technetium-tc-99m-pyrophosphate and Coronary-Disease

One of the strongest points of the field of nuclear medicine has been its ability to adapt to the development of new drugs, new machines, and changing clinical needs. As in many other areas of medicine, however, this progression makes it difficult for the occasional user to stay abreast of the latest offerings in the field. This article provides some background and guidelines to assist in the selection of radioisotopic procedures for cardiovascular applications, with the goal of directing the study to an individual patient's needs.

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

The use of nuclear imaging techniques allows the accurate detection of myocardial infarction, determination of the impact of infarction on ventricular performance, assessment of the myocardial salvage with thrombolysis, identification of preserved regional metabolism in jeopardized myocardial segments, and the elucidation of inducible reversible ischemia requiring aggressive therapeutic intervention. Assessment of myocardial salvage after thrombolysis or revascularization can be accomplished with serial perfusion imaging. Infarct-avid imaging with Tc-99m-PYP can be used to rapidly determine the size and location of the acute transmural myocardial infarction. In the future, however, the improved image quality and diagnostic accuracy of immunoscintigraphy with antimyosin antibodies may supplant PYP imaging. Studies of global ventricular function can be performed at rest, or with multiple interventions using portable scintigraphic devices. The measurement of the dynamic response of left ventricular ejection fraction over time shows promise for risk stratification. As yet, there has been no comprehensive comparison of the relative predictive value of metabolic imaging parameters, perfusion/antibody uptake mismatch, Tl-201 redistribution, or ejection fraction response data. Such a comparison could optimize the diagnostic algorithm for post-infarction damage assessment and risk stratification.

Topics: Coronary Disease; Female; Heart; Humans; Male; Myocardial Infarction; Nitriles; Organotechnetium Compounds; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

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: Adult; Aged; Coronary Disease; Diagnosis, Differential; Electrocardiography; Exercise Test; False Negative Reactions; Female; Heart; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

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

99mTc-PYP myocardial scintigrams represent a means to detect and localize acute myocardial necrosis. These scintigrams are expected to be abnormal with acute myocardial infarcts of at least 3 grams in weight if serial imaging is utilized and proper attention to technique is provided. Any etiology of myocardial necrosis may produce abnormal 99mTc-PYP scintigrams if the damage is relatively localized and includes at least 3 grams of tissue. It is possible to accurately size acute anterior and anterolateral transmural myocardial infarcts using area or 2 dimensional measurements. Further development in imaging cameras and computer techniques allowing three dimensional reconstruction of myocardial infarcts with this and similar imaging techniques may allow relatively precise quantitation of other types of myocardial infarcts. The "doughnut" and "persistently abnormal" 99mTc-PYP scintigrams appear to have anatomic and prognostic significance at least in subsets of patients studied, but larger numbers of individuals need to be evaluated before final conclusions regarding their ultimate prognostic significance can be reached.

Topics: Animals; Calcium; Coronary Disease; Heart; Humans; Inclusion Bodies; Microscopy, Electron; Mitochondria, Heart; Myocardial Infarction; Myocardium; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Among a group of patients (n = 15) with acute coronary syndrome, the results of using two new myocardial radiopharmaceuticals--123I-labelled 15-(p-iodo-phenyl)-3,R,S-methylpentadecanoic acid (BMIPP) and 123I-meta-iodobenzyl guanidine (MIBG)--were compared with dual 201Tl/99Tcm-pyrophosphate (Tl-PYP) imaging using single photon emission tomography (SPET). Defect scores were evaluated on a segment-by-segment basis for a total of 270 segments. For the 201Tl, BMIPP, and early and delayed MIBG studies, the mean (+/- S.D.) sums of defect scores were 9 +/- 8, 18 +/- 9, 22 +/- 12 and 29 +/- 9, respectively, revealing significantly higher scores for BMIPP and MIBG than 201Tl (P < 0.005). This was the case irrespective of various functional conditions, such as successful recanalization, failure of coronary angioplasty or restenosis. The culprit coronary artery was best identified using BMIPP, while MIBG SPET showed the most extensive defects. Normal perfusion with decreased BMIPP and MIBG uptake was frequently observed and associated with hypokinesis. 123I-BMIPP and MIBG are more sensitive for the detection of damaged myocardium, and the difference between perfusion and metabolism seems to reflect myocardial stunning.

Topics: 3-Iodobenzylguanidine; Acute Disease; Adult; Aged; Coronary Artery Bypass; Coronary Disease; Coronary Vessels; Decanoic Acids; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Stunning; Syndrome; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

Perioperative myocardial infarction (POMI) is a complication of coronary artery bypass grafting (CABG) with a potential prognostic impact. Technetium-99m pyrophosphate myocardial scintigraphy (MS) is used in the diagnosis of POMI; however it shows a limited sensitivity for subendocardial lesions. Cardiovascular magnetic resonance imaging (CMRI), in turn, has a high accuracy in the detection of myocardial necrosis.. To compare CMRI and MS for the detection of POMI after CABG.. A total of 24 patients with chronic coronary artery disease were studied using the delayed contrast enhanced CMRI and MS before and after CABG by analyzing the development of areas of perioperative myocardial necrosis (POMI). Biochemical markers of myocardial injury (CKMB and troponin I) were also determined before and after surgery.. Nineteen patients completed the study. Of these, 6 (32%) presented POMI on CMRI and 4 (21%) on MS (p = NS). Of the 323 left ventricular segments assessed, 17 (5.3%) showed perioperative necrosis on CMRI and 7 (2.2%) on MS (p = 0.013). Moderate agreement was observed between the methods (kappa = 0.46). There was disagreement regarding the diagnosis of POMI in 4 (21%) cases, most of them with small areas of perioperative necrosis on CMRI which were not visualized on MS. In all cases with POMI on CMRI, significant CKMB and troponin I elevations were observed.. Moderate diagnostic agreement was observed between the methods for the detection of POMI, but CMRI enabled visualization of small areas of perioperative myocardial necrosis which were not identified on MS and were associated with elevation of biochemical markers of myocardial injury.

Topics: Biomarkers; Chronic Disease; Coronary Disease; Creatine Kinase, MB Form; Female; Humans; Intraoperative Complications; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Necrosis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate; Troponin I

The incidence of missed diagnoses of acute cardiac ischemia in the emergency department could be reduced by a new imaging modality. In the present study, the clinical significance of (99m)Tc-pyrophosphate (PYP), (123)I-beta-methyl-p-iodephenyl-pentadecanoic acid (BMIPP), (201)TlCl scintigraphy (imaging) and T2-weighted inversion-recovery magnetic resonance imaging (MRI) for the detection of culprit lesion in patients with acute coronary syndromes (ACS) was compared.. The study group comprised 18 patients with ACS: 12 patients with acute myocardial infarction (AMI) (11 males; mean age, 63+/-11 years) and 6 patients with unstable angina (UA) (3 males, mean age, 67+/-5 years). Of the 12 patients with AMI, 10 underwent (201)TlCl and PYP single photon emission computed tomography (SPECT) studies as a dual-energy acquisition ((201)TlCl/PYP) and 8 underwent (201)TlCl SPECT within 1 week of the BMIPP study. All 18 patients underwent BMIPP SPECT and MRI. The MRI pulse sequence was black blood turbo short-inversion-time inversion recovery (STIR) (breath-hold T2-weighted studies). The T2-weighted inversion-recovery MRI showed higher sensitivity and negative predictive value than PYP and (201)TlCl, and higher specificity and positive predictive value than BMIPP and (201)TlCl. The area under the receiver-operating characteristic curve for PYP, BMIPP, (201)TlCl and MRI was 0.787, 0.725, 0.731 and 0.878, respectively. The difference between the areas of MRI and BMIPP was significant (p<0.05).. Accurate detection of culprit lesion is improved by using MRI rather than BMIPP, particularly for patients with ACS.

Topics: Acute Disease; Aged; Coronary Disease; Fatty Acids; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Magnetic Resonance Imaging; Male; Middle Aged; ROC Curve; Syndrome; Technetium Tc 99m Pyrophosphate; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

This study was undertaken to determine whether the findings of dual SPECT with Tc-99m pyrophosphate (PYP) and Tl-201 were predictive of further cardiac events after acute myocardial infarction.. The authors evaluated 88 patients with acute myocardial infarction who underwent dual SPECT for single-vessel coronary artery disease.. Twenty-nine patients showed overlapping of Tc-99m PYP and Tl-201 in the same location (overlap-positive group), and 59 patients had no overlap (overlap-negative group). In patients in the overlap-positive group, the incidence of subsequent events was significantly higher than in patients in the overlap-negative group (P < 0.001). In the overlap-positive group, the number of overlap segments in patients with further events was significantly greater than that in patients without further events (P < 0.005).. Areas with overlapping of Tc-99m PYP and Tl-201 may contain jeopardized myocardium. These results suggest that patients who have a Tc-99m PYP and Tl-201 overlap-negative scan are a low risk group, whereas patients who have more overlapping segments may require catheterization and revascularization. Thus simultaneous SPECT imaging with Tc-99m PYP and Tl-201 might be useful to identify patients with greater ischemic risk after acute myocardial infarction.

Topics: Aged; Angina Pectoris; Angioplasty, Balloon, Coronary; Cardiac Catheterization; Coronary Artery Bypass; Coronary Disease; Death, Sudden, Cardiac; Female; Follow-Up Studies; Forecasting; Heart; Humans; Image Processing, Computer-Assisted; Incidence; Male; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Predictive Value of Tests; Radiopharmaceuticals; Recurrence; Risk Factors; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

The validity of dual energy single-photon emission computed tomography (SPECT) with technetium-99m pyrophosphate (Tc-99m PPi) and thallium-201 for the diagnosis of right ventricular (RV) infarction, and the clinical features of RV infarction, were investigated in 190 patients with acute myocardial infarction. Diagnosis of RV infarction was performed by Tc-99m PPi accumulation in the RV myocardium on thallium-201 and Tc-99m PPi over-lay images at the dual SPECT with simultaneous imaging taken 2 to 9 days after the onset of myocardial infarction. Thirty RV infarctions were found among the 190 patients with left ventricular infarction (15.8%): 29 (97%) in association with the inferior and 1 (3%) with the lateral infarction. Tc-99m PPi accumulation was mostly observed in the posterior wall of the right ventricle. A total occlusion or a severe stenosis of the right coronary artery was demonstrated angiographically in 92% of the patients with RV infarction. The prevalence of RV infarctions was significantly lower in patients who achieved successful early reperfusion than in those who did not (26.7 vs 68.4%, respectively, p < 0.01). However, a successful early reperfusion therapy could not significantly decrease the rate of RV involvement in patients without significant collateral flow (p < 0.01). Thus, dual isotope SPECT with Tc-99m PPi and thallium-201 can be used as a reliable method for the diagnosis of RV infarction.

Topics: Aged; Coronary Angiography; Coronary Disease; Evaluation Studies as Topic; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

The effect of diltiazem on stunned myocardium was evaluated by measuring the myocardial uptake of 99mTc-PYP (pyrophosphate) in open chest experiments with dogs. Myocardial stunning was induced by a 30 min ischemic occlusion of the anterior descending coronary artery. Regional wall motion was monitored by echocardiography of the epicardium for 2 h during reperfusion. After a 30 min occlusion of the coronary artery, it was reperfused and 99mTc-PYP was injected, followed by 201Tl 2 h later. The ischemic area was defined by Evans blue dye, and the infarct area by TTC staining. No dogs showed infarcts or 201Tl defects in this study group. Five dogs of the control-1 group (C1, ischemic area = 19.1 +/- 3.2%) showed decreased regional wall motion during occlusion (15.5 +/- 3.5% of control), and a slow recovery from depressed motion after 2 h of reperfusion (20.3 +/- 9.3%) with uptake ratio (compared to the non-ischemic area uptake) of 99mTc-PYP (4.96 +/- 2.28). In contrast, both groups with diltiazem infusion (20 micrograms/kg/min), started either 30 min before ischemia (D1 = 5 dogs) or just after reperfusion (D2 = 5 dogs), showed significantly better recovery after 2 h of reperfusion (D1:115.4 +/- 36.0%, D2:109.2 +/- 44.2%) than C1 (p less than 0.05), D1 and D2 groups also showed suppressed 99mTc-PYP uptake ratio (D1:1.06 +/- 0.33, D2:2.34 +/- 2.05, p less than 0.05 vs C1) in spite of comparable ischemic area. Four dogs with small ischemic area (C2:5.3 +/- 5.0%) did not show increased 99mTc-PYP uptake (1.15 +/- 0.35), and regional wall motion after 2 h of reperfusion was 96.1 +/- 24.1% of the control value (p less than 0.05 vs C1). Thus, diltiazem was effective in enhancing the suppression of 99mTc-PYP uptake in the stunned myocardium, and similar results were obtained for small ischemic areas. The protective effect of diltiazem appears to be strongly related to the mechanism of 99mTc-PYP uptake.

Topics: Animals; Coronary Disease; Diltiazem; Dogs; Echocardiography; Female; Heart; Male; Myocardial Contraction; Myocardial Reperfusion Injury; Myocardium; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathy, Dilated; Chronic Disease; Coronary Disease; Heart; Humans; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

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

Clinical features of 37 cases of stunned myocardium were studied. Mean duration of asynergy was 22.6 +/- 15.7 days. In all 11 cases of unstable angina without any significant serum creatine kinase leakage, the duration of asynergy was within 14 days. Related coronary lesions were reperfused (spontaneously or by interventional therapy) to TIMI grade II or higher. Transient Q waves were observed in 39% of all cases. Negative T waves tended to be prolonged, and persisted after disappearance of asynergy in 74% of all cases. 201Tl uptake in the stunned area varied widely between individual cases (ranging from "absent" to "normal"), although it became normal in all cases in the chronic stage. Mal-distribution of 99mTc-pyrophosphate (PYP) to the endocardial side of the stunned area was observed in 33%. In 186 cases of acute coronary syndrome, we studied whether or not reversibility of ischemia-disturbed myocardium could be predicted by simultaneous dual isotope SPECT, and found that 201Tl-uptake in the chronic stage significantly improved in the region showing absence of 99mTc-PYP accumulation or maldistribution of 99mTc-PYP to the endocardial side, while reversibility of the region showing transmural 99mTc-PYP accumulation and a dought pattern was poor. Ischemia-associated myocardial damage recovered to various degrees, and dual isotope SPECT was useful in evaluating the reversibility of such damage already at the acute stage.

Topics: Adult; Aged; Angina, Unstable; Coronary Disease; Echocardiography; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

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

In addition to the conventional indices of radionuclide angiography with ECG-gait in equilibrium, the authors determined the volume indices of the left ventricle at rest by the so-called nongeometric method in 30 patients with ischemic heart disease. Patients without myocardial infarct (13 subjects) had decreased total left-ventricular ejection fraction (EF), as a result of increase in the end systolic volume index (ESVI) in one of the tested patients. Changes in the regional fractions and in the wall kinetics were detected in 6, resp. in 8 patients. Patients with myocardial infarct--13 subjects--had decreased total left ventricular EF, as a result increased ESVI in 4 patients. Disturbances in the regional fraction and in the wall kinetics had 9 patients. Estimated for the whole group, the mean ESVI level was significantly higher than in the former group of patients. Patients with postinfarction aneurysm, in addition to the marked decrease of the total left ventricular EF, had increased and-systolic and diastolic volume index, which in some of the patients was associated with reduced stroke volume index. The minute flow levels were significantly lower than in the former two groups. Determination of the volume indices is an important supplement to the efforts to gain precise information on the functional state of the left ventricle and for evaluation of the hemodynamics and of the effect of complications which occur with the advancing of the ischemic heart disease.

Topics: Adult; Coronary Disease; Erythrocytes; Female; Gated Blood-Pool Imaging; Heart Aneurysm; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tin; Tin Polyphosphates

To investigate the potential uses of right and left ventricular systolic and diastolic rate indices in identifying patients with ischaemic heart disease (IHD), gated blood-pool imaging was performed for 19 normal subjects (group 1) and 56 patients, of whom 31 had resting LVEF greater than or equal to 50% (group 2) and 25 had resting LVEF less than or equal to 50 (group 3). The peak ejection rate (PER) and peak filling rate (PFR), their timing and the mean filling rate (MFR) were derived from the time-activity curves analysis. Group 2 patients had significantly reduced LV PER and PFR (3.00 +/- 0.58 EDV/s, p less than 0.005, 2.29 +/- 0.54 EDV/s, p less than 0.0009) as compared to normal (3.90 +/- 0.70 EDV/s and 3.35 +/- 0.80 EDV/s respectively). Patients with profoundly depressed LVEF had significantly low PER and PFR (1.96 +/- 0.50 EDV/s, 1.46 +/- 0.27 EDV/s respectively). However, there was considerable overlap in values between groups. Therefore, we conclude that there is no single parameter more sensitive than LVEF in identifying IHD patients with normal LVEF at rest.

Topics: Adult; Coronary Disease; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Myocardial Contraction; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

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

We have previously demonstrated that enhanced glucose utilization in reperfused myocardium as assessed by F-18 2-deoxyglucose (FDG) and positron tomography predicts functional recovery. In this study, we compared segmental uptake of F-18 FDG with that of Tl-201 and Tc-99m (Sn) pyrophosphate (Tc-99m PPi) as conventional markers of tissue viability in seven dogs after a 3-hour intracoronary balloon occlusion and 20 hours of reperfusion. Myocardial blood flow was determined with microspheres. Regional retention fractions were calculated from tracer tissue concentrations, the arterial input function, and blood flow. Ischemic injury was assessed by triphenyltetrazolium chloride (TTC) staining and histologic analysis. At 24 hours, blood flow was 22% lower in reperfused than in control myocardium (p less than 0.05). Uptake of Tl-201 was related linearly to blood flow (r = 0.92), while glucose utilization and Tc-99m PPi were 2.9 (p less than 0.01) and 4.7 (p less than 0.05) times higher in reperfused than in control myocardium. Retention fractions of Tc-99m PPi increased with the degree of ischemic injury, while F-18 FDG uptake was highest in segments with mild cell injury. Thus, in ischemically injured myocardium, Tl-201 primarily reflects blood flow. F-18 FDG as a marker of glucose utilization identifies ischemically injured but viable tissue. The admixture of necrotic cells can be determined with Tc-99m PPi. Our results indicate that a dual tracer approach might best characterize the presence and extent of reversibly and of irreversibly injured tissue in a given myocardial region.

Topics: Animals; Coronary Circulation; Coronary Disease; Deoxy Sugars; Deoxyglucose; Dogs; Fluorine Radioisotopes; Heart; Hemodynamics; Myocardium; Necrosis; Polyphosphates; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tin Polyphosphates

This study compares exercise radionuclide ventriculography (RNVG) and exercise myocardial scintigraphy with 201Tl (MSC) both computed trisectorially. 137 patients before and after transluminal angioplasty (TCA) were investigated. While specificity equivalent was set at 90% for both methods (10% percentile of the controls [n = 29]) overall sensitivity for RNVG was 79% (n = 86) and for MSC 78% (n = 98). Sensitivity of RNVG for lesions of the posterior wall was lower than for the anterior wall: LAD stenoses 83% (n = 46), RCA stenoses 71% (n = 17), and LCX stenoses 63% (n = 8). Sensitivity of MSC presents only a slight difference between anterior and posterior wall lesions: LAD stenoses 78% (n = 51), RCA stenoses 73% (n = 22), RCX stenoses 100% (n = 8). Reproducibility of pathological findings before and after non-successful TCA and the determination of the stenosed vessel was slightly better with MSC than with RNVG. Functional improvement after a successful TCA is predictable by MSC, whereas RNVG documents the functional improvement.

Topics: Adult; Aged; Angioplasty, Balloon; Coronary Disease; Coronary Vessels; Exercise Test; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates

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

Results from 388 patients, examined with quantitative equilibrium radionuclide ventriculography (qERNV) at rest, were stored in a data bank system and evaluated statistically. The value of time and velocity parameters [ejection time (ET), filling time (FT), time ES to peak filling rate (TpFR), mean (mER) and peak (pER) ejection rate, peak filling rate (pFR)] were evaluated in patients with coronary heart disease (CHD, with and without history of earlier myocardial infarction) or with cardiomyopathy (CMP). Significant (p less than 0.025) changes vs. normal in CHD I/II were obtained from pER, pFR, ET, in CHD III from gEF, EDV, mER, pER, pFR, in CHD IV from gEF, EDV, mER, pER, pFR, in patients with infarction or with CMP from gEF, EDV, mER, pER, pFR, ET and TpFR. Resting qERNV revealed a sensitivity in diagnosing a CHD (stages I-III) by mER of 30-59%, by pER of 40-65%, by pFR of 48-60% and by ET of 58-61%, which was higher than the sensitivity of gEF (19-56%).

Topics: Cardiac Output; Cardiomyopathy, Dilated; Coronary Disease; Factor Analysis, Statistical; Heart; Heart Failure; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

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

To compare serial functional and perfusion scintigraphic changes after myocardial infarction, we performed left ventricular (LV) cineangiograms and thallium (TI)-201 myocardial perfusion scintigrams before and 1 hour, 2 days, 9 days, and 1 month after closed chest coronary occlusion in 14 dogs as survival permitted. Survivors were studied with technetium-99m (stannous) pyrophosphate (TcPYP) scintigrams at 48 hours, and at postmortem examination infarction was documented and measured after nitroblue tetrazolium (NBT) staining. The TcPYP image was abnormal in 10 dogs, each of which had infarcts on NBT staining measuring 3 to 23 gm. In all 14 dogs, perfusion scintigrams became abnormal and LV ejection fraction (EF) fell when measured within 48 hours of occlusion. In the nine late survivors studied over 1 week after the event, perfusion scintigrams and EF improved in those which developed infarcts and normalized in those without infarction. The decrement in LVEF after coronary occlusion generally showed serial improvement and correlated with the size of the defect in the accompanying TI-201 scintigram (r = 0.74). TI-201 defect size seen in late studies correlated well with NBT infarct size (r = 0.89) and TcPYP image infarct size (r = 0.82), as it did with the decrement in LVEF noted in late studies (r = 0.86). The results suggest that early perfusion scintigrams together with TcPYP images may be useful for estimating the amount of reversible dysfunction after coronary occlusion.

Topics: Animals; Arterial Occlusive Diseases; Cardiac Volume; Coronary Disease; Dogs; Myocardial Infarction; Nitroblue Tetrazolium; Radioisotopes; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates

We have investigated the pattern of accumulation of Tc-99m(Sn2+)pyrophosphate (Tc-99m PPi) in myocardial tissue of dogs during the early stages of acute occlusion of the left anterior descending coronary artery. Three groups were studied after: (a) 40 min occlusion followed by 6 hr reperfusion (n = 6); (b) 6 hr occlusion followed by one hour reperfusion (n = 5); and (c) 7 hr occlusion with no reperfusion (n = 4). Areas of myocardial infarction were defined with triphenyl-tetrazolium chloride (TTC) staining, and blood flow was determined with 9-mu radioactive microspheres. In Group C uptake in infarcted and peri-infarct areas was not enhanced, most likely owing to low flow. In Group B, with late reperfusion, Tc-99m PPi sequestration was increased in both infarcted and peri-infarcted tissues. In Group A, areas ischemic during occlusion but with normal flow and viability by TTC after 6 hr of reperfusion showed significant uptake of Tc-99m PPi (twice the uptake of nonischemic regions).

Topics: Animals; Coronary Circulation; Coronary Disease; Dogs; Female; Histocytochemistry; Male; Models, Biological; Myocardial Infarction; Polyphosphates; Radionuclide Imaging; Regional Blood Flow; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

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 evaluated 193 consecutive unstable angina patients by clinical features, hospital course and electrocardiography. All patients were managed medically. Of the 193 patients, 150 (78%) had a technetium-99m pyrophosphate (Tc-PYP) myocardial scintigram after hospitalization. Of these, 49 (33%) had positive scintigrams. At a follow-up of 24.9 +/- 10.8 months after hospitalization, 16 of 49 patients (33%) with positive scintigrams died from cardiac causes, compared with six of 101 patients (6%) with negative scintigrams (p less than 0.001). Of 49 patients with positive scintigrams, 11 (22%) had had nonfatal myocardial infarction at follow-up, compared with seven of 101 patients (7%) with negative scintigrams (p less than 0.01). Age, duration of clinical coronary artery disease, continuing angina during hospitalization, ischemic ECG, cardiomegaly and a history of heart failure also correlated with cardiac death at follow-up. Ischemic ECG and a history of angina with a crescendo pattern also correlated with nonfatal infarction at follow-up. Patients with continuing angina, an ischemic ECG and a positive scintigram constituted a high-risk unstable angina subgroup with a survival rate of 58% at 6 months, 47% at 12 months and 42% at 24 and 36 months. We conclude that the assessment of clinical features, hospital course, ECG and Tc-PYP scintigraphy may be useful in identifying high-risk unstable angina patients.

Topics: Acute Disease; Adult; Aged; Angina Pectoris; Cardiomegaly; Coronary Disease; Electrocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Polyphosphates; Radiography; Radionuclide Imaging; Regression Analysis; Risk; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Coronary Disease; False Positive Reactions; Heart Ventricles; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates

"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