 90 internal mammary artery anastomotic sites evaluated within 1 year of operation. A total of 83 vein grafts and 84 internal mammary artery anastomotic sites evaluated within 1 year of operation. A total of 83 vein grafts and 84 internal mammary artery anastomoses were found to be patent. Thus the patency rate for vein grafts was 90% and for internal mammary artery grafts, 93%. During the follow-up period (8 to 52 months), three patients died and one was lost to follow-up. Among the remaining patients, 79 had complete relief from symptoms, three had minimal symptoms, and one patient obtained no relief from symptoms. Based on these results, we have concluded that the extended use of internal mammary artery, constructing sequential anastomoses, is technically feasible and provides adequate perfusion to the area of myocardium supplied by such grafts.

Topics: Adult; Aged; Coronary Angiography; Coronary Artery Bypass; Coronary Disease; Diphosphates; Exercise Test; Female; Graft Occlusion, Vascular; Humans; Internal Mammary-Coronary Artery Anastomosis; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Postoperative Complications; Radionuclide Imaging; Saphenous Vein; Technetium; Technetium Tc 99m Pyrophosphate

Cardiac scintigraphy provides an exciting new diagnostic modality. Currently, its two major clinical applications are the identification of patients with ischemic heart disease and the characterization of ventricular function. These techniques also appear to have utility in assessing the size of myocardial infarction, the severity of obstructive coronary disease, and the effects of medical or surgical therapy. Continued careful correlation of clinical and scintigraphic findings will make these techniques even more useful in the future.

Topics: Coronary Circulation; Coronary Disease; Diphosphates; Exercise Test; Humans; Myocardial Contraction; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Two hundred twelve patients who underwent isolated coronary bypass graft surgery were prospectively evaluated for perioperative ischemic injury. All patients underwent preoperative and postoperative testing with technetium 99m pyrophosphate first-pass ventriculography combined with myocardial uptake scans, 12-lead electrocardiography, and serial creatinine phosphokinase MB determination. Fifteen percent of the patients had ischemic injury with at least two test results positive, but only 4 percent had positive results of all three tests. No single test proved adequate. Enzyme levels were highly sensitive and had value as a screening test. The electrocardiogram was specific but only moderately sensitive. The single best test was the radionuclide scan with good sensitivity and no false-positive results. All three tests are required to rigorously diagnose ischemic injury.

Topics: Coronary Artery Bypass; Coronary Disease; Creatine Kinase; Diphosphates; Electrocardiography; Humans; Isoenzymes; Myocardial Contraction; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Saphenous Vein; Technetium; Technetium Tc 99m Pyrophosphate

To study the incidence of right ventricular infarction and the effect of intracoronary thrombolysis on the ischaemic right ventricular myocardium, we performed intracoronary myocardial thallium scintigraphy in 18 patients with complete occlusion of the right coronary artery who underwent intracoronary thrombolysis. In 15 of these patients, intracoronary thallium-201 and technetium-99 m pyrophosphate scintigrams were performed simultaneously. All 18 patients had a right ventricular thallium defect before thrombolysis, and all had new thallium uptake after thrombolysis. 17 out of 18 patients had a left ventricular thallium defect before thrombolysis, but only 10 of them showed new thallium uptake after thrombolysis. 14 out of 15 patients had a left ventricular technetium-99 m pyrophosphate spot after thrombolysis and some diffuse pyrophosphate accumulation in the area of the right ventricle. In one patient pyrophosphate accumulation was found only in the area of the right ventricle. Thus, right ventricular thallium defects were detected by intracoronary thallium scintigraphy in the majority of patients with inferior acute myocardial infarction due to right coronary artery occlusion. Right ventricular thallium defects were always reversible in contrast to left ventricular thallium defects in the same patients, suggesting that right ventricular myocardium tolerates ischaemia better than left ventricular myocardium.

Topics: Adult; Aged; Collateral Circulation; Coronary Disease; Diphosphates; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Streptokinase; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

Nuclear cardiology offers an exciting array of techniques to visualize the structure and measure the function of the heart. These techniques include thallium perfusion scanning, isotope angiocardiography, and myocardial infarct scanning. Accurate and clinically relevant diagnostic information is provided by these methods.

Topics: Angiocardiography; Coronary Disease; Diphosphates; Exercise Test; Humans; Myocardial Infarction; Perfusion; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Myocardial contrast echocardiography has been shown recently to accurately assess the "area at risk" for necrosis after acute coronary occlusion in the experimental model. Risk area quantitation, however, has been studied primarily from single tomographic planes. Because the three-dimensional extent of myocardial necrosis depends on the total volume of myocardium at risk, the total left ventricular "area at risk" was determined in 11 dogs (Group A) with either left anterior descending or left circumflex artery occlusion using contrast echocardiography and compared with risk area determined by technetium autoradiography. An excellent correlation was found between the two methods (r = 0.96%, y = 0.91x + 1.5, p less than 0.001, SEE = 3.17). A comparison of risk area for individual levels of the left ventricle using both methods, however, showed some variation in the degree of correlation, with the poorest fit being apparent at the apex. To identify the source of the variation, errors caused by data registration were minimized in six additional dogs (Group B) by implanting epicardial markers at a single level and measuring "area at risk" at this level using both methods. When no registration error was present, the correlation between the two methods was excellent (r = 0.99, y = 0.92x + 2.6, p less than 0.001, SEE = 0.55). In conclusion, the "area at risk" for infarction after acute coronary occlusion can be determined accurately for the entire left ventricle as well as for a single tomographic slice using myocardial contrast echocardiography. This was validated using technetium autoradiography, which is an established method of determining "area at risk" in the experimental setting.

Topics: Animals; Contrast Media; Coronary Circulation; Coronary Disease; Diatrizoate; Diatrizoate Meglumine; Diphosphates; Dogs; Drug Combinations; Echocardiography; Microspheres; Myocardium; Radioisotopes; Scandium; Technetium; Technetium Tc 99m Pyrophosphate

The general and regional contractility of the left ventricle was studied in 69 patients with chronic coronary heart disease (CHD) and in 10 practically healthy persons using the method of radionuclide ventriculography (RNVG). The contractility indicators in dynamic and static RNVG were correlated. A high degree of correlation was obtained between them as well as with the findings of radiopaque ventriculography. It was established that data processing with the help of a cardiosynchronizer is of high informative value, significant and can be used in RNVG variants thus making it possible to use the same program of processing. The frequency of the methods and mean dispersion of the results were assessed. Numerical values of the general and regional contractility in healthy persons and in patients with varying severity of chronic CHD were determined.

Topics: Adult; Chronic Disease; Coronary Disease; Diphosphates; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Pentetic Acid; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Myocardial scintigraphy was carried out in 105 coronary heart disease patients using 99mTc -pyrophosphate. Twenty-nine of these patients suffered from acute myocardial infarction. The scintigrams were analyzed with the aid of original " MAREA " programmes devised for the diagnosis of acute myocardial infarction. The results obtained suggest the possibility of using this method of the scintigram processing for assessing the severity and predicting the course of coronary heart disease.

Topics: Acute Disease; Adult; Aged; Computers; Coronary Artery Bypass; Coronary Disease; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Coronary Disease; Diphosphates; Electrocardiography; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Angiography; Cardiology; Coronary Disease; Diphosphates; Electrocardiography; Exercise Test; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Nuclear Medicine; Radioisotopes; Radionuclide Angiography; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

This study compares the use of St Thomas' cardioplegia and cold saline cardioplegia at 4 degrees C for protection against global myocardial ischaemia in a model of heterotopic cardiac transplantation in rats of isogeneic strain. The parameters of myocardial injury applied were the uptake of Technetium 99m pyrophosphate (Tc 99m Pyp) in the transplanted heart and the measurement of serum total creatine kinase (CK) and creatine kinase MB (CK:MB) isoenzyme activity. The findings indicate that St Thomas' cardioplegic solution confers improved myocardial protection compared with normal saline as judged by statistically significant differences between: (a) the uptake of Tc 99m Pyp between the two solutions at 30 min storage: and (b) the peak total serum creatine kinase enzyme activity at 90 min storage. Excellent correlation was present between the uptake of Tc 99m Pyp and peak total serum creatine kinase activity. Further application of this model is described.

Topics: Animals; Coronary Disease; Creatine Kinase; Diphosphates; Heart Arrest, Induced; Heart Transplantation; Hypothermia, Induced; Isoenzymes; Male; Myocardium; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Coronary Disease; Diphosphates; Female; Heart Block; Humans; Male; Middle Aged; Myocardial Infarction; Pacemaker, Artificial; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

Topics: Animals; Calcium; Citrate (si)-Synthase; Coronary Disease; Diphosphates; Dogs; Female; Male; Microscopy, Electron; Mitochondria, Heart; Oxidative Phosphorylation; Technetium; Technetium Tc 99m Pyrophosphate

Nuclear cardiology is a comparatively new field of cardiovascular medicine in which technologic advances have provided relatively noninvasive means of evaluating cardiovascular abnormalities. The purpose of this two-part review is to emphasize some important recent advances and to place in perspective the advantages and disadvantages of those new techniques that are particularly useful clinically.

Topics: Coronary Disease; Diphosphates; Heart; Humans; Myocardial Infarction; Myocardial Revascularization; Perfusion; Potassium Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Coronary Disease; Diagnosis, Differential; Diphosphates; Heart Block; Humans; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In 40 patients with angiographically-documented coronary artery disease, technetium 99m pyrophosphate (99mTc-PYP) myocardial scintigrams were obtained prior to and four to six weeks after aorto-coronary bypass surgery. In the majority of patients, preoperative and postoperative exercise testing with simultaneous pulmonary artery pressure recordings was performed. In 22 of 30 patients with preoperatively increased 99mTc-PYP myocardial activity, no tracer accumulation could be found postoperatively. In the latter patients, there was also a significant increase in exercise capacity and lessening of ischemic ST-segment depression in the exercise ECG. In the remaining eight patients in whom increased tracer accumulation was found to persist postoperatively, there was no improvement in exercise capacity. In ten patients with no myocardial tracer accumulation preoperatively, unchanged myocardial scintigrams and a significant decrease of the ischemic ST-segment depression in the exercise ECG were seen postoperatively except in one patient with perioperative myocardial infarction. These results were also partially confirmed by repeated coronary angiography and ventriculography. Patent bypass grafts were associated with regional improvement in left ventricular function. The results indicate that postoperative absence of myocardial tracer accumulation appears due to amelioration of preexisting myocardial ischemia at rest. Thus, in the assessment of the results of aorto-coronary bypass surgery, the 99mTc-PYP scintigram offers an important diagnostic potential.

Topics: Coronary Artery Bypass; Coronary Disease; Diphosphates; Electrocardiography; Hemodynamics; Humans; Myocardial Contraction; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In 9 dogs a transient myocardial ischemia was provoked using complete occlusion of the ramus interventricularis anterior of the left coronary artery. The occlusion was removed after 5, 10 or 15 min. Four hrs after removal of the occlusion a scan of the myocardium was carried out using 99mTc-labelled pyrophosphate. In 7 out of 9 dogs under study the scan was markedly positive, in 2 dogs negative. ECG demonstrated ischemic changes practically in all dogs; the changes became normal after removal of the occlusion, namely in 5 to 35 min. The histological examination of the tissue demonstrated in all 9 dogs only a slight impairment of the myocardium.

Topics: Animals; Coronary Disease; Diphosphates; Dogs; Heart; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Coronary Circulation; Coronary Disease; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The purpose of the study was to find the optimal conditions for scintigraphic examination in acute myocardial infarction (AMI), as well as to develop an algorithm and a computer programme for a more objective processing of the results obtained with gamma camera, and, finally, to juxtapose the evidence obtained and the clinical pattern. Thirty-six patients aged 34-80 years (28 with AMI and 8 with chronic ischaemic heart disease) were examined with the aid of a gamma camera. The scintigrams were evaluated visually by three experts independently and were assigned scores from 0 through 3. They were also processed with a computer. Maximal indicator accumulation was found by the end of hour 2 after injection. The indicator accumulation was higher on days 3-5 after the onset of the condition as compared with that on the first two days. The accumulation extent depends on the severity and, in some projections, on the location of the AMI as well. The scintigraphic imaging and assessment of the severity of AMI is reliable and useful, especially when the findings are processed with a computer.

Topics: Adult; Aged; Coronary Disease; Diagnosis, Computer-Assisted; Diphosphates; Electrocardiography; Heart Failure; Humans; 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

We have constructed a bifocal diverging collimator (BDC), capable of simultaneously recording two views of the heart 50 degrees apart on each half of a standard imaging field. In this study, simultaneous two-view blood-pool scans using the BDC were compared with the same two separate views obtained using an all-purpose parallel-hole collimator (PHC), assessing left-ventricular ejection fraction and regional wall motion in 20 patients undergoing contrast left ventriculography (CV). Ejection fraction by BDC correlated closely with PHC (r = 0.94) and with CV (r = 0.88). Regional wall motion was scored qualitatively on a five-point scale from 3 (normal) to--1 (dyskinesis) with an 88% agreement between BDC and PHC and PHC for segment scores. The percentages for agreement between BDC and CV, and between PHC and CV, were identical, 79%. A single blood-pool scan acquisition using a new BDC provides information about global and regional left-ventricular function in two planes, comparable with that of a PHC.

Topics: Coronary Disease; Diphosphates; Heart Ventricles; Humans; Image Enhancement; Radionuclide Imaging; Technetium; Thallium

Topics: Coronary Disease; Diphosphates; Electrocardiography; Heart; Heart Ventricles; Humans; Myocardial Contraction; Posture; Technetium; Tomography, Emission-Computed

"Hot-spot" and "cold-spot" myocardial imaging and first-pass and gated equilibrium blood pool studies are the most common cardiovascular nuclear medicine procedures. The data provided by these tests may be vitally important in making decisions, primarily in patients with suspected coronary artery disease. These studies are best performed where there is close coordination between the cardiovascular specialist and the nuclear medicine department. We believe that only a minority of patients with heart disease require these tests, but for those in whom they are indicated, the information obtained can be invaluable.

Topics: Coronary Disease; Diphosphates; Heart; Humans; Methods; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Animals; Coronary Disease; Diphosphates; Dogs; Heart; Ligation; Perfusion; Radionuclide Imaging; Technetium

Topics: Coronary Disease; Diphosphates; Evaluation Studies as Topic; Heart; Humans; Radioisotopes; Radionuclide Imaging; Technetium; Thallium

Scintigraphy of the myocardium with pyrophosphate-99mTc was used in the examination of 45 patients with chronic ischemic heart disease and 3 patients with vegetovascular dystonia. A direct dependence of the character of the scintigram on the anginous attack was revealed. Accumulation of pyrophosphate-99mTc in the myocardium was observed in all patients with the agent injected just before the attack, during the attack or in the first 8 hours after it. Pyrophosphate-99mTc accumulation in the myocardium demonstrated on the scintigrams of the myocardium was less intense but more diffuse and extensive in chronic ischemic heart disease than in the focus of acute myocardial infarction.

Topics: Adult; Chronic Disease; Coronary Angiography; Coronary Disease; Diphosphates; Heart; Humans; Middle Aged; Radionuclide Imaging; 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

Topics: Coronary Disease; Diphosphates; Heart; Heart Diseases; Humans; 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

Topics: Coronary Circulation; Coronary Disease; Diphosphates; Erythrocytes; Heart Diseases; Humans; Myocardial Infarction; Myocardium; Radioisotopes; Radionuclide Imaging; Serum Albumin; Technetium; Thallium

This study indicates that abnormal myocardial scintigrams with Tc-99m pyrophosphate tend to improve after coronary-artery bypass surgery, frequently changing from positive to normal. The significance of this change is uncertain. It does not correlate well with the clinical state but may simply reflect the natural course of myocardial scintigraphy in response to hospitalization, medical management, and presumably improved myocardial oxygenation. Postoperative myocardial scintigrams are useful in detecting perioperative infarction. ECG interpretation may be difficult in the immediate postoperative period and, in three cases, there were scintigraphic criteria of perioperative infarction without diagnostic changes on ECG. Patients with positive preoperative scintigrams, especially in association with Functional Class IV angina, are at increased risk during coronary-artery bypass surgery.

Topics: Coronary Artery Bypass; Coronary Disease; Diphosphates; Heart; Humans; Myocardial Infarction; Postoperative Care; Preoperative Care; Radionuclide Imaging; Risk; Technetium; Tin

The relation between the accumulation of pyrophosphate and technetium-99m in myocardium with reversible and irreversible ischmic injury was studied in dogs subjected to transitory or persistent coronary arterial occlusion. Among four dogs with coronary occlusion maintained for less than 20 minutes, none had either increased MB creatine kinase (CK) (the "myocardial" CK isoenzyme) activity serum or a positive 99mTc stannous pyrophosphate image. Seven dogs with coronary occlusion maintained for 30 or more minutes had elevated serum MB CK activity, and five of the seven had positive (abnormal) images. Thus, although false negative images may occur occasionally despite myocardial damage, both increased serum MB CK and abnormal images generally accompanied prolonged coronary occlusion. In contrast, ischemia without infarction was not associated with abnormal images. Both 99mTc and 32P labeled pyrophosphate were accumulated extensively and proportionally in myocardium from zones of infarction, and uptake of both tracers was comparable although modest in isolated mitochondria. Similar results were obtained after myocardial infarction in animals with induced profound leukopenia. Thus, phagocytosis of the radiopharmaceutical agent by leukocytes migrating into the infarct is not an essential mechanism accounting for uptake. These results indicate that abnormal images reflect uptake of pyrophosphate, associated with 99mTc, by irreversibly injured myocardium rather than leukocytic infiltration involved in the inflammatory response in the heart.

Topics: Animals; Chick Embryo; Coronary Disease; Creatine Kinase; Diphosphates; Disease Models, Animal; Dogs; False Negative Reactions; Leukocytes; Mitochondria; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Tin Polyphosphates

Although acute infarction of the myocardium is known to accumulate 99mtechnetium pyrophosphate, it is not entirely clear that ischemia alone without necrosis does not result in abnormal uptake of 99mtechnetium pyrophosphate. The present study investigates whether transient myocardial ischemia is associated with localization of 99mtechnetium pyrophosphate by evaluating images obtained with the scintillation camera at rest and after exercise in 15 patients with unequivocal myocardial ischemia. All patients had angina pectoris, multivessel coronary artery stenoses by selective arteriographic studies, and electrocardiographic ischemic responses on treadmill exercise. Eleven of the 15 patients also underwent radionuclide imaging with 81rubidium at rest and after exercise; the results demonstrated scintigraphic ischemia. The scintiscans with 99mtechnetium pyrophosphate revealed no evidence of increased myocardial radioactivity after exercise compared to rest in 14 of the 15 patients. In contrast, myocardial activity was observed with 99mtechnetium pyrophosphate after treadmill exertion in the remaining patient, in whom a small subendocardial infarction appeared to have occurred with the exercise. It is concluded from these results that transient myocardial ischemia does not cause localization of 99mtechnetium pyrophosphate. These findings support the specificity of abnormal localization of 99mtechnetium pyrophosphate for acute myocardial infarction.

Topics: Adult; Coronary Disease; Diphosphates; Evaluation Studies as Topic; Humans; Myocardial Infarction; Myocardium; Physical Exertion; Radionuclide Imaging; Technetium

Topics: Animals; Biological Transport; Calcium; Coronary Disease; Diphosphates; Dogs; Female; Male; Myocardium; Technetium; Time Factors

Topics: Coronary Disease; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Animals; Coronary Disease; Diphosphates; Dogs; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium

Topics: Acute Disease; Animals; Autoantibodies; Coronary Circulation; Coronary Disease; Diphosphates; Dogs; Gallium Radioisotopes; Myocardial Infarction; Myosins; Oxygen Radioisotopes; Radioisotopes; Radionuclide Imaging; Regional Blood Flow; Rubidium; Strontium Radioisotopes; Tetracyclines

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

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: Acute Disease; Coronary Disease; Diphosphates; Heart Ventricles; Humans; Myocardial Infarction; Physical Exertion; Radioisotopes; Technetium; Thallium

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

The pyrophosphate of Tc99m attaches itself to ischaemic myocardial cells, and therefore makes it possible to obtain a scintigram of necrotic or necrosing myocardium. In a series of 65 cases the scintigram was positive in every case in which there had been a recent transmural infarct (17 cases). The results showed greater variation in the other ischaemic conditions involving the myocardium (limited infarcts or simple angina). The progress as a function of time was stuided in a series of fairly recent and older infarcts. The limitations and future prospects of this investigations are discussed.

Topics: Coronary Disease; Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium