sodium-pertechnetate-tc-99m and Myocardial-Infarction

Developments over the past decade have allowed one to visualize the right and left ventricles using radionuclide techniques and to study the influence of a wide range of physiologic, pharmacologic and surgical interventions on global and regional ventricular function thereby providing important diagnostic insight and improved therapeutic capabilities. These tests are relatively non-invasive, they can be performed serially, they may be performed in patients that are seriously ill, and they have no recognized risk other than low level radiation exposure. With continued improvement in noninvasive imaging and processing and in the sophistication of associated computer systems, one may expect significant and wide ranging additional contributions in the assessment of myocardial function using radionuclide ventriculographic techniques.

Topics: Cardiac Output; Coronary Disease; Diastole; Exercise Test; Heart; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Myocardial Infarction; Pain; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Technetium; Thorax; Ventricular Function

Consecutive survivors of a first Q wave anterior myocardial infarction were studied to observe the impact of recombinant tissue-type plasminogen activator (rt-PA) therapy on the incidence and associations of left ventricular thrombus. Fifty-four patients received rt-PA within 4 hours after the onset of cardiac pain, followed by heparin infusion. Forty-four patients who did not qualify for rt-PA therapy but who were anticoagulated with heparin served as a control group. Two-dimensional echocardiography was performed in all patients on days 3 and 7 to detect thrombi and analyze wall motion. Ejection fraction was determined by radionuclide angiography in all patients on day 7. Apical thrombi were detected on day 3 in three patients (5.5%) who received rt-PA and in eight control patients (18%) (p less than 0.05). All patients with a thrombus had apical dyskinesis and 8 of 11 (73%) had an aneurysm. Of the 87 patients without thrombosis, apical dyskinesis and aneurysm were present in 42 (48%) and 11 (13%) patients, respectively (p less than 0.01). Ejection fractions and wall motion scores of patients without a thrombus were significantly better when compared with data from those with a thrombus. There were fewer patients with apical dyskinesis (17 of 54) in the group receiving rt-PA therapy compared with the control group (36 of 44) (p less than 0.01). Ejection fractions and wall motion scores were better in patients who received rt-PA compared with control subjects (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Echocardiography; Electrocardiography; Heart Diseases; Heart Ventricles; Humans; Incidence; Infusions, Intravenous; Middle Aged; Myocardial Infarction; Prospective Studies; Radionuclide Angiography; Recombinant Proteins; Sodium Pertechnetate Tc 99m; Stroke Volume; Thrombosis; Tissue Plasminogen Activator

The extent of abnormality in early thallium-201 and gated cardiac blood pool scintigrams has been reported to be useful for predicting mortality in patients with acute myocardial infarction (AMI). To compare the two techniques, 91 patients admitted consecutively with evident or strongly suspected AMI underwent both imaging studies within 15 hours of the onset of symptoms. Patients with pulmonary edema or shock were excluded. AMI developed in 84% of patients, and 6-month mortality for the entire group was 16%. A thallium defect score of 7.0 or greater (corresponding to at least a moderate reduction of activity involving 40% of the left ventricular circumference) identified a subgroup of 14 patients with 64% 6-month mortality rate. Similarly, a left ventricular ejection fraction of 35% or less identified a high-risk subgroup of 10 patients with a 6-month mortality of 60%. Mortality in the remaining patients was 8% for thallium score less than 7 and 11% for ejection fraction greater than 35%. The mortality rate was highest among patients who had concordant high-risk scintigrams (five of six, 83%), lowest in those with concordant low-risk studies (five of 64, 8%) and intermediate in those with discordant results (four of 11, 36%). Of a number of clinical variables, only the appearance of Q waves, peak creatine kinase greater than 1000 IU/I, and history of infarction were significantly associated with mortality. High-risk thallium or blood pool scintigraphic results were significantly more predictive and a thallium score of 7 or greater was more sensitive for detecting nonsurvivors than ejection fraction 35% or less at a similar level of specificity. Stepwise multiple logistic analysis showed that the thallium score was the best predictor of mortality, but that appearance of Q waves and ejection fraction were additive. Using these three variables, 11 patients were calculated to have a 50% or greater chance of dying and eight (73%) actually died, compared with six of 70 (9%) with a calculated chance of death of less than 50%. These results in a prospectively identified and consecutive group of patients support the value of early thallium and blood pool scintigraphy for separating high- and low-risk subgroups of hemodynamically stable infarct patients.

Topics: Adult; Aged; Electrocardiography; Erythrocytes; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Thallium; Time Factors

Molecular imaging is useful for longitudinal assessment of engraftment. However, it is not known which factors, other than cell number, can influence the molecular imaging signal obtained from reporter genes.. The effects of cell dissociation/suspension on cellular bioenergetics and the signal obtained by firefly luciferase and human sodium-iodide symporter labeling of cardiosphere-derived cells were investigated.. (18)Fluorodeoxyglucose uptake, ATP levels, (99m)Tc-pertechnetate uptake, and bioluminescence were measured in vitro in adherent and suspended cardiosphere-derived cells. In vivo dual-isotope single-photon emission computed tomography/computed tomography imaging or bioluminescence imaging (BLI) was performed 1 hour and 24 hours after cardiosphere-derived cell transplantation. Single-photon emission computed tomography quantification was performed using a phantom for signal calibration. Cell loss between 1 hour and 24 hours after transplantation was quantified by quantitative polymerase chain reaction and ex vivo luciferase assay. Cell dissociation followed by suspension for 1 hour resulted in decreased glucose uptake, cellular ATP, (99m)Tc uptake, and BLI signal by 82%, 43%, 42%, and 44%, respectively, compared with adherent cells, in vitro. In vivo (99m)Tc uptake was significantly lower at 1 hour compared with 24 hours after cell transplantation in the noninfarct (P<0.001; n=3) and infarct (P<0.001; n=4) models, despite significant cell loss during this period. The in vivo BLI signal was significantly higher at 1 hour than at 24 hours (P<0.01), with the BLI signal being higher when cardiosphere-derived cells were suspended in glucose-containing medium compared with saline (PBS).. Adhesion is an important determinant of cellular bioenergetics, (99m)Tc-pertechnetate uptake, and BLI signal. BLI and sodium-iodide symporter imaging may be useful for in vivo optimization of bioenergetics in transplanted cells.

Topics: Adenosine Triphosphate; Animals; Cell Adhesion; Cell Tracking; Disease Models, Animal; Energy Metabolism; Fluorodeoxyglucose F18; Gene Expression Regulation; Genes, Reporter; Humans; Image Processing, Computer-Assisted; Luciferases, Firefly; Luminescent Measurements; Male; Multimodal Imaging; Myocardial Infarction; Myocytes, Cardiac; Polymerase Chain Reaction; Positron-Emission Tomography; Radiopharmaceuticals; Rats; Rats, Inbred WKY; Signal Processing, Computer-Assisted; Sodium Pertechnetate Tc 99m; Spheroids, Cellular; Symporters; Time Factors; Tomography, X-Ray Computed; Transfection

In-vivo visualisation and quantification of the extent and time-frame of cell death after acute myocardial infarction would be of great interest. We studied in-vivo cell death in the hearts of patients with an acute myocardial infarction using imaging with technetium-99m-labelled annexin-V-a protein that binds to cells undergoing apoptosis.. Seven patients with an acute myocardial infarction and one control were studied. All patients were treated by percutaneous transluminal coronary angioplasty (six primary and one rescue), resulting in thrombolysis in myocardial infarction (TIMI) III flow of the infarct-related artery. 2 h after reperfusion, 1 mg annexin-V labelled with 584 MBq Tc-99m was injected intravenously. Early (mean 3.4 h) and late (mean 20.5 h) single-photon-emission computed tomographic (SPECT) images of the heart were obtained. Routine myocardial resting-perfusion imaging was also done to verify infarct localisation.. In six of the seven patients, increased uptake of Tc-99m-labelled annexin-V was seen in the infarct area of the heart on early and late SPECT images. No increased uptake was seen in the heart outside the infarct area. All patients with increased Tc-99m-labelled annexin-V uptake in the infarct area showed a matching perfusion defect. In a control individual, no increased uptake in the heart was seen.. Increased uptake of Tc-99m-labelled annexin-V is present in the infarct area of patients with an acute myocardial infarction, suggesting that programmed cell death occurs in that area. The annexin-V imaging protocol might allow us to study the dynamics of reperfusion-induced cell death in the area at risk and may help to assess interventions that inhibit cell death in patients with an acute myocardial infarction.

Topics: Aged; Angioplasty, Balloon, Coronary; Annexin A5; Apoptosis; Cell Death; Coronary Circulation; Coronary Vessels; Female; Follow-Up Studies; Heart; Humans; Image Processing, Computer-Assisted; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Protein Binding; Radiopharmaceuticals; Reperfusion Injury; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Aged; Evaluation Studies as Topic; Gated Blood-Pool Imaging; Heart Aneurysm; Heart Ventricles; Humans; Middle Aged; Myocardial Infarction; Sodium Pertechnetate Tc 99m

The effectiveness of sequential imaging of early regional left ventricular contraction in the detection of ischemic abnormalities was assessed in 47 patients (15 with previous infarction) with angiographically proven coronary artery disease, and 11 normal volunteers, undergoing first pass radionuclide angiography with a multielement gamma camera at rest and at peak exercise. Global left ventricular hemodynamic parameters, and functional images of regional ejection fraction and ejection rate were compared to 6 pairs of sequential rate images showing the decrease and the increase of regional left ventricular volume during a time-interval of 80-280 ms (at rest) and 50-175 ms (at stress) from end-diastole. Diagnostic accuracy of sequential images (67-91%) was higher than that of ejection rate image (71-72%), and of global hemodynamic parameters (33-60%), in the detection of coronary patients. Regional sensitivity of stress sequential increase and decrease image achieved 77% and 100%, respectively. During early systole sensitivity of stress sequential increase and decrease images approached 100% even at rest, subsequently decreasing because of normalizing contraction. Thus, the analysis of early systolic dysfunction provided by dynamic sequential functional images of ejection rates proved to be an effective diagnostic tool in the detection of myocardial ischemic dysfunction.

Topics: Adult; Aged; Coronary Disease; Diastole; Female; Gated Blood-Pool Imaging; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Ventricular Function, Left; Ventriculography, First-Pass

Forty-eight patients with acute myocardial infarction were subjected to radionuclide ventriculography during exercise and dobutamine infusion after a mean duration of 25 +/- 18 days following acute myocardial infarction. The results were compared and correlated with coronary angiography. Two patterns of abnormal response of radionuclide ventriculography were identified: (1) a worsening of the baseline wall motion abnormality confined to the infarcted area, and (2) fresh regional wall motion abnormalities in areas with normal motion at rest. Of 44 patients with significant coronary artery lesions (> or = 70% diameter stenosis), 18 had single vessel disease and 26 had multivessel disease. Dobutamine and exercise radionuclide ventriculography identified 23 and 21, respectively, of 26 multivessel disease patients yielding sensitivities of 88% and 80%. Seven of 18 single vessel disease patients showed a worsening of baseline wall motion abnormality of infarct area on dobutamine infusion radionuclide ventriculography. Subgroup analysis of coronary angiograms of single vessel disease revealed that 10 of 18 patients had subtotal occlusion of infarct-related artery supplying a hypokinetic area and the rest had a totally occluded coronary artery supplying an akinetic area. Dobutamine infusion and exercise radionuclide ventriculography detected 7 and 6 of these 10 patients implying the presence of jeopardized myocardium in infarcted/peri-infarct area. Dobutamine stress radionuclide ventriculography is an acceptable alternative to exercise testing to stratify risk following acute myocardial infarction.

Topics: Coronary Angiography; Dobutamine; Erythrocytes; Exercise Test; Exercise Tolerance; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Ventriculography; Risk Factors; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

Topics: Antibody Formation; Blood Platelets; Exercise Tolerance; Gated Blood-Pool Imaging; Humans; Immunity, Cellular; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Platelet Aggregation; Sodium Pertechnetate Tc 99m

Topics: Aged; Antibodies, Monoclonal; Evaluation Studies as Topic; Female; Gated Blood-Pool Imaging; Humans; Myocardial Infarction; Myocardium; Myosins; Necrosis; Sodium Pertechnetate Tc 99m

In acute myocardial infarction, beta-adrenergic blockade might depress left ventricular contractility or improve contractility by reducing ischemia. Gated equilibrium radionuclide ventriculography and cuff blood pressure were employed in 10 patients to assess the left ventricular systolic pressure/volume (P/V) ratio as an index of contractility before and after intravenous metoprolol 9.3 +/- 2.5 hr after onset of infarction. In 13 normal subjects, the baseline left ventricular PV ratio was 3.5 and the left ventricular ejection fraction (LVEF) was 70%, both greater than the patients with infarction. In the patients after blockade, the systolic blood pressure decreased (p = 0.02), and the left ventricular end-systolic volume increased (p = 0.003), thus decreasing the P/V ratio from 1.7 to 1.4 (p = 0.003), while the ejection fraction (EF) was unchanged (55% versus 52%). The right ventricular ejection fraction (RVEF) decreased from 50% to 43% (p = 0.004). Thus, radionuclide ventriculography demonstrated that left ventricular contractility was reduced in patients with acute myocardial infarction and that beta-adrenergic blockade further decreased left ventricular contractility and right ventricular performance.

Topics: Adrenergic beta-Antagonists; Adult; Aged; Depression, Chemical; Gated Blood-Pool Imaging; Hemodynamics; Humans; Male; Metoprolol; Middle Aged; Myocardial Contraction; Myocardial Infarction; Reference Values; Sodium Pertechnetate Tc 99m

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 effects of postextrasystolic potentiation during spontaneous ventricular ectopy on both left and right ventricular function were studied in 12 patients with the aid of list-mode radionuclide ventriculography. The left ventricular ejection fraction showed a significant increase (+ 11.0 +/- 5.0%; p less than .001) with associated mild increases in end-diastolic volumes (+ 4.9 +/- 4.6; p less than .01) and significant decreases in end-systolic volumes (-13.4% +/- 7.3%; p less than .001). A more heterogeneous response was seen for the right ventricle. Right ventricular ejection increased significantly in 8/12 patients (+ 3.3 +/- 3.0%; p less than .02). Despite a large increase in end-diastolic volumes (+ 10 +/- 7.9%; p less than .001), there were only mild changes in end-systolic volumes (+ 2.2 +/- 9.0; p = NS). It is concluded that, for spontaneous ventricular ectopy in man, the increase in right ventricular ejection fraction reflects improved ventricular filling whereas the increase in left ventricular ejection fraction is linked to improved emptying.

Topics: Adult; Aged; Cardiac Complexes, Premature; Cardiac Output; Cardiomyopathies; Coronary Disease; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The use of an expanded set of parameters of radionuclide ventriculography with 99mTc-pertechnetate, characterizing myocardial function, made it possible to specify radionuclide semiotics of myocardial infarction, to identify 4 cardiodynamic types, and to establish correlation between a degree of cardiodynamic changes and a site of lesion, and the relationship with exercise tolerance.

Topics: Heart; Humans; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

A total of 93 patients with myocardial infarction were investigated 3-4 mos. after the beginning of disease by the method of radionuclide ventriculography. Total and regional ejection fractions (for 7 zones), left ventricular functional volumes (end-systolic, end-diastolic and stroke volumes), rates of contraction and expulsion were determined. A certain level of left ventricular pump function in patients after myocardial infarction was determined by the ratio of the number of hypokinetic segments and the expression of a decrease in their contractility and normo- and hyperkinetic segments which are the main compensatory factor. Variations in the structure of formation of the total ejection fraction with relation to a site of myocardial infarction were revealed. Compensatory significance of hyperkinetic zones is decreased with a growing degree of expression of contraction asynergia.

Topics: Humans; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

Because of its potential use in the detection of right ventricular myocardial infarction, we performed radionuclide ventriculography in 80 consecutive cases of electrocardiographically anterior acute MI. Regional wall motion of both ventricles was studied on amplitude-phase images. Forty-five patients (56%) showed normal right ventricular function and 35 (44%) regional right ventricular dyskinesia: 19 in the septal, 14 in the apical and 2 in the free wall region. Right ventricular septal, respectively apical asynergy were virtually always associated with asynergy in the homologous parts of the left ventricle. This could be a consequence of the proximity of these regions, or alternatively be due to a common vascular supply. Thus it remains uncertain if asynergy in these regions signifies necrosis of part of the right ventricular wall. Free wall asynergy was considered as evidence of right ventricular wall necrosis. Thus, in our study group the prevalence of right ventricular myocardial infarction in anterior left ventricular myocardial infarction was at least 2.5%.

Topics: Adult; Aged; Female; Fourier Analysis; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

Authors performed quantitative assessment of 13 global and regional, left ventricular wall motion parameters obtained from 52 radioactive blood pool cardiac scintigrams. Of these performed in 1986 examinations, authors selected 3 equipotent patients' groups (myocardial infarction, cardiac aneurysm, cardiomyopathy) thus the contractility disorders were located in inferior wall segments. 13 examinations of the same material, without contractility disorders were selected (standard). Using time-activity curve authors measured following global parameters: ejection fraction (EFg1), mean ejection rate (MER), peak ejection rate (PER), peak filling rate (PFR), time from the end-systole to peak filling rate (tPFR) and regional parameters such as: regional and local ejection fraction (EFr and EF1), time from the beginning of the cycle to the end-diastole (ED) and to the end-systole (ES), contractility (KURCZ), amplitude of contractions. (AMPL) and of phase (PHASE) as well as standardized variables of amplitude distribution (SDU). The most significant quantitative parameter was EFgl. Dyskinesis symptom was the most important for cardiac eneurysm diagnosis. Phase shift served a confirmation of aneurysm earlier diagnosed using a cinematic display.

Topics: Cardiomyopathy, Dilated; Erythrocytes; Heart; Heart Aneurysm; Heart Ventricles; Humans; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m

Topics: Aged; Cardiac Output; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Prognosis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The acute effects of intravenous metoprolol were evaluated in 30 patients with myocardial infarction by means of serial hemodynamic and radionuclide measurements of left ventricular function. Within 1 hour of completion of the metoprolol dosing, 90% of the patients underwent cardiac catheterization to define anatomy and to assess patients for interventional therapy; the remainder had catheterization by 72 hours. All patients tolerated intravenous metoprolol without significant side effects. Patient responses to therapy were divided into two groups based on the angiographic findings. At catheterization, all group 1 patients had visible collaterals to or a patent vessel supplying the vascular distribution of the infarction. All group 2 patients had occluded coronary arteries without evidence of collaterals to the infarct zone. Group 1 (n = 13) improved both systolic and diastolic left ventricular function (mean ejection fraction [EF] = 46% to 55%, peak filling rate [PFR] = 2.1 to 3.2 Edv/sec), while group 2 (n = 17) patients were unchanged (EF = 43% to 42%, PFR = 2.0 to 1.9). Patient characteristics and time to treatment were similar in both groups, as were the hemodynamic effects of metoprolol. Heart rate decreased 20% in group 1 and 22% in group 2 and cardiac output fell 22% in group 1 and 32% in group 2. Acute improvement in ventricular function in these patients appears to be closely related to the coronary anatomy, and in those with flow to the infarct zone, intravenous metoprolol may be effective in preserving left ventricular function.

Topics: Administration, Oral; Cardiac Catheterization; Diastole; Drug Evaluation; Female; Heart Ventricles; Hemodynamics; Humans; Injections, Intravenous; Male; Metoprolol; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Time Factors

Ambulatory radionuclide monitoring of left ventricular function was performed with the nuclear Vest device in 35 patients early after acute myocardial infarction. Patients were evaluated during post-infarction treadmill, other activities that included mental stress and cold pressor challenge, and with stress thallium imaging and cardiac catheterization. Of the 35 patients evaluated, 14 had ischemic responses on treadmill testing and 21 had negative responses. By contrast, 20 had redistribution by thallium imaging suggesting ischemia. Vest studies demonstrated 56 responses suggestive of ischemia in 23 patients. Twenty-two occurred during exercise and 13 with mental stress. Seventy-five percent were silent and only 39% had associated electrocardiographic changes. Vest responses were compared in patients whose thallium scan was indicative of ischemia (thallium-positive) and those without ischemia (thallium-negative). Ejection fraction was higher in the thallium-positive group (0.52 +/- 0.11), as compared with thallium-negative patients (0.44 +/- 0.1). With exercise, ejection fraction decreased for the thallium-positive patients from 0.52 +/- 0.11 to 0.40 +/- 0.09 at peak exercise. For thallium-negative patients, ejection fraction changes were not significant. During mental stress, ejection fraction decreased from 0.51 +/- 0.11 to 0.45 +/- 0.12 for thallium-positive patients while thallium-negative patients were unchanged. Vest-measured decreases in ejection fraction of greater than or equal to 5 units during exercise were highly sensitive (90%), specific (73%) and predictive (82%) of a positive thallium scan. The same response for mental stress was specific (87%) and predictive (85%) of a positive scan result.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cold Temperature; Coronary Disease; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Monitoring, Physiologic; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stress, Psychological; Stroke Volume; Thallium Radioisotopes

The changes in ventricular function after reperfusion by coronary thrombolysis are important when deciding about further definitive treatment necessary to ensure long-term vessel patency. The purpose of this study was to evaluate the early changes in left ventricular function after reperfusion. Left ventricular function was serially evaluated for 10 days in a group of 18 patients receiving intracoronary thrombolytic therapy for an acute myocardial infarction. Comparison of the global ventricular function in the successfully and unsuccessfully reperfused groups of patients showed significantly better function in the successful group than the unsuccessful group after the first day, which was maintained for the entire study period. Global and regional ventricular function in the successfully reperfused patients showed significant early improvement during the initial 72 h with maintenance of this improvement for the study period of 10 days. In the patients in whom reperfusion was unsuccessful, regional ventricular function showed no change, while the global function declined from day 5 to day 8 of the study period. This study then confirms the significant improvement in ventricular function after successful reperfusion. The time course pattern of the change in ventricular function indicates that the most significant improvement occurs within the first 72 h after reperfusion. These changes are similar to those previously reported in experimental animals.

Topics: Angioplasty, Balloon; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Streptokinase; Stroke Volume

Topics: Aged; Diastole; Heart; Heart Ventricles; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Systole; Time Factors

To determine right (RV) and left ventricular (LV) volumes, a new technique was developed using ECG-gated single-photon emission computed tomography (SPECT). RV volumes of nine patients and LV volumes of 22 patients measured by SPECT and biplane contrast cineangiography were compared. In addition, volume and ejection fraction (EF) of the RV and LV were obtained by SPECT for 10 normal controls, 21 patients with old myocardial infarction (OMI), eight patients with hypertrophic cardiomyopathy (HCM) and 12 patients with dilated cardiomyopathy (DCM), and these results were compared. The intracardiac blood pool was labeled with Tc-99m sodium pertechnetate and 32 images were recorded through 180 degrees by a rotating gamma-camera. End-diastolic and end-systolic counts during 50 msec were recorded during 50 or 60 cardiac cycles. These counting data were reconstructed as tomographic images of vertical long-axial slices with thickness of a pixel without any attenuation correction. The numbers of voxels within the % cut-off level were summed, and the sum was multiplied by the one voxel volume. The cut-off level for ventricular delineation was determined as 45% by phantom studies. 1. The values obtained from SPECT and contrast angiography correlated well. 2. In normal controls, LV end-diastolic and end-systolic volumes were significantly less than those of the RV (p less than 0.05, p less than 0.001) and LVEF was significantly greater than the RVEF (p less than 0.001). 3. In OMI (single vessel disease), both end-diastolic and end-systolic volumes of the LV were significantly greater than those of normals (p less than 0.01, p less than 0.001) and LVEF was significantly less. In HCM end-systolic volumes of the RV were significantly less (p less than 0.05) than those of the normals. 4. LV volume was greater and LVEF was extremely low both in DCM and in OMI (multivessel disease) compared to that of the normals. In DCM, RV end-systolic volumes was greater and RVEF was lower than that of OMI (multi-vessel disease), indicating the deterioration of RV contractility , primarily in DCM. From these findings, it was concluded that this noninvasive technique may be useful for estimating left and right ventricular volumes.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radiography; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, Emission-Computed

Because the left ventricular "area at risk" is the most important determinant of ultimate infarct size, it would be useful to know the size of the area at risk during acute myocardial infarction to make therapeutic decisions. We therefore performed a series of experiments in four groups of dogs. In group I dogs (n = 15) we attempted to determine whether current methods of assessing left ventricular function during acute myocardial infarction reflect the true size of the area at risk. At each of two to five sequential stages, a more proximal coronary occlusion was performed to produce a larger area at risk until cardiovascular collapse occurred. At each stage, the area at risk (measured by myocardial contrast echocardiography), hemodynamic variables, and left ventricular ejection fraction (LVEF) were measured. Hemodynamic variables became abnormal when the area at risk was large (25% to 40% of the left ventricle), whereas LVEF became abnormal when the area at risk was of moderate size (18%). When cardiac output and LVEF were normalized to baseline values, a close inverse relationship was noted between these variables and area at risk. In contrast, there was a poor relationship between normalized mean arterial pressure and area at risk (r = .42). In group II dogs (n = 9) the area at risk was measured serially over 6 hr after coronary occlusion. The size of the area at risk remained unchanged regardless of the transmural extent of the ultimate infarct. The circumferential endocardial extent of the area at risk closely predicted the circumferential endocardial extent of the infarct at 6 hr in eight of nine dogs that developed an infarct. Group III dogs (n = 7) underwent the same protocol as group II dogs, but the duration of occlusion was 3 hr. The circumferential endocardial extent of the area at risk closely predicted the circumferential endocardial extent of the infarct. Group IV dogs (n = 5) underwent subtotal coronary occlusion. Although regional wall motion abnormalities were noted in this group, no area at risk could be defined. We conclude that although a close inverse relationship is noted between normalized cardiac output and area at risk, the absolute values for cardiac output and other hemodynamic variables become abnormal only when the area at risk is large (25% to 40%); measurement of LVEF may provide a better assessment of the size of the area at risk than hemodynamic variables.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Animals; Contrast Media; Diatrizoate; Diatrizoate Meglumine; Dogs; Drug Combinations; Echocardiography; Heart Ventricles; Hemodynamics; Myocardial Infarction; Myocardium; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Stroke Volume; Time Factors

Topics: Adult; Exercise Test; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

"Stunned" myocardium prevents the assessment of myocardial salvage after streptokinase. In order to unmask "stunning," we sought to evaluate left ventricular inotropic contractile reserve of patients after streptokinase. Radionuclide ventriculograms were obtained in 75 consecutive patients 2 weeks after myocardial infarction, at rest and during intravenous isoproterenol infusion. Resting and isoproterenol-stressed ejection fractions were compared in the patent and closed-infarct vessel groups. Although there was no difference in the resting ejection fractions between the patent group (0.48 +/- 0.02) and the closed group (0.48 +/- 0.02), isoproterenol increased the ejection fractions in the patent group (increase 0.14 +/- 0.01) significantly more than in the closed group (increase 0.06 +/- 0.01) (p less than 0.0001). Thus, despite identical resting ventricular function, the greater inotropic contractile reserve in the patent infarct vessel group suggests that restoration of blood flow in acute myocardial infarction salvages myocardium.

Topics: Adult; Blood Pressure; Female; Heart; Heart Rate; Humans; Isoproterenol; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stimulation, Chemical; Streptokinase; Stroke Volume; Time Factors

Noninvasive tests for the diagnosis of right ventricular (RV) infarction--two-dimensional echocardiography (2DE), ST elevation in V4R, and clinical parameters--were compared with equilibrium gated blood pool study (GBPS) in 50 patients after acute inferior myocardial infarction. Twenty-two of 50 patients had RV wall motion abnormalities on GBPS and 20 of 50 on 2DE. Sensitivity and specificity of 2DE was 82% and 93%, ST elevation in V4R was 50% and 71%, elevation of venous pressure was 77% and 85%, and a positive Kussmaul's sign was found in 59% and 89% for the detection of RV infarction compared to GBPS. Patients with RV infarction had higher peak creatine kinase levels and lower left ventricular ejection fractions than patients without RV infarction. Three patients died and all had significant left ventricular damage. At 20 weeks' follow-up, two thirds of the patients had no residual RV wall motion abnormalities, and all but two patients showed some recovery.

Topics: Adult; Aged; Coronary Circulation; Creatine Kinase; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Time Factors

Topics: Adult; Exercise Test; Heart; Humans; Isometric Contraction; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Fourteen patients with postinfarctual ventricular aneurysm underwent equilibrium radionuclide angiocardiography at rest (ERNA) before and after oral digoxin administration in order to evaluate the effects of increasing myocardial contractility upon both ventricular aneurysm mechanical behaviour and global ventricular function. The ejection fraction (EF) was not significantly affected by digoxin therapy. However, digoxin induced changes in EF (delta EF) correlated inversely with changes in aneurysm size and directly with changes in the extent of the hypokinetic area. Two types of aneurysm were observed: high-compliance aneurysm the size of which increased after digoxin administration while both EF and the extent of the hypokinetic area fell, and low compliance aneurysm for which opposite changes occurred. This different behaviour of ventricular aneurysm may have important practical implications as surgery would be probably more effective than medical treatment in improving resting ventricular function in patients with high-compliance aneurysm.

Topics: Adult; Aged; Blood Pressure; Cardiac Output; Digoxin; Female; Heart Aneurysm; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

To evaluate the incidence, severity and clinical course of right ventricular (RV) involvement after acute inferior myocardial infarction (IMI), 78 patients (pts) with IMI were investigated by both 99Tcm-pyrophosphate (PYP) scan and gated blood pool scan (GBPS). GBPS was performed at admission and 10 days, whereas 99Tcm-PYP scan was performed at 3 to 6 days. RV uptake of PYP was demonstrated in 25 (32%) pts on 99Tcm-PYP scan and RV akinesis or moderate hypokinesis by GBPS was observed in 39 (50%) pts on the acute scan; 25 pts (Group A) with positive RV uptake and 14 pts (Group B) with no RV uptake. In the remaining 39 pts (Group C) had normal RV wall motion. Severely depressed RVEF improved nearly 10 points on the tenth day in Group A (from 30.8 +/- 12.3 to 40.9 +/- 6.7%, p less than 0.01) and Group B (from 35.6 +/- 8.2 to 44.5 +/- 10.5%, p less than 0.01), respectively. Group C showed normal RVEF (from 47.4 +/- 7.6 to 50.1 +/- 10.2%). Fourteen pts of 39 (Groups A and B) who had developed shock or hypotension improved strikingly after appropriate therapy except for one death during their hospital course. Our data demonstrated: some patients with RV dysfunction in IMI do not have severe necrosis as judged by PYP scanning, those with positive RV uptake and depressed RV function show a lower degree of recovery than those with no RV uptake, but start from a lower initial value of RV function, and the combination of 99Tcm-PYP scan and GBPS offers prognostic information in IMI with RV dysfunction.

Topics: Adult; Aged; Diphosphates; Erythrocytes; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate

Proton (hydrogen-1) magnetic resonance imaging techniques have potential for the detection and characterization of changes associated with myocardial ischemia. Since image contrast is dependent on T1 and T2 relaxation times, we examined these parameters in a canine preparation of occlusion of the left anterior descending coronary artery. Of 16 dogs studied, seven underwent 3 hr of coronary artery occlusion and nine underwent 3 hr of occlusion followed by 1 hr of reperfusion. After the dogs were killed, the hearts of four from each group were imaged in a small bore, 1.4 tesla magnet. From all hearts myocardial segments were obtained from the normal zone and the central ischemic zone (CZ). These segments were divided into epicardial and endocardial sections and studied in a spectrometer (20 MHz). After 3 hr of occlusion, CZ endocardial T1 and T2 increased significantly (p less than .01 and p less than .05, respectively). Changes in CZ epicardial relaxation times were not as marked. Although T1 and T2 tended to be higher in the reperfused group compared with the nonreperfused group, the differences did not reach statistical significance. In keeping with the spectrometric findings, T1-dependent inversion recovery images and T2-dependent spin-echo images of the excised hearts demonstrated excellent contrast between normal and ischemic myocardium. Modest correlations were noted for both groups between blood flows during occlusion measured by the microsphere technique and T1 and T2 relaxation times. In summary, relaxation times T1 and T2 increase regionally after 3 hr of coronary artery occlusion and tend to be accentuated by reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Constriction; Coronary Circulation; Coronary Vessels; Dogs; Endocardium; Heart; Magnetic Resonance Spectroscopy; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spectrum Analysis; Time Factors

We studied 33 patients (28 males, 5 females) with first inferior acute myocardial infarction (AMI) and 12 normal volunteers. They underwent first-pass (FP) and equilibrium-gated radionuclide angiography (EGRA) within 4 days of the onset of symptoms. The parameters [ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR)] of the time-activity curve (TAC) of both ventricles [left ventricle (LV), right ventricle (RV)] were computed. The regional wall motion (RWM) was evaluated by parametric images (amplitude and phase). In 43% of the patients with AMI, we found a depressed RVEF, while the LVEF was decreased in only 33%. The sensitivity of diastolic parameters was shown to be clearly superior to that of the systolic parameters (RVPFR, 78%; LVPFR, 79%). The abnormalities of the overall performance of both ventricles were significantly correlated with those of the RWM. The abnormal RVEF allowed us to assess the necrotic involvement of the RV, while a depressed RVPFR suggested an impaired RV compliance mostly on an ischemic basis. Congestive heart failure (CHF) and shock syndrome were significantly correlated with depressed RV parameters, while the LVEF, despite RWM abnormalities, was in the normal range. EGRA with computation of the TAC parameters of both ventricles appeared to be useful for in-hospital prognostic evaluation, therapeutic planning and clinical follow-up of patients with inferior myocardial infarction.

Topics: Adult; Aged; Cardiac Output; Female; Follow-Up Studies; Heart; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Radionuclide cardiac imaging is a safe, noninvasive alternative to cardiac catheterization for observation and evaluation of cardiac wall motion and calculation of ejection fraction. Nuclide imaging offers a greater degree of sensitivity and specificity in detecting myocardial ischemia and infarction than do conventional electrocardiographic and cardiac enzyme studies. It is especially useful in problem cases. Myocardial infarction can usually be evaluated with respect to size and relative age of infarction.

Topics: Diphosphates; Erythrocytes; Heart; Humans; Myocardial Contraction; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

To study the pathologic and prognostic significance of--and possible underlying mechanisms for--a pathological exercise ECG in athletes, two age-matched groups were selected from a total population of 117 middle-aged and old endurance athletes: Group A: 21 with a pathological exercise-ECG, and group B: 21 with normal exercise-ECGs. Data from 201-thallium perfusion scintigraphy, 99 m-technetium multiple gated acquisition ventriculography (MUGA), resting echocardiography and 3 years follow-up are as follows: None had thallium findings indicating reversible myocardial ischaemia, but one from group A had a probable old myocardial infarction. All had normal resting MUGA, but group A men slightly more often presented a subnormal increase in ejection fraction according to exercise MUGA than group B men (9/20 vs 4/21). The former also more often had ventricular hypertrophy (LVH) (19/21 vs 14/21). However, apart from slightly longer ventricular filling time among group A men the echocardiograms revealed no group differences e.g. in cardiac dimensions or in indices of systolic or diastolic function. Regardless of exercise-ECG response, 18/42 athletes had one or more value of left ventricular dimensions or diameter exceeding the 95th percentile of the normal range. Since one patient from group A had asymmetric septal hypertrophy, one developed cardiomyopathy during the 3 years follow-up and one had a previous myocardial infarction, only 3/21 had cardiac disease which might explain the pathological exercise-ECG. Thus, pathological exercise-ECG rarely signifies heart disease in athletes, and very rarely coronary heart disease. Rather, the pathological exercise-ECG may be related to LVH and various subtle alterations in cardiac physiology following long-term endurance training.

Topics: Adult; Cardiac Output; Cardiomegaly; Coronary Disease; Echocardiography; Electrocardiography; Exercise Test; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Skiing; Sodium Pertechnetate Tc 99m; Thallium

The clinical value of an index of left ventricular synergic pumping efficiency (EFF) was evaluated in 50 patients with uncomplicated myocardial infarction in which radionuclide ventriculography was performed within 72 h of the onset of the infarction and between 7 and 13 days post infarction. EFF was defined as the ratio of global left ventricular stroke volume to the magnitude of all intraventricular blood pool variations measured on a pixel by pixel basis. EFF correlated better with a subjectively evaluated wall motion index (r = 0.84) than did the ejection fraction (EF) measurements (r = 0.69). In all patients, but most significantly in patients with inferoposterior infarctions, EFF measurements in the acute phase were a better predictor of the predischarge ventricular performance than the EF measurements. The left ventricular EFF is a reliable parameter to quantitate the effect of regional wall motion disturbances on global ventricular function in a standardized manner.

Topics: Adult; Aged; Cardiac Output; Erythrocytes; Heart Ventricles; Humans; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Cardiology; Cardiomyopathies; Heart; Heart Function Tests; Heart Valve Diseases; Humans; Lung Diseases, Obstructive; Myocardial Infarction; Nuclear Medicine; Prognosis; Quality Control; Radiation Dosage; Radioisotopes; Reference Values; Sodium Pertechnetate Tc 99m; Terminology as Topic; Tomography, Emission-Computed

Fourier amplitude and phase image analysis were evaluated in 66 patients. Thirty patients served as a control group and 36 had coronary artery disease (CAD). Each patient in our control group had a rest and exercise radionuclide cineangiogram (RNCA) study (60 total). The amplitude and phase images for controls were uniform. No statistically significant difference in the histogram distribution of amplitude or phase occurred between rest and exercise. Twenty-five patients with CAD had a prior myocardial infarction (MI). Fourier analysis, when compared to the left ventricular ejection fraction (LVEF) and visual cine wall motion analysis, improved the sensitivity of the rest RNCA study to detect CAD from 68% to 92%. Regional Fourier amplitude and phase image analysis demonstrated an 85% sensitivity in localizing regions of previous infarction. Thirteen of 25 patients with prior MI and an additional 11 patients with recent onset of angina but no previous infarction, had exercise RNCA studies. When compared to cardiac catheterization data, regional Fourier amplitude and phase image analysis demonstrated sensitivities of 87% and 80%, respectively, in correctly identifying clinically significant major coronary artery involvement in these two subsets of patients. Fourier amplitude and phase image analysis were also able to distinguish normals from patients with previous MI, and patients with CAD but no prior infarction. All comparisons were statistically significant. We conclude that the semiquantitative image analysis of Fourier amplitude and phase data increases the clinical utility of the RNCA study in patients with CAD.

Topics: Adult; Aged; Cardiac Catheterization; Coronary Disease; Exercise Test; Female; Fourier Analysis; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume

This study was designed to investigate the potential role of radionuclide angiographic phase imaging in defining ventricular pacing sites. Twenty patients were paced from multiple right ventricular and left ventricular sites. Ten patients had both normal wall motion and normal electrocardiograms (ECGs), while 10 patients had segmental wall motion abnormalities and/or bundle branch block. Both continuous pacing and premature ventricular stimuli were performed. Multiple (two to three) views of each pacing site were obtained by radionuclide angiography and the ventricular site was determined by subsequent phase imaging. Simultaneous 12-lead ECGs were also obtained. The phase-imaging technique accurately localized all 35 right ventricular and 21 of 25 (84%) left ventricular sites to a specific segment. Statistically, this localization ability was independent of baseline wall motion or conduction system disease. In addition, sites as close as 1.5 cm were identified. The 12-lead ECG distinguished left ventricular from right ventricular pacing sites in all patients. Segmental localization by ECG in the right ventricle was accurate in 24 of 35 (69%) and in the left ventricle in 17 of 25 (68%). Thus, radionuclide angiographic phase imaging provides excellent descriptive information regarding the focus of ventricular pacing ectopy and can define both sites of continuous pacing and intermittent premature ventricular stimulation. These findings provide a basis for further assessment of the role of phase imaging in the evaluation of patients with spontaneous ventricular ectopy.

Topics: Bundle-Branch Block; Cardiac Complexes, Premature; Cardiac Pacing, Artificial; Coronary Disease; Electrocardiography; Heart Valve Diseases; Heart Ventricles; Humans; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Wolff-Parkinson-White Syndrome

Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Electrocardiographic sites of infarction were: 35 anterior, 49 inferoposterior and 11 nonlocalized. Abnormal motion of the anterior wall, septum or apex was seen in 97 and 100% of anterior infarctions by radionuclide ventriculography and echocardiography, respectively. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r = 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period.

Topics: Adult; Aged; Echocardiography; Electrocardiography; Erythrocytes; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

One hundred nine patients with persistently positive technetium-99m pyrophosphate (Tc-99m-PPi) myocardial scintigrams 6 months after acute myocardial infarction (MI) (Group A) and 185 patients without such persistently positive scintigrams (Group B) were compared with regard to enzymatically determined infarct size, early and late measurements of left ventricular (LV) function determined by radionuclide ventriculography, and preceding clinical course during the 6 months after MI. The CK-MB-determined infarct size index in Group A (17.4 +/- 10.6 g-Eq/m2) did not differ significantly from that in Group B (16.0 +/- 14.6 g-Eq/m2). Similarly, myocardial infarct areas in the 2 groups, determined by planimetry of acute Tc-99m-PPi scintigrams in those patients with well-localized 3+ or 4+ anterior pyrophosphate uptake, were not significantly different (35.7 +/- 13.4 vs 34.4 +/- 13.1 cm2, respectively). However, patients in Group A had significantly lower LV ejection fractions than those in Group B, both within 18 hours of the onset of MI (0.42 +/- 0.14 vs 0.49 +/- 0.14, p less than 0.01) and at 3 months after MI, both at rest (0.42 +/- 0.14 vs 0.51 +/- 0.14, p less than 0.01) and at maximal symptom-limited supine bicycle exercise (0.44 +/- 0.17 vs 0.51 +/- 0.17, p less than 0.01). Peak exercise levels achieved in the 2 groups were not significantly different. Furthermore, patients in Group A demonstrated a greater incidence of congestive heart failure during the initial hospital admission (41 vs 24%; p less than 0.01) and a greater requirement for digoxin (p less than 0.05) and furosemide (p less than 0.01) after discharge.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Ambulatory Care; Creatine Kinase; Diphosphates; Electrocardiography; Erythrocytes; Follow-Up Studies; Heart Ventricles; Humans; Isoenzymes; Myocardial Infarction; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

The purpose of this study was to assess the clinical usefulness of phase and amplitude images and of the left ventricle time-activity curve (LVTAC) obtained by equilibrium gated radionuclide ventriculography (EGRV) in patients with acute myocardial infarction (AMI). Fifty-six patients were studied within 4 days of the onset of AMI by EGRV; of these 49 also underwent first-pass (FP) angiocardiography, for comparison with EGRV, and 21 underwent repeated EGRV 3 months after AMI. Phase and amplitude images were obtained by Fourier analysis. LVTAC analysis was performed by a third degree polynomial fitting to determine peak ejection rate (PER) and peak filling rate (PFR). A substantial equivalence of EGRV and FP methods was demonstrated, as regards left ventricle ejection fraction (LVEF), while a sharp superiority of EGRV with Fourier analysis was shown with regard to the sensitivity of RWM abnormality detection. With only one exception all the cases showed RWM abnormalities, while LVEF was normal in 21 of 27 patients with less than three affected segments. The most sensitive global function index was the LVPFR. In the acute phase regional dyskinesis was observed in 14 of 56 patients. About 40% of our cases showed an improvement of the kinetic abnormalities 3 months after AMI. The highest rate of improvement was observed in the group with ECG patterns of limited infarction and with normal LVEF.

Topics: Adult; Aged; Angiocardiography; Erythrocytes; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Time Factors

Topics: Cardiac Output; Cardiomyopathies; Coronary Circulation; Coronary Disease; Coronary Vessels; Heart; Heart Diseases; Heart Valve Diseases; Heart Ventricles; Humans; International Cooperation; Lung Diseases, Obstructive; Myocardial Infarction; Perfusion; Quality Control; Radionuclide Imaging; Reference Values; Societies, Medical; Sodium Pertechnetate Tc 99m; Terminology as Topic; Tomography, Emission-Computed; World Health Organization

Topics: Adult; Aged; Electrocardiography; Heart; Humans; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Thallium

A comparison was made of the estimated size of the myocardial infarction occurring in 26 patients with a first infarction using creatine kinase (CK) enzyme release between radionuclide gated blood pool measurement of total and regional ventricular function and thallium-201 scintigraphic measurement of myocardial perfusion defects. Creatine kinase estimates of infarct size (enzymatic infarct size) correlated closely with the percent of abnormal contracting regions, left ventricular ejection fraction and thallium-201 estimates of percent of abnormal perfusion area (r = 0.78, 0.69 and 0.74, respectively, p less than 0.01). A close correlation also existed between percent abnormal perfusion area and percent of abnormal contracting regions (r = 0.81, p less than 0.01) and left ventricular ejection fraction (r = 0.69, p less than 0.01). Enzymatic infarct size was larger in anterior (116 +/- 37 CK-g-Eq) than inferior (52 +/- 29 CK-g-Eq) myocardial infarction (p less than 0.01) and was associated with significantly more left ventricular functional impairment as determined by left ventricular ejection fraction (33 +/- 7 versus 60 +/- 10%) (p less than 0.01) and percent abnormal perfusion area (58 +/- 14 versus 13 +/- 12) (p less than 0.01). No significant correlation was observed between enzymatic infarct size and right ventricular ejection fraction. These different methods of estimating infarct size correlated closely with each other in these patients with a first uncomplicated myocardial infarction.

Topics: Adult; Aged; Creatine Kinase; Erythrocytes; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Thallium

To assess the chronic effects of myocardial infarction on right ventricular function, 48 subjects were studied utilizing radionuclide angiography and two-dimensional echocardiography. Ten were normal subjects (group I), 11 had previous inferior wall myocardial infarction (group II), 10 had previous anteroseptal infarction (group III), 11 had combined anteroseptal and inferior infarction (group IV) and 6 had extensive anterolateral infarction (group V). The mean (+/- standard deviation) left ventricular ejection fraction was 0.66 +/- 0.03 in group I, 0.58 +/- 0.02 in group II, 0.52 +/- 0.02 in group III, 0.33 +/- 0.03 in group IV and 0.33 +/- 0.01 in group V. No systematic correlation between left and right ventricular ejection fraction was observed among the groups. The mean right ventricular ejection fraction was significantly reduced in the presence of inferior myocardial infarction (0.30 +/- 0.03 in group II and 0.29 +/- 0.03 in group IV compared with 0.43 +/- 0.02 in group I [p less than 0.001]). The group II and IV patients also had increased (p less than 0.001) right ventricular end-diastolic area and decreased (p less than 0.001) right ventricular free wall motion by two-dimensional echocardiography. In the presence of anteroseptal infarction (group III), right ventricular free wall motion was increased (p less than 0.05) compared with normal subjects (group I). Thus, the effects of prior myocardial infarction on right ventricular function depend more on the location of infarction than on the extent of left ventricular dysfunction. Inferior infarction was commonly associated with reduced right ventricular ejection fraction and increased right ventricular end-diastolic area. The right ventricular free wall excursion was increased in the presence of anteroseptal infarction, suggested loss of contribution of interventricular septal contraction to right ventricular ejection.

Topics: Adult; Cardiac Catheterization; Echocardiography; Erythrocytes; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Time Factors

Two-dimensional echocardiographic determination of right ventricular ejection fraction was compared with right ventricular ejection fraction obtained by first pass radionuclide angiography in 39 patients with coronary artery disease. Apical four chamber and two chamber right ventricular views were obtained in 34 (87%) of the 39 patients, while a subcostal four chamber view was obtained in 31 patients (80%). Right ventricular ejection fraction by two-dimensional echocardiography was calculated by the biplane area-length and Simpson's rule methods using two paired orthogonal views and utilizing a computerized light-pen method for tracing the right ventricular endocardium. A good correlation (r = 0.74 to 0.78) was found between radionuclide angiographic and two-dimensional echocardiographic right ventricular ejection fraction for each method used. Patients with acute inferior myocardial infarction had the lowest right ventricular ejection fraction by radionuclide angiography and two-dimensional echocardiography (p less than 0.05 compared with patients with right coronary artery obstruction and no infarction). There were no differences in right ventricular ejection fraction between patients with acute and old inferior myocardial infarction by both techniques. No correlation was found between left and right ventricular ejection fraction by radionuclide angiography (r = 0.16). It is concluded that 1) right ventricular ejection fraction by two-dimensional echocardiography correlates well with radionuclide angiographic measurements and can reliably evaluate right ventricular function in coronary artery disease, 2) patients with inferior myocardial infarction have reduced right ventricular ejection fraction, and 3) changes in left ventricular ejection fraction do not directly influence right ventricular function.

Topics: Adult; Aged; Cardiac Output; Coronary Disease; Echocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Angiocardiography; Cardiac Volume; Coronary Disease; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Arteries; Diagnosis, Differential; Humans; Myocardial Infarction; Radionuclide Imaging; Serum Albumin; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Aggregated Albumin; Veins

Topics: Adult; Aged; Angina Pectoris; Cardiac Output; Cineangiography; Coronary Artery Bypass; Female; Humans; Male; Middle Aged; Myocardial Infarction; Physical Exertion; Prognosis; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

To assess various factors associated with anterior S-T segment depression during acute inferior myocardial infarction, 47 consecutive patients with electrocardiographic evidence of a first transmural inferior infarction were studied prospectively with radionuclide ventriculography an average of 7.3 hours (range 2.9 to 15.3) after the onset of symptoms. Thirty-nine patients (Group I) had anterior S-T depression in the initial electrocardiogram and 8 (Group II) did not have such "reciprocal" changes. There was no difference between the two groups in left ventricular end-diastolic or end-diastolic volume index or left ventricular ejection fraction. Stroke volume index was greater in Group I than in Group II. There were no group differences in left ventricular total or regional wall motion scores. A weak correlation existed between the quantities (mV) or inferior S-T segment elevation and reciprocal S-T depression. No relation between anterior S-T segment depression and the left ventricular end-diastolic volume index could be demonstrated; the extent of left ventricular apical and right ventricular wall motion abnormalities, both frequently associated with inferior infarction, did not correlate with the quantity of anterior S-T depression. These data show that anterior S-T segment depression occurs commonly during the early evolution of transmural inferior infarction, is not generally a marker of functionally significant anterior ischemia and cannot be used to predict left ventricular function in individual patients. Anterior S-T segment depression may be determined by reciprocal mechanisms.

Topics: Cardiac Catheterization; Clinical Enzyme Tests; Creatine Kinase; Electrocardiography; Heart Ventricles; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

The application of dual tracer transaxial emission computed tomography of the heart was studied with use of technetium-99m pyrophosphate and technetium-99m-labeled red blood cells for measuring infarct size in 20 patients with acute myocardial infarction and 10 without infarction. Imaging was performed with a standard gamma camera and with a multidetector transaxial emission computed tomographic body scanner 3 hours after injection of technetium-99m pyrophosphate. Immediately after the scanning procedure, technetium-99m pertechnetate was injected to label red blood cells, and the scanning protocol was repeated. Technetium-99m pyrophosphate was detected in the anterior wall with involvement of the interventricular septum or lateral wall in patients with electrocardiographic criteria for anterior infarction, whereas uptake was detected in the diaphragmatic left ventricular wall with involvement of the posterior, posteroseptal or posterolateral left ventricle or of the right ventricle in patients with electrocardiographic criteria for inferior or posterior infarction. Infarct size measured from transaxial images ranged from 14.0 to 117.0 g in weight. There was a direct relation between infarct size and patient prognosis in that, of the 13 patients with infarct greater than 40 g, 11 (85 percent) had complications, whereas only 2 (29 percent) of 7 patients with an infarct less than 40 g had complications during a follow-up period averaging 17.8 months (p less than 0.05).

Topics: Aged; Creatine Kinase; Diphosphates; Electrocardiography; Erythrocytes; Humans; Middle Aged; Myocardial Infarction; Particle Size; Prognosis; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Heart; Heart Septal Defects; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates

In 40 patients with chronic ischaemic heart disease [IHD) and 10 healthy subjects the total and local myocardial contractility was assessed during threshold-level exercise. The patients were subjected to radionuclide ventriculography in a modification recording the first passage of the radioindicator through the heart cavities. In the control subjects the exercise induced a 27% increase in the total ejection fraction, with increased contractility of all left ventricular segments. In the patients with IHD the reactions to exercise varied. In 40% of the patients the total ejection fraction increased adequately, in 17.5% the increase was nonadequate, in 20% no increase was observed, and in 22.5% the ejection fraction decreased. The most marked reduction in myocardial contractility was found in patients who had sustained myocardial infarction and reacted positively to the exercise test. In 34 patients there were observed left ventricular segments showing a paradoxical response of contractility to exercise--a decrease in the local ejection fraction. This pathological local reaction occurred rather in a normal function at rest than in a myocardium with hypokinetic segments at rest.

Topics: Adult; Cardiac Output; Coronary Disease; Heart Ventricles; Humans; Middle Aged; Myocardial Contraction; Myocardial Infarction; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Cineradiography; Heart Aneurysm; Heart Ventricles; Humans; Myocardial Infarction; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Technetium Tc 99m Pentetate