technetium-tc-99m-pyrophosphate and Heart-Failure

The two most common types of cardiac amyloidosis are caused by fibril deposits of immunoglobulin light chains (AL) and transthyretin (TTR), each with distinct prognosis and clinical management. Cardiac amyloidosis is under-recognized among heart failure patients with preserved ejection fraction (HFpEF). Bone-seeking tracers like. The clinical scope of cardiac amyloidosis among HFpEF patients and current literature supporting the use of bone-seeking tracers for TTR cardiac amyloidosis are presented. The differences of imaging techniques for cardiac amyloid and bone disease evaluation, bone tracer pharmacodynamics, and imaging interpretation criteria for cardiac amyloidosis diagnosis are discussed. Finally, a diagnostic algorithm to use bone scintigraphy in cardiac amyloidosis diagnosis among HFpEF patients is proposed. Bone scintigraphy with

Topics: Amyloid Neuropathies, Familial; Cardiomyopathies; Echocardiography; Heart; Heart Failure; Humans; Radionuclide Imaging; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate

More than half of all subjects with chronic heart failure are older adults with preserved ejection fraction (HFpEF). Effective therapy for this condition is yet to be delineated by clinical trials, suggesting that a greater understanding of underlying biologic mechanisms is needed, especially for the purpose of clinical intervention and future clinical trials. Amyloid infiltration of the myocardium is an underappreciated contributing factor to HFpEF that is often caused by misfolded monomers or oligomers of the protein transthyretin. While previously called senile cardiac amyloidosis and traditionally requiring endomyocardial biopsy for diagnosis, advances in our pathophysiologic understanding of this condition, coupled with nuclear imaging techniques using bone isotopes that can diagnose this condition noninvasively and the development of potential therapies, have resulted in a renewed interest in this previously considered "rare" condition. This reviewer focuses on the re-emergence of nuclear cardiology using pyrophosphate agents that hold promise for early, noninvasive identification of affected individuals.

Topics: Amyloidosis; Heart; Heart Diseases; Heart Failure; Humans; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

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

Sixty-eight patients with biopsy-proven ATTRwt-CM who underwent PYP SPECT/CT were enrolled. Baseline clinical characteristics, echocardiographic parameters, and qualitative and/or quantitative indices of planar and SPECT/CT imaging in PYP scintigraphy for each patient were included. For quantitative analysis of SPECT/CT, the accumulation ratio of PYP in the septum, posterior, anterior, lateral, and apex walls to the cavity pool was calculated as the septal wall-to-cavity ratio (Se/C), lateral wall-to-cavity ratio (La/C), anterior wall-to-cavity ratio (An/C), inferior wall-to-cavity ratio (In/C), and apical wall-to-cavity ratio (Ap/C), respectively. Endpoints for prognostic accuracy evaluation were cardiac death or hospitalization due to heart failure. Event-free survival rate was evaluated through Cox proportional hazards regression analysis, providing estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and Kaplan-Meier curves.. High-sensitivity cardiac troponin T (hs-cTnT), La/C, age, interventricular septal thickness in diastole, and E/e' ratio in the septal wall were significantly associated with event-free survival (P < 0.05). For a multivariable Cox proportional hazards analysis, hs-cTnT (HR 1.153; 95% CI 1.034-1.286; P < 0.01), La/C (HR 2.091; 95% CI 1.012-4.322; P = 0.046), and age (HR 1.116; 95% CI 1.007-1.238; P = 0.037) were significant independent prognostic factors.. This study indicated that the quantitative indices of PYP SPECT/CT can help to predict the prognosis of ATTRwt-CM patients.

Topics: Aged; Amyloid Neuropathies, Familial; Diphosphates; Heart Failure; Humans; Prealbumin; Prognosis; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Pyrophosphate

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

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

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a form of heart failure (HF) with preserved ejection fraction (HFpEF). Technetium Tc 99m pyrophosphate scintigraphy (PYP) enables ATTR-CM diagnosis. It is unclear which patients with HFpEF have sufficient risk of ATTR-CM to warrant PYP.. To derive and validate a simple ATTR-CM score to predict increased risk of ATTR-CM in patients with HFpEF.. Retrospective cohort study of 666 patients with HF (ejection fraction ≥ 40%) and suspected ATTR-CM referred for PYP at Mayo Clinic, Rochester, Minnesota, from May 10, 2013, through August 31, 2020. These data were analyzed September 2020 through December 2020. A logistic regression model predictive of ATTR-CM was derived and converted to a point-based ATTR-CM risk score. The score was further validated in a community ATTR-CM epidemiology study of older patients with HFpEF with increased left ventricular wall thickness ([WT] ≥ 12 mm) and in an external (Northwestern University, Chicago, Illinois) HFpEF cohort referred for PYP. Race was self-reported by the participants. In all cohorts, both case patients and control patients were definitively ascertained by PYP scanning and specialist evaluation.. Performance of the derived ATTR-CM score in all cohorts (referral validation, community validation, and external validation) and prevalence of a high-risk ATTR-CM score in 4 multinational HFpEF clinical trials.. Participant cohorts included were referral derivation (n = 416; 13 participants [3%] were Black and 380 participants [94%] were White; ATTR-CM prevalence = 45%), referral validation (n = 250; 12 participants [5%]were Black and 228 participants [93%] were White; ATTR-CM prevalence = 48% ), community validation (n = 286; 5 participants [2%] were Black and 275 participants [96%] were White; ATTR-CM prevalence = 6% ), and external validation (n = 66; 23 participants [37%] were Black and 36 participants [58%] were White; ATTR-CM prevalence = 39%). Score variables included age, male sex, hypertension diagnosis, relative WT more than 0.57, posterior WT of 12 mm or more, and ejection fraction less than 60% (score range -1 to 10). Discrimination (area under the receiver operating characteristic curve [AUC] 0.89; 95% CI, 0.86-0.92; P < .001) and calibration (Hosmer-Lemeshow; χ2 = 4.6; P = .46) were strong. Discrimination (AUC ≥ 0.84; P < .001 for all) and calibration (Hosmer-Lemeshow χ2  = 2.8; P = .84; Hosmer-Lemeshow χ2  = 4.4; P = .35; Hosmer-Lemeshow χ2 = 2.5; P = .78 in referral, community, and external validation cohorts, respectively) were maintained in all validation cohorts. Precision-recall curves and predictive value vs prevalence plots indicated clinically useful classification performance for a score of 6 or more (positive predictive value ≥25%) in clinically relevant ATTR-CM prevalence (≥10% of patients with HFpEF) scenarios. In the HFpEF clinical trials, 11% to 35% of male and 0% to 6% of female patients had a high-risk (≥6) ATTR-CM score.. A simple 6 variable clinical score may be used to guide use of PYP and increase recognition of ATTR-CM among patients with HFpEF in the community. Further validation in larger and more diverse populations is needed.

Topics: Amyloidosis; Cardiomyopathies; Female; Heart Failure; Humans; Male; Prealbumin; Radiopharmaceuticals; Retrospective Studies; Stroke Volume; Technetium Tc 99m Pyrophosphate

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

Transthyretin cardiac amyloidosis (ATTR) is a rare, but underdiagnosed, cardiomyopathy. Traditionally diagnosed invasively, ATTR can be diagnosed with non-invasive. Forty-three subjects (24 ATTR, 19 non-ATTR) were imaged with Philips Dual-Head Anger (planar) and General Electric CZT cameras. Myocardial uptake was quantified by heart-to-contralateral (H/CL) ratios. CZT scans were quantified by two readers blinded to planar H/CL, with one repeating blinded quantification. Using the previously validated diagnostic threshold (H/CL ≥ 1.5), sensitivity and specificity of CZT scintigraphy was measured. McNemar's test and Pearson's correlation coefficient were calculated.. Among subjects (76.7% male, age 77 ± 9), there was no significant difference in proportion of ATTR-positive identification between modalities. There was high correlation between CZT and planar H/CL ratios (r = 0.92, P < 0.0001), with low intra- [ICC = 0.89 (0.80-0.94)] and inter-observer [ICC = 0.80 (0.65-0.89)] variability. CZT scintigraphy had 100% sensitivity and specificity for diagnosing ATTR.. ANTECEDENTES: la amiloidosis cardíaca asociada a transtiretina (ATTR) es una cardiomiopatía poco frecuente y poco diagnosticada. Tradicionalmente el diagnóstico se realiza de forma invasiva, aunque se puede diagnosticar con gammagrafía planar con tecnecio 99m pirofosfato (99mTc-PYP). En el presente trabajo se desarrolla y se valida un protocolo diagnóstico de ATTR. MéTODO: Se estudiaron 43 sujetos (24 con diagnóstico de ATTR y 19 sin ATTR) las imágenes fueron adquiridas con las cámaras Philips Dual-Head Anger (planar) y General Electric CZT. La captación miocárdica se cuantificó con proporción corazón-contralateral (H/CL). La adquisición con las cámaras CZT se cuantificaron mediante 2 lectores cegados a la proporción H/CL planar, con una cuantificación ciega repetida. Utilizando el umbral de diagnóstico previamente validado (H/CL ≥ 1.5), se midió la sensibilidad y la especificidad de la gammagrafía con CZT. Para el análisis estadístico se utilizó la prueba De McNemar y el coeficiente de correlación de Pearson. RESULTADOS: entre la población de estudio (76.7% varones, edad 77 ± 9), no hubo diferencias estadísticamente significativas en la proporción de identificación de ATTR positiva. Se identificó una alta correlación entre la cámara CZT y la proporción planar H/CL (r = 0.92, p < 0.0001), así como una baja variabilidad intraobservador (ICC = 0.89 (0.80-0.94)) e interobservador (ICC = 0.80 (0.65-0.89)). La gammagrafía con CZT tuvo una sensibilidad y especificidad del 100% para el diagnóstico de ATTR. CONCLUSIóN: La imagen con 99mTc-PYP en cámaras CZT es altamente sensible y específica para el diagnóstico de ATTR. Estos hallazgos son de relevancia debido a la aparición de terapias modificadoras de la enfermedad.. 背景: 甲状腺素转运蛋白相关型心脏淀粉样变 (ATTR) 是一种罕并且难以诊断的心肌病。 传统的诊断方法是有创的, ATTR 可以通过无创99m锝标记的焦磷酸钙 (99mTc-PYP) 平面闪烁扫描进行诊断。而其它非平面成像方法尚未得到验证。本研究中我们探讨了一种镉锌碲化物(CZT)成像方案用于ATTR的可行性。 方法: 43 名受试者 (24名ATTR, 19名非ATTR) 分别使用飞利浦公司双探头显像仪平面扫描,以及通用公司CZT探头显像仪进行扫描。 心肌摄取采用心/对侧肺 (H/CL) 放射性计数比值作为定量方法。CZT 图像由2位研究者在不知道(双探头)平面扫描 H/CL 值的情况下进行定量测量。 以既往验证的 H/CL ≥ 1.5 作为 ATTR 诊断阈值,评价 CZT 扫描的诊断敏感性和特异性。 (统计学上) 计算了配对卡方检验和皮尔逊相关系数。 结果: 在受试者中 (男性占76.7%,年龄77 ± 9岁), ATTR 阳性诊断率无显著差异。 CZT 与平面扫描 H/CL 值相关性高 (r = 0.92, p  < 0.0001), 观察者内部 (ICC = 0.89(0.80-0.94)) 和观察者之间 (ICC = 0.80(0.65-0.89)) 的变异系数低。 CZT 扫描诊断 ATTR 的敏感性和特异性均为 100%。 结论: 99mTc-PYP CZT 扫描对 ATTR 的诊断具有与双探头扫描类似的高灵敏度和特异性。 鉴于 ATTR 疾病调节疗法的出现,这种新的扫描方法由于提高了诊断能力将具有重要的临床价值。.. L’amyloïdose cardiaque à transthyrétine (ATTR) est une cardiomypathie rare, mais sous-diagnostiquée. Traditionnellement diagnostiquée de façon invasive, l’ ATTR peut être évaluée par scintigraphie planaire au 99mTechnetium (99mTc-PYP). Dans cette étude, nous avons développé et validé un protocole avec detectors Cadmium Zinc Telluride (CZT) pour le diagnostic de l’ATTR. MéTHODES: 43 sujets (24 ATTR, 19 non-ATTR), ont été évaluées avec la camera Anger double tête de Philips et avec la camera CZT de General Electric. L’uptake myocardique du tracer a été quantifié en utilisant le rapport cœur- hemithorax contro-latéral (H/CL). Les scintigraphies obtenues sur camera CZT ont été analysées à deux reprises par deux experts qui n’avaient pas connaissance des résultats des images planaires obtenus au moyen de la caméra Philips. Utilisant le seuil diagnostique précédemment validé (H/CL) de 1.5, la sensibilité et la spécificité de la scintigraphie CZT ont été mesurées. Le test de McNemar et le coefficient de corrélation de Pearson ont été calculés. RéSULTATS: Nous n’avons pas observé de difference significative dans l’identification de l’amyloïdose cardiaque à transthyrétine (ATTR) chez les sujets étudies (76,7% d’ hommes, 77 à 9 ans) entre les deux modalitées scintigraphiques. De plus, nous avons noté une étroite correlation entre les résultats H/CL obtenus par imagerie CZT et Anger planaire (r-0,92, p-0,0001), avec une faible variabilité intra- (ICC-0,89(0,80-0,94)) et inter-observateurs (ICC 0,80 (0,65-0,89)). Le diagnostique de l’ATTR par scintigraphie à CZT a montré une sensibilité et une spécificité de 100%.. l’imagerie scintigraphique au 99mTc-PYP obtenue sur camera CZT est aussi sensible et spécifique que celle obtenue sur camera Anger planaire pour le diagnostiqe de l’amyloidose cardiaque ATTR. L’utilisation des caméras CZT devraient faciliter le diagnostic et par conséquent l’implémentation des nouvelles thérapies de l’amyloidose cardiaque ATTR.

Topics: Aged; Aged, 80 and over; Amyloidosis; Cadmium; Cardiology; Electrocardiography; Female; Follow-Up Studies; Heart Diseases; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prealbumin; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate; Tellurium; Zinc

Topics: Aged; Aged, 80 and over; Amyloidosis; Cross-Sectional Studies; Echocardiography; Electrocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Phenotype; Prealbumin; Prevalence; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Transthyretin amyloid deposition is present in 17% of autopsies of patients with heart failure and a preserved ejection fraction (HFpEF). Technetium-pyrophosphate scintigraphy (Tc-PYP) is sensitive and specific to diagnose cardiac transthyretin amyloid deposition (ATTR). The prevalence of ATTR by Tc-PYP was evaluated along with echocardiographic parameters in patients with HFpEF. One-hundred consecutive patients with HFpEF, who had Tc-PYP, were retrospectively evaluated. Echocardiographic variables were analyzed to compare patients with positive versus negative ATTR infiltration. Myocardial ATTR was present in 19% of patients. Individuals with ATTR were older with a mean age of 82 ± 7 versus 75 ± 13 years (P = 0.03), had increased left ventricular hypertrophy with the interventricular septum measuring 1.6 (IQR, 1.4-2.0) versus 1.4 (IQR, 1.3-1.6) cm (P = 0.002), had a greater mean left ventricular mass index of 160 ± 50 g/m versus 131 ± 44 g/m (P = 0.01), and a reduced global longitudinal strain measuring -11% (IQR, -9 to -12) versus -12% (IQR, -10 to -16), P = 0.04. The prevalence of ATTR myocardial deposition demonstrated by Tc-PYP in patients with HFpEF is comparable to that of autopsy studies. It is more common in older patients, with increased left ventricular hypertrophy and reduced global longitudinal strain.

Topics: Acute Disease; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Cardiomyopathies; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Radiopharmaceuticals; Stroke Volume; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Technetium pyrophosphate (. An imaging protocol using 750 K counts, 10 mCi of

Topics: Aged; Amyloidosis; Biopsy; Cardiac Imaging Techniques; Cardiology; Cardiomyopathies; Diphosphonates; Female; Heart Failure; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Mutation; Myocardial Perfusion Imaging; Organotechnetium Compounds; Prealbumin; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Aged, 80 and over; Amyloid Neuropathies, Familial; Asymptomatic Diseases; Cardiomyopathies; Disease Progression; Early Diagnosis; Female; Genetic Predisposition to Disease; Heart Failure; Humans; Male; Middle Aged; Mutation; Phenotype; Prealbumin; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

A study of 45 patients with chronic obstructive bronchitis by the method of radionuclide ventriculography with 99mTc showed that even the early stages of the disease were characterized by an inhibition of the contractile function of the left cardiac ventricle. With progression of respiratory insufficiency, maintaining of the left cardiac ventricle stroke volume is achieved by increase of the final-diastolic and final-systolic volumes. Appearance of signs of cardiac decompensation is accompanied by a breakdown of this compensatory mechanism accompanied by a reduction of the strike volume and diminished rate of contraction of the circular fibers of the left ventricle myocardium.

Topics: Adult; Bronchitis; Chronic Disease; Gated Blood-Pool Imaging; Heart Failure; Humans; Middle Aged; Pulmonary Heart Disease; Respiratory Insufficiency; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

Topics: Chronic Disease; Diphosphates; Exercise Test; Heart; Heart Failure; Hemodynamics; Humans; Pulmonary Circulation; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Nicardipine is a new calcium ion antagonist with vasodilating properties which has been shown to be effective in the treatment of hypertension and angina. We have studied its effect on systolic and diastolic left ventricular function in patients with mild to moderate degrees of congestive heart failure. Ten male patients with New York Heart Association Class II and III heart failure underwent acute treatment with an intravenous infusion of nicardipine (10 mg over 10 minutes). A nuclear probe was used to monitor left ventricular ejection fraction, peak filling rate, and relative cardiac output. Blood pressure and heart rate were also measured. The blood pressure (mean +/- SD) fell from 133 +/- 26/86 +/- 11 mmHg to 103 +/- 22/69 +/- 13; the heart rate rose from 67 +/- 9 beats/min to 85 +/- 10; left ventricular ejection fraction from 31 +/- 7 to 38 +/- 6%; relative cardiac output from 24 +/- 9 to 41 +/- 11; peak filling rate from 1.18 +/- 0.4 end-diastolic volume per second to 1.82 +/- 0.4 (p less than 0.001 in all cases) at the end of infusion. After 4 weeks of chronic treatment in eight patients (20 mg to be taken three times daily (tds) in one and 40 mg tds in 7), the blood pressure and heart rate had returned to baseline values but the improvements in left ventricular ejection fraction, relative cardiac output, and peak filling rate were sustained; this was associated with functional improvement in all 8 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Adult; Aged; Calcium Channel Blockers; Cardiac Output; Dose-Response Relationship, Drug; Drug Administration Schedule; Heart Failure; Humans; Infusions, Parenteral; Male; Middle Aged; Myocardial Contraction; Nicardipine; Nifedipine; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Aortic Valve Insufficiency; Heart Failure; Heart Ventricles; Humans; Mitral Valve Insufficiency; Myocardial Contraction; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

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

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

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

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

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

Perfusion scintigraphy with thallium-201, infarct scintigraphy with technetium-99m pyrophosphate (TcPYP), and equilibrium blood pool scintigraphy were performed during the initial hospitalization for acute myocardial infarction (MI) in 25 patients without evidence of heart failure who presented with advanced electrocardiographic rhythm and conduction disturbances requiring treatment. Scintigraphic findings during short-term hospitalization were related to the late clinical follow-up performed an average of 14 months later, where patients were grouped as asymptomatic, 8 patients; symptomatic, 9 patients; and deceased, 8 patients. Quantitation of perfusion abnormalities, TcPYP image abnormalities, and left ventricular ejection fraction (EF) revealed that the deceased group had significantly larger TcPYP abnormalities (36 +/- 20 cm2), absolute perfusion abnormalities (32 +/- 16 cm2), and perfusion abnormalities expressed as a percentage of the projected left ventricular area (42 +/- 8%) than the asymptomatic group (13 +/- 8 cm2, 14 +/- 6 cm2, and 20 +/- 9%; p less than 0.05, p greater than 0.05, and p less than 0.01, respectively). The percent perfusion abnormality was significantly larger in the deceased group (42 +/- 8%, p less than 0.01) than in either the symptomatic group (35 +/- 13%, p less than 0.01) or the asymptomatic group (20 +/- 9%), and this parameter in the symptomatic group also differed from that in the asymptomatic group (p less than 0.01). The study indicates that patients with rhythm and conduction disturbances and without congestive heart failure during acute MI may follow an uncomplicated or a complicated late clinical course. Early scintigraphic measurements of MI and perfusion correlate well with this outcome; however, EF could not differentiate among prognostic subgroups.

Topics: Adult; Aged; Arrhythmias, Cardiac; Diphosphates; Electrocardiography; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

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

A focal or diffuse pattern of Tc-99m pyrophosphate (Tc-99m PPi) myocardial uptake may occur in patients with acute myocardial necrosis from various causes. A recent study has shown intense Tc-99m PPi myocardial uptake in experimental viral perimyocarditis in mice. This report describes a patient with perimyocarditis, with intense, persistent, and generalized myocardial uptake of Tc99m PPi.

Topics: Diphosphates; Heart; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Myocarditis; Myocardium; Pericarditis; 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

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