technetium-tc-99m-pyrophosphate and Myocardial-Infarction

Myocardial necrosis plays an important role in the pathogenesis of various cardiovascular disorders and can result from different myocardial insults. Its non-invasive identification and localisation therefore may help in the diagnosis of these disorders, as well as in prognosis and assessment of treatment response. Apoptosis, or programmed cell death, is important in the spectrum of myocardial damage since it is gradually becoming more apparent that cell death may begin as apoptosis and not as necrosis. First attempts to directly visualise the area of myocardial necrosis were based on recognition of myocardial infarction with "hot spot imaging agents" in patients with chest pain. Since then, the study of myocardial necrosis with gamma imaging agents has gone beyond the detection of myocardial infarction, and attempts have been made to diagnose other cardiovascular disorders associated with cardiac cell death such as heart transplant rejection, myocarditis, cardiotoxicity and cardiomyopathies. Traditionally, two hot spot imaging agents have been used for the detection of myocardial necrosis, (99m)Tc-pyrophosphate and (111)In-antimyosin. In addition, preliminary studies have demonstrated promising results with (99m)Tc-glucarate. Recently, (99m)Tc-annexin V has been successfully used for non-invasive gamma imaging of apoptosis after acute myocardial infarction, acute myocardial ischaemia, acute cardiac allograft rejection and malignant intracardiac tumours. This review article focusses on the characteristics of these different myocardial necrotic and apoptotic markers and compares their role in the assessment of myocardial damage.

Topics: Annexin A5; Apoptosis; Glucaric Acid; Heart; Humans; Immunoglobulin Fab Fragments; Myocardial Infarction; Myocardium; Necrosis; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Topics: Heart; Humans; Myocardial Infarction; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Heart; Humans; Myocardial Infarction; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Tc-99m pyrophosphate is the grandfather of infarct avid agents. Its value is its clinical availability and ease of use. However, its shortcomings are the delay of 2 to 3 days for reliable interpretation in nonreperfused myocardial infarction (MI) and the overarching bone activity. Antimyosin provides exquisite specificity for the detection of myocardial necrosis irrespective of the cause of the injury. Therefore, diagnosis of equivocal MI or confirmation of diffuse myocardial necrosis would benefit from the availability of In-111 labeled antimyosin Fab. The drawback of antimyosin, like that of Tc-99m pyrophosphate, is the delay, in this case because of the protracted blood clearance of the antibody protein macromolecules. Tc-99m glucaric acid, on the other hand, may fulfill the original role envisioned for antimyosin, which was to enable early, rapid diagnosis of acute MI. However, the window for the use of Tc-99m glucaric acid appears to be limited to within the first day of the acute event. Therefore, there is a potential use of both Tc-99m glucaric acid and In-111 antimyosin in tandem with Tc-99m glucaric acid, which would not only facilitate early detection and diagnosis of acute MI and diagnosis of equivocal MI, but also may permit stratification of the infarct age.

Topics: Animals; Dogs; Heart; Humans; Indium Radioisotopes; Myocardial Infarction; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

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

Topics: Angina, Unstable; Coronary Artery Disease; Diagnosis, Differential; Heart; Humans; Myocardial Infarction; Myocardium; Necrosis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Pyrophosphate

Topics: Heart; Humans; Image Processing, Computer-Assisted; Myocardial Infarction; Myocardium; Necrosis; Phantoms, Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

For almost two decades, Tc-99m pyrophosphate has been the preferred infarct-avid imaging agent in nuclear cardiology. More recently, Indium-III- and Tc-99m-labeled antimyosin monoclonal antibody imaging have been extensively investigated. Although In-III antimyosin is not yet available in North America, this radioimmunoscintigraphic procedure is very promising for detection of both Q-wave and non-Q-wave myocardial infarction, especially when other standard diagnostic modalities fail to be contributive. When appropriately applied, radionuclide imaging with infarct-avid agents may provide very helpful clinical information.

Topics: Animals; Antibodies, Monoclonal; Humans; Indium Radioisotopes; Myocardial Infarction; Myocarditis; Myosins; Necrosis; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

In recent years, nuclear cardiology techniques have been successfully applied in patients with acute myocardial infarction. These scintigraphic measurements have provided important diagnostic, therapeutic, and prognostic information based on the extent of myocardial damage and the functional reserve of the left ventricle. In particular, in the thrombolytic era, myocardial perfusion imaging and radionuclide angiography have been shown to be valuable methods for studying the effects of reperfusion on the extent of myocardial damage. Nuclear magnetic resonance imaging, preferably with contrast enhancement, is one of the newly developed nuclear imaging techniques that have probably the greatest potential in accurately delineating myocardial infarct size and in evaluating left ventricular function. Radionuclide procedures, on the other hand, employ more biologically oriented tracers and are therefore capable of monitoring biochemical changes in the course of acute myocardial infarction.

Topics: Antibodies, Monoclonal; Contrast Media; Heart; Humans; Indium Radioisotopes; Magnetic Resonance Imaging; Myocardial Infarction; Nitriles; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Ventriculography; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

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

Various noninvasive nuclear imaging techniques provide powerful information regarding infarct site and size, regional and global ventricular function, myocardial perfusion, metabolic function and viability, as well as myocardial salvage after reperfusion in patients with acute coronary syndromes. This information is valuable to clinicians in streamlining diagnostic and therapeutic decision-making for critically ill cardiac patients.

Topics: Angina, Unstable; Critical Care; Heart Ventricles; Humans; Myocardial Infarction; Myocardial Reperfusion; Radionuclide Ventriculography; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

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

Radioisotope studies are currently used mainly to assess the individual risk before and after myocardial infarction. Scintigraphy will be used increasingly to diagnose and localize acute myocardial infarction, to measure the infarct size and to detect reperfusion, whether spontaneous or after lysis, in the infarct area. High sensitivity and specificity are obtained by using tomographic imaging modalities and by the combined and simultaneous use of markers for perfusion and necrosis. This technique allows recognition even of nontransmural infarctions, involvement of the right ventricle, subendocardial necroses, and ischemic injuries in unstable angina pectoris.

Topics: Antibodies, Monoclonal; Diphosphates; Humans; Myocardial Infarction; Myosins; Nitriles; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes

Topics: Coronary Vessels; Diphosphates; Drug Evaluation; Fibrinolytic Agents; Heart; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

In summary, a variety of nuclear techniques may be used to investigate the effects of thrombolytic therapy and myocardial reperfusion. Assessments of global and regional ventricular function, myocardial perfusion, and metabolic integrity are available and appear to add substantially to conventional assessment. Timing of studies appears to be critical. Complementary data can be obtained in both the acute and convalescent phase of myocardial infarction.

Topics: Diphosphates; Fibrinolytic Agents; Heart; Humans; Myocardial Contraction; Myocardial Infarction; Organometallic Compounds; Physical Exertion; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sestamibi; Thallium

Radionuclide techniques for the detection of acutely infarcted myocardium have been available for several years, but they are rarely used. Recent advances, such as the introduction of single-photon emission computed tomography and the introduction of novel radiopharmaceuticals, have suggested new clinical and research applications for them.

Topics: False Positive Reactions; Humans; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates; Tomography, Emission-Computed

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; Heart; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Cardiac Pacing, Artificial; Coronary Vessels; Diphosphates; Dobutamine; Echocardiography; Electrocardiography; Fluid Therapy; Heart; Heart Ventricles; Hemodynamics; Humans; Myocardial Infarction; Nitroprusside; Physical Examination; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Recent advances in perioperative management and surgical technique have been associated with low operative mortality and a high incidence of symptomatic relief in patients undergoing coronary artery bypass graft (CABG) operations. The frequency and importance of perioperative myocardial infarction (MI) and immediate as well as long-term changes in left ventricular (LV) performance are factors of considerable current interest in any critical analysis of the effectiveness of CABG surgery. The present review describes the effects of patient selection, anesthetic techniques, and newer methods of myocardial protection as they relate to perioperative MI and LV performance. In addition, newer tests useful in the diagnosis of perioperative MI are discussed. The application of noninvasive techniques for the serial determination of LV performance and myocardial perfusion in CABG operations is also described.

Topics: Anesthesia; Clinical Enzyme Tests; Coronary Artery Bypass; Diphosphates; Electrocardiography; Exercise Test; Heart; Hemodynamics; Humans; Intraoperative Period; Monitoring, Physiologic; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

Topics: Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Electrocardiography; Heart Atria; Heart Ventricles; Humans; Isoenzymes; Myocardial Infarction; Myocardium; Myoglobin; Myosins; Organotechnetium Compounds; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tetracyclines; Thallium; Tomography, X-Ray Computed

In the patient with cardiac trauma, radionuclide imaging may provide important information about cardiac mechanical function, vascular anatomy and integrity, myocardial perfusion, and myocardial metabolism. Studies require only minimal patient cooperation, can be performed relatively rapidly and often at the bedside, and may be repeated at frequent intervals for serial evaluations. These studies provide valuable adjunctive knowledge when selected and interpreted with knowledge of the mechanism of injury, timing of the examination relative to the time of injury, and most likely differential diagnoses.

Topics: Aged; Contusions; Diagnosis, Differential; Diphosphates; Electric Injuries; Female; Heart Aneurysm; Heart Injuries; Heart Neoplasms; Humans; Male; Methods; Middle Aged; Myocardial Infarction; Myxoma; Pericardial Effusion; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Tricuspid Valve Insufficiency; Wounds, Gunshot

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

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

Topics: Animals; Creatine Kinase; Dogs; Echocardiography; Electrocardiography; Humans; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates; Tomography, X-Ray Computed

Topics: Acute Disease; Animals; Coronary Vessels; Heart; Humans; Myocardial Infarction; Polyphosphates; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates

Topics: Coronary Care Units; Erythrocytes; Heart; Humans; Myocardial Infarction; Polyphosphates; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates

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

Infarct avid scintigraphy has emerged as a noninvasive method for determining the presence, location, and extent of myocardial necrosis secondary to infarction. In the future, it may replace studies such as serum enzyme tests, electrocardiography, and vector cardiography, all of which provide only indirect evidence of these parameters.

Topics: Animals; Diphosphates; False Positive Reactions; Humans; Methods; Myocardial Infarction; Myocardium; Radionuclide Imaging; Recurrence; Technetium; Technetium Tc 99m Pyrophosphate

Few studies have compared the ability of cardiac magnetic resonance (CMR) with that of scintigraphy using 201-thallium (201-Tl) and 99m-technetium pyrophosphate (99m-Tc PYP) to evaluate microvascular obstructions (MOs). In the present study the relationship between the scintigraphic and CMR characteristics of MOs after acute myocardial infarction (MI) was examined.. The 14 patients (age 69±8 years, 11 males) underwent 201-Tl/99m-Tc PYP SPECT 7±3 days, initial CMR 16±12 days, and follow-up CMR 193±20 days after a reperfused first acute MI. Each image was analyzed using a 17-segment model. Segmental extent of delayed enhancement (DE), wall motion (WM) and degree of 201-Tl uptake were scored in 238 segments. Of 91 MI segments, MO was recognized in 22 (25%) segments on CMR. WM was significantly better in proportion to 201-Tl uptake (P=0.01) in MO segments. All 8 MO segments with WM improvement at follow-up had 99m-Tc PYP uptake, although only 3 (21%) of 14 MO segments that did not show WM improvement at follow-up had 99m-Tc PYP uptake (P=0.001).. 99m-Tc PYP and 201-Tl scintigraphy have the potential to predict WM status and improvement of the MO region after reperfused acute MI.

Topics: Aged; Female; Humans; Image Processing, Computer-Assisted; In Vitro Techniques; Magnetic Resonance Angiography; Male; Middle Aged; Myocardial Infarction; Myocardial Perfusion Imaging; Predictive Value of Tests; Radiography; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

We compared Takotsubo cardiomyopathy (transient left ventricular apical ballooning) with acute myocardial infarction (AMI) using two-dimensional echocardiography, 99mTc-tetrofosmin, 99mTc-PYP, 123I-BMIPP and 123I-MIBG myocardial SPECT.. We examined 7 patients with Takotsubo cardiomyopathy and 7 with AMI at the time of emergency admission (acute phase), and 2-14 days (subacute phase), one month (chronic phase), and 3 months (chronic II phase) after the attack. The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored according to five grades from normal (0) to severely abnormal (4).. Coronary angiography showed the absence of stenotic regions in patients with Takotsubo cardiomyopathy, and severely stenotic and/or occlusive lesions in patients with AMI. The total ST segment elevation on electrocardiograms (mm) was 7.8 +/- 3.7 in those with Takotsubo cardiomyopathy, and 7.3 +/- 3.9 in patients with AMI. Abnormal wall motion scores on echocardiograms were 14.2 +/- 4.6, 4.7 +/- 4.0, 1.7 +/- 2.0 and 0.5 +/- 0.4 during the acute, subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 14.0 +/- 4.3, 11.4 +/- 3.9, 8.8 +/- 3.6 and 5.2 +/- 4.8 in those with AMI. Abnormal myocardial perfusion scores on 99mTc-tetrofosmin images were 11.8 +/- 3.5, 3.2 +/- 3.0, 0.5 +/- 1.2 and 0.2 +/- 0.4 during the acute, subacute, chronic and chronic II phases, in patients with Takotsubo cardiomyopathy, and 16.2 +/- 4.3, 13.9 +/- 4.6, 7.9 +/- 4.6 and 5.0 +/- 4.5, respectively, in those with AMI. Abnormal myocardial fatty acid scores on 123I-BMIPP images were 12.6 +/- 3.7, 6.8 +/- 3.2 and 0.4 +/- 0.6 during the subacute, chronic and chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 16.5 +/- 5.1, 14.7 +/- 4.8 and 7.5 +/- 4.5 in those with AMI. Abnormal myocardial sympathetic nerve function scores on 123I-MIBG images were 14.8 +/- 4.0, 8.8 +/- 4.0 and 0.4 +/- 0.6 during the subacute, chronic, chronic II phases, respectively, in patients with Takotsubo cardiomyopathy, and 18.6 +/- 6.5, 16.8 +/- 6.8 and 12.9 +/- 5.2 in those with AMI. Myocardial 99mTc-PYP uptake was abnormal not only in patients with AMI but also in those with Takotsubo cardiomyopathy during the acute phase.. Takotsubo cardiomyopathy might represent a stunned myocardium caused by a disturbance of the coronary microcirculation.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Cardiomyopathies; Diagnosis, Differential; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Syndrome; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

GIK-201Tl imaging reportedly improves the detection of viable myocardium, so the present study evaluated whether it can detect myocardial viability after acute myocardial infarction (AMI).. Resting 201Tl and 99mTc-pyrophosphate (PYP) dual single photon emission computed tomography (SPECT) and 201Tl SPECT after 201Tl with GIK (10% glucose, insulin 5 U, and KCl 10 mmol) infusion (GIK-201Tl) were performed in 25 AMI patients within 10 days of admission. GIK-201Tl SPECT images were obtained immediately and 4 h after infusion. Left ventriculography (LVG) was performed within 3 weeks and at 6 months when follow-up 201Tl SPECT was also performed. From 20 SPECT segments, both the summed defect score (RDS) and the number of defect segments (ES) were calculated. The infarcted area was defined as 99mTc-PYP uptake segments. Wall motion was estimated in 7 LVG segments. The ES of R-201Tl (5.5 +/- 2.8), immediate GIK-201Tl (4.0 +/- 2.3), and 4-h GIK-201Tl (5.6 +/- 2.7) were lower than that of 99mTc-PYP (7.5 +/- 4.1) (p<0.05), and the ES had significantly declined 6 months later on 201Tl (3.5 +/- 2.8) (p<0.05). Although the RDS of R-201Tl (11.3 +/- 7.9) and 4-h GIK-201Tl (11.2 +/- 6.3) were greater than at the 6-month 201Tl (7.1 +/- 6.5), immediate GIK-201Tl (7.4 +/- 6.5) was equivalent to follow-up 201Tl. The sensitivity of immediate GIK-201Tl was highest among the imaging methods.. To detect myocardial viability after AMI, early imaging with GIK-201Tl is more useful than resting 201Tl imaging.

Topics: Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Cardioplegic Solutions; Female; Gated Blood-Pool Imaging; Glucose; Heart; Humans; Insulin; Male; Middle Aged; Myocardial Infarction; Myocardial Stunning; Myocardium; Potassium; Radiopharmaceuticals; Rest; Stents; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Ischemic "memory image" is a phenomenon of 123I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) in which an area at risk of acute myocardial infarction (AMI), could be detected as a defect in a couple of weeks even after successful reperfusion therapy. The purpose of this study was to clarify the incidence of the ischemic "memory image" of 123I-BMIPP in patients with AMI by comparing 99mTc-PYP and 201Tl dual-isotope SPECT. Materials consisted of 14 patients with successfully reperfused AMI and 20 patients with old myocardial infarction (OMI). All AMI patients underwent PYP/Tl dual-isotope SPECT within 1 week after the onset of AMI, and BMIPP SPECT was performed within 1 week after the PYP/Tl dual-isotope SPECT. The extent and severity of the defect of BMIPP and Tl were visually scored into four grades: 0 = no defect to 3 = large or severe defect. These scores were compared. PYP positive AMI lesions were concordant with BMIPP defects (13/14). In AMI, both the extent and severity scores of BMIPP were higher than 201Tl (p < 0.001). Differences (BMIPP - Tl) of extent and severity scores were greater in AMI than in OMI (p < 0.001). In conclusion, the ischemic "memory image" obtained by means of the BMIPP is a common phenomenon (13/14) in AMI, and helpful in evaluating the area at risk.

Topics: Aged; False Negative Reactions; Fatty Acids; Female; Humans; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Myocardial Reperfusion Injury; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed, Single-Photon

201Tl and 99mTc-pyrophosphate (PYP) dual scintigraphy is daily used in the detection of acute myocardial infarction (AMI). However, 201Tl is not available on emergent situation. We proposed a new method for detection of AMI combined 99mTc-PYP with 99mTc-tetrofosmin (TF).. 99mTc-PYP (740 MBq) was administered to 25 patients with AMI, and 3.5 hours later, planar imaging (PYP planar) and SPECT were performed (PYP-SPECT). Immediately after cessation of PYP-SPECT, 99mTc-TF (370-740 MBq) was injected and 5 minutes later SPECT was performed in the same position (TF-SPECT). PYP-SPECT and TF-SPECT were reconstructed in the same geometric status to permit superimpose of PYP-SPECT and TF-SPECT images. Two experts and 2 beginners of nuclear medicine physician interpreted the images in three ways; PYP planar image only, PYP-SPECT, and PYP-SPECT with TF-SPECT.. PYP-SPECT combined with TF-SPECT shows 100% detectability of the AMI lesions, which is significantly higher than other two methods in both experts and beginners.. PYP-SPECT combined with TF-SPECT is a powerful method for detection of AMI.

Topics: Aged; Female; Humans; Male; Myocardial Infarction; Observer Variation; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

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

We evaluated clinical significance of dual-nuclide SPECT imaging (D-SPECT) of thallium-201 and technetium-99m pyrophosphate (PYP) in patients of acute inferior left ventricular infarction with PYP uptake in the right ventricle (PYP (+) group) in comparison with those without PYP uptake (PYP (-) group). There was no difference in coronary risk factors, history of angina, blood pressure, heart rate, and hemodynamics on admission between PYP (+) group and PYP (-) group. The duration from onset to admission was longer in PYP (+) group and coronary reperfusion therapies were carried out in few cases. In 7 of 8 PYP-positive patients, the diagnosis of right ventricular infarction was made only by D-SPECT. Four of 8 were complicated with shock within three days, and the duration of hospitalization was longer. Coronary angiography demonstrated many proximal lesions (50%) in PYP (+) group but few ones (18%) in PYP (-) group. D-SPECT was very useful for diagnosing acute right ventricular infarction, and it might contribute to the prevention of shock if performed within a few days.

Topics: Aged; Aged, 80 and over; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Dual SPECT using 99mTc-PYP and 201Tl was performed in 70 patients with acute myocardial infarction, and the ratio of overlap zone between 201Tl and 99mTc-PYP uptake in the infarcted area was determined (the Y-ratio). The Y-ratio was significantly higher in the group with redistribution in the infarcted area on exercise thallium myocardial scintigraphy in the chronic stage of infarction, as well as in the group with normal left ventricular wall motion. Thus, the Y-ratio value was apparently useful in the evaluation of myocardial viability. Patients from 60% of the Y-ratio upward are suggested that myocardial viability had been survived. When the Y-ratio was determined in 30 patients who underwent early reperfusion therapy (ICT or direct-PTCA), no significant difference was found between the ICT group and the direct-PTCA group. However, the Y-ratio was significantly higher when reperfusion was performed within 6 hours than when it was performed after 6 hours, and a significant positive correlation (r = 0.63, p < 0.01), was found between reperfusion time from cardiac event within 9 hours and the value of (100--the Y-ratio).. The Y-ratio was grateful appeared to be useful for the quantitative evaluation of myocardial viability in the acute stage of myocardial infarction. In addition, it appears to be important to perform reperfusion as soon as possible to improve myocardial salvage.

Topics: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Myocardium; Predictive Value of Tests; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Thrombolytic Therapy; Tissue Survival; Tomography, Emission-Computed, Single-Photon

In a subgroup of 45 patients with acute myocardial infarction (AMI) from the German multicenter trial of anisoylated plasminogen streptokinase activator complex (APSAC) (n = 20) versus heparin (n = 25), simultaneous thallium (TI)-201 technetium (Tc)-99m pyrophosphate (PYP) tomography was initiated to elucidate a possible benefit of APSAC over heparin. Findings in the 2 treatment groups were similar with respect to TI-201 defect score, relative scintigraphic infarct size, and in keeping with the main group coronary artery patency, global ejection fraction and maximal creatine kinase level. However, 2 different TI-201/Tc-99m PYP accumulation patterns within the area of infarction (homogeneous, group A; inhomogeneous, group B) were identified. Both treatment groups were similar with regard to the frequency of the homogeneous and inhomogeneous pattern. In comparing the 2 accumulation patterns, creatine kinase peaked earlier in group A than in group B, and global left ventricular ejection fraction was significantly higher in group A than in group B. In Group A, 30 of 31 patients and in group B 7 of 11 patients had a patent infarct-related vessel (p < 0.025). TI-201 defect score was lower in group A than in group B. Likewise, relative size of the infarction as determined from Tc-99m PYP images was significantly lower in group A than in group B. Fifteen patients experienced cardiogenic shock or severe heart failure. Patients in group B had a higher incidence of these in-hospital complications than patients in group A (92 vs 12%, p < 0.0005). Scintigraphic infarct size and TI-201 defect score were greater in patients with the aforementioned clinical events.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anistreplase; Coronary Circulation; Coronary Vessels; Creatine Kinase; Female; Heparin; Humans; Male; Middle Aged; Myocardial Infarction; Stroke Volume; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Thrombolytic Therapy; Tomography, Emission-Computed; Vascular Patency; Ventricular Function, Left

Clinical value of 111In-antimyosin monoclonal antibody F ab (AM) was compared with 99mTc-pyrophosphate (PYP) in 13 patients with myocardial infarction and 3 patients with myocarditis. Following PYP injection, PYP imaging was performed 3 hours later. Immediately after PYP imaging, AM was administrated and AM images were obtained 48 hours later. Abnormal accumulation in the infarcted myocardium was observed in 11 patients (85%) on AM images but only in 3 patients (23%) on PYP images. All patients within 8 days after the onset of infarction showed abnormal uptake on both images. Of 5 patients with 1 to 2 weeks after the onset of infarction, abnormal uptake was observed in all of them on AM images but only in one of them on PYP imaging. Furthermore, of 6 patients with more than 2 weeks after the onset, AM imaging showed abnormal uptake in 4 (67%) but PYP imaging did not show abnormal uptake in any of them. Similarly. Of 3 patients with myocarditis, diffuse uptake in the myocardium ws observed in 2 of them on AM images but none of them showed abnormal uptake on PYP images. We conclude that AM imaging is a useful means for identifying not only acute stages but also subacute stages of myocardial necrosis where PYP imaging did not show any abnormality.

Topics: Adult; Aged; Antibodies, Monoclonal; Clinical Trials as Topic; Diphosphates; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Myocardial Infarction; Myocarditis; Myosins; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The effects of abrupt withdrawal or continuation of beta-blockade therapy during acute myocardial infarction were evaluated in 326 patients participating in the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Thirty-nine patients previously receiving a beta-blocker and randomly selected for withdrawal of beta-blockers and placebo treatment during infarction (group 1) were compared with 272 patients previously untreated with beta-blockers who were also randomly assigned to placebo therapy (group 2). There were no significant differences between the two groups in MB creatine kinase isoenzyme (15.8 +/- 10.9 vs 18.2 +/- 14.4 g-eq/m2, respectively) estimates of infarct size, radionuclide-determined left ventricular ejection fractions within 18 hr of infarction (0.44 +/- 0.15 vs 0.47 +/- 0.16) or 10 days later (0.42 +/- 0.14 vs 0.47 +/- 0.16), creatine kinase-determined incidence of infarct extension (13% vs 6%), congestive heart failure (43% vs 37%), nonfatal ventricular fibrillation (5% vs 7%), or in-hospital mortality (13% vs 9%). Patients in group 1 had more recurrent ischemic chest pain (p = .002) within the first 24 hr after infarction, but not thereafter. However, this did not appear to be related to a rebound increase in systolic blood pressure, heart rate, or double product. In a separate analysis, 20 propranolol-eligible group 1 patients randomly selected for withdrawal of beta-blockade (group 3) were compared with 15 patients randomly selected for continuation of prior beta-blockade therapy (group 4). This comparison yielded similar results. These data indicate that the beta-blockade withdrawal phenomenon is not a major clinical problem in patients with acute myocardial infarction. beta-Blockade therapy can be discontinued abruptly during acute myocardial infarction if clinically indicated.

Topics: Aged; Ambulatory Care; Angina Pectoris; Blood Pressure; Clinical Trials as Topic; Creatine Kinase; Diphosphates; Electrocardiography; Female; Heart Rate; Heart Ventricles; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Propranolol; Radionuclide Imaging; Random Allocation; Substance Withdrawal Syndrome; Technetium; Technetium Tc 99m Pyrophosphate

The effects of coronary artery recanalization by intracoronary administration of streptokinase on left ventricular function during acute myocardial infarction have received increasing attention in recent years. Although myocardial dysfunction is often more pronounced in the right ventricle than in the left ventricle in patients with acute inferior wall myocardial infarction, the effect of coronary artery recanalization on right ventricular dysfunction has not been previously addressed. Accordingly, in this investigation, 54 patients who participated in a prospective, controlled, randomized trial of recanalization during acute myocardial infarction were studied. Among 30 patients with inferior wall infarction, 19 had right ventricular dysfunction on admission; 11 of these 19 had positive uptake of technetium-99m pyrophosphate in the right ventricle, indicative of right ventricular infarction. Patients with successful recanalization (n = 6) exhibited improved right ventricular ejection fraction from admission to day 10 (26 +/- 7 to 39 +/- 14%, p less than 0.03). However, control patients (n = 6) and patients who did not undergo recanalization (n = 7) also exhibited improvement (20 +/- 7 to 29 +/- 11% [p less than 0.02] and 30 +/- 8 to 40 +/- 6% [p less than 0.03], respectively). Improvement in several other variables of right ventricular dysfunction evolved at an equal rate with the ejection fraction changes. Patients with or without right ventricular infarction improved similarly. These data indicate that the right ventricular dysfunction commonly associated with inferior wall infarction is often transient, and improvement is the rule, irrespective of early recanalization of the "infarct vessel."

Topics: Aged; Clinical Trials as Topic; Coronary Circulation; Coronary Vessels; Diphosphates; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Random Allocation; Streptokinase; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

The authors prospectively compared the ability of Tc-99m pyrophosphate (PYP) and Tc-99m methylene diphosphonate (MDP) to detect acute myocardial infarctions. The agents used were PYP (12 mg) with 3.4 mg of stannous chloride, MDP (10 mg) with 1.0 mg of stannous chloride, and MDP (10 mg) with 3.4 mg of stannous chloride. Imaging was performed on three consecutive days on 34 patients with proven myocardial infarctions, using the same agent on the first and third days of the study and an alternate agent on the second day. Agents were assigned randomly to each of six groups of patients. First images were obtained an average of 3.7 days (range, one to six days) following myocardial infarction. Seventeen of 23 patients (75%) had images positive for acute myocardial infarction with Tc-99m PYP, whereas only two of 21 patients (9.5%) had positive studies with Tc-99m MDP with 3.4 mg of stannous chloride and one of 24 patients (4.2%) had positive studies with Tc-99m MDP and 1.0 mg of stannous chloride. All three myocardial infarctions detected by Tc-99m MDP were extensive and transmural. When MDP and PYP were both positive in the same patient, the apparent size of the myocardial infarction was much smaller with the MDP. It is concluded that MDP can detect only large myocardial infarctions, has poor localization in the infarcted tissue, and varying the stannous chloride content of the preparation does not improve the ability of MDP to detect acute myocardial infarctions.

Topics: Adult; Aged; Diphosphonates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tin; Tin Compounds; Tin Polyphosphates

Topics: Adult; Aged; Clinical Trials as Topic; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Clinical Trials as Topic; Diphosphates; Diphosphonates; Double-Blind Method; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Aged; Computed Tomography Angiography; Contrast Media; Humans; Male; Myocardial Infarction; Percutaneous Coronary Intervention; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Topics: Cardiology; Contrast Media; Coronary Angiography; Electrocardiography; Female; Heart Septum; Humans; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Cardiotoxicity in acute aconitine intoxication is well known; however, elevation of troponin I level and abnormal scintigraphy findings had not previously been reported.. A 60-year-old man developed chest tightness, syncope and convulsion after ingesting processed Aconitum carmichaeli (Chuanwu) extract for treatment of headache. Electrocardiogram showed first degree atrioventricular (AV) block. Troponin I level was elevated at 14.8 ng/mL 13 hours post-ingestion. Creatine kinase was also increased to 414 U/L. However, echocardiography did not show any abnormal cardiac wall motion. Tc-99m-PYP scintigraphy revealed diffusely increased uptake in the myocardium, suggesting the presence of myocardial necrosis or myocarditis.. Aconitine poisoning can mimic acute myocardial infarction with chest tightness and elevated cardiac enzymes. Increased cardiac markers and myocardial insult seen in this patient were likely to be related to the toxicity of aconitine. Care should be taken in making the diagnosis in such instances. Management is primarily supportive.

Topics: Aconitine; Creatine Kinase; Diagnosis, Differential; Drugs, Chinese Herbal; Echocardiography; Humans; Male; Middle Aged; Myocardial Infarction; Plant Extracts; Poisoning; Powders; Technetium Tc 99m Pyrophosphate; Troponin I

Microcirculatory failure after reperfusion is clinically indicated to cause reperfusion injury whereas excessive intracellular calcium ion overload is experimentally proved as a key mechanism of reperfusion injury. We hypothesized that technetium-99m ((99m)Tc) pyrophosphate (Tc-PYP) uptake in injured but viable infarct-related myocardium with preserved myocardial perfusion after reperfusion estimated by thallium-201 ((201)Tl) uptake would be associated with final functional recovery.. Dual-isotope Tc-PYP/(201)Tl single-photon emission computed tomography (SPECT) was performed 2 days after successful reperfusion therapy in patients with first acute myocardial infarction, and 50 patients (63 +/- 13 years old, female 22%) with preserved (201)Tl uptakes of > or = 50% in reperfused myocardium was followed for 1 month. Tc-PYP uptake was assessed as the heart-to-sternum (H/S) ratio. Two-dimensional echocardiography was also performed 2 days and 1 month after reperfusion to evaluate functional recovery.. High Tc-PYP uptake, defined as the H/S ratio > or = 0.81, was predictive of chronic phase no functional recovery (73.7% in 14 of 19 patients with high uptake vs 16.1% in five of 31 patients without those, p < 0.0001). After adjustment for potential confounding variables, including electrocardiographic persistent ST segment elevation at 1 h after reperfusion, high Tc-PYP uptake remained independently predictive of no functional recovery with odds ratio of 8.7 (95% confidential interval = 2 to 38.7; p = 0.005).. High Tc-PYP uptake in reperfused but viable infarct-related myocardium was a powerful predictor of no functional recovery, which may reflect excessive intracellular calcium ion overload caused by reperfusion injury. Tc-PYP/(201)Tl dual-isotope SPECT imaging can provide prognostic information after reperfusion.

Topics: Humans; Myocardial Infarction; Myocardial Reperfusion Injury; Recovery of Function; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

A 42-year-old woman presented with chest pain and ECG changes suggestive of acute myocardial infarction. However, a coronary angiogram showed no significant epicardial coronary stenosis. Nonetheless, abnormal Tc-99m pyrophosphate activity accumulated within the inferolateral wall, consistent with acute necrosis. Cardiac magnetic resonance revealed near transmural extent of late gadolinium-enhancement with mild hypokinesis in the mid to basal inferolateral segments. Dipyridamole Tl-201 single photon emission computed tomography 6 months later demonstrated stress-induced ischemia in the corresponding area, with subendocardial scar in the mid level. Nuclear perfusion scintigraphy is needed for accurate assessment of infarct size and coronary flow after the acute stage of a myocardial infarction has passed.

Topics: Adult; Contrast Media; Coronary Stenosis; Female; Humans; Magnetic Resonance Imaging; Myocardial Infarction; Myocardial Perfusion Imaging; Technetium Tc 99m Pyrophosphate; Ultrasonography

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

This study was designed to evaluate the factors that affect myocardial salvage after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).. One hundred and eighty-three patients with AMI who had undergone successful PCI were recruited for this study. Patients underwent (99m)Tc-pyrophosphate single photon emission computed tomography (SPECT) on the third day and (99m)Tc-MIBI SPECT on the sixth day after admission. In the 20 SPECT segments, the summed defect score (TDS) and extent score (ES) of AMI segments were determined and the percentage of the salvaged myocardium was calculated based on the TDS and ES. We performed multivariate analysis to evaluate factors that can affect myocardial salvage. Multivariate analysis was performed among the value of myocardial salvage rate and the 15 clinical variables. Administration of nicorandil (p=0.006), prodromal angina (p<0.001), and high TIMI grade (p<0.001) had significant positive correlation to myocardial salvage rate. Use of a distal protection device had a significant negative correlation with myocardial salvage rate (p=0.006).. The presence of high TIMI grade before PCI and prodromal angina are very important for salvaging myocardium. Furthermore, administration of nicorandil is important in salvaging myocardium in patients with AMI.

Topics: Angioplasty, Balloon, Coronary; Female; Humans; Male; Middle Aged; Myocardial Infarction; Nicorandil; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

Topics: Aged, 80 and over; Aortic Valve Stenosis; Coronary Stenosis; Endocardium; Female; Humans; Image Enhancement; Myocardial Infarction; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed, Single-Photon

An 86-year-old man with chest pain was admitted to our hospital. Coronary angiography revealed 99% stenosis of the mid segment of the left anterior descending coronary artery, therefore, a coronary stent was implanted. Immediately after the stent implantation, 99% stenosis occurred at the proximal site of the 1st diagonal artery because of stent jeal. On the 4th hospital day, ECG-gated 201TL/99mTc-PYP dual myocardial quantitative gated SPECT was performed at rest and during low-dose dobutamine loading. The 201Tl scintigraphy revealed moderately reduced uptake in the anterior, septal and apical walls, and 99mTc-PYP uptake was observed in the mid-anterior wall. A three-dimensional surface display of gated 201Tl SPECT images showed severe hypokinesis in the anterior, septal and apical walls at rest. On the other hand, during low-dose dobutamine loading, improved wall motion was observed in the basal anterior and septal walls, while no change was observed in the midanterior and apical wall movements. Three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed similar patterns of wall motion as those of gated 201Tl SPECT images at rest. During low-dose dobutamine loading, on the other hand, a three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images revealed improved wall motion in the basal anterior, septal and apical walls, but worsened wall motion of the mid-anterior wall. After 6 months, a follow-up coronary angiography revealed no re-stenosis of the stent, but 99% stenosis at the proximal aspect of the 1st diagonal artery. Left ventriculography revealed improved wall motion in the apex and akinesis of the mid-anterior wall. These wall motion findings were similar to those visualized in the three-dimensional surface display of gated 201Tl/99mTc-PYP dual SPECT images during low-dose dobutamine loading in the acute phase. These results suggest that 201Tl/99mTc-PYP dual myocardial quantitative gated SPECT using low-dose dobutamine loading could be useful for the assessment of myocardial viability after reperfusion therapy in patients with acute myocardial infarction.

Topics: Aged, 80 and over; Coronary Angiography; Coronary Artery Bypass; Dobutamine; Gated Blood-Pool Imaging; Heart; Humans; Male; Myocardial Contraction; Myocardial Infarction; Radiopharmaceuticals; Stents; Technetium Tc 99m Pyrophosphate; Tissue Survival; Tomography, Emission-Computed, Single-Photon

This report describes a 77-year-old woman with a single coronary artery who suffered an acute anterior wall myocardial infarction. The single coronary artery arose from the right coronary artery through the transverse trunk, and there were no other cardiovascular anomalies. Coronary angiography did not reveal significant coronary artery stenosis in the left anterior descending artery. The patient was treated medically in the acute phase. She developed typical angina and evidence of myocardial ischemia, and underwent successful coronary artery bypass grafting in the chronic phase with anterior chest pain.

Topics: Aged; Angina Pectoris; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies; Electrocardiography; Female; Heart; Humans; Myocardial Infarction; Myocardial Ischemia; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

We reported a case of a 72-year-old man with chest pain. An electrocardiogram showed ST segment elevation in I, II, III, aVL, aVF and V1-6 leads. 99mTc-tetrofosmin myocardial SPECT showed defect in the anterior, septal, apical and inferior walls. Coronary angiography showed 99% stenosis of the proximal right coronary artery and total occlusion of the midsegment of the left anterior descending coronary artery. Therefore, direct PTCA was performed for each lesion to achieve reperfusion. We didnt's see reperfusion injury during PTCA of the left coronary artery. On the other side, we saw severe reperfusion injury, such as slow-flow, arrhythmia and falling blood pressure during PTCA of the right coronary artery. After four hours, 99mTc-PYP myocardial SPECT showed marked uptake in the apical and inferior walls, and mild uptake in the anterior and posterior walls. After three days, severely-reduced uptake of 99mTc-PYP in the apex was noted, and mild uptake in the mid-portion of the anterior wall and the mid-portion of the inferior wall. Though reperfusion injury was seen, three was mild myocardial uptake of 99mTc-PYP in the area of the right coronary artery. On the other side, despite no reperfusion injury, there showed marked uptake during the acute phase and defect during the subacute phase in the area of the left coronary artery. Wall motion of the left ventricle was normal in the area of the right coronary artery and akinesis was seen on the left. These findings suggest that 99mTc-tetrofosmin and 99mTc-PYP myocardial SPECT are useful for visualization of reperfusion injury during the acute phase and for estimation of function during the chronic phase, better even than electrocardiogram or coronary angiography.

Topics: Acute-Phase Reaction; Aged; Angioplasty, Balloon, Coronary; Humans; Male; Myocardial Infarction; Myocardial Reperfusion Injury; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

A 76-year-old man with chest pain was admitted to hospital where electrocardiography (ECG) showed ST-segment elevation in leads V1-4, indicative of acute anterior myocardial infarction. ST-segment elevation was also present in the right precordial leads V4R-6R. Emergency coronary angiography revealed that the left coronary artery was dominant and did not have significant stenosis. Aortography showed ostial occlusion of the right coronary artery (RCA). Left ventriculography showed normal function and right ventriculography showed a dilated right ventricle and severe hypokinesis of the right ventricular free wall. Conservative treatment was selected because the patient's symptoms soon ameliorated and his hemodynamics was stable. 99mTc-pyrophosphate and 201Tl dual single-photon emission computed tomography showed uptake of 99mTc-pyrophosphate in only the right ventricular free wall, but no uptake of 99mTc-pyrophosphate and no perfusion defect of 201Tl in the left ventricle. The peak creatine kinase (CK) and CK-MB were 1,381 IU/L and 127 IU/L, respectively. His natural course was favorable and the chest pain disappeared under medication. Two months after the onset, the ECG showed poor R progression in leads V1-4 indicating an old anterior infarction. Coronary angiography confirmed the ostial stenosis of the hypoplastic RCA. This was a case of pure right ventricular free wall infarction because of the occlusion of the ostium of the hypoplastic RCA, but not of the right ventricular branch. Because the electrocardiographic findings resemble those of an acute anterior infarction, it is important to consider pure right ventricular infarction in the differential diagnosis.

Topics: Aged; Coronary Angiography; Electrocardiography; Hemodynamics; Humans; Myocardial Infarction; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Ventricular Dysfunction, Right

Myocardial viability in area at risk of acute myocardial infarction (AMI) after reperfusion therapy may be underestimated by the 24-hour images due to reverse redistribution (r-RD).. Subjects were 37 AMI patients in whom Tc-99m pyrophosphate (PYP)/Tl-201 dual-isotope SPECT was positive. The 24-hour delayed scan was performed with only a Tl window. One month later, follow up rest Tl SPECT was performed to evaluate myocardial viability. In early (at PYP/Tl-201 dual-isotope SPECT), 24-hour, and one month follow up Tl studies, Tl uptake in the area of AMI was scored into four grades: 3 as normal to 0 as severely reduced. The scores were evaluated.. Among the 37 AMI lesions, there were 16 r-RD, 3 RD, 16 fixed defect (FD) and 2 normal (positive PYP and normal Tl). Mean Tl scores were early; 1.4 +/- 1.1, 24-hr; 0.9 +/- 0.9 and one month; 1.3 +/- 1.1. The 24-hour Tl score was lower than the early and one month Tl scores (p < 0.01).. Reverse redistribution is frequently observed in an area at risk where PYP SPECT was positive. Nuclear medicine physicians should be aware of the existence of frequent r-RD in Tl scan to avoid the underestimation of myocardial viability in the acute phase after PTCA.

Topics: Aged; Angioplasty, Balloon, Coronary; Female; Humans; Male; Myocardial Infarction; Myocardial Reperfusion; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Time Factors; Tomography, Emission-Computed, Single-Photon

A new method was devised to estimate infarct size using dual single photon emission computed tomography with thallium-201 and technetium-99m pyrophosphate. Designating the ratio of infarct area to whole myocardial volume as %MI, the correlation of %MI with other markers of left ventricular dysfunction was examined: peak creatine kinase, ejection fraction and left ventricular asynergy. As %MI correlated well with these markers, it is considered that %MI will be useful for estimating infarct size and predicting the severity of left ventricular dysfunction in the early stage of acute myocardial infarction.

Topics: Adult; Aged; Aged, 80 and over; Creatine Kinase; Female; Humans; Male; Middle Aged; Myocardial Infarction; Stroke Volume; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

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

Factor analysis of dynamic structures (FADS) facilitates the extraction of relevant data, usually with physiologic meaning, from a dynamic set of images. The result of this process is a set of factor images and curves plus some residual activity. The set of factor images and curves can be used to retrieve the original data with reduced noise using an inverse factor analysis process (iFADS). This improvement in image quality is expected because the inverse process does not use the residual activity, assumed to be made of noise. The goal of this work is to quantitate and assess the efficiency of this method on gated cardiac images.. A computer simulation of a planar cardiac gated study was performed. The simulated images were added with noise and processed by the FADS-iFADS program. The signal-to-noise ratios (SNRs) were compared between original and processed data. Planar gated cardiac studies from 10 patients were tested. The data processed by FADS-iFADS were subtracted to the original data. The result of the substraction was studied to evaluate its noisy nature.. The SNR is about five times greater after the FADS-iFADS process. The difference between original and processed data is noise only, i.e., processed data equals original data minus some white noise.. The FADS-iFADS process is successful in the removal of an important part of the noise and therefore is a tool to improve the image quality of cardiac images. This tool does not decrease the spatial resolution (compared with smoothing filters) and does not lose details (compared with frequential filters). Once the number of factors is chosen, this method is not operator dependent.

Topics: Computer Simulation; Factor Analysis, Statistical; Female; Heart; Humans; Image Enhancement; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate

Topics: Aged; Fibrinolytic Agents; Humans; Male; Myocardial Infarction; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Renal Insufficiency; Rhabdomyolysis; Streptokinase; Technetium Tc 99m Pyrophosphate; Thrombolytic Therapy; Whole-Body Counting

A 72-year-old woman who presented with transient electrocardiographic ST segment elevation and left ventricular asynergy in an acute phase of subarachnoid hemorrhage was found to have normal coronary angiogram and normal Tc-99m PYP myocardial infarct scan. These findings suggested that noninvasive Tc-99m PYP myocardial infarct scan could substitute coronary angiogram for differentiating wall motion and electrocardiographic abnormalities secondary to subarachnoid hemorrhage from those caused by coronary artery disease in patients with subarachnoid hemorrhage.

Topics: Aged; Coronary Angiography; Coronary Vessels; Electrocardiography; Female; Humans; Myocardial Infarction; Radionuclide Imaging; Subarachnoid Hemorrhage; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed; Ventricular Dysfunction, Left

To evaluate whether the findings of dual single-photon emission computed tomography (SPECT) with technetium-99m pyrophosphate (Tc-99m PPi) and thallium-201 were predictive of further cardiac events in their hospital course, we studied 130 patients recovering from acute myocardial infarction (AMI). Fifty-four patients showed overlapping of Tc-99m PPi and thallium-201 in the same location (overlap positive group), and 76 patients had no overlap (overlap negative group). Of the 130 patients, 36 (28%) had a cardiac event. In patients in the overlap positive group, the incidence of subsequent events was significantly higher than in patients in the overlap negative group (44% versus 16%; p < 0.001). In the overlap positive group, the Tc-99m PPi uptake score and the number of overlap segments in patients with further events was significantly higher than those in patients without further events (10.2 +/- 5.1 versus 6.4 +/- 4.1, p < 0.005 and 5.2 +/- 2.0 versus 3.3 +/- 1.3, p < 0.001, respectively). These results suggest that patients who have a Tc-99m PPi and thallium-201 overlap negative scan can be candidates for early hospital discharge. In contrast, patients who have a greater number of overlap segments may require early catheterization and revascularization, so that simultaneous SPECT imaging Tc-99m PPi and thallium-201 might be useful for identifying patients with further ischemic risk after AMI in their hospital course.

Topics: Aged; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Prognosis; Radiopharmaceuticals; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

We present the case of a young man who suffered severe anteroapical myocardial necrosis caused by electrocution. In addition to the enzymatic and electrocardiographic changes suggesting necrosis, a clear positive segmental image on 99mTc-pyrophosphate scintigraphy and a defect on a 201Tl SPECT scan at rest were also found. Although these tests were indicative of extensive anteroapical transmural myocardial necrosis, the echocardiographic study only revealed mild anteroapical hypokinesia.

Topics: Adult; Electric Injuries; Electrocardiography; Heart Arrest; Heart Injuries; Humans; Male; Myocardial Infarction; Myocardium; Necrosis; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

To evaluate the area at risk and the myocardial viability of acute myocardial infarction (AMI), we compared rest 123I-beta-methyl iodophenyl pentadecanoic acid (123I-BMIPP) and 201Tl myocardial SPECT with 201Tl/99mTc-PYP dual SPECT (D-SPECT) in 65 patients (mean age 64 +/- 11 years) with AMI. D-SPECT was performed in 3 to 5 days, 123I-BMIPP myocardial SPECT in 5 to 7 days, and left ventriculography on 1 month after onset of AMI. Furthermore, 201Tl/123I-BMIPP myocardial SPECT and left ventriculography were performed on 4 months after onset of AMI. The area which showed the reduced 123I-BMIPP uptake was larger than that showed the accumulation of 99mTc-PYP. The improvement of regional wall motion on 4 months after onset of AMI tended to be more closely correlated with the existence of discrepancy zone between 201Tl and 123I-BMIPP uptake than that of overlap zone between 201Tl and 99mTc-PYP uptake in acute period. We conclude that 201Tl/123I-BMIPP myocardial SPECT is more useful to evaluate the area at risk and myocardial viability of AMI than D-SPECT.

Topics: Aged; Fatty Acids; Female; Heart; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Risk; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tissue Survival; Tomography, Emission-Computed, Single-Photon

We report a previously healthy 17-year-old woman who experienced coronary artery dissection with an acute transmural anterior myocardial infarction and myocardial contusion following blunt chest trauma in a motorcycle accident. A chest roentgenogram on admission was normal, and an electrocardiogram showed an acute transmural anterior myocardial infarction with complete right-bundle-branch block. A 2D echocardiogram revealed an akinesis of the anterior wall and a hypokinesis of the posterior wall in the left ventricle. Initial coronary angiography demonstrated severe stenosis with delayed antegrade filling in the proximal left anterior descending artery. Technetium-99m pyrophosphate myocardia scintigraphy demonstrated diffuse tracer uptake in the left ventricular wall. Follow-up coronary angiography performed 1 year after the accident showed a minor stenosis without any filling defects. We describe long-term follow-up of the coronary artery dissection following blunt chest trauma with spontaneous healing.

Topics: Adolescent; Aortic Dissection; Coronary Aneurysm; Coronary Angiography; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Heart Injuries; Humans; Myocardial Infarction; Radiopharmaceuticals; Remission, Spontaneous; Technetium Tc 99m Pyrophosphate; Wounds, Nonpenetrating

Ischemic cell injury and the uptake mechanism of 99mTc-PYP (Pyrophosphate) were studied with preconditioning and calcium antagonist.. The coronary artery of an adult mongrel dog was clamped for 1 hour, followed by reperfusion and 99mTc-PYP injection. A control group (group C, n = 8), a group in which continuous drip infusion of diltiazem (10 mg/kg) (group D, n = 7), and a group preconditioned by six 5-minute clampings and perfusions before occlusion (group P, n = 6) were compared.. Wall motion was fully recovered in group D but not in group P after 2 hours of reperfusion. The 99mTc-PYP uptake ratio showed a significant (p < 0.05) reduction in group D (11.5 : 3.6 compared with group C), but not in group P (11.5 : 9.1, p = 0.25). The infarct area was 1.2 +/- 0.6% of the left ventricle in group D, 1.3 +/- 0.4 in group P, and 6.4 +/- 1.0 in group C (p < 0.01 in groups D and P vs. group C).. These findings suggest that preconditioning does not alleviate stunning, but it improves cell injury in spite of high uptake of 99mTc-PYP. Diltiazem protects from both stunning and cell injury, suggesting a different mechanism of myocardial protection from that of preconditioning.

Topics: Animals; Calcium Channel Blockers; Coronary Circulation; Diltiazem; Dogs; Myocardial Infarction; Myocardial Ischemia; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

Simultaneously acquired dual-isotope imaging is a unique and useful approach in SPECT. Photon spillover, however, is a potential limitation of this technique.. To investigate the degree of 99mTc downscatter into the 201Tl window in patients, simultaneously acquired dual-isotope 201Tl/99mTc-pyrophosphate imaging was performed in 17 patients with acute myocardial infarction (MI). Thallium-201 SPECT imaging was performed first, with a 201Tl photopeak window after the 201Tl injection (early 201Tl images), followed by 99mTc injection and SPECT acquisition using dual-isotope windows (dual 201Tl images). Twenty-four hours after the 99mTc injection, a third set of 201Tl images was obtained (24-hr 201Tl images). Thallium defect size (extent score) and defect severity (severity score) were calculated from these three sets of 201Tl images to quantify the MI.. Technetium-99m accumulation of varying intensity was recognized in all patients. Extent scores and severity scores were identical in early 201Tl images and 24-hr 201Tl images. Both scores, however, in the dual 201Tl images were decreased by 36% and 53%, respectively.. There in a considerable 99mTc downscatter into the 201Tl window, which prevents precise quantification of MI in simultaneously acquired dual-isotope 201Tl/99mTc-pyrophosphate imaging.

Topics: Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Time Factors; Tomography, Emission-Computed, Single-Photon

The aim of this study was to evaluate the role of volume-rendered three-dimensional imaging in the diagnosis of acute myocardial infarction (AMI) using 99Tcm-pyrophosphate (99Tcm-PYP) scintigraphy in a diagnostically difficult group of patients. In total, 117 patients were studied using planar, single photon emission tomography (SPET) and 3-D volume-rendered imaging performed 3 h after receiving 555 MBq (15 mCi) of 99Tcm-PYP intravenously. 555MBq (15 mCi) of 99Tcm-PYP intravenously. Two teams of physicians reported in a blinded and random fashion on each planar, SPET and 3-D rotating image study. Individual reports were compared with reports that used all three imaging modalities in combination. Observer reproducibility was between 85 and 90% and inter-observer team agreement was between 87 and 91%. A score based on clinical history, electrocardiography, serum cardiac enzyme levels and cardiac risk factors was validated and used as a de facto 'gold standard' for AMI for 75 of the subjects for whom all these details were available. The sensitivity, specificity and overall accuracy of combined planar, SPET and 3-D rotating image modalities were all 84%. Analysis of each modality in isolation showed SPET imaging to have the highest sensitivity (74%) and specificity (89%). In combination with SPET and planar imaging, 3-D rotation image presentation increases diagnostic sensitivity without appreciably altering overall diagnostic accuracy. 99Tcm-PYP myocardial SPET imaging shows good utility in the diagnosis of AMI in diagnostically difficult patients.

Topics: Adult; Chest Pain; Humans; Myocardial Infarction; Observer Variation; Predictive Value of Tests; Random Allocation; Reproducibility of Results; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Detection of acute myocardial infarction by SPECT with Tc-99m pyrophosphate is complicated by overlying bony structures, such as the ribs and sternum. The authors report a technique using volume rendered rotating SPECT images with digital subtraction of overlying ribs. The technique is described and illustrated by case reports in which the diagnostic accuracy was improved with its use. This technique has diagnostic use in difficult clinical cases, and where avid radiotracer uptake in the ribs or sternum obscures the underlying myocardium.

Topics: Female; Humans; Male; Middle Aged; Myocardial Infarction; Subtraction Technique; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Topics: Antibodies, Monoclonal; Heart; Humans; Indium Radioisotopes; Myocardial Infarction; Organometallic Compounds; Prognosis; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Topics: Antibodies, Monoclonal; Cardiomyopathies; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Contrast Media; Diagnosis, Differential; Heart Diseases; Heart Transplantation; Humans; Indium Radioisotopes; Myocardial Infarction; Myocarditis; Myosins; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes

Technetium-99m-pyrophosphate (PYP) is bound to calcium in necrotic myocardium and has been used clinically to evaluate myocardial infarction. Technetium-99m-PYP is also reported to accumulate in myocardium with unstable angina pectoris and it is speculated that severe ischemia with noninfarcted tissue may also increase uptake of 99mTc-PYP. In this paper, 99mTc-PYP uptake was determined in various models of myocardial ischemia of short duration to examine its applicability to the assessment of myocardial viability.. In 23 open-chest dogs under anesthesia, models of ischemia-reperfusion of the left anterior descending artery (LAD) subjected to ischemia for 10, 30 or 60 min were produced. Wall motion was examined by echocardiography and myocardial blood flow was calculated using colored microspheres. Technetium-99m-PYP was injected after each ischemic intervention and reperfusion.. Technetium-99m-PYP showed 1.18 +/- 0.009 in the uptake ratio (ischemic area/normal area) following 10-min ischemia (11 dogs). The uptake ratio following 30-min ischemia (8 dogs) showed a significantly higher increase than that following 10-min ischemia (4.09 +/- 1.75; p < 0.05), permitting in vivo and ex vivo imaging. After 60-min ischemia resulting in infarction (4 dogs), 99mTc-PYP uptake of the ischemic area showed an uptake ten times that of the normal area (transmural: 12.2 +/- 2.9, epicardium: 7.5 +/- 1.9, endocardium: 16.8 +/- 4.1).. These findings indicate that since 99mTc-PYP accumulates in injured myocardium, its concurrent use with blood flow imaging is useful for the assessment of severity of ischemia, injured area and myocardial viability.

Topics: Animals; Coronary Circulation; Dogs; Heart; Myocardial Contraction; Myocardial Infarction; Myocardial Ischemia; Myocardial Reperfusion Injury; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Time Factors; Tissue Survival

Left ventricular contraction is routinely assessed by radionuclide ventriculography. Although a planar image is conventionally used, tomography has been to improve the detection of wall motion abnormalities. A blood pool image is often used in positron emission tomography on which to superimpose metabolic tracers. Can this image also be used to assess left ventricular contraction? Nine healthy controls, mean (S.D.) age 55 (5) years, and 12 patients, mean (S.D.) age 61 (8) years, with normal, proven or suspected left ventricular damage underwent blood pool tomography with 11CO positron emission tomography (PET) and 99Tcm single photon emission computed tomography (SPECT). A normal value of ejection fraction and range of phase were defined. The normal left ventricular ejection fraction was > or = 37% for PET and > or = 40% for SPECT. The ejection fractions obtained by the two methods in the patient group were positively correlated (r = 0.89, P < 0.001). Abnormalities of left ventricular contraction were detected in nine patients by PET and 10 patients by SPECT imaging. The discrepancy was in a patient with a previous inferior myocardial infarction. Blood pool imaging with 11CO PET can be used to assess left ventricular ejection fraction and regional wall motion.

Topics: Carbon Monoxide; Carbon Radioisotopes; Female; Fourier Analysis; Gated Blood-Pool Imaging; Heart Diseases; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Myocardial Infarction; Stroke Volume; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Ventricular Function, Left

The aim of this study was to assess the utility of ejection fraction at rest (rEF) and its change during stress (delta EF) as a predictor of cardiac events during the follow-up of patients (pts) with myocardial infarction.. 74 pts (44 treated with thrombolytic therapy (TR), and 30 not (noTR)), were studied with 99mTcPYP angiography within 2 +/- 1 months, after AMI. By 20 +/- 10 months, 41 pts had no events (Group A) while 33 pts experienced cardiac events (3 deaths, 16 angina, 12 CABG, and 2 PTCA).. rEF was similar in both Groups A and B (A 47 +/- 8 vs B 45 +/- 10 p. ns), 44 +/- 15 vs B-noTR 46 +/- 12 p. ns). delta EF was different between Groups A and B. Group A showed a positive delta EF (3.2 +/- 6), and this result was more evident in thrombolyzed AMI (A-TR 4.4 +/- 4.5 vs A-noTR 1.16 +/- 3.9 p. < 0.01). Group B showed a negative delta EF (-4.4 +/- 5.3), and this result was more evident in non thrombolyzed AMI (B-TR -2 +/- 6.4 vs B-noTR -5.8 +/- 8 p. < 0.01).. A decrease in EF during exercise radionuclide angiography is useful in identifying pts with high risk of cardiac events after AMI. Thrombolytic therapy improves stress EF in both Groups A and B.

Topics: Adult; Aged; Aged, 80 and over; Exercise Test; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Rest; Streptokinase; Stroke Volume; Technetium Tc 99m Pyrophosphate; Thrombolytic Therapy; Urokinase-Type Plasminogen Activator

The significance of ST segment re-elevation at reperfusion by thrombolysis was evaluated.. The significance of ST re-elevation has not been studied. Hence, we evaluated whether ST re-elevation is an indicator of marked myocardial necrosis after reperfusion.. Twelve-lead electrocardiograms were recorded serially, before thrombolysis and immediately after each coronary angiographic procedure during thrombolysis.. In 32 patients with acute myocardial infarction, 15 showed transient ST re-elevation at reperfusion (group 1) and 17 showed reduction (group 2). Peak creatine kinase (CK) and CK-MB isoenzyme activity levels were significantly higher in group 1 than in group 2. Twelve patients in group 1 had strongly positive findings on early technetium-99m pyrophosphate scintigraphy, compared with one patient in group 2 (p < 0.001). The regional ejection fraction did not increase from the acute phase to the chronic phase in group 1. The ST deviation before thrombolysis was significantly greater in group 1 than in group 2 (p < 0.001). All 14 patients in group 1 showed Thrombolysis in Myocardial Infarction (TIMI) grade 0 flow and 12 of these patients did not have good collateral flow before thrombolysis.. These data suggest that 1) ST re-elevation at reperfusion is a sign of limited myocardial salvage by thrombolysis, and 2) high ST elevation and TIMI grade 0 flow without good collateral flow before thrombolysis may be predictive variables for marked myocardial necrosis after reperfusion.

Topics: Aged; Analysis of Variance; Clinical Enzyme Tests; Coronary Angiography; Creatine Kinase; Electrocardiography; Female; Heart; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Myocardial Reperfusion Injury; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Thrombolytic Therapy; Time Factors; Ventricular Function, Left

Emergent cardiac catheterization was performed on a 70-year-old female patient who was admitted for further evaluation of acute myocardial infarction. Coronary angiography didn't reveal any significant stenotic lesion, but levogram showed extensively abnormal contractility around the center of the apex region. On the second hospital day, 99mTc-PYP/201TlCl dual SPECT gave findings similar to those found in acute myocardial infarction, but myocardium--released enzyme stayed within the normal range. Two weeks after, 201TlCl myocardial scintigraphy showed disappearance of the perfusion defect, and normal contractility was observed on the levogram of the chronic phase. Since this case was clinically denied to be myocardial infarction, it was considered a typical case of stunned myocardium which showed prolonged left ventricular abnormal contractility with transient myocardial ischemia. This is a case suggestive for estimations of myocardial reversibility in patients with myocardial perfusion and metabolic disorder in dual SPECT.

Topics: Aged; Cardiac Catheterization; Coronary Angiography; Diagnosis, Differential; Electrocardiography; Female; Humans; Myocardial Contraction; Myocardial Infarction; Myocardial Reperfusion Injury; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

This study aimed investigate whether thallium-201 and technetium-99m pyrophosphate dual rest-redistribution emission computed tomography early after intracoronary thrombolysis may provide supplementary information for the management of patients with acute myocardial infarction. Fifty patients who received intracoronary thrombolysis underwent simultaneous dual emission computed tomography 3 days after first acute myocardial infarction. All patients who had a technetium-99m pyrophosphate accumulation were selected. Thallium-201/technetium-99m pyrophosphate overlap in the initial and delayed images early after intracoronary thrombolysis identified successful recanalization with sensitivities of 68% and 90% (p < 0.05), specificities of 47% 79% (p < 0.05), positive predictive accuracies of 68% and 88%, negative predictive accuracies of 47% and 80% (p < 0.05), and overall accuracy of 60% and 86% (p < 0.01), respectively. The patients were divided into 3 groups according to the change in thallium-201 uptake from the initial image to the delayed image on dual emission computed tomography: 20 patients had no change in thallium-201 uptake (fixed type), 16 had increases in thallium-201 uptake (redistribution type), and 14 had decreases in thallium-201 uptake (reverse redistribution type). The number of patients with successful recanalization was significantly higher in the redistribution type than in the other types (redistribution type vs reverse redistribution type or fixed type; p < 0.01, respectively). In the redistribution type a frequency of reinfarction in the same infarcted area during the hospital course was significantly higher than in the other types (redistribution type vs reverse redistribution type or fixed type; p < 0.05, respectively), which was mainly due to the patients having high grade residual stenosis. Thus, a thallium-201/technetium-99m pyrophosphate overlap in the delayed image early after acute myocardial infarction can be used as an index for predicting successful early recanalization and probably viable myocardium. In addition, the redistribution patterns on thallium-201 emission computed tomography early after intracoronary thrombolysis can be helpful in identifying patients with successful early recanalization and a high risk subset.

Topics: Adult; Aged; Cardiac Catheterization; Female; Humans; Male; Middle Aged; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Time Factors; Tomography, Emission-Computed; Urokinase-Type Plasminogen Activator

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

To evaluate the extent and characteristics of infarct areas, we performed indium-111 monoclonal antimyosin Fab (InAM), thallium-201 (TL) and Tc-99m pyrophosphate (PYP) imagings in 17 patients with acute myocardial infarction, and tried to find out the mechanism that causes difference of these imagings. In each study, the extent scores as an index of the infarct area were obtained by single photon emission computed tomography (SPECT), and comparisons were made between the results obtained. The overlap between InAM and TL imagings obtained by SPECT was evaluated. Location, severity, extent and patterns of accumulation were compared between InAM and PYP with both planar image and SPECT. The extent scores of InAM correlated well with those of TL (r = 0.73, p < 0.01). However, the overlap of both methods was recognized in 8 of 17 patients, in whom wall thickness of the infarct area as obtained by echocardiography was well preserved. The left ventricular regional asynergy was mild in 6 of these 8 patients. Coronary angiography showed poor or no collateral circulation in these cases. Although there were generally close correlations of the extent scores between InAM and PYP, discrepancy was noted in 2 cases for location; 2 for severity, 5 for extent, and 3 for patterns of accumulation. These differences may be attributed to the timings of imaging, coronary reperfusion and different mechanisms of accumulation. In conclusion, the extent of acute myocardial infarction obtained by InAM correlates well with those obtained by TL and PYP, with some exceptions.

Topics: Adult; Aged; Antibodies, Monoclonal; Female; Heart; Humans; Immunoglobulin Fab Fragments; Indium Radioisotopes; Male; Middle Aged; Myocardial Infarction; Myosins; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Tc-99m PYP scintigraphy performed on a patient with severe anterior chest pain showed diffuse intense uptake with central decreased activity corresponding to the left ventricular cavity. Tl-201 myocardial perfusion scintigraphy at rest revealed a minimal perfusion abnormality with decreased apical uptake in the lateral view. Because of these findings, diffuse subendocardial infarction was suggested.

Topics: Acute Disease; Aged; Endocardium; Female; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Topics: Electrocardiography; Heart; Humans; Magnetic Resonance Imaging; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography

The aim of this prospective study was to evaluate the postoperative haemodynamic variables and medication requirements in patients with perioperative myocardial infarction (PMI), following elective coronary artery bypass graft (CABG) surgery, as documented by technetium pyrophosphate scintigraphy using single-photon emission computed tomography (TcPPi-SPECT). A high-dose fentanyl anaesthetic technique was applied. Twelve of 58 patients (21%) developed PMI with an infarcted myocardial mass of 35.7 +/- 3.9 g. Over the 48 hr postoperative period, patients with positive TcPPi-SPECT (n = 12) did not differ from those with negative TcPPi-SPECT (n = 46) in mean heart rate (below 100 bpm), systolic blood pressure (100-120 mmHg) or central venous pressure (8-16 mmHg). However, patients with positive TcPPi-SPECT had higher pulmonary artery diastolic pressures at 5-8 hr after surgery. No differences were found in the incidence and dosage requirements for postoperative sedative or vasoactive drugs (morphine, diazepam, propranolol, lidocaine, nitroglycerin and nitroprusside) between the two groups. There was no difference in the incidence of dopamine requirement between the groups (positive-scan: 16.7%, negative-scan: 13.0%). However, the dopamine dosage for inotropic support was higher in the positive TcPPi-SPECT group over 24 hr (318.5 +/- 125.2 mg vs 71.2 +/- 24.7 mg, P less than 0.05) and 48 hr (869.1 +/- 19.0 mg vs 142.3 +/- 49.4 mg, P less than 0.001) periods after surgery. We postulate that careful control of postoperative haemodynamic variables did not prevent but may limit the extent of PMI in elective CABG patients.

Topics: Coronary Artery Bypass; Dopamine; Female; Hemodynamics; Humans; Hypnotics and Sedatives; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

PYP SPECT images were underwent in 15 patients with acute myocardial infarction 2-5 times in three weeks. PYP SPECT images were reconstructed as to include both vertebral images and myocardial images. Quantitative estimation of PYP images was performed by the ratio of maximal PYP myocardial uptake to maximal PYP vertebral uptake in the central sagittal images (%PYP). Disappearance of PYP images was defined as the day, when %PYP reached 50%. Normalization of serum myosin light chain I (LCI) level was defined as the day, when LCI level reached 2.5 ng/ml. %PYP decreased continuously and maximal PYP point remained at the same area. Shape of PYP images varied and diminished. In case of anterior wall infarction apical PYP uptake persisted longer than basal uptake. In case of inferior wall infarction basal PYP uptake persisted longer than apical uptake. The mean period from onset to the disappearance of PYP images was 9 +/- 3 days. Pattern of serial serum MB level was simple, however corresponding pattern of serial serum LCI level showed various types. The mean period from onset to the peak level was 4.1 +/- 1 day. Normalization of LCI level was 9.3 +/- 2.9 days. It showed that process of destruction of necrotic myocardium vary in each case. Weak relation was noted between disappearance of PYP images (DAY-PYP) and normalization of LCI level (DAY-LCI). DAY-PYP = 4.4 +/- 0.46 DAY-LCI (n = 13, r = 0.4). Quantitative PYP images were useful for detecting ongoing necrotic myocardium and serum LCI level was useful for estimating destruction of necrotic myocardium.2+ level were useful to study the process of destruction of necrotic myocardium.

Topics: Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Myosins; Necrosis; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The unfolded map method of 201Tl single photon emission computed tomography (SPECT) was evaluated as to the ability to quantify and the clinical reliability in estimation of infarct size. At first, the following results were obtained in basic experiments using thoracic phantom: 1) the defect area estimated by the unfolded map method was well correlated with the real defect area in spite of overestimation of the defect area, when the defect area was determined by an isocount method (below 80% of maximum count) (y = 1.941 + 2.29x, r = 0.971, p less than 0.001); 2) the defect volume estimated by short-axis images of 201Tl SPECT was closely correlated with real defect volume in spite of overestimation of defect volume (y = 0.762 + 2.156x, r = 0.982, p less than 0.001); 3) when the defect area was estimated by division of the defect volume by the mean myocardial compartment thickness, it was closely correlated with real defect area (y = 0.946 + 1.232x, r = 0.990, p less than 0.001); 4) when the volume was calculated from the summation of voxels in the regions districted by isocount threshold level at each section of the 99mTc SPECT, the optimal isocount threshold level (percentage to maximum count) was 55%. In addition, the clinical reliability of the unfolded map method as infarct sizing was evaluated in 26 patients with acute myocardial infarction by comparing it with enzymatic method, Bull's eye method, and 99mTc pyrophosphate (PYP) SPECT method. In 14 first attack cases of patient without right ventricular infarction, infarct area (IA) of the unfolded map method correlated most closely with the accumulated creatine kinase MB isoenzyme release (CK-MBr) (r = 0.897), compared with the extent score (ES) (r = 0.853) and the severity score (SS) (r = 0.871) of Bull's eye method and the infarct volume (IV) (r = 0.595) of 99mTc PYP SPECT. In conclusion, although the unfolded map method of 201Tl SPECT has the tendency which overestimate infarct size, it is accurate and clinically reliable method in estimating infarct size.

Topics: Adult; Aged; Aged, 80 and over; Female; Heart; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

To assess the prognostic value of exercise left ventricular function, and if this test improves the prognostic value of clinical data and exercise test, 146 patients (mean age 56 +/- 9 years) underwent rest and exercise radionuclide angiography, 10 days after myocardial infarction. During follow-up (mean 16 +/- 5 months), 32 patients had new coronary events: 5 died, 9 had a new myocardial infarction and the remaining 18 developed unstable angina (Class III-IV of the CCS classification). Patients with new coronary events had more frequently severe left ventricular failure (Killip III-IV) (15% vs 3%; p less than 0.05) and postinfarction angina (32% vs 9%; p less than 0.01) than their counterparts. There were no differences regarding rest ejection fraction between both groups of patients. Exercise ejection fraction increased significantly (50 +/- 14% to 56 +/- 16%, p less than 0.001), while there was no change in patients with new coronary events (46 +/- 16% to 43 +/- 15%, NS). Logistic regression analysis including only clinical data identified postinfarction angina (p less than 0.01) and left ventricular failure (Killip III-IV) (p less than 0.01) as independent predictors of new coronary events. The sensitivity and specificity of the regression equation obtained with clinical data were 43% and 90%, respectively. Analyzing data from clinical variables, as well as exercise test and both, rest and exercise radionuclide angiography, logistic regression analysis identified, exercise ejection fraction (p less than 0.001), postinfarction angina (p less than 0.01) and rest ejection fraction (p less than 0.05) as independent predictors of new coronary events.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Chi-Square Distribution; Exercise Test; Follow-Up Studies; Gated Blood-Pool Imaging; Humans; Myocardial Infarction; Prognosis; Regression Analysis; ROC Curve; Technetium Tc 99m Pyrophosphate; Ventricular Function, Left

The clinical and predictive value of 99mTc pyrophosphate myocardial scintigraphy was studied in 164 patients with various clinical courses of unstable angina pectoris. Some patients with the unstable anginal syndrome proceeding with prolonged pain attacks were shown to have irreversible myocardial lesions detectable by 99mTc pyrophosphate myocardial scintigraphy. However, the study indicated that the presence of small myocardial necrotic foci in this case was of insignificant predictive value.

Topics: Adult; Aged; Angina, Unstable; Coronary Vessels; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate

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

Various types of radiopharmacons such as 201Tl, 99mTc-pyrophosphate(PYP), 123I-metaiodobenzyl-guanidine(MIBG), 111In-antimyosin Fab (AM) and 123I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) were applied to a patient under successful reperfusion therapy. In the patient, elevated serum enzyme activity region in the subacute phase. Ten months after the ischemic event, AM uptake was noted at the region which maintained contractility. Two years after the ischemic event, depressed BMIPP uptake and delayed washout were noted at the apical region and the basal anteroseptal region. From these findings, the following conclusions were reached. Depressed 201Tl uptake was noted in the salvaged jeopardized myocardium. The lesions noted in the MIBG images showed depressed myocardial norepenephrine activity. This suggested that depressed sympathetic nervous function caused by severe ischemia persisted long after both myocardial perfusion and myocardial contractility had been restored. From abnormal AM uptake in the contractile myocardium myocardial cell damage, which permitted AM uptake, was persistent ten months after the ischemic event. Depressed BMIPP uptake and delayed washout suggested that abnormal fatty acid metabolism caused by severe ischemia was persistent. Severe ischemia caused various types of pathological states in the myocardium and radioisotope image was useful for studying these states.

Topics: 3-Iodobenzylguanidine; Aged; Angioplasty, Balloon, Coronary; Fatty Acids; Heart; Humans; Indium Radioisotopes; Iodine Radioisotopes; Iodobenzenes; Male; Myocardial Infarction; Myocardial Reperfusion; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Aged; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Female; Heart; Heart Function Tests; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

A 56-year-old man, complaining of severe substernal chest pain, was admitted. In this patient, right ventricular infarction following by acute inferior myocardial infarction was suggested by serial enzymes, electrocardiogram, echocardiogram, and hemodynamic data, but it was not confirmed. A dual isotope SPECT with 99mTc-pyrophosphate and 201Tl-Cl was performed and color-coded tomograms were obtained. It showed a characteristic image of right ventricular infarction, especially in the short axis view right ventricular infarction looked like shape of a tongue which protruded from left ventricle. We concluded that though the diagnosis of right ventricular infarction is difficult, a dual isotope SPECT is a useful method because it shows a characteristic image.

Topics: Diphosphates; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed, Single-Photon

To assess the diagnostic value of Tc-99m PYP, Tl-201 dual isotope SPECT for the evaluation of myocardial viability, segmental comparison between dual isotope SPECT and exercise, delayed, and reinjected Tl study were performed with 18 AMI patients. Among 72 damaged myocardial segments, 48 segments (67%) were judged as viable by chronic phase Tl studies. The segments with severely reduced Tl uptake by dual SPECT showed significantly lower prevalence of viable myocardium than the segments with reduced and normal Tl uptake (p less than 0.001). The segments with PYP accumulation localized to the subendocardium represented the favorable outcome compared with the transmural accumulation (p less than 0.001). And overlap segments show better prognosis than the segments without overlap (p less than 0.05). Most importantly, we can get better predictive accuracy of myocardial scar by dual isotope SPECT than the judgement by Tl or PYP SPECT alone (83.3% vs 77.8%, 68.1%). Thus, we conclude that Tc-99m PYP, Tl-201 dual isotope SPECT is useful to assess the severity of myocardial damage in the acute phase of myocardial infarction.

Topics: Adult; Aged; Diphosphates; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tissue Survival; Tomography, Emission-Computed, Single-Photon

The pattern of Thallium-201 reverse redistribution (r-RD) at rest has been reported in some patients with acute myocardial infarction (AMI) in the acute phase. But there is no report of this pattern in the later phase. To investigate the significance of Thallium-201 reverse redistribution in the subacute phase, 37 patients with AMI underwent Thallium-201 SPECT at rest a month after the onset. The patients were classified into three groups visually and 19 of 37 patients (51%) showed the persistent defect pattern (Group PD), and the remaining 18 patients (49%) had the reverse redistribution pattern (Group r-RD). None of them had the redistribution pattern. Coronary reflow was earlier and the incidence of the scintigraphic overlap on Dual SPECT image of 99mTc-PYP/201TlCl in the acute phase was more frequent in Group r-RD than in Group PD. A decrease in thallium defect size of patients with r-RD from the acute phase to one month after the onset represented improvement more significantly than that with PD. Initial %Tl uptake of the infarcted region of Group r-RD was greater than that of Group PD. The degree of stenosis of the infarct-related coronary artery in Group r-RD was less severe than that in Group PD. And corresponding regional wall motion of Group r-RD was less impaired. The Thallium-201 washout in the infarcted region with r-RD was significantly faster than that in the normal region. It is concluded that the r-RD pattern at rest in the 1st month after the onset of AMI may be a sign of viable myocardium.

Topics: Aged; Female; Humans; Male; Middle Aged; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Technetium-99m pyrophosphate (Tc-99m PYP) myocardial scintigraphy was performed in 110 clinically stable patients with acute or healed acute myocardial infarction (AMI). Tomography was performed 12 hours to 7 days (group A), 7 to 30 days (Group B), 1 to 6 months (Group C) and after greater than 6 months (group D) after AMI. All 40 patients in group A, 9 of 31 in group B, 1 of 22 in group C, and no patient (0 of 17) in group D had a pathologic Tc-99m PYP tomogram. Relative Tc-99m PYP accumulation within the area of infarction was measured as infarct zone to blood pool ratio, which decreased significantly (p less than 0.001) from group A (1.54 +/- 0.39) to group B (0.89 +/- 0.24), group C (0.8 +/- 0.19) and group D (0.76 +/- 0.13). These data were confirmed by sequential scintigraphy in 17 patients. It is concluded that a persisting Tc-99m PYP uptake is rarely found greater than 1 month after AMI using tomographic imaging techniques in clinically stable patients with coronary artery disease. Positive results on Tc-99m PYP tomography are a reliable indicator of AMI. Thus, Tc-99m PYP tomography is not only a sensitive but also a specific imaging technique for AMI, which might be especially useful for diagnosis of reinfarction.

Topics: Adult; Aged; Aged, 80 and over; Follow-Up Studies; Gated Blood-Pool Imaging; Heart; Humans; Middle Aged; Myocardial Infarction; Myocardium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Time Factors; Tomography, Emission-Computed

To develop a method to measure myocardial infarct size by magnetic resonance imaging and to compare the results with pyrophosphate scanning by single photon emission computed tomography.. All patients underwent magnetic resonance imaging and pyrophosphate scanning 5-7 days after the onset of symptoms. Both measurements of infarct size were compared with the release of creatine kinase MB and with ventricular performance estimated by radionuclide ventriculography.. 19 patients (age 40-68 years) who had sustained their first uncomplicated myocardial infarction and who had not been treated with thrombolytic therapy.. The site of infarction was clearly shown by both imaging techniques and was identical in each patient. The volume of infarcted tissue measured by magnetic resonance imaging agreed well with the infarct size measured by single photon emission tomography (mean difference 2.7 cm3). Correlations of both imaging techniques with the release of creatine kinase MB were best when total release rather than peak release was used. Both imaging techniques correlated closely with the subsequent ventricular performance.. Magnetic resonance imaging after acute infarction allows measurement of infarct size and this may prove useful in assessing new treatments designed to salvage myocardium.

Topics: Adult; Aged; Creatine Kinase; Female; Heart; Humans; Isoenzymes; Magnetic Resonance Imaging; Male; Middle Aged; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The usefulness of a scoring system with early technetium-99m pyrophosphate scintigraphy as a method for evaluating the efficacy of myocardial preservation after thrombolysis was studied. The mean time from the onset of acute myocardial infarction to injection of the tracer was 5.6 +/- 1.5 h (range 2.8 to 11.9 h). All 36 patients underwent successful recanalization. Patients with strongly positive technetium-99m pyrophosphate uptake in anterior acute myocardial infarction had a significantly lower regional ejection fraction and a significantly larger thallium-201 defect score than those with 2+ positive results in chronic stage. Similarly, in inferior acute myocardial infarction, the thallium-201 defect score was significantly larger in patients with strongly positive uptake than in those with 2+ and negative uptake scores. In conclusion, strongly positive results in early technetium-99m pyrophosphate scintigraphy within 12h after the onset of acute myocardial infarction may indicate failure in limiting the infarct size by coronary thrombolysis.

Topics: Aged; Chi-Square Distribution; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Radionuclide Imaging; Stroke Volume; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Thrombolytic Therapy

To evaluate the usefulness of serum level of cardiac myosin light chain I (LC I) for the estimation of the extent of acute myocardial infarction (AMI), peak LC I level was compared with myocardial infarction weight (AMI weight) which was obtained by myocardial emission tomography with Tc-99m pyrophosphate (PYP). In 11 patients with AMI, serum LC I levels were measured once a day in most cases, and plasma CPK levels were measured serially (every 4 hours at least 48 hours after admission). Tc-99m PYP imagings were performed at second or third day of AMI, and AMI weight was calculated from the voxel numbers of myocardial hot spot in which Tc-99m PYP had accumulated. Peak LC I level correlated well with AMI weight (r = 0.72, p less than 0.02). As well as peak LC I level, peak CPK level correlated well with AMI weight (r = 0.68, p less than 0.05). But the estimation of the infarct size from peak LC I level had the following advantages over the estimation from peak CPK level. 1) We could compare peak LC I level with AMI weight in all 11 patients, but peak CPK level was able to compared with AMI weight in only 9 of them. This was because CPK level changed rapidly and reached maximum within 24 hours after the onset of AMI, while LC I level peaked after 3 to 5 days. 2) A good correlation between LC I and AMI weight was obtained by the determination of serum LC I level once a day.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myosins; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Heart Ventricles; Humans; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Various types of radiopharmacons such as Tl-201, Tc-99m pyrophosphate (PYP), I-123 Metaiodobenzylguanidine (MIBG) and In-111 antimyosin Fab (AM), were applied to a patients under successful reperfusion therapy. In the patient QS waves in precordial leads and elevated serum enzyme activity was noted, however well anterior wall movement was maintained in chronic phase. At 4th hospital day PYP uptake was noted at apical region and basal anteroseptal region. Most portion of PYP uptake was overlapped by Tl-201 uptake. Depressed Tl-201 uptake in subacute phase improved. In chronic phase depressed MIBG uptake was noted at the region corresponding to the abnormal region in acute phase. Then months after the ischemic event AM uptake was noted at the region which maintained contractility. From these findings it was concluded as followings. Salvaged jeopardized myocardium remained ischemia in subacute phase. The lesions noted in the MIBG images showed depressed myocardial norepinephrine activity. This suggested that sympathetic nervous function was damaged by severe ischemia and the depressed sympathetic nervous function persisted long after myocardial perfusion had been restored. From abnormal AM uptake ten months after ischemic event it was suspected that myocardial cell membrane damage caused by severe ischemia might be persistent at the region which maintained contractility. Radioisotope image was useful to study pathological myocardium due to ischemic event.

Topics: 3-Iodobenzylguanidine; Aged; Angioplasty, Balloon, Coronary; Heart; Humans; Immunoglobulin Fab Fragments; Indium Radioisotopes; Iodine Radioisotopes; Iodobenzenes; Male; Myocardial Infarction; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Topics: 3-Iodobenzylguanidine; Antibodies, Monoclonal; Energy Metabolism; Heart; Humans; Indium Radioisotopes; Iodine Radioisotopes; Iodobenzenes; Myocardial Infarction; Myocardium; Myosins; Nitriles; Organotechnetium Compounds; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

To assess the diagnostic accuracy, extent, and characteristics of 111In-antimyosin Fab scintigraphy (In-AM) in acute myocardial infarction (AMI), we studied In-AM in 17 patients with AMI and compared with In-AM, 99mTc-PYP and 201Tl scintigraphy. Intensity of In-AM uptake was classified into 3 grades. Fourteen of 17 patients (82%) showed positive uptake of In-AM. The locations of infarct area diagnosed by In-AM were in accordance with those by electrocardiography. There was a good correlation between the extent score of In-AM planar and that of SPECT (r = 0.72), In-AM SPECT and Tl SPECT (r = 0.79), In-AM planar and PYP planar (r = 0.92), In-AM SPECT and PYP SPECT (r = 0.76), respectively (p less than 0.01). Thus, In-AM is a useful method for diagnosis of AMI.

Topics: Adult; Aged; Antibodies, Monoclonal; Female; Humans; Immunoglobulin Fab Fragments; Indium Radioisotopes; Male; Middle Aged; Myocardial Infarction; Myosins; Predictive Value of Tests; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Recent imaging studies suggest that technetium-99m (Tc-99m) pyrophosphate yields a considerably larger estimate of myocardial infarct size than does indium-111 (In-111) monoclonal antimyosin antibody. To determine whether Tc-99m pyrophosphate may be taken up by reversibly injured myocytes, particularly in the setting of coronary reperfusion, the tissue localization of Tc-99m pyrophosphate and antimyosin antibody was compared in 11 dogs 24 to 68 h after anterior descending coronary artery occlusion (4 dogs with permanent occlusion, 7 with reperfusion). Technetium-99m pyrophosphate and In-111 antimyosin antibody content was determined in serial 2 to 3 mm wide endocardial and epicardial samples taken through the infarct zone in multiple short-axis left ventricular slices. The number of samples with increased In-111 antimyosin antibody (defined as greater than or equal to mean + 2 SD of normal) was not significantly different from that with increased Tc-99m pyrophosphate. This was true in both reperfused and nonreperfused infarcts. However, the intensity of uptake of Tc-99m pyrophosphate exceeded that of In-111 antimyosin antibody, particularly in the border zones of reperfused infarcts, and the area with moderate to marked increase in tracer uptake (greater than or equal to 2 times normal) was significantly larger with Tc-99m pyrophosphate than In-111 antimyosin antibody (p less than 0.001). A specific zone of abnormal Tc-99m pyrophosphate with normal In-111 antimyosin antibody content could not be identified. Histologic evidence of myocardial necrosis was found in virtually every sample with increased In-111 antimyosin antibody, Tc-99m pyrophosphate, or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Antibodies, Monoclonal; Diphosphates; Dogs; Female; Indium Radioisotopes; Male; Myocardial Infarction; Myocardial Reperfusion; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Antibodies, Monoclonal; Diphosphates; Dogs; Indium Radioisotopes; Myocardial Infarction; Myocardial Reperfusion; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Antibodies, Monoclonal; Diphosphates; Dogs; Glucaric Acid; Humans; Indium Radioisotopes; Myocardial Infarction; Myocardial Reperfusion; Organometallic Compounds; Organotechnetium Compounds; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

To test the hypothesis that simultaneous dual energy single photon emission computed tomography (SPECT) with technetium-99m (99mTc) pyrophosphate and thallium-201 (201TI) can provide an accurate estimate of the size of myocardial infarction and to assess the correlation between infarct size and peak serum creatine kinase activity, 165 patients with acute myocardial infarction underwent SPECT 3.2 +/- 1.3 (SD) days after the onset of acute myocardial infarction. In the present study, the difference in the intensity of 99mTc-pyrophosphate accumulation was assumed to be attributable to difference in the volume of infarcted myocardium, and the infarct volume was corrected by the ratio of the myocardial activity to the osseous activity to quantify the intensity of 99mTc-pyrophosphate accumulation. The correlation of measured infarct volume with peak serum creatine kinase activity was significant (r = 0.60, p less than 0.01). There was also a significant linear correlation between the corrected infarct volume and peak serum creatine kinase activity (r = 0.71, p less than 0.01). Subgroup analysis showed a high correlation between corrected volume and peak creatine kinase activity in patients with anterior infarctions (r = 0.75, p less than 0.01) but a poor correlation in patients with inferior or posterior infarctions (r = 0.50, p less than 0.01). In both the early reperfusion and the no reperfusion groups, a good correlation was found between corrected infarct volume and peak serum creatine kinase activity (r = 0.76 and r = 0.76, respectively; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

In a postmortem study of a 69-yr-old female patient who had suffered 2 yr previously a non-Q-wave anterior infarction and who had sustained just seven days earlier a left inferior and right ventricular infarction, the distribution of 111In-antimyosin Fab was compared to the results of 99mTc-pyrophosphate imaging and histologic examination. Indium-111-antimyosin Fab imaging could not be performed because of cardiogenic shock. However, postmortem gamma scintillation counting revealed increased activities of antimyosin Fab in the inferoapical and right ventricular infarcted regions in which 99mTc-pyrophosphate positive imagings were observed; in contrast, a histologically confirmed old subendocardial anterior infarction had no definite activity. Thus, the myocardial distribution of 111In-antimyosin Fab corresponded well to the results of 99mTc scintigrams and histologic examinations in a human heart, suggesting that this technique could be useful in vivo for detecting several-day-old myocardial infarction of the right ventricle as well as the left ventricle. Tissue from the 2-yr-old infarction was not identified by this technique.

Topics: Aged; Antibodies, Monoclonal; Diphosphates; Female; Humans; Myocardial Infarction; Myocardium; Organometallic Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Myocardial scintigraphy with 99mTc-pyrophosphate is a widely used highly sensitive and specific method for the evaluation of patients with acute myocardial infarction (AMI) with optimum visualization within 24-72 h after the onset of chest pain. In some cases the so called doughnut-shaped 99mTc-pyrophosphate myocardial scintigrams may occur. As a rule patients with scintigraphic images of this type have a poor prognosis. Old-aged patients are characterized by peculiar features in the interpretation of 99mTc-pyrophosphate myocardial uptake. Findings of 4 patients aged 88 to 92 (2 patients with verified AMI and 2 CHD patients without AMI) with doughnut-shaped 99mTc-pyrophosphate myocardial scintigraphic images were analyzed. The authors present two case reports of aged patients with AMI and without it with this type of myocardial uptake and one case report of a 50-year old patient with vast anterior myocardial infarction with a poor prognosis and doughnut-shaped 99mTc-pyrophosphate myocardial scintigraphy. In old-aged patients the uptake of 99mTc-pyrophosphate in the myocardium may occur not only with but also without AMI as a result of increased calcification. These features should be taken into account while establishing correct diagnosis.

Topics: Age Factors; Aged; Aged, 80 and over; Diagnosis, Differential; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The purpose of the present study was to evaluate the tissue characterization of the ischemic myocardium by dual single photon emission computed tomography (SPECT) with thallium-201 (Tl-201) and technetium-99m pyrophosphate (Tc-99m PYP) using the simultaneous collection method. The subjects consisted of 84 patients with acute coronary syndrome followed by protracted left ventricular asynergy. For precise interpretation of clinical scintigraphy, we used phantom experiments and the results were as follows: 1. The residual myocardium in the infarcted area could be evaluated to some extent from the severity of the defect on Tl-201 SPECT with optimal and unified image processing standardized by maximal pixel counts in the myocardium. 2. The influence of cross talk between two radionuclides on each tomographic image was negligible under usual clinical conditions. 3. In a subendocardial infarction model where the Tc-99m layer was located within 50% inside the phantom wall and the other space was filled with 201TlCl solution, the Tc-99m layer was clearly visualized inwardly as compared with the Tl-201 layer on dual SPECT with optimal image processing. 4. Transmural infarction could be visualized as a total defect on Tl-201 SPECT only when its diameter was greater than 2 to 2.5 cm. Taking these results into account, we evaluated clinical cases. According to the peak CK value and Tl-201 SPECT in the chronic phase, the subjects were categorized as transmural infarction (TMI), nontransmural infarction (NTMI) and unstable angina pectoris (UAP), and the scintigraphic characteristics of each group were compared. Short-axis tomographic features of all lesions were classified in nine types from 1A to IIIC by the combination of Tl-201 uptake grades (total defect: I, reduced uptake: II, normal: III) and the condition of Tc-99m PYP accumulation (negative: A, transmural: B, subendocardial: C). The relationship between recovery from asynergy and the dual scintigraphic findings was also evaluated and 17 patients in whom asynergy had nearly resolved in the chronic phase was especially classified in a reversible ischemic myocardial damage (RIMD) group. The clinical results were as follows: 1. In cases without reinfarction, a Tl-201 uptake in ischemically-injured lesions was variably improved in the chronic phase. In 9% of all the lesions of NTMI, a Tl-201 uptake showed total defects in the acute phase. 2. Type IIC lesions were most frequently observed, accounting for 43% of all le

Topics: Aged; Angina Pectoris; Female; Heart; Humans; Male; Middle Aged; Models, Structural; Myocardial Contraction; Myocardial Infarction; Myocardium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Topics: Diphosphates; Evaluation Studies as Topic; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Ferric pyrophosphate (Fe-PyP) was investigated in an animal model of acute myocardial infarction for its potential to provide contrast enhancement of the peri-infarct zone using magnetic resonance (MR) imaging. Radiotracer studies compared the biodistribution of soluble 59Fe-PyP with 99mTc-PyP in excised tissue samples. Preferential localization of 59Fe-PyP in the peri-infarct zone was found to be similar to 99mTc-PyP. The ratio (percent dose/gram of tissue) at the edge of the infarct to normal tissue was 1.30 +/- 0.16 and 1.44 +/- 0.33 for 99mTc-PyP and 59Fe-PyP, respectively. In initial studies with high doses of the contrast agent, gated T1-weighted MR images of animals with 48-hour-old infarcts were obtained at 15-minute intervals after injection of Fe-PyP at a dose of 350 mg/kg. Contrast enhancement of the infarct zone was observed in all studies and was maximal 15-30 minutes after injection. Signal intensity ratios (infarct/normal) increased from a baseline 1.31 +/- 0.22 to a peak 1.90 +/- 0.57. Studies were then performed with smaller amounts of Fe-PyP. Images obtained with 50 mg/kg Fe-PyP showed contrast enhancement beginning at 60 minutes. Toxicology studies showed primarily respiratory effects, which became significant at doses of 190 mg/kg. These preliminary studies suggest that Fe-PyP potentially could serve as an MR contrast agent to localize and size acute myocardial infarcts; however, its clinical use may be limited by potential toxicity and dose limitations.

Topics: Animals; Diphosphates; Gated Blood-Pool Imaging; Image Enhancement; Iron Radioisotopes; Magnetic Resonance Imaging; Myocardial Infarction; Myocardium; Swine; Technetium; Technetium Tc 99m Pyrophosphate; Tissue Distribution

The diagnostic value of 111In-antimyosin (AM) imaging for identifying myocardial infarction was evaluated in comparison with 99mTc-pyrophosphate (PPi) imaging. Twenty-four patients with various stages of myocardial infarction, ranging from three days to nine months after the onset of infarction, underwent both AM and PPi scans. Of 26 infarct lesions AM scan identified 22 (85%), while PPi scans detected 10 (38%) (p less than 0.01). When less than a week had passed since the onset both scans demonstrated all infarct lesions. For seven subacute lesions studied within one to two weeks of onset, AM scans detected (100%), while PPi scans identified only 2 (29%). Furthermore, AM scans showed discrete myocardial uptake in 7 (64%) of those studied more than two weeks after onset. The intensity of AM uptake in the infarcts studied more than seven days after onset was less than that in acute infarcts studied within seven days of onset (p less than 0.05). These preliminary data indicate that the abnormal myocardial uptake of AM persists beyond the first two weeks when PPi no longer accumulates. Thus, AM scans can be considered to provide a sensitive diagnosis of subacute as well as acute myocardial necrosis.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Diphosphates; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Myocardial Infarction; Myosins; Organometallic Compounds; Radionuclide Imaging; 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

Topics: Alanine Transaminase; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Echocardiography; Electrocardiography, Ambulatory; Humans; Isoenzymes; Myocardial Infarction; Postoperative Complications; Prospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Methods of radionuclide diagnosis modified with regard to the clinical problems and combined with new mathematic approaches to the processing of the data obtained make it possible to substantially enlarge the diagnostic information on myocardial contractility, central hemodynamics, the status and perfusion of the myocardium and to use it in combination with the latest research methods applied in cardiological patients.

Topics: Diphosphates; Electrocardiography; Heart; Heart Defects, Congenital; Heart Diseases; Humans; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

In early (mean time, 6.9 +/- 0.2 hours following the onset of an anginal episode), 99mTc pyrophosphate myocardial scintigraphy was performed in 28 patients who received thrombolytic therapy under angiographic monitoring. The sensitivity and specificity of an early administration of pyrophosphate into the myocardium as a noninvasive marker of successful coronary reperfusion was 95.7% and 100%, respectively.

Topics: Adult; Aged; Diphosphates; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Streptokinase; Technetium; Technetium Tc 99m Pyrophosphate; Thrombolytic Therapy; Tissue Plasminogen Activator

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

The purpose of this study was to validate different scintigraphic approaches for assessing acute myocardial infarctions. 201Tl, 99Tcm pyrophosphate (PPi) and combined 201Tl/99Tcm PPi tomograms were evaluated in 115 consecutive patients, in 85 of whom clinical examination revealed acute myocardial infarction. The overall sensitivity and specificity for infarct detection was 80% versus 56% for 201Tl alone, 61% versus 97% for 99Tcm PPi alone, and 100% each for the combined 201Tl/99Tcm PPi imaging. The sensitivity for nontransmural infarcts was 57% for 201Tl, 37% for 99Tcm PPi and 100% for combined imaging. The overlay of 201Tl and 99Tcm PPi images increases the observer's confidence in the diagnosis and provides better localization of the infarction. 201Tl alone could localize the infarction in 80%, 99Tcm PPi alone in 49% and 201Tl/99Tcm PPi in 100% of the cases. ECG and 201Tl/99Tcm PPi tomography concurred upon infarct localization in 98% of the patients. Based on the 201Tl/99Tcm accumulation pattern, 94% of the Q-wave infarctions were judged to be transmural and 83% of the non-Q-wave infarctions were judged to be nontransmural. It is concluded that combined 201Tl/99Tcm PPi tomography is highly accurate for determining the presence and location of acute myocardial infarction. This technique appears to be superior to studies where only one radioisotope is used.

Topics: Adult; Aged; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Observer Variation; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

The myocardial uptake of In-111 antimyosin Fab and Tc-99m pyrophosphate was studied in dogs undergoing coronary artery occlusion for 90 minutes followed by reperfusion. The regional myocardial blood flow was determined by injecting Sc-46 labeled microsphere and was related to the relative concentrations of In-111 antimyosin and Tc-99m pyrophosphate. There was an inverse linear correlation between In-111 antimyosin Fab localization and the regional blood flow in both the subendocardial (r = 0.81) and subepicardial myocardium (r = -0.80). The greatest uptake of antimyosin was observed in areas of severe blood flow reduction (0-10% of normal). On the other hand, there was no correlation between the Tc-99m pyrophosphate uptake and the degree of blood flow reduction. Maximal subendocardial localization of Tc-99m degree of blood flow reduction. Maximal subendocardial localization of Tc-99m pyrophosphate was observed in areas where the blood flow was reduced to 31-50% of the normal. In the case of the subepicardium, the greatest uptake was localized to areas of 0 to 10% of the normal flow. In addition, there was significant myocardial uptake in regions where the blood flow was minimally reduced (greater than 81%). This study suggests that In-111 antimyosin Fab is a specific and quantitative tool in the evaluation of myocardial necrosis.

Topics: Animals; Coronary Circulation; Diphosphates; Dogs; Immunoglobulin Fab Fragments; Indium Radioisotopes; Myocardial Infarction; Myocardial Reperfusion; Myosins; Technetium; Technetium Tc 99m Pyrophosphate

50 consecutive patients hospitalized because of suspected myocardial infarction were examined by 99mTc-pyrophosphate scintigraphy. The scans were interpreted blind by one of the authors. There were positive results in 17 of 21 patients with myocardial infarction (sensitivity 0.81). However, scintigraphy was also positive in 13 patients with no evidence of myocardial infarction as assessed by ECG and enzyme criteria (specificity 0.55). We conclude that, in our hospital, 99mTc-pyrophosphate myocardial scintigraphy did not contribute valuable information to the routine diagnosis of myocardial infarction.

Topics: Humans; Myocardial Infarction; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

This clinical study evaluated the accuracy of planar myocardial scintigraphy with antimyosin monoclonal antibodies radiolabeled with indium-111 (AMA-Fab) in the detection and localization of acute myocardial infarction (AMI). Fifty-seven patients admitted for suspected AMI were studied; 17 patients underwent thrombolytic therapy with intravenous streptokinase and 11 had clinical signs of reperfusion; 9 had had a previous myocardial infarction. Fifty of 57 patients were discharged from the coronary care unit with a confirmed diagnosis of AMI. The AMA-Fab study results were positive for AMI in 49 patients (98%) and negative in 1 (2%). Among the 7 patients without AMI, 5 had unstable angina, 1 had Prinzmetal's variant angina and 1 had acute pancreatitis. AMA-Fab results were negative in 6 of 7 patients (85%) and positive in 1 (15%). Therefore, the sensitivity and specificity of AMA-Fab scintigraphy were 0.98 and 0.85, respectively. To assess accuracy in defining the extent and location of AMI, AMA-Fab results were compared with those of the electrocardiogram, echocardiogram, technetium-99m pyrophosphate myocardial scintigraphy and coronary angiography and left ventriculography. AMA-Fab scintigraphy showed a good concordance with the traditional techniques in the topographic definition of the infarcted regions. No uptake of AMA-Fab was seen in the regions of previous old infarcts. Ten healthy volunteers also underwent AMA-Fab scintigraphy. No evidence of myocardial tracer uptake was noted in them. No adverse reactions or side effects were noted after injection of AMA-Fab in any patient. It is concluded that planar myocardial scintigraphy with AMA-Fab is a reliable method for AMI detection and location.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Diphosphates; Echocardiography; Electrocardiography; Female; Heart; Humans; Immunoglobulin Fragments; Indium Radioisotopes; Male; Middle Aged; Myocardial Infarction; Myosins; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The present study investigated whether the lack of enzyme increase is reason enough to exclude necrosis in patients with ischemic heart disease who develop electrocardiographic sustained ST-T changes in the absence of Q waves. In 15 consecutive patients with angina who developed sustained ST-T changes during hospitalization, the presence of myocardial necrosis was investigated by a prospective multiparametric approach. Serum enzymes and myoglobin, pyrophosphate uptake, 2-dimensional echocardiography, perfusion scintigraphy, left ventriculography and coronary angiography were evaluated. According to creatine kinase and creatine kinase-MB peak at twice the upper normal value, the diagnosis of acute myocardial infarction applied only to 40% of patients. However, myoglobin was positive in 80% and a perfusion defect could be documented by an electrocardiographic gated microsphere technique in 100% of patients. The positivity of myoglobin increased to 100% and of creatine kinase and creatine kinase-MB to 87 and 60%, respectively, when a peak value twice the individual lowest value was considered for positivity. The 100% presence of perfusion defects associated with the high prevalence of both positive pyrophosphate uptake (87%) and regional dyssynergies (87 and 73%, respectively, by left ventriculography and echocardiography) strongly suggest that sustained (greater than or equal to 7 days) ST-T changes in this population were indicative of myocardial necrosis. Thus, by conventional enzymatic approach, diagnosis of non-Q-wave infarction can be missed in a sizable number of patients and present important clinical implications.

Topics: Adult; Aged; Creatine Kinase; Diphosphates; Echocardiography; Electrocardiography; Female; Humans; L-Lactate Dehydrogenase; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate

The susceptibility of the cardiovascular system to exposure to a high-boiling coal liquid (heavy distillate, HD) was studied in the rat using an isoproterenol (ISO) myocardial infarction model. Male Fischer rats were exposed to HD by inhalation (0.7 mg/l), 6 h/day, 5 days/week, for 6 weeks. After a 10-day recovery period, sham-exposed and HD-exposed rats were injected subcutaneously with 0, 20, 40 or 60 mg ISO/kg body weight. Blood pressure, heart rate, electrocardiogram and 99mTc uptake by the heart were measured 1 day later. A dose-related increase was observed in the uptake of 99mTc by the hearts of both sham-exposed and HD-exposed animals after ISO injection; however, uptake by the sham-exposed group was significantly greater than that of exposed groups. The most striking observation was a 20% elevation in arterial blood pressure of HD-exposed rats over that of sham-exposed animals when no ISO was injected. These results suggest that the cardiovascular system could be detrimentally affected by exposure to coal-derived complex mixtures and, possibly, to other complex organic mixtures.

Topics: Administration, Inhalation; Animals; Blood Pressure; Coal Tar; Diphosphates; Disease Models, Animal; Dose-Response Relationship, Drug; Electrocardiography; Heart Rate; Isoproterenol; Male; Myocardial Infarction; Rats; Rats, Inbred F344; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

The combined TI-201/Tc-99mPPi tomography was compared to planar Tc-99m-PPi scintigraphy in terms of diagnosis and localization of the infarction. In 32 consecutive patients with recent myocardial infarctions, the necrosis could be detected by means of planar imaging in 17 out of 22 patients with transmural and in three out of 10 patients with intramural infarctions. Six out of seven patients without recent myocardial infarctions were accurately diagnosed. Double radionuclide tomography made possible accurate diagnoses in all patients. Artefacts resulting from residual radioactivity within the cardiac blood pool and uptake of tracer in bones that overlie the heart were only observed with planar imaging.. double radionuclide tomography is superior to planar imaging in the diagnosis of acute myocardial infarction.

Topics: Adult; Aged; Diphosphates; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

The incidence of acute myocardial infarction (AMI) complicating coronary artery bypass grafting (CABG) has previously been based on concordance of electrocardiographic, enzymatic and scintigraphic criteria. Technetium-99m pyrophosphate (Tc-PPi) single-photon emission computed tomography now enables detection of AMI with high sensitivity and specificity. Using this technique, perioperative AMI was detected in 12 of 58 patients (21%) undergoing successful elective CABG for stable angina pectoris. Stepwise multivariate logistic regression analysis was performed to compare the predictive value of preoperative (New York Heart Association class, left ventricular ejection fraction and use of beta blockers) and intraoperative (number of grafts constructed, use of internal mammary anastomoses, use of sequential saphenous vein grafts, smallest grafted distal vessel lumen caliber and aortic cross-clamp time) variables. Preoperative New York Association class (p = 0.04) and smallest grafted distal vessel lumen caliber (p = 0.03) were significant multivariate predictors of perioperative AMI. Only 1 perioperative patient with AMI (and 1 pyrophosphate-negative patient) developed new Q waves. Serum creatine kinase-MB was higher in patients with AMI by repeated measures analysis of variance (p = 0.0003). Five AMIs occurred in myocardial segments revascularized using sequential saphenous vein grafts, and 7 in segments perfused by significantly stenosed epicardial vessels with distal lumen diameter and perfusion territory considered too small to warrant CABG. At 6-month follow-up, the mean left ventricular ejection fraction increased from 0.61 to 0.65 in Tc-PPI-negative patients (p = 0.01), but not in perioperative patients with AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Angina Pectoris; Coronary Angiography; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Predictive Value of Tests; Regression Analysis; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; 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

The aim of the study was to compare the effectiveness of planar and single photon emission computed tomography (SPECT) imaging with 99mTc-pyrophosphate in the verification of acute myocardial infarction. The study was performed on 39 patients (26 males, 13 females) aged between 41-76 years (mean 61 +/- 9) admitted to CCU for acute myocardial infarction. Patients underwent planar and SPECT imaging using a double-head-camera with a 360 degrees rotation arc within 6 days of admission. Planar images were obtained in three standard projections (anterior, LAO 45 degrees, LAO 75 degrees) with acquisitions of 500000 counts each. To obtain SPECT images ninety projections, each lasting 20 seconds, were taken; subsequently images reconstruction was performed using an iterative algorithm. Positive planar images were found in 21 out of 39 patients; SPECT images were positive in 33 patients. In "Q wave" myocardial infarctions planar images were positive in 13 out of 15 patients, whereas SPECT images were positive in all subjects; in "non-Q wave" myocardial infarctions planar images were positive in 6 out of 22 patients whereas SPECT images were positive in 16 patients (p less than 0.005); in 2 patients with left bundle branch block both planar and SPECT images were positive. A bidimensional echocardiogram was carried out on 38 patients: an alteration of left ventricular regional wall motion was present in 30 subjects; in one patient diffuse hypokinesia was present.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Diphosphates; Echocardiography; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radiography; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Myocardial infarct size in 41 patients with the first attack of acute transmural myocardial infarction (MI) was assessed by technetium-99m pyrophosphate single photon emission computed tomography (99mTcPYP-SPECT). A ratio of the number of voxels of 99mTcPYP uptake into the infarct area to that into the thorax was calculated as a parameter of MI size. The ratio was positively correlated with both peak CPK activity (r = 0.53, p less than 0.005, n = 24) and extent score in 201TI-SPECT (r = 0.70, p less than 0.005, n = 14) significantly in patients with anterior MI but not in patients with inferior MI. There was also significant negative correlation between the ratio and the left ventricular ejection fraction (LVEF) measured by RI angiography in both acute (r = -0.67, p less than 0.005, n = 18) and chronic (r = -0.75, p less than 0.005, n = 25) phases in patients with anterior MI. Recovery in LVEF at chronic phase was noted in patients with small anterior MI but not with large anterior MI. 8 of 14 patients with inferior MI had right ventricular MI, that might have affected evaluation of MI size and resulted in no correlation between variables. It was suggested that 99mTcPYP-SPECT was a useful method to evaluate MI size and to predict prognosis of cardiac function in patients with anterior MI but not in patients with inferior MI.

Topics: Adult; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Diagnostic contribution of Conventional Planar Scintigraphy (CPSc) and Single Photon Emission Computed Tomoscintigraphy (SPECT), using 99mTc-Pyrophosphate (99mTc-PYP), have been compared in 49 patients with either transmural (T.I., N = 40), or non-transmural (N.T.I., N = 9) infarction. Sensitivity ratios were, respectively for CPSc and SPECT, 75% and 100% in T.I., 78% and 88% in N.T.I. CPSc was non-diagnostic in 6 out of 49 patients, SPECT in only 1. Extent of the necrotizing process was better delineated on SPECT studies than on CPSc. Specificity of 99mTc-PYP tomoscintigraphy evaluated in a group of 6 young (under 40 years old) normal patients was 6/6 (100%). In nine out of ten additional patients without proven infarction who had underwent contrast coronarography within two weeks after a positive 99mTc-PYP SPECT study, significant stenosis (greater than 50%) were found on arteries supplying blood to pathologic territories as demonstrated on tomoscans. It is concluded that 99mTc-PYP SPECT is a very sensitive and specific way--better than CPSc--in the diagnosis as well as in the evaluation of the extent of necrotic myocardial process.

Topics: Aged; Diphosphates; Female; Heart; Humans; Male; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

The investigation studied the relation of 99mTc-pyrophosphate incorporation (99mTc-PYP) into experimental, 48-hours old myocardial infarction in dogs to tissue vascular supply and to the extent of necrotic tissue. The experimental myocardial infarction was induced in five animals during an operation by the ligation RIVA. The myocardial blood supply was measured in tissue samples, taken from transverse sections of the infarction by means of 86Rb captation. The extent of myocytolysis was measured by depletion of tissue creatine kinase (CK). In the subendocardial layer of the infarction it became obvious that 99mTc-PYP incorporation was proportional to the decrease of tissue blood supply. No relation between the extent of necrosis and the incorporation of the radioactive chemical was demonstrated. The accumulation of 99mTc-PYP requires the necrosis to be present, but its extent apparently does not influence the intensity of incorporation. In the subepicardial infarction layer there was neither a relation of the radioactive chemical cumulation to the blood flow, nor to the extent of the necrosis proved.

Topics: Animals; Diphosphates; Dogs; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Coronary Artery Bypass; Diphosphates; Humans; Myocardial Infarction; Postoperative Complications; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

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

Topics: Diphosphates; Humans; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Among 144 patients with hypertrophic cardiomyopathy, eight (58.3 +/- 7.0 years, M:F = 7:1) had complicating myocardial infarction, which was diagnosed clinically and by elevated cardiac enzymes or new Q-waves on electrocardiography. Coronary occlusion or stenosis evidenced by coronary angiography and nuclear cardiological findings were investigated. In six of the eight patients, coronary atherosclerosis caused infarction. These patients had many coronary risk factors compared to the other two patients. Sixteen of the 144 patients (11%) with hypertrophic cardiomyopathy had coronary atherosclerosis, the rate of which is reportedly 10 to 20%. Two of the eight patients had no coronary atherosclerosis. One patient had a diffusely spastic diathesis provoked by the intravenous administration of ergonovine maleate during coronary angiography, suggesting that coronary spasm caused myocardial infarction. The other patient had recurrent episodes of supraventricular tachyarrhythmia and no evidence of spasm during coronary angiography, suggesting coronary embolism as a cause of myocardial infarction. Myocardial infarction in patients with hypertrophic cardiomyopathy and normal coronary arteries as advocated by Maron et al. may have such pathogenesis. We conclude that coronary angiography may be mandatory in patients with hypertrophic cardiomyopathy, especially those who have many coronary risk factors and anginal symptoms. In these patients, ST-T changes and abnormal Q-waves on electrocardiography sometimes may be misleading when diagnosing the occurrence of acute myocardial infarction by electrocardiography alone. In such cases, infarct-avid scintigraphy with 99 m-Tc pyrophosphate is preferable.

Topics: Adult; Aged; Cardiomyopathy, Hypertrophic; Coronary Angiography; Coronary Artery Disease; Coronary Vasospasm; Diphosphates; Electrocardiography; Embolism; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

The region of overlap of thallium-201 (Tl) and technetium-99m pyrophosphate (Tc) was evaluated as a scintigraphic prognosticator of future necrosis. Serial time courses of myocardial perfusion according to Tl and left ventricular wall motion evaluated by two-dimensional echocardiography (2D echo) were used in 22 patients. In all, dual energy emission computed tomography (dual-SPECT) showed the Tl/Tc overlap on identical slices on the third post-infarction day. According to the results of dual-SPECT, the patients were categorized in three groups: nine with large Tl/Tc overlap (group A); five with small Tc accumulation and small Tl/Tc overlap (group B); and eight with large Tl defect and Tc accumulation, which are concordant with each other (group C). Tl-201 SPECT and 2D echo were attempted serially on the 1st and 2nd days, the 7th-10th days and the 28th-30th days. To estimate infarct size with Tl-201 SPECT, we measured pixel counts of eight short-axis images with the 40% cut-off level and computed "% defect". To evaluate the viability of the myocardium, "% Tl uptake" was computed from the ROIs both in the centers of the infarct areas and their border zones. 2D echoes of the left ventricular short axis at the chordae tendineae level were recorded to identify the time course of percent fractional area change (% FAC) of the ischemic left ventricular wall. The scintigraphic results were compared with the serial changes of regional ejection fraction in the areas of infarcts and ischemic lesions. The % defect remained unchanged in group C (29.2 +/- 11.5----25.7 +/- 8.3%); whereas those of groups A and B decreased significantly (21.2 +/- 11.3----9.9 +/- 6.3%, 13.8 +/- 2.6----5.4 +/- 2.9%, respectively). In groups A and B, % FAC improved significantly in the centers of the infarct areas and the border zones, but not in group C. Exercise-induced ischemia determined by redistribution of Tl at the chronic phase was observed more frequently in groups A and B than in group C. These findings indicated that more myocardium can be saved from necrosis in group A than in group C. In conclusion, it is suggested that there is considerable viable myocardium in patients with large Tl/Tc overlap on dual-SPECT.

Topics: Aged; Diphosphates; Echocardiography; Female; Heart; Humans; Myocardial Infarction; Myocardium; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; 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

Both acute myocarditis and myocardial infarction must be considered in the differential diagnosis of the young patient with angina-like chest pain. Initial assessment may be difficult, since both diseases may produce similar clinical presentations, electrocardiographic changes, and elevations in cardiac enzymes. Early differentiation is important, however, since myocarditis and myocardial infarction differ greatly in their management and prognosis. These difficulties are illustrated by the 2 cases presented, and guidelines for diagnosis and treatment are given.

Topics: Acute Disease; Adult; Angina Pectoris; Diagnosis, Differential; Diphosphates; Echocardiography; Electrocardiography; Heart; Humans; Male; Myocardial Infarction; Myocarditis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

To examine the significance of technetium-99m pyrophosphate/thallium-201 scintigraphic overlap as an indicator of identifying early coronary reperfusion (less than or equal to 3 hours), 32 patients, in whom coronary recanalization was attempted for acute myocardial infarction (AMI), underwent myocardial imaging 3 days after the onset of AMI. The imaging was performed by simultaneous dual emission computed tomography, which allows simultaneous recording of technetium-99m pyrophosphate and thallium-201 images and comparison between both images in the same slice. The patients were separated into 3 groups: 9 patients in whom reperfusion was successful and showed scintigraphic overlap (group A), 12 with successful recanalization but no overlap (group B) and 11 with neither coronary reflow nor overlap (group C). No patient in whom reperfusion failed showed scintigraphic overlap (p less than 0.05). Groups A and B were comparable in age, infarct vessel, collateral circulation, residual coronary stenosis and cumulative release of creatine kinase-MB isoenzyme. However, compared with group B, group A had a shorter interval between onset of AMi and reflow (2.5 +/- 0.8 vs 4.8 +/- 1.3 hours, p less than 0.001). The presence of scintigraphic overlap identified early coronary reflow with a sensitivity of 80%, specificity of 91%, positive predictive accuracy of 89% and negative predictive accuracy of 83%. Thus, technetium-99m/thallium-201 overlap on dual emission computed tomography can be used as an index of documenting early recanalization and might reflect the presence of salvaged myocardium adjacent to the necrotic tissue.

Topics: Clinical Enzyme Tests; Coronary Angiography; Coronary Circulation; Creatine Kinase; Diphosphates; Evaluation Studies as Topic; Humans; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Time Factors; Tomography, Emission-Computed

A cohort of 76 patients with acute myocardial infarction was studied with infarct-avid scan, radionuclide ventriculography, and thallium-201 myocardial perfusion scintigraphy. Infarct area, left ventricular ejection fraction, and defect score were calculated as radionuclide indices of the extent of myocardial infarction. The correlation was studied between these indices and cardiac events (death, congestive heart failure, postinfarction angina, and recurrence of myocardial infarction) in the first postinfarction year. High-risk patients (nonsurvivors and patients who developed heart failure) had a larger infarct area, a lower left ventricular ejection fraction, and a larger defect score than the others. Univariate linear discriminant analysis was done to determine the optimal threshold of these parameters for distinguishing high-risk patients from others. Radionuclide parameters obtained in the early phase of acute myocardial infarction were useful for detecting both patients with grave complications and those with poor late prognosis during a mean follow-up period of 2.6 years.

Topics: Adult; Aged; Cardiac Output; Diphosphates; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Recurrence; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Diphosphates; Diphosphonates; Humans; Middle Aged; Myocardial Infarction; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Clinical Enzyme Tests; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Heart; Humans; Intraoperative Complications; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Labelled monoclonal antimyosin antibodies have been proposed for the diagnostic imaging of acute myocardial infarction (AMI). In order to verify in the clinical practice the theoretical advantages of this new approach, we performed planar imaging with a commercial kit of 111In-antimyosin (111In-AM) in 17 patients admitted to our Coronary Care Unit with the diagnosis of AMI. The results were compared with the echocardiographic assessment of AMI and, in 9 subjects, also with 99mTc-pyrophosphate (99mTc-PYP) scintigraphy. Furthermore, the in-vivo kinetics of 111In-AM was investigated in 11 patients (blood pool activity curve; column gel-chromatography of the injected compound and patient serum). 111In-AM images showed a myocardial uptake in 16/17; 99mTc-PYP scintigraphy in 7/9. The site of AMI was correctly identified by 111In-AM in 14/17, was mistaken in one and impossible to evaluate in another (diffuse uptake pattern). AMI extent, qualitatively assessed in 111In-AM images was consonant with echocardiography in 8/17 and with 99mTc-PYP in 5 of 9 subjects studied also with this method. An apparent underestimation, in comparison with echocardiography was found in 2 cases, whilst an overestimation was seen in 5 cases. One patient was also underestimated in comparison with 99mTc-PYP. 111In-AM images showed a poor quality, with considerable liver, bone marrow, kidney and blood pool activity and therefore low target to background ratio. In-vivo kinetics was characterized by a slow clearance from the blood pool.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Diphosphates; Echocardiography; Female; Humans; Indium Radioisotopes; Isotope Labeling; Kinetics; Male; Middle Aged; Myocardial Infarction; Myosins; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Diphosphates; Humans; Male; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

99mTc-aminohexylidendiphosphonate (99mTc-AHDP) is a new Czechoslovak pharmaceutical of the phosphonate line which contains the amino group NH2 in its molecule. This substance was tested in 5 dogs with experimentally provoked 48-h old myocardial infarction. The in-vivo scan and the radioactivity of tissue samples demonstrated that 99mTc-AHDP is as suitable for imaging acute myocardial infarction as is the commonly used 99mTc-pyrophosphate.

Topics: Animals; Diphosphates; Diphosphonates; Dogs; Myocardial Infarction; Organometallic Compounds; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The accuracy with which intracoronary thallium and technetium pyrophosphate scintigraphy during intracoronary thrombolysis predicts myocardial salvage was studied in 58 patients with acute myocardial infarction by comparing the acute scintigraphic findings with subsequent left ventricular function. Scintigrams obtained before and immediately after thrombolysis were interpreted by three independent observers using a scoring system. Regional wall motion in the infarct area was determined from left ventricular (LV) cine angiograms using the center-line method. Patients with mild hypokinesis (hypokinesis less than or equal to -2 SD from normal) could be distinguished from those with severe hypokinesis (hypokinesis greater than -2 SD) using the prethrombolysis thallium score with an accuracy of 83%. Accuracy using the post-thrombolysis score was 76%. When the post-thrombolysis thallium and technetium pyrophosphate scores were combined, differentiation was possible in 91% of all patients studied, and in 100% of patients with anterior myocardial infarction. Thus, analysis of combined thallium and technetium pyrophosphate scintigraphy accurately predicts recovery of LV function after thrombolysis and may be helpful in deciding whether acute percutaneous transluminal coronary angioplasty or bypass surgery should be performed after thrombolysis.

Topics: Cardiac Output; Coronary Thrombosis; Coronary Vessels; Diphosphates; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Signal Processing, Computer-Assisted; Streptokinase; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Predictive value of myocardial 99mTc-pyrophosphate scintigraphy was assessed in 122 patients with postinfarction cardiosclerosis. In those cases where clinical and scintigraphic complication risk estimates considered, further evidence was shown to be redundant. Prognosis in patients with positive scintigraphic results and asymptomatic postinfarction cardiosclerosis or first-to-second class stable angina should take into account the size of myocardial pyrophosphate accumulation focus and the pattern of stress-induced changes in blood supply of the sites of myocardial damage. Negative scintigraphic results have no predictive value in those postinfarction cardiosclerosis patients who show clinical signs of heart failure and/or severe coronary insufficiency at the time of investigation.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Diphosphates; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Thallium Radioisotopes; Tomography, Emission-Computed

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: Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Heart; Humans; Isoenzymes; Myocardial Infarction; Myocardial Revascularization; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Diphosphates; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion Injury; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Topics: Adult; Antibodies, Monoclonal; Diphosphates; False Negative Reactions; False Positive Reactions; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Myocardial Infarction; Myosins; Necrosis; Predictive Value of Tests; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

To evaluate the clinical significance of scintigraphic overlap of thallium-201 (201T1) and technetium-99m pyrophosphate (99mTc), we observed 28 patients with acute myocardial infarction (AMI) in whom coronary reperfusion was attempted. All patients underwent dual energy emission computed tomography (D-ECT) on the third post AMI day which facilitated comparing 99mTc and 201T1 images from identical slices simultaneously. The scintigraphic results of the 28 patients were as follows: (table, see text) In conclusion, (1) significant 201T1 and 99mTc overlap on D-ECT suggest very early and successful reperfusion, and (2) none of the patients with unsuccessful reperfusion exhibits overlap.

Topics: Diphosphates; Evaluation Studies as Topic; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tomography, Emission-Computed

Single-photon emission computed tomography (SPECT) with 99mTc-pyrophosphate (99mTc-PYP) has been reported to be useful in the detection and localization of acute nontransmural infarctions. Localized uptake of 99mTc-PYP has been shown in patients with nontransmural infarction in these studies. It is likely, however, that anatomically transmural infarctions could be mislabelled as nontransmural infarctions, since the absence of new abnormal Q waves has been used in differentiating between nontransmural and transmural infarctions. We report a case of relatively diffuse nontransmural infarction demonstrated by a semicircle of 99mTc-PYP activity which significantly overlapped 201Tl uptake on the SPECT study.

Topics: Aged; Diphosphates; Humans; Male; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

Based on serial vectorcardiographic and cardiac scintigraphic studies of 62 patients with acute myocardial infarction, we propose vectorcardiographic criteria for the diagnosis of acute right ventricular infarction. These criteria are: (1) the direction of the maximal spatial ST vector points either to the right-anterior-inferior or to the right-posterior-inferior octant, and (2) the magnitude of the projection of the maximal spatial ST vector is greater than or equal to 0.15 mV in the horizontal plane. By using these criteria correlated with scintigraphic results, 92% sensitivity was achieved together with 98% specificity; the Kappa statistic was 0.90. In patients with acute inferior and right ventricular infarction, the serial maximal spatial ST vector swung to-and-fro like a 'tug of war' between right-anterior-inferior and right-posterior-inferior octants during the acute stage. In patients with acute inferior-posterior and right ventricular infarction, the serial maximal spatial ST vector pointed to the right-posterior-inferior octant during the whole course of the acute stage. Failure to recognize this electrical phenomenon may make the clinician inaccurate when judging the clinical course of acute right ventricular infarction or over-estimate the result of therapeutic intervention.

Topics: Adult; Aged; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates; Vectorcardiography

Topics: Antibodies, Monoclonal; Fatty Acids; Heart; Humans; Magnetic Resonance Imaging; Myocardial Infarction; Myosins; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes; Tin Polyphosphates

To test the hypothesis that scans with technetium-99m pyrophosphate (Tc-99m-PPi) are positive when performed early after successful thrombolytic therapy for acute myocardial infarction (AMI), 16 consecutive patients with AMI who received thrombolytic therapy within 5 hours after the onset of chest pain were studied. Patients were included if chest pain lasted for greater than 30 minutes, was unresponsive to sublingual nitroglycerin and was associated with at least 0.2 mV ST-segment elevation in at least 2 contiguous electrocardiographic leads. All patients received 1.5 million IU of streptokinase intravenously, a mean of 195 +/- 99 minutes after onset of chest pain. Tc-99m-PPi scans and coronary cineangiograms were recorded 491 +/- 156 minutes and 518 +/- 202 minutes, respectively, after the onset of symptoms. Effective reperfusion was present in 10 patients, 6 of whom had positive Tc-99m-PPi scans (sensitivity of 60% to detect reperfusion). Of the 6 patients without effective reperfusion, 3 had positive Tc-99m-PPi scans (specificity of 50%, p greater than 0.05). Analysis of the data using various definitions of effective reperfusion or artery patency yielded similar results. Thus, our findings indicate that early AMI scanning with Tc-99m-PPi does not accurately detect the presence or absence of reperfusion in patients with AMI after treatment with intravenous streptokinase. At this time, coronary cineangiography is the only reliable method to detect reperfusion promptly after thrombolytic therapy.

Topics: Aged; Cineangiography; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Myocardial Infarction; Perfusion; Polyphosphates; Streptokinase; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

The value of technetium-99m pyrophosphate (Tc-99m-PYP) scintigraphy as an indicator of reperfusion 2.8 to 8 hours after the onset of symptoms of acute myocardial infarction was compared with the value of early peak creatine kinase (CK) and CK-MB release within 16 hours after the onset of symptoms. In 29 patients who received thrombolytic therapy, recanalization was seen (group 1) and in 7 it was not (group 2). In 23 patients (79%) in group 1 scintigraphic findings were positive and in all 7 in group 2 they were negative. In 15 patients (52%) in group 1 and 1 patient (14%) in group 2, CK reached its peak level within 16 hours. In 20 patients (69%) in group 1 and 3 (43%) in group 2 the CK-MB level reached a peak within 16 hours. The sensitivity, specificity and predictive accuracy of positive results of early Tc-99m-PYP scintigraphy in predicting the reperfusion were 79%, 100% and 83%. These values are significantly higher than or similar to those of early peaking of CK and CK-MB release. In contrast to measurements of enzyme release, reperfusion data for Tc-99m-PYP scintigraphy are available immediately after thrombolytic therapy. Therefore, early Tc-99m-PYP scintigraphy (3 to 8 hours after onset of symptoms) is valuable as a noninvasive technique for early diagnosis of reperfusion.

Topics: Aged; Angiocardiography; Cineangiography; Coronary Angiography; Creatine Kinase; Diphosphates; Female; Heart; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Urokinase-Type Plasminogen Activator

Topics: Adult; Burns, Electric; Diagnosis, Differential; Diphosphates; False Positive Reactions; Heart; Humans; Male; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Early appearance of positive findings on a technetium-99m pyrophosphate scan has been shown to be associated with the presence of a reperfused acute myocardial infarction (AMI). Early technetium-99m pyrophosphate imaging was performed by emission computed tomography to evaluate reperfusion and to test the feasibility of estimating infarct size soon after coronary reperfusion based on acute positive tomographic findings. Twenty-seven patients with transmural AMI who were treated with intracoronary urokinase infusion followed by percutaneous transluminal coronary angioplasty underwent pyrophosphate imaging 8.7 +/- 2.1 hours after the onset of AMI. None of the 8 patients in whom reperfusion was unsuccessful had acute positive findings. Of 19 patients in whom reperfusion was successful, 17 had acute positive findings (p less than 0.001). In these 17, tomographic infarct volumes were determined from reconstructed transaxial images. The threshold for areas of increased pyrophosphate uptake within the infarct was set at 60% of peak activity by the computerized edge-detection algorithm. The total number of pixels in all transaxial sections showing increased tracer uptake were added and multiplied by a size factor and 1.05 g/cm3 muscle to determine infarct volume. The correlations of tomographic infarct volumes with peak serum creatine kinase (CK) levels (r = 0.82) and with cumulative release of CK-MB isoenzyme (r = 0.89) were good. Moreover, the time to positive imaging was significantly shorter than that to peak CK level (8.5 +/- 2.3 vs 10.4 +/- 2.2 hours, p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Creatine Kinase; Diphosphates; Female; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Perfusion; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors; Tomography, Emission-Computed

Topics: Adolescent; Adult; Aged; Aortic Valve; Child; Creatine Kinase; Diphosphates; Electrocardiography; Female; Heart Valve Prosthesis; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Angina Pectoris; Angina, Unstable; Bundle-Branch Block; Diphosphates; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The clinical significance of right ventricular (RV) infarction has been neglected compared with left ventricular infarction. In recent years, however, the clinical importance of RV function in the treatment of myocardial infarction has been well recognized. We performed prospective radionuclide studies to assess the incidence and prognosis of RV infarction in 50 cases of initial acute myocardial infarction (25 cases of anterior and 25 of inferior infarction). Radionuclide ventriculography was performed within the first two days after onset of symptoms, and repeated one-two weeks and one month after the attack, respectively. RV infarction was diagnosed by the presence of severe RV regional wall motion abnormalities and positive signs of at least one of the following diagnostic signs: ST elevation at V4R in the ECG, positive 99m-technetium pyrophosphate myocardial scintigram at the RV free wall, and positive right heart catheterization findings. Results were as follows: 1. RV infarction was documented in 15 of 25 cases with inferior infarction, but there were no cases in anterior infarction. 2. There were no remarkable changes of RV ejection fraction (EF) in anterior myocardial infarction during one month (41% +/- 8% in acute phase and 43 +/- 8% in four weeks later). However, RVEF was markedly improved from 34 +/- 11% during first two days, to 38 +/- 7% during one-two weeks, and 39 +/- 8% four weeks after the attack, in cases of inferior infarction with RV infarction. Without RV infarction, RVEF in cases of inferior infarction did not show improvement. 3. In 11 of 15 cases with RV infarction, RV regional wall motion abnormalities improved to the normal range, which seemed to contribute to the improvement of RVEF. 4. Hemodynamic findings with Swan-Ganz catheters showed typical findings compatible with RV infarction only in seven of 13 cases with RV infarction. Thus this finding implies that RV failure did not always accompany RV infarction. 5. Coronary arteriography revealed that right coronary arterial lesions proximal to the RV branch were documented in all 10 cases with RV infarction who had coronary arteriography. RV infarction, caused by deranged coronary blood flow at the RV branch of the right coronary artery, showed marked improvement of RVEF during four weeks after the attack in prospective radionuclide studies. This finding was not seen in left ventricular infarction. The pathophysiological mechanism of improvement of RVEF in RV infarction would be

Topics: Cardiac Catheterization; Diphosphates; Electrocardiography; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

A crossover study to examine the potential of In111 antimyosin Fab fragment to detect fresh myocardial infarcts in comparison with Tc99m pyrophosphate is reported. In 27 cases indium antimyosin correctly diagnosed 19 patients with infarcts and 4 true negatives. There were also 2 false positive and 2 false negative scintigrams. Tc99m pyrophosphate detected 21 infarcts and 6 true negatives correctly.

Topics: Diphosphates; Humans; Immunoglobulin Fab Fragments; Indium Radioisotopes; Myocardial Infarction; Myosins; Pentetic Acid; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

Emission computed tomography with 99mTc-PYP was used to estimate infarct size in 38 patients with documented acute myocardial infarction. In the present study, the effect of thrombolysis with Urokinase on infarct size and on left ventricular function was assessed. Fourteen patients with acute myocardial infarction who underwent intracoronary thrombolysis within six hours after the onset of symptoms, and 24 patients who underwent conventional therapy were the subjects of this study. Infarct size was measured by drawing a region of interest around the myocardial pyrophosphate uptake for each tomographic slice. The boundary was then defined as 65% of the maximal count within the region of interest as determined by phantom volume studies. The total number of voxels was obtained by adding those in all slices and multiplying the sum by the voxel volume (0.205 ml per one voxel) to determine the infarct volume. Measurement of the 99mTc-PYP uptake on the tomographic image revealed an average infarct size of 100.1 +/- 36.0 ml (ranged 45 to 198). The calculated infarct volume correlated significantly with sigma CPK (p less than 0.01) and with left ventricular ejection fraction (p less than 0.01), but not with the peak CPK. In patients with acute inferior myocardial infarction, the mean infarct volume was 78.4 +/- 29.1 ml in the coronary thrombolysis group, and 105.1 +/- 33.7 ml in the conventional bypass graft treatment group (p less than 0.05). We concluded that successful intracoronary thrombolysis may reduce infarct size. ECT imaging with 99mTc-PYP to determine infarct size may be clinically applicable in patients with acute myocardial infarction.

Topics: Adult; Aged; Aged, 80 and over; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Urokinase-Type Plasminogen Activator

Twelve patients with acute transmural myocardial infarction (AMI) were treated with percutaneous transluminal coronary angioplasty (PTCA) following intracoronary thrombolysis using urokinase, and underwent technetium-99m stannous pyrophosphate (Tc-99m-PPi) imaging 9.2 +/- 2.1 hours after the onset of chest pain. The imaging was performed with emission computed tomography (ECT). Compared to planar imaging, this allowed more accurate detection of small myocardial infarcts and accurate measurements of infarcts irrespective of their location was also made. Early Tc-99m-PPi images were obtained to test the hypothesis that an early, abnormal Tc-99m-PPi image suggest successful reperfusion. The results were presented for two groups of patients: three with unsuccessful reperfusion (Group A) and nine with successful reperfusion (Group B). Eight of the nine patients with successful reperfusion had positive acute Tc-99m-PPi images. On the contrary, all the three patients for whom reperfusion failed had negative acute Tc-99m-PPi images. We also examined the feasibility of estimating infarct size using positive Tc-99m-PPi images in patients with successful reperfusion during the early phase of AMI. The Tc-99m-PPi uptake score (Tc-US) was used to measure infarct size in this study. Areas of increased Tc-99m-PPi uptake within myocardial infarcts were threshold at 60% of the peak activity. The Tc-US of each patient was obtained to sum the scores of all myocardial segments using a scoring system with a maximum score of 108. Using this method, Tc-US ranged from 2 to 39. The correlation of Tc-US with the peak serum creatine kinase level was significant (r = 0.91).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Angioplasty, Balloon; Evaluation Studies as Topic; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Polyphosphates; Predictive Value of Tests; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates; Tomography, Emission-Computed; Urokinase-Type Plasminogen Activator

Technetium-99m-labeled pyrophosphate and radiolabeled antimyosin antibodies are two infarct localizing agents with apparently different kinetics of localization. To determine whether these agents localize in a similar fashion in early acute myocardial necrosis, we studied the simultaneous distribution of 111In-labeled antimyosin and 99mTc-labeled pyrophosphate in dogs after intracoronary (i.c.) (n = 9) or intravenous (i.v.) (n = 9) administration of a mixture of these two agents in a reperfused infarct model. The mean infarct size (+/- s.d.) delineated by pyrophosphate [20.2 +/- 14.1 (i.v.), 29.8 +/- 12.3 (i.c.)] was larger than that by antimyosin [14.2 +/- 11.3 (i.v.) (p = 0.05), 20.0 +/- 11.8 (i.c.) (p = 0.05)] which was larger than that by triphenyl tetrazolium chloride [13.9 +/- 8.0 (i.v.) (p = 0.05), 15.3 +/- 6.5 (i.c.) (p = 0.05)]. This overestimation persisted whether the radiopharmaceuticals were administered by intracoronary or intravenous injections, although the latter with antimyosin was only slightly larger (TTC:AM = 13.9:14.2) (p = n.s.). There was a good correlation, however, between antimyosin and pyrophosphate delineated infarct sizes in dogs with intracoronary injection (y = 0.82x + 13.33, r = 0.79) or i.v. injection (y = 1.208x + 3.01, r = 0.97) of the mixture of the two agents. Since the images of the 111In and 99mTc activities were obtained consecutively by identical methods, the overestimation of infarct size by pyrophosphate cannot be due to differences in spatial resolution of the techniques used. The differences in the areas of myocardial damage delineated by pyrophosphate and antimyosin in our study most probably denote the area of viable but compromised myocardium.

Topics: Animals; Antibodies, Monoclonal; Diphosphates; Dogs; Female; Immunoglobulin Fab Fragments; Indium; Male; Myocardial Infarction; Myosins; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Early 99mTc-pyrophosphate (PYP) scintigrams of 29 patients receiving coronary thrombolysis induced by urokinase, 3.9 +/- 1.2 hours after the onset of acute myocardial infarction (AMI), were evaluated. Intravenous 99mTc-PYP scintigraphy was performed 2.8 to 8.0 hours after the onset of AMI. All 19 patients with positive findings on early scintigrams had good recanalization, compared to only 3 of the 10 patients with negative findings. The seven patients with unsuccessful recanalization after coronary thrombolysis had total occlusion or subtotal occlusion with delayed washout of contrast material, and three of them had collaterals. The sensitivity, specificity, and predictive accuracy of positive results of early scintigraphy in predicting the presence of early reperfusion were 73%, 100%, and 90%, respectively. Patients with positive early scintigrams showed increasing regional ejection fraction and decreasing thallium defect scores from the acute stage to the chronic stage. These findings indicate that early 99mTc-PYP scintigraphy is a sensitive noninvasive technique for detecting early recanalization in infarcted vessels. The collateral flow or antegrade flow with delay is not enough to cause 99mTc-PYP uptake in a very early stage of AMI.

Topics: Aged; Coronary Angiography; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

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

Technetium-99m 2,3-dimercaptosuccinic acid (Tc-99m DMSA) has been used successfully for imaging acute myocardial infarction in a canine model. The application in humans, however, has not been previously reported. In order to determine the feasibility of using this agent in clinical studies and to compare the agent to technetium-99m pyrophosphate (Tc-99m PPi), ten patients with proven myocardial infarction were studied. While imaging of transmural infarctions in humans was achieved using Tc-99m DMSA, scores for the Tc-99m DMSA images (1.8 +/- 0.96) were not as high as for Tc-99m PPi (2.5 +/- 0.45) (P less than 0.05). Discordance among four independent interpreters was greater for images obtained with Tc-99m DMSA. The superiority of Tc-99m PPi was evident whether images were obtained early (within 24 hours) or late (within five days). Although DMSA images were not obscured by rib uptake, they were less sensitive (63%) than Tc-99m PPi (97%). A potential advantage of Tc-99m DMSA in imaging acute myocardial infarction is that radiotracer concentration in the infarct occurs primarily in the early postinfarction period. The longer postinfarction that Tc-99m DMSA imaging was attempted, the lower the concentration of radiotracer. Thus, Tc-99m DMSA would not be expected to have the same persistence pattern as Tc-99m PPi into the remote postinfarction period. The persistent positivity of Tc-99m PPi has made it difficult to diagnose reinfarction.

Topics: Aged; Animals; Diphosphates; Dogs; Humans; Kinetics; Male; Middle Aged; Myocardial Infarction; Myocardium; Organometallic Compounds; Radionuclide Imaging; Species Specificity; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pyrophosphate; Time Factors

The purpose of our study was to evaluate, with noninvasive procedures, the incidence and the clinical picture of right ventricular involvement in patients with acute transmural inferior myocardial infarction. Our study group was constituted of 107 consecutive patients admitted to our Coronary Care Unit within 10 hours from the onset of symptoms; in every patient a standard 12-leads ECG and the precordial leads V3R and V4R were obtained at admission in CCU and then every 12 hours. 80 patients underwent B-mode echocardiographic evaluation within 36 hours and in 93 patients a myocardial scintigraphy was performed, between the 48th and 72nd hour from the onset of chest pain, 1-2 hours after injection of Tc-99m-pyrophosphate.. 45 patients (42.1%) had ECG positive for right ventricular infarction, 49 patients (51.6%) had positive Tc-99m-pyrophosphate scintigraphy and 24 patients (30%) positive echocardiography. By using the positivity of ECG and another method at least, patients were separated into 2 groups: group A (associated inferior and right infarction) was constituted of 45 patients, and group B (isolated inferior infarction) was constituted of 62 patients. In group A we noted a higher incidence of hypotension (systolic blood pressure less than 100 mmHg) and oliguria (less than 30 ml/h)- p less than 0.01-, of 2nd and 3rd A-V blocks-p less than 0.001- and primary ventricular fibrillation -p less than 0.01. The incidence of parossistic atrial fibrillation, severe bradycardia or SA blocks and of mortality was not statistically different between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Diphosphates; Echocardiography; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Prognosis; Technetium; Technetium Tc 99m Pyrophosphate

The prognostic significance of the doughnut pattern of technetium-99m pyrophosphate myocardial uptake was evaluated in 140 patients with acute anterior infarction. There were significantly higher early complications, greater mortality and more severe hemodynamic abnormalities in the doughnut pattern group than in the non-doughnut pattern group. The former had a more depressed left ventricular ejection fraction and larger thallium-201 defect size (27.6 +/- 10.4 versus 40.0 +/- 13.5%, p less than 0.001 and 9.9 +/- 3.6 versus 5.6 +/- 3.3, p less than 0.001, respectively). There was, however, considerable overlap of the ranges of these variables for both groups. The patency rate of the infarct vessel during the acute phase of infarct in each group was similar (54.8 versus 45.2%). It is concluded that the prognostic value of the doughnut pattern may be limited to some extent by this overlapping and the presence of this pattern does not appear to correlate with the lack of residual blood flow to the infarcted area.

Topics: Cardiac Catheterization; Coronary Angiography; Diphosphates; Electrocardiography; Female; Heart; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Previously, technetium-99m-stannous pyrophosphate (99mTc-PPi) has been used to localize and estimate the size of myocardial infarcts in animals after permanent coronary artery occlusion. This study tested the hypothesis that 99mTc-PPi accurately sizes myocardial infarctions produced by temporary coronary artery occlusion and reflow in dogs. Three groups of dogs were studied: group A underwent 3 hr of occlusion followed by 2 hr of reperfusion, with 99mTc-PPi injected 10 min after reflow (n = 10); group B underwent 3 hr of occlusion followed by 2 hr of reperfusion, with 99mTc-PPi injected 90 min after reflow (n = 11); and group C underwent 3 hr of occlusion followed by reflow with 99mTc-PPi injected at 10 min and again at 48 hr after reflow (n = 5). Myocardial slices from group A and B dogs were imaged in vitro. Group C dogs were imaged with single photon-emission computed tomography (SPECT) in vivo, and myocardial slices were imaged in vitro at the conclusion of the study. The extent of myocardial infarction was defined with triphenyltetrazolium chloride (TTC) staining, and coronary blood flow was estimated with radioactive microspheres. In addition, transmural myocardial tissue samples were taken from the center of the myocardial infarction, the lateral portion of the myocardial infarction, the normal myocardium adjacent to the lateral aspect of the infarcts, and from the normal myocardium and counted for 99mTc-PPi activity. A significant correlation was found between infarct size determined by areas of increased 99mTc-PPi uptake and that estimated from TTC staining for both group A (r = .89) and group B animals (r = .98).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Constriction; Coronary Circulation; Coronary Vessels; Dogs; Myocardial Infarction; Polyphosphates; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors; Tin Polyphosphates; Tomography, Emission-Computed

The usefulness of single photon emission computed tomography (SPECT) using technetium-99m pyrophosphate (99mTc-PPi) was evaluated in 15 patients with acute myocardial infarction. SPECT was performed with a rotating gamma camera after conventional planar images were made. Infarct size was measured from transaxial images of myocardial pyrophosphate uptakes. In each slice, the boundary was defined by subtracting 70 percent of the maximal counts and the number of voxels automatically counted. This subtraction rate was determined by phantom study and by comparing SPECT using 99mTc-PPi with thallium-201-gated myocardial scintigraphy (201Tl gated SPECT). The planar images showed diffuse uptakes in two of the 15 patients, and in these cases it was difficult to detect the infarct site. In contrast, SPECT images clearly imaged the infarct site consistent with the electrocardiographic findings, and they were definitely separated from the uptakes in the bones in all cases. Infarct size, ranging from 3.4 ml to 78.3 ml, correlated well with cumulative creatine kinase release (r = 0.84, p less than 0.01, y = 772x + 13900). Correlation of infarct size with peak serum creatine kinase level was also significant (r = 0.66, p less than 0.01, y = 10.6x + 693). In conclusion, SPECT with 99mTc-PPi is a useful means of investigating the spatial distribution of pyrophosphate uptake and of evaluating the size of myocardial infarction.

Topics: Aged; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

To evaluate the usefulness of single photon emission computed tomography (SPECT) with technetium-99m-pyrophosphate (99mTc-PYP) for estimating infarct size, we compared SPECT data with maximum creatine phosphokinase values. Background threshold was established in a series of phantom experiments. When a 40% cut-off was applied, the SPECT data most closely approximated actual phantom volumes. Therefore, the 40% cut-off level was used in the present study. In 10 patients with acute myocardial infarction, planar 99mTc-PYP myocardial scintigraphy and SPECT using a rotating gamma camera were performed two days after the initial myocardial infarction episode. The maximum creatine phosphokinase value (CPKmax) was also measured repeatedly following the episode. When the infarct size measured by SPECT using transaxial images and calculated by the pixel counts, it correlated very closely with CPKmax (r = 0.94). Most studies so far have reported that the CPKmax level reflects infarct size. We conclude that the infarct size as measured by 99mTc-PYP SPECT closely approximates the actual infarct size, and that this method is useful to determine the severity of infarcts clinically. Among the 10 patients in this series, three of five with infarcts greater than 60 ml died of pump failure. Therefore, we may be able to predict prognosis after accumulating more such cases and improving the methodology.

Topics: Aged; Aged, 80 and over; Creatine Kinase; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Models, Theoretical; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

The values of several non-invasive methods for the diagnosis of right ventricular necrosis in inferior myocardial infarction were compared in 51 consecutive patients who underwent serial radionuclide ventriculography, pyrophosphate scintigraphy, and cross sectional echocardiography. In addition a unipolar electrocardiographic lead V4R was recorded on admission, daily, and during episodes of further pain. Profound right ventricular dysfunction was evident in 50% of patients studied by radionuclide methods after inferior myocardial infarction but recognition on clinical groups alone was poor. Functionally important right ventricular infarction was best detected and followed serially by radionuclide ventriculography. Echocardiographic methods for evaluating right ventricular ejection fraction correlated poorly with radionuclide methods. Increased uptake of radioactivity by the right ventricle on pyrophosphate scintigraphy usually indicated poor right ventricular function, but a scan that was negative in the right ventricular territory did not exclude dysfunction. ST segment elevation in V4R was not specific for right ventricular infarction and its routine use may lead to overdiagnosis of this condition. Serial measurements suggest that profound right ventricular dysfunction persists after acute inferior infarction and is associated with considerable morbidity and mortality. Of 25 patients with severe right ventricular dysfunction, six died in the late hospital period. In the remaining 19 patients mean right ventricular ejection fraction over a two month period did not improve; six patients had persistent right ventricular dyskinesia and features of chronic right ventricular failure developed in three survivors.

Topics: Adult; Aged; Diphosphates; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Prospective Studies; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

To determine whether technetium-99-pyrophosphate accumulation immediately after intravenous thrombolysis can serve as a marker of reperfusion and infarct size, 17 patients with acute myocardial infarction were studied. Immediately after thrombolysis 10 mCi of technetium-99m pyrophosphate were injected intravenously. Coronary and left ventricular angiography were then performed in all patients, revealing patent coronary arteries in 13 patients. In all patients, 0.3 and 0.5 mCi of thallium-201 were injected into the right and left coronary artery, respectively, followed by planar scintigraphy. 6 patients with patent coronary arteries and a large thallium-201 defect had massive (more than one third of the cardiac silhouette) pyrophosphate accumulation (group A), whereas 7 patients with a small or no thallium-201 defect in the presence of a patent infarct artery had either focal or no pyrophosphate accumulation (group B). In contrast, 4 patients with an occluded infarct artery showed no acute pyrophosphate uptake despite a large thallium-201 defect (group C). Emission computed tomography confirmed the planar scintigraphic data in group A patients and revealed small thallium-201 defects and focal pyrophosphate accumulation in group B patients with negative planar scintigrams. Global and regional ejection fractions in the infarct area, measured from the acute and follow-up left ventricular angiograms, were higher in group A than in group B and C patients. It is concluded that early intravenous technetium-99m pyrophosphate scintigraphy in patients with acute myocardial infarction undergoing intravenous thrombolysis may serve as an indicator of reperfusion and infarct size.

Topics: Adult; Aged; Cardiac Output; Coronary Circulation; Diphosphates; Humans; Middle Aged; Myocardial Contraction; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Urokinase-Type Plasminogen Activator

Intracoronary thallium-201/technetium-99m pyrophosphate planar scintigraphy was performed in 60 patients with acute myocardial infarction undergoing intracoronary thrombolysis to predict salvage of myocardium immediately after thrombolysis. In eight patients a significant overlap of new thallium uptake and technetium pyrophosphate accumulation was found after thrombolysis. Intravenous planar thallium scintigraphy revealed thallium uptake in the region of overlap in all patients; circumferential profile analysis showed no difference in the thallium scintigrams before and after technetium injections. Both findings indicate that overlap is not the result of scattering of technetium into the thallium window. Emission computed tomography revealed thallium/technetium pyrophosphate uptake in identical slices and regions. Regional wall motion in the area of overlap remained depressed in all patients, in contrast to patients with similar thallium uptake without overlap. These data suggest that thallium/technetium pyrophosphate overlap reflects the close proximity of viable and necrotic myocardial cells and predicts depressed wall motion after thrombolysis.

Topics: Adult; Aged; Cineangiography; Diphosphates; Humans; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radioisotopes; Streptokinase; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors; Tomography, Emission-Computed; Urokinase-Type Plasminogen Activator

The potential of magnetic resonance imaging (MRI) to detect and localize acute myocardial infarction (AMI) in 27 patients a mean interval of 15 days after AMI was evaluated. Eighteen asymptomatic volunteers were also studied to determine the specificity of the observations. The diagnosis of AMI was established by conventional criteria; the infarct was localized by electrocardiography in all patients, technetium pyrophosphate scintigraphy in 19 and necropsy in 1 patient. MRI detected increased myocardial signal intensity in 88%, cavitary signal in 74% and regional wall thinning in 67% of the patients. At least 1 of these 3 features was seen in the area of the infarct in each patient. The sensitivity of these MRI observations was not influenced by location of the infarct or presence of Q waves. Asymptomatic volunteers also had increased myocardial signal in 83%, cavitary signal in 94% and wall thinning in 11% of cases. Some patients had these findings in myocardial segments not suspected of being involved by recent or remote AMI. It is concluded that AMI can be detected by MRI performed an average of 15 days after infarction. However, the hearts of normal volunteers and apparently normal myocardial segments of patients with AMI may have the MRI findings previously associated with AMI. Of these findings, wall thinning was the most predictive of and specific for AMI.

Topics: Adult; Aged; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

The case of a 62-year-old man with an acute myocardial infarction detected by planar Tc-99m PYP imaging is presented. The use of SPECT imaging provided more information with regard to infarct localization by demonstrating uptake by the septum, a finding not apparent on the conventional planar images.

Topics: Diphosphates; Heart Septum; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Component fractions of 99mTc(NaBH4)-HEDP mixtures, isolated by anion exchange high performance liquid chromatography (HPLC), have been evaluated as myocardial infarct imaging agents in two animal models. Results from both the isoproterenol-induced myocardial infarction model, and the heat-induced myocardial necrosis model, show that the several HPLC isolated components exhibit significantly different abnormal/normal heart uptake ratios. In addition, the HPLC isolated component of shortest chromatographic retention time exhibits a higher abnormal/normal heart uptake ratio than does 99mTc(Sn)-PyP, the current agent of choice for clinical myocardial infarct imaging.

Topics: Animals; Borohydrides; Chromatography, High Pressure Liquid; Drug Combinations; Etidronic Acid; Female; Myocardial Infarction; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Adult; Aged; Aged, 80 and over; Clinical Enzyme Tests; Diagnosis, Differential; Diphosphates; Electrocardiography; Humans; L-Lactate Dehydrogenase; Middle Aged; Myocardial Infarction; Myocardium; Myoglobin; Technetium; Technetium Tc 99m Pyrophosphate

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

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

Topics: Angina Pectoris; Angina, Unstable; Diphosphates; Female; Heart; Humans; Male; Myocardial Infarction; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Deoxyglucose; Fluorodeoxyglucose F18; Heart; Heart Diseases; Humans; Image Processing, Computer-Assisted; Myocardial Infarction; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tin Polyphosphates; Tomography, Emission-Computed; Tomography, X-Ray Computed

We previously found that a pulse dose of vitamin D3 increased [99mTc]PPi uptake by rat myocardial necrosis. Vitamin D3 raised serum and lesion [Ca] but not, we now report, lesion [Fe]. We now also report that D3 increased [99Tc]PPi uptake by myocardial infarcts (L) in dogs from 0.345 +/- 0.007% administered (kg) dose/g in controls to 0.703 +/- 0.089 in treated (p less than 0.025). Vitamin D3 decreased uptake by dog bone (B) as measured in rib and sternum, increasing L/B from 1.10 +/- 0.23 to 2.30 +/- 0.52 (p = 0.06) X (L) was positively, (p less than 0.005) and uptake by sternum was negatively (p less than 0.05) correlated with serum [Ca] and [P], respectively. Scintigrams graded by a "blinded" observer, showed 4+, 4+, and 3+ infarcts, respectively, in three D3-treated dogs, and 2+, 2+, and 1+, respectively, in three untreated. One untreated and one treated dog were negative; the latter showed the least response to D3 in serum [Ca] and [99mTc] in tissue samples. Vitamin D3 can increase L/B in dogs, enhancing scintigraphic images.

Topics: Animals; Bone and Bones; Calcium; Cholecalciferol; Diphosphates; Dogs; Iron; Myocardial Infarction; Phosphorus; Radionuclide Imaging; Rats; Rats, Inbred Strains; 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

A patient with hypokalemic metabolic alkalosis, hypophosphatemia, and hypomagnesemia/hypocalcemia is described. Electrocardiography demonstrated the pattern of acute anterior myocardial infarction. Further evaluation revealed that the patient had not actually had the acute myocardial infarction and that the electrocardiographic change was a mere simulation. The possible role of hypomagnesemia in the pathogenesis of the electrocardiographic change and the interrelation between the metabolic disturbances noted are discussed.

Topics: Alkalosis; Diagnosis, Differential; Diphosphates; Electrocardiography; Humans; Hypocalcemia; Hypokalemia; Hypophosphatemia, Familial; Magnesium; Male; Metabolism, Inborn Errors; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

A false-positive Tc-99m PYP myocardial scan may result due to gastric activity from breakdown of radiopharmaceutical and accumulation of Tc-99m pertechnetate in gastric cells. Importance of anatomic landmarks during early blood pool images is emphasized to prevent this error.

Topics: Adult; Diphosphates; False Positive Reactions; Humans; Male; Myocardial Infarction; Radionuclide Imaging; 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

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

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

Single photon-emission computed tomography (SPECT) with 99mTc-pyrophosphate (PPi) has been shown to estimate size of myocardial infarction accurately in animals. We tested the hypothesis that SPECT with 99mTc-PPi and blood pool subtraction can provide prompt and accurate estimates of size of myocardial infarction in patients. SPECT estimates are potentially available early after the onset of infarction and should correlate with estimates of infarct size calculated from serial measurements of plasma MB-creatine kinase (CK) activity. Thirty-three patients with acute myocardial infarction and 16 control patients without acute myocardial infarction were studied. Eleven of the patients had transmural anterior myocardial infarction, 16 had transmural inferior myocardial infarction, and six had nontransmural myocardial infarction. SPECT was performed with a commercially available rotating gamma camera. Identical projection images of the distribution of 99mTc-PPi and the ungated cardiac blood pool were acquired sequentially over 180 degrees. Reconstructed sections were color coded and superimposed for purposes of localization of infarct. Areas of increased PPi uptake within myocardial infarcts were thresholded at 65% of peak activity. The blood pool was thresholded at 50% and subtracted to determine the endocardial border for the left ventricle. Myocardial infarcts ranged in size from 1 to 126 gram equivalents (geq) MB-CK. The correlation of MB-CK estimates of size of infarct with size determined by SPECT (both in geq) was good (r = .89 with a regression line of y = 13.1 + 1.5x).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Radiography; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Although infarct size correlates generally with prognosis after acute myocardial infarction, an absolute measure of infarct size may have differing prognostic significance depending on absolute left ventricular mass. To test the hypothesis that single photon emission computed tomography can accurately measure myocardial infarct size as a percent of total left ventricular mass ("infarction fraction"), thallium-201 and technetium-99m pyrophosphate tomograms were acquired in 21 dogs 24 to 48 hours after fixed occlusion of the left anterior descending or circumflex coronary artery. Pathologic infarct weight was measured as the myocardial mass that showed no staining with triphenyltetrazolium chloride. Scintigraphic infarct mass by technetium-99m pyrophosphate was calculated from the total number of left ventricular volume elements (voxels) demonstrating technetium-99m pyrophosphate uptake X voxel dimension [( 0.476 cm]3) X specific gravity of myocardium (1.05 g/cm3). Scintigraphic left ventricular mass was calculated in a similar fashion using an overlay of the thallium-201 and technetium-99m pyrophosphate scans. The "infarction fraction" was calculated as: infarction fraction = infarct mass/left ventricular mass. There was good correlation between single photon emission computed tomography and pathologic measurements of infarct mass (technetium-99m pyrophosphate mass = 1.01 X pathologic infarct mass + 0.96; r = 0.98), left ventricular mass (single photon emission computed tomographic left ventricular mass = 0.60 X pathologic left ventricular mass + 37.4; r = 0.86) and "infarction fraction" (single photon emission computed tomographic infarction fraction = 1.09 X pathologic infarction fraction - 1.7; r = 0.94).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Diphosphates; Dogs; Heart Ventricles; Myocardial Infarction; Organ Size; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed

Topics: Adult; Aged; Cardiac Output; Creatine Kinase; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Stroke Volume; 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

The clinical value of myocardial scintigraphy with 99mTc-pyrophosphate in conjunction with bicycle ergometry was assessed through the correlation of the latter's results with the clinical course of coronary heart disease over 1 year in 21 patients with first myocardial infarction during its early healing stage and 17 anginal patients without a history of myocardial infarction. The disease ran a stable course at the time of the testing in all the patients; later on, 11 of those developed various complications associated with coronary heart disease, or died. Three scintigraphic recordings were made: prior to, at the peak of, and after the exercise. Thirteen scintigraphic patterns were identified. They are interpreted on the basis of presumed variation in the degree of myocardial damage and blood supply to affected areas under the effect of exercise; a relation is also noted with predicted risk of complications. The method has proved reliable in identifying patients at low risk for complications. Providing indirect evidence of the quality of blood supply to damaged myocardial areas during rationed exercise, it furnishes additional criteria for the assessment of the patients' working capacity.

Topics: Adult; Aged; Angina Pectoris; Coronary Circulation; Diphosphates; Exercise Test; Female; Heart; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Risk; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Technetium-99m-pyrophosphate (TcPYP) scintigraphy may have great value in patients with suspected acute myocardial infarction (AMI), but interobserver variability undoubtedly has adverse impact on predictive value. TcPYP scintigrams for 133 (80%) of 166 consecutive patients admitted for suspected AMI were interpreted independently by three experienced readers. Although there was complete agreement for 87 interpretations (65%), major discrepancies (i.e., at least one positive and one negative reading on the same scan) occurred for 28 scans (21%). To assess predictive accuracy, patients were categorized as follows: 36 had definite AMI manifest by new ECG Q waves and/or CK-MB evidence of AMI (group I), 56 were classified as possible AMI (group II), and 41 had AMI excluded (group III). Using only the definitive diagnostic categories (groups I and III), accuracy for each reader approximated 0.68, with no single reader being correct more often than any other.

Topics: Creatine Kinase; Diagnostic Errors; Diphosphates; Electrocardiography; Humans; Isoenzymes; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Electrocardiograms (ECG) and enzyme criteria are usually used to confirm the diagnosis of acute myocardial infarction in the case of chest pain. However, ECG is not always diagnostic. Elevated enzyme values may be due to causes other than myocardial infarction. In uncertain cases, the ECG and enzyme criteria can be supplemented by emission tomography, performed with technetium pyrophosphate that will accumulate in the site of infarction. Twenty-nine patients with suspected acute myocardial infarction were studied with emission tomography. Of these 12 had acute transmural infarction. Both enzyme tests and ECG were diagnostic in only 7 of these 12 cases, 4 had positive enzyme tests but a nondiagnostic ECG and in one case neither enzymes nor ECG were diagnostic. In 11 patients the infarcted myocardial area was detected with emission tomography. Six patients had acute nontransmural infarction. Only 2 of these had positive emission tomography. The chest pain was not due to infarction in 11 patients. All these patients had negative emission tomography. The sensitivity of emission tomography was 92% and specificity 100% in transmural acute infarction. In nontransmural infarction the specificity was only 33%. Emission tomography is a valuable diagnostic tool. It may be the decisive method when ECG and enzymes are not diagnostic. Emission tomography also shows the localization and size of the infarcted area in the myocardium.

Topics: Adult; Aged; Clinical Enzyme Tests; Diphosphates; Electrocardiography; Humans; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

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

Topics: Adult; Aged; Diphosphates; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Risk; Technetium; Technetium Tc 99m Pyrophosphate

The aims of this comparative study by vectorcardiography and myocardial scintigraphy in the topographical analysis of primary inferior and/or posterior wall infarction, were: to obtain data confirming the value of identifying true posterior wall infarction; to confirm the diagnostic value of vectorcardiography in this condition. The patients in this retrospective study were admitted to hospital for primary inferior and/or posterior wall infarction and underwent vectorcardiography and myocardial scintigraphy either with Thallium 201 (137 patients) or 99m Technetium (88 patients) in the acute phase. The scintigraphies of all patients included showed hypofixation compatible with inferior and/or posterior infarction as this was used as the topographical reference. The results of vectorcardiography and myocardial scintigraphy were concordant in 164 of the 225 patients (72.8%), 18 with true posterior infarction [%), 110 with inferior wall infarction (48.8%) and 36 with postero-inferior wall infarction (16%). The results were discordant in 61 patients (27.1%); infarcts of the inferior or posterior walls according to one technique, were observed on the posterior or inferior walls with the other. The majority of these cases had postero-inferior wall changes on vectorcardiography and inferior wall infarction alone on scintigraphy (35 patients: 15.5%). The specificity of the vectorcardiographic signs of true posterior wall infarction remained satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Diphosphates; Humans; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Vectorcardiography

To evaluate the contribution of Tc-99m pyrophosphate scintigraphy (TPS) on the overall management of patients suspected of having acute myocardial infarction (AMI), hospital records of 58 consecutive patients who underwent TPS, were evaluated in depth. The results indicate that TPS was essential for the diagnosis of AMI in 16% of the patients. TPS was most rewarding in perioperative patients and in patients with borderline or uninterpretable electrocardiographic and enzyme changes. Also, in some cases, TPS was able to confirm or exclude the diagnosis of AMI prior to the confirmation by serial electrocardiograms (ECG) and serial enzyme changes. TPS was less rewarding in patients with clinically low index of suspicion for AMI. It may also be confusing in patients with high clinical likelihood of AMI and a history of prior myocardial infarction because of the possibility of persistently positive TPS in some of these patients. Considering the limitations of ECGs, the cardiac enzymes, and atypical clinical presentations in the patient population we evaluated, TPS appears to be fairly accurate when the scintigraphic findings are compared with the final diagnosis at the time of discharge from the hospital.

Topics: Aged; Clinical Enzyme Tests; Diphosphates; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

To assess the clinical significance of technetium-99m-pyrophosphate (Tc-99m-PYP), -methylene diphosphonate (Tc-99m-MDP) and thallium-201 (Tl-201) myocardial scintigraphy in the diagnosis of cardiac amyloidosis and in the differential diagnosis of cardiac diseases, 12 patients with biopsy-proved systemic amyloidosis (seven with familial amyloid polyneuropathy (FAP) and five with primary amyloidosis) were investigated. The results obtained were as follows: In 10 patients (six with FAP and four with primary amyloidosis) studied by Tc-99m-PYP scintigraphy, two (FAP one, primary amyloidosis one) had diffusely positive myocardial uptake, which was of greater intensity than that of the sternum. Six (four FAP; two primary amyloidosis) also had diffusely positive myocardial uptakes, but the intensity was less than that of the sternum. The remaining two (one FAP; one primary amyloidosis) had only equivocal myocardial uptakes. Two of these patients also had hepatic uptakes and another had both hepatic and thyroid uptakes. The intensity of myocardial uptake of Tc-99m-PYP in patients with echocardiographic left ventricular hypertrophy and/or highly refractile myocardial echoes, so-called granular sparkling appearance (GS) was slightly greater than that in patients with neither myocardial hypertrophy nor GS. FAP had slightly less intensity than primary amyloidosis. In 29 persons with other cardiac diseases and normal subjects examined by Tc-99m-PYP scintigraphy, seven (two dilated cardiomyopathy; two sarcoidosis; three hypertensive heart disease) also had diffusely positive myocardial scans of mild or moderate degree. However, none of them had marked myocardial or other tissue uptakes. Both Tc-99m-PYP and -MDP scintigraphic studies were performed in four patients (three FAP; one primary amyloidosis). In Tc-99m-MDP scintigraphy, diffusely positive myocardial uptakes were observed in two patients with FAP and the remaining two had negative scans. The intensity of Tc-99m-MDP myocardial uptake in each patient was significantly lower than that of Tc-99m-PYP uptake. Tl-201 scintigraphy was carried out in 10 patients (six FAP; four primary amyloidosis). Left ventricular hypertrophy was found in six patients and right ventricular visualization in five. Although electrocardiograms in seven of 10 patients showed QS patterns in the right to mid precordial leads, similar to that seen in antero-septal and extensive anterior myocardial infarctions, neither myocardial perfusion defec

Topics: Aged; Amyloidosis; Biopsy; Diagnosis, Differential; Diphosphates; Diphosphonates; Echocardiography; Electrocardiography; Endocardium; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Polyneuropathies; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Thallium

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

A study of the relationship between the frequency of labelled pyrophosphate detection in the heart muscle and the incidence of clinical signs of heart failure or angina in 185 postmyocardial-infarction patients demonstrated that the distribution of patients with postinfarction cardiosclerosis among the positive and negative 99mTc-pyrophosphate scintigraphy groups was governed by the presence of heart failure in these patients, a finding suggestive of the scarry fields within the myocardium as the principal cause of myocardial accumulation of labelled pyrophosphate in postinfarction cardiosclerosis. Pyrophosphate accumulation in patients with postinfarction cardiosclerosis can be regarded as an indicator of unfavorable developments, as confirmed by one-year follow-up results in 114 patients.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Diphosphates; Endomyocardial Fibrosis; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Diphosphates; Female; Gluconates; Male; Myocardial Infarction; Organotechnetium Compounds; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Diphosphates; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed

A study of 38 patients with acute myocardial infarction verified by clinical, laboratory and electrocardiographic data made use of single-photon emission computered tomography, a new radiodiagnostic method for the assessment of the extent of myocardial lesion. Its findings were compared with cardiospecific enzyme activity data and showed good correlation. The new technique was found to be more informative as compared to plane scintigraphy. Possibilities of single-photon emission computered tomography are discussed with reference to the diagnosis of acute infarction at different sites and showing different radionuclide inclusion patterns.

Topics: Acute Disease; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Humans; Isoenzymes; L-Lactate Dehydrogenase; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

The aim of this study was to compare the clinical values of 99mTc pyrophosphate scintigraphy and M mode and 2D echography in the diagnosis of right ventricular infarction and in the predicting of some of its complications. Fifty-two patients were prospectively studied by echocardiography and scintigraphy at the acute stage of inferior wall infarction. Scintigraphy was performed in the antero-posterior and 45 degrees left anterior oblique incidences during the first 3 days of infarction. Right ventricular infarction was diagnosed if the right ventricular fixation was separated from the left ventricle by fixation at the base of the septum. Echocardiography was performed at an early stage by the usual 3 incidence. Dilatation of the right ventricle on the parasternal and submitral incidences; abnormal right ventricular contraction was searched for in all the incidences. The following results were obtained: scintigraphy showed a localised fixation allowing a topographic study in 40/52 patients (77%); satisfactory echocardiographic studies were obtained in 46/52 patients (88.5%). Signs of right ventricular infarction: scintigraphy showed signs of necrosis of the right ventricle in 12/40 patients (30%) who had a localised fixation; echocardiography showed dilatation (greater than 25 mm) of the superior part of the right ventricle with a right/left ventricle ratio greater than 0.5 in 16/46 patients (37%) with interpretable studies and obvious abnormalities of right ventricular wall motion in 7 patients (15.2%), less obvious in 10 other patients (22%).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Diphosphates; Echocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Cardiomyopathies; Diagnosis, Differential; Echocardiography; Electrocardiography; Heart Aneurysm; Heart Diseases; Humans; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Thrombosis; Tin Polyphosphates

Topics: Aged; Heart; Humans; Middle Aged; Myocardial Infarction; Polyphosphates; Radionuclide Imaging; Scintillation Counting; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Fourteen patients with transmural acute myocardial infarction (AMI) were treated with intravenous streptokinase a mean of 4 +/- 1 hours after chest pain and underwent technetium-99m stannous pyrophosphate (Tc-99m-PPi) imaging 7 +/- 2 hours after the onset of chest pain. The early Tc-99m-PPi images were obtained to test the hypothesis that an early, strongly abnormal Tc-99m-PPi image suggests reperfusion. Eleven of 14 patients had early peaking (within 16 hours) serum creatine kinase isoenzyme levels (CK-B) at a mean of 11 +/- 3 hours. Ten of 14 patients had 3+ or 4+ acute Tc-99m-PPi images. Eight of 11 patients had patent infarct-related vessels at cardiac catheterization 15 days after AMI. One patient who had both an early positive Tc-99m-PPi image and CK-B peak level had an occluded infarct-related artery at catheterization. Acute left ventricular (LV) ejection fraction (EF) by radionuclide ventriculography was compared with LVEF on day 15, and improved from 0.37 +/- 0.13 to 0.50 +/- 0.16 (p = 0.004) in the 10 patients with strongly positive acute Tc-99m-PPi images. LVEF also improved from 0.37 +/- 0.12 to 0.49 +/- 0.15 (p = 0.003) in the 11 patients with early peaking serum CK-B values. Three patients without evidence of reperfusion failed to improve the LVEF from the initial value to the one obtained at hospital discharge. Six control patients had acute Tc-99m-PPi images 10 +/- 2 hours after chest pain; none had strongly positive acute Tc-99m-PPi images, and the mean time to peak CK-B was 19 +/- 5 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cardiac Catheterization; Coronary Circulation; Creatine Kinase; Humans; Isoenzymes; Myocardial Infarction; Perfusion; Polyphosphates; Radionuclide Imaging; Streptokinase; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

The use of up-to-date diagnostic methods and the estimation of the extent of myocardial lesion in patients with intermediate coronary conditions (serial assays of CPK and MV-CPK activity with subsequent computation of the weight of affected myocardium, ECTG and myocardial 99mTc-Sn-pyrophosphate scintigraphy using a gamma-counter) demonstrated: the presence of necrotic foci in patients with acute focal myocardial dystrophy; a considerable variation in the weight of affected myocardium; and high diagnostic value of ECTG for the assessment of the extent of myocardial lesion in patients with intermediate coronary conditions. Objective criteria have been worked out for the differential diagnosis of various intermediate coronary conditions.

Topics: Adult; Aged; Atrophy; Creatine Kinase; Diagnosis, Differential; Heart; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Myocardium; Necrosis; Organ Size; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Aged; Diphosphates; Evaluation Studies as Topic; Heart; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To assess myocardial necrosis immediately after intracoronary thrombolysis, thallium-201 (TL-201) and technetium-99m pyrophosphate (Tc-99m PYP) were injected simultaneously into the coronary artery in 25 patients with acute transmural myocardial infarction. In 17 of the 25 patients, the occluded coronary artery was reopened. Minutes after the intracoronary injection of Tc-99m PYP into the reopened coronary artery a localized accumulation was seen within the area of the Tl-201 defect in all patients. Control intravenous scintigraphy, which was performed in 8 of these 17 patients 1-6 days later, and in 2 patients 18 and 42 days after infarction, revealed a Tc-99m PYP spot similar to that of the acute intracoronary Tc-99m PYP scintigram in all 10 patients. In the 8 of the 25 patients, in whom intracoronary thrombolysis failed, no localized Tc-99m PYP accumulation was seen after injection into the infarct vessel. In 5 of these patients, a control intravenous scintigram, performed 1-8 days later, resulted in a Tc-99m PYP spot in the area of the Tl-201 defect. We conclude that, in the presence of therapeutic or spontaneous reperfusion, Tc-99m PYP scintigraphy may provide a useful method of assessing myocardial necrosis during the early stage of an acute myocardial infarction.

Topics: Adult; Aged; Coronary Circulation; Coronary Vessels; Diphosphates; Humans; Injections, Intra-Arterial; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Streptokinase; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

Topics: Angiography; Cardiomyopathy, Dilated; Diphosphates; Electrocardiography; Exercise Test; Heart Diseases; Heart Valve Diseases; Humans; Isoenzymes; Myocardial Infarction; Perfusion; Prognosis; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

To evaluate the potential occurrence of right ventricular infarction, 53 patients with acute inferior transmural myocardial infarction were studied within 36 hours of symptoms by right heart catheterization, equilibrium radionuclide angiography and two-dimensional echocardiography. Technetium-99m pyrophosphate myocardial scintigraphy was performed 3 days after the onset of symptoms. The hemodynamic standard for right ventricular infarction was defined as both a right atrial pressure of 10 mm Hg or more and a right atrial/pulmonary artery wedge pressure ratio of 0.8 or more. Eight (15%) of the 53 patients had hemodynamic measurements at rest characteristic of right ventricular infarction, and 6 (11%) additional patients met these criteria after volume loading (p less than 0.05). Nineteen (37%) of the 51 patients who had radionuclide angiography had right ventricular dysfunction manifested by both a reduced right ventricular ejection fraction (less than 40%) and right ventricular regional wall motion abnormalities (akinesia or dyskinesia). An abnormal radionuclide angiogram was observed in 12 of 13 patients with hemodynamic measurements indicating right ventricular infarction. In 12 patients with an abnormal radionuclide angiographic study, right ventricular ejection fraction improved 6 to 12 weeks after infarction (27 +/- 7 to 36 +/- 9%, p less than 0.01). Twenty-two (49%) of the 45 patients with adequate two-dimensional echocardiograms had a right ventricular regional wall motion abnormality. An abnormal two-dimensional echocardiogram was seen in 9 of 11 patients with hemodynamic measurements characteristic of right ventricular infarction. Technetium-99m pyrophosphate scintigraphy was positive for right ventricular infarction in 3 of 12 patients who had hemodynamic measurements indicating right ventricular infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Cardiac Catheterization; Diphosphates; Echocardiography; Heart; Heart Rate; Hemodynamics; Humans; Middle Aged; Myocardial Infarction; Prospective Studies; Pulmonary Wedge Pressure; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

The results of pyrophosphate 99mTc scintigraphy of the myocardium during exercise were compared with the parameters of the tolerance and adaptation to the load and the frequency of manifestations of myocardial ischemia during bicycle ergometry in relation to the prognostic value with regard to coronary heart disease (CHD) development. The studies involved 21 patients with myocardial infarction at the early recovery period and 23 CHD patients without a history of myocardial infarction. Manifestations of myocardial ischemia and the pattern of pyrophosphate build-up in the myocardium during exercise are approximately equally informative with regard to the prognosis of a high risk of complications in CHD patients. As regards the capacity to detect patients with a low risk of CHD complications, the finding of pyrophosphate 99mTc scintigraphy of the myocardium are more reliable than the electrocardiographic manifestations of myocardial ischemia or chest pain during bicycle ergometry. The parameters of the tolerance and adaptation to the load were found to be of little use in predicting CHD complications.

Topics: Adaptation, Physiological; Adult; Aged; Blood Pressure; Diphosphates; Exercise Test; Female; Heart Rate; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

The primary determinant of prognosis after acute myocardial infarction (AMI) is the size of the acute infarct. The present study evaluates 46 patients with different infarct distributions and sizes to test the hypothesis that single photon emission computed tomography with technetium-99m pyrophosphate (Tc-99m-PPi) and blood pool overlay allows measurements of AMI size that provide insight into prognosis irrespective of infarct location. Identical Tc-99m-PPi and ungated blood pool projections were acquired over 180 degrees with a rotating gamma camera. Reconstructed sections were color-coded and superimposed for purposes of infarct localization. Areas of increased pyrophosphate uptake within myocardial infarcts were thresholded at 65% of peak activity. The blood pool was thresholded at 50% and subtracted so as to determine an endocardial border for the left ventricle. Using this method, myocardial infarcts weighed 2.5 to 81.2 g. The correlation of infarct mass with prognosis showed that patients without previous AMI and with acute infarcts that weighed more than 40 g had an increased frequency of death and congestive heart failure (p less than 0.001). The correlation of measured infarct mass with peak serum creatine kinase level was significant (r = 0.83, p less than 0.001; y = 0.015x + 13.20). The correlation coefficients for anterior, inferior and nontransmural AMI were not significantly different from those for the entire group. In conclusion, tomographically determined infarct mass data correlate with subsequent clinical prognosis, and Tc-99m-PPi tomography with blood pool overlay is a safe and effective means of sizing infarcts in patients with AMI.

Topics: Adult; Aged; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Statistics as Topic; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

A rare case of isolated right ventricular infarction (RVI) is described. The lack of clinical and electrocardiographic findings characteristic of isolated RVI makes this pathology a diagnostic challenge. The role of the radionuclide scintigraphic procedures as a single possible tool for the diagnosis of isolated RVI is emphasized.

Topics: Diphosphates; Electrocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

Studies of pathology have shown that involvement of the right ventricle (RV) in acute myocardial infarction (AMI) is relatively common. Our experience in the noninvasive diagnosis of RVAMI and its early prognosis is presented. Sixty patients with AMI were prospectively studied: 40 patients with inferior AMI and 20 patients with anterior AMI. The evaluation was made by: (1) CLINICAL FINDINGS: hypotension, congestive heart failure, sinus bradycardia less than 40/min, dysrhythmia, and conduction disturbances; (2) ECG record including precordial lead (V4R); (3) Radioisotope heart scintigraphy: 99mTc-PYP infarct scintigraphy and multigated acquisition MUGA blood pool scanning. Of the 40 patients diagnosed as having inferior AMI, 20 cases (50%) were found to be associated with RVAMI. All of them were diagnosed by positive radionuclide studies, and 17 (85%) also demonstrated a ST segment elevation of 0.1 mV, and pathological Q waves in the V4R lead. The ejection fraction (EF) of RV was found to be significantly decreased in patients with RVAMI compared with the other group (mean, 27% versus 57%). Among the 20 patients with RVAMI, 16 (80%) showed various complications during the hospitalization period, versus 9 patients (45%) from the group with inferior AMI. The most common complication in RVAMI patients was conduction disturbances (7 of 20 versus 2 of 20 patients). The clinical and prognostic importance of the early diagnosis of RVAMI is stressed.

Topics: Arrhythmias, Cardiac; Diphosphates; Electrocardiography; Heart Ventricles; Humans; Myocardial Infarction; Prognosis; Prospective Studies; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Diphosphates; Diphosphonates; Humans; Myocardial Infarction; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The authors present comparative characteristics of different methods of assessing the size of myocardial infarction. They included among others radioimmunoassay of myoglobin and the activity of MB-CPK in the blood serum, ECG charting with the calculation of the ST-coefficient and 99mTc-pyrophosphate scanning of the myocardium. The most informative methods were determination of the serum content of myoglobin and of its hourly increment, monitoring of the total rise of the ST segment and ST coefficient on the cartogram and the measurement of the area of accumulation of radiopharmacologic preparations during myocardial scanning.

Topics: Aged; Creatine Kinase; Diphosphates; Drug Therapy, Combination; Electrocardiography; Female; Heart; Humans; Isoenzymes; Isosorbide Dinitrate; Male; Middle Aged; Myocardial Infarction; Myocardium; Myoglobin; Necrosis; Nitroglycerin; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Animals; Diphosphates; Dogs; Mice; Myocardial Infarction; Organophosphates; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Pyrophosphate; Tissue Distribution

Topics: Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

The concentration of 125I-phenylphosphate (I phi PA), a long-lived bone-seeking radio-pharmaceutical (T1/2 biol = 962 days) that localizes in acute infarction (MI), was studied in 30 rats after ligation of the anterior descending coronary artery. At 23 h postMI, I phi PA was given intravenously to all animals, and five of this group received 99Tcm-pyrophosphate (99Tcm-pyro) intravenously. These five rats were sacrificed 2 h later and the content of I phi PA and 99Tcm-pyro activities was determined for normal and infarcted (INF) heart segments. There is a zone of INF that contains residual I phi PA which also concentrates 99Tcm-pyro consistently after MI. This zone may represent jeopardized myocardium which has not undergone complete necrosis.

Topics: Animals; Coronary Vessels; Diphosphates; Iodine Radioisotopes; Ligation; Male; Myocardial Infarction; Organophosphorus Compounds; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

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

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

Fifty consecutive patients undergoing coronary artery bypass grafting for chronic stable angina were assessed by serial electrocardiography, preoperative and postoperative myocardial scanning with technetium-99m pyrophosphate, gated radionuclide ventriculography, and serial measurement of creatine kinase, aspartate aminotransferase, urea stable lactic dehydrogenase, and creatine kinase isoenzyme (MB) to assess the incidence of perioperative myocardial infarction and identify the most appropriate diagnostic techniques. The correlation between myocardial scanning and the measurement of peak enzyme and isoenzyme activity was excellent in the diagnosis of perioperative infarction, although electrocardiography proved less helpful. There appeared to be no advantage in measuring creatine kinase MB rather than the more routinely measured enzymes. There were two deaths and evidence of myocardial infarction in five other patients, an incidence of 14%. Perioperative infarction was associated with a significant reduction in resting ejection fraction in two cases. In those patients without evidence of perioperative infarction the mean increase in ejection fraction of 7.8% was statistically significant.

Topics: Adult; Aged; Angina Pectoris; Clinical Enzyme Tests; Coronary Artery Bypass; Diphosphates; Electrocardiography; Heart; Heart Ventricles; Humans; Intraoperative Complications; Middle Aged; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

Technetium pyrophosphate myocardial scintigraphy has become, together with Thallium scintigraphy, a common diagnostic aid in recent myocardial infarction. However, some cases with moderate diffuse fixation (2+ diffuse in Parkey's classification) are considered equivocal results by many workers. We tried to assess the value of emission tomoscintigraphy in classifying these border-line cases. This non-invasive investigation requires sophisticated equipment, including a rotating gamma camera coupled to a computer. The computer reconstructs tomographic images in the three planes (frontal, sagittal, transverse) at 6 mm intervals. After analysis of 34 coronary patients using classical clinical criteria, standard and tomographic scintigraphy were performed and the results interpreted by a double blind procedure. The following conclusions were drawn: Interpretation of the results of tomography was more reproducible than that of standard scintigraphy (91 p. 100 compared with 79 p. 100). The sensitivity of detection of myocardial infarction was higher (96 p. 100 compared to 80 p. 100) without any loss of specificity (preliminary study in 15 non-coronary patients); this improvement is due to the elimination of the "equivocal" cases observed on standard scintigraphy. The infarcted area was easier to determine as the interpretation was more reproducible. The estimation of the size of the infarcted area and the detection of rudimentary infarcts did not seem to be improved by emission tomography. Our criteria of positivity for the tomographic images were : at least 2+ fixation (significant but less intense than that of the sternum); fixation visible in at least 2 different tomographic planes (e.g. sagittal and frontal); fixation visible on at least 2 consecutive images in each plane.

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

To test the hypothesis that single-photon emission computed tomography (SPECT) of 99mTc-pyrophosphate (99mTc-PPi) with and without the overlay of tomographic blood pool scintigrams might detect small infarcts not identified by planar imaging, 52 patients were studied 3.2 +/- 2.0(SD) days after hospital admission for suspected acute myocardial infarction. Patients were chosen prospectively for tomographic study primarily, but not exclusively, because planar four-view imaging with 99mTc-PPi was either negative or equivocal. SPECT was performed with a commercial rotating detector system immediately after planar imaging on one occasion. Corresponding 99mTc-PPi and blood pool sections were mapped into opposite halves of a bichromic color table and displayed as an overlay. Planar images, SPECT and SPECT with blood pool overlay were interpreted separately and in random order without knowledge of clinical data. Seventeen patients had transmural infarcts (four anterior, 13 inferior), 19 had nontransmural infarcts, and 16 patients did not have acute myocardial infarction. The sensitivity of SPECT with blood pool overlay was significantly better than planar imaging for the entire group with myocardial infarction (97% vs 78%; p less than .025); this was primarily due to increased sensitivity in the detection of nontransmural myocardial infarction (95% vs 67%; p less than .05), although in one additional patient inferior transmural myocardial infarction was also detected by the SPECT overlay technique. The specificities of the SPECT overlay technique and planar imaging were not significantly different; however, receiver operating characteristic analysis showed enhanced observer confidence with the tomographic method. SPECT without overlay was intermediate in sensitivity and specificity.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

A patient with intense technetium pyrophosphate myocardial activity is presented. The scintigraphic findings are unique in that a pattern consistent with extensive myocardial necrosis was present, but no significant coronary artery stenosis was present by coronary cineangiography.

Topics: Adult; Cardiac Catheterization; Cineangiography; Coronary Angiography; Diphosphates; Humans; Male; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Adult; Aged; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

To depict the three-dimensional distribution of 99mTc-pyrophosphate in the heart, emission computed tomography (ECT) was performed, following the conventional planar imaging, in 32 cases with suspected acute myocardial infarction (AMI). There were 23 cases with evidence of AMI, 7 with unstable angina (UA), and 2 with dilated cardiomyopathy (DCM). While the planar images showed discrete cardiac activity in only 11 of the 23 cases (48%) with AMI, the ECT images delineated focal myocardial uptake clearly in 20 of them (87%). On the other hand, the ECT images revealed cardiac blood-pool activity without significant myocardial uptake in all cases with UA and DCM in which the planar images showed diffuse activity. Thus, the ECT imaging of 99mTc-pyrophosphate seems to be a valuable technique for assessing the presence and localization of myocardial necrosis, especially in cases showing diffuse cardiac activity in the planar imaging.

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Cardiomyopathies; Diagnosis, Differential; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Tomography, X-Ray

In 67 consecutive patients with inferior wall acute myocardial infarction (AMI), 99m-technetium pyrophosphate scintigraphy was performed 36 to 72 hours after the onset of chest pain to detect right ventricular (RV) involvement. All patients were continuously monitored during at least 3 days to detect rhythm and conduction disturbances. In 29 patients RV involvement was diagnosed by scintigraphy. None of these 29 patients showed clinical signs of right-sided heart failure. Fourteen of the 19 patients showing atrioventricular (AV) nodal condution disturbances in the setting of inferior AMI also had RV involvement. Therefore, the incidence of high-degree AV nodal block in patients with RV involvement (14 of 29 patients) was 48% compared to only 13% (5 of 38) in patients with inferior AMI without RV involvement.

Topics: Adult; Aged; Diphosphates; Electrocardiography; Female; Heart Block; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

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

Visualization of the myocardial necrotic focus with the aid of 99mTc -pyrophosphate is an informative method of determining the infarction degree and localization in the cardiac muscle. Scanning enables evaluation of the area of the necrotic focus in patients with acute myocardial infarction within two weeks of the disease onset. Scintigraphy with both the diffuse and the focal variants of isotope accumulation is shown to be of high diagnostic value in acute myocardial infarction. The specificity and sensitivity of scintigraphy are 87% and 96%, respectively.

Topics: Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Adult; Aged; Angina, Unstable; Diphosphates; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Diphosphates; Iodine Radioisotopes; Male; Myocardial Infarction; Organophosphorus Compounds; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Pyrophosphate

The hypothesis that anterior ST segment depression represents concomitant posterior infarction was tested in 49 patients admitted with a first transmural inferior myocardial infarction. Anterior ST depression was defined as 0.1 mV or more ST depression in leads V1, V2 or V3 on an electrocardiogram recorded within 18 hours of infarction. Serial vectorcardiograms and technetium pyrophosphate scans were obtained. Eighty percent of the patients (39 of 49) had anterior ST depression. Of these 39 patients, 34% fulfilled vectorcardiographic criteria for posterior infarction, and 60% had pyrophosphate scanning evidence of posterior infarction. Early anterior ST depression was neither highly sensitive (84%) nor specific (20%) for the detection of posterior infarction as defined by pyrophosphate imaging. Of patients with persistent anterior ST depression (greater than 72 hours), 87% had posterior infarction detected by pyrophosphate scan. In patients with inferior myocardial infarction, vectorcardiographic evidence of posterior infarction correlated poorly with pyrophosphate imaging data. Right ventricular infarction was present on pyrophosphate imaging in 40% of patients with pyrophosphate changes of posterior infarction but without vectorcardiographic evidence of posterior infarction. It is concluded that: 1) the majority of patients with acute inferior myocardial infarction have anterior ST segment depression; 2) early anterior ST segment depression in such patients is not a specific marker for posterior infarction; and 3) standard vectorcardiographic criteria for transmural posterior infarction may be inaccurate in patients with concomitant transmural inferior myocardial infarction or right ventricular infarction, or both.

Topics: Diphosphates; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Vectorcardiography

Topics: Aged; Diphosphates; Heart; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Risk; 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

The location and extent of myocardial infarction (MI) are important predictors of patient course. The current study tests the hypothesis that MI size could be measured accurately using rotating gamma camera single-photon emission computed tomography ( SPECT ) and technetium-99m pyrophosphate (PPi) and that the accuracy of these measurements was independent of MI location and transmural or nontransmural distribution. SPECT was performed in 38 dogs 48 hours after ligation of the left anterior descending coronary artery (14 dogs) or left circumflex coronary artery (LC) (24 dogs) at the mid-level or below. Projection images were corrected for center-of-rotation and field nonuniformity and processed with a 1-dimensional low-pass filter to diminish rib activity. Sixteen 0.5-cm-thick transverse sections, including the entire left ventricle, were reconstructed by filtered backprojection , low-pass filtered, contrast enhanced and processed with a 3-dimensional boundary enhancement operator. The boundary of PPi uptake in each slice was marked automatically using an algorithm that combined a directional derivative and a threshold, and required continuity of the boundary in 3 dimensions. The total number of volume elements that showed abnormal tracer uptake were summed, corrected to absolute volume, and multiplied by the specific weight of cardiac muscle. Scintigraphic MI weight was compared with pathologic MI weight. There was an excellent correlation between scintigraphic and pathologic MI weight. The poorer correlation for nontransmural compared with transmural MIs is most likely a function of size alone, since MIs that weighed less than 10 g (n = 12, range 1.3 to 9.5 g), both transmural and nontransmural, showed a similar correlation: S = 1.07 X P + 0.56 (r = 0.81, standard error of the slope = 0.245).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Coronary Vessels; Diphosphates; Dogs; Ligation; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Emission computed tomography with technetium-99m pyrophosphate was used to delineate the location and estimate the size of myocardial infarcts in 20 patients with documented acute myocardial infarction. Tomography was performed after planar imaging within 2-5 days after the onset of infarction. A series of transaxial, frontal, and sagittal tomograms were reconstructed from 32 views imaged from the left side of the patient's chest with a rotating gammacamera. Infarct volume was measured from the tomographic images by computerised planimetry and was compared with the cumulative release of creatine kinase MB isoenzyme. The planar images showed discrete myocardial uptake in 13 of the 20 patients and diffuse uptake throughout the cardiac region in the remaining seven. In contrast, the tomographic images clearly delineated discrete myocardial uptake by avoiding confusion of myocardial activity with that of surrounding structures, particularly bones, in all patients. For the 10 patients whose infarct size was assessed by analysis of the creatine kinase MB curve there was a close correlation between infarct volume estimated by tomography and by cumulative creatine kinase MB release. Thus emission computed tomography can provide a three dimensional map of technetium-99m pyrophosphate distribution within the heart and is thus able accurately to localise and estimate the size of myocardial infarcts in man.

Topics: Adult; Aged; Creatine Kinase; Diphosphates; Female; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Scintigraphy with 99mTc -Sn-glucoheptonate permits the determination of the focus of transmural myocardial infarction at the earliest stages of the disease (from three hours to the fifth day of the disease) whereas scintigraphy with 99mTc -Sn-pyrophosphate makes it possible to follow-up the zone of transmural infarction from Day 2 through Day 7-10. Both methods fail to provide enough information to diagnose non-transmural myocardial infarction. A comparative evaluation of the nature of glucohepatonate and pyrophosphate incorporation in the myocardium of patients with unstable angina is suggestive of the severity of ischemic changes in the myocardium.

Topics: Adult; Aged; Angina Pectoris; Humans; Middle Aged; Myocardial Infarction; Organotechnetium Compounds; Polyphosphates; Radionuclide Imaging; Sugar Acids; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors; Tin Polyphosphates

We studied the efficacy of technetium Tc 99m pyrophosphate imaging in patients with equivocal evidence of acute myocardial infarction. Only patients with positive enzyme findings (regardless of ECG findings) had scans with greater than or equal to 2+ focal uptake. None of 26 patients with negative or equivocal enzyme findings (regardless of ECG findings) had greater than 2+ diffuse uptake. These results support the contention that infarct-avid imaging has little clinical utility in patients with equivocal evidence of myocardial infarction.

Topics: Clinical Enzyme Tests; Diphosphates; Electrocardiography; Humans; Myocardial Infarction; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

To study the value of the electrocardiogram in diagnosing right ventricular involvement in acute inferior wall myocardial infarction, the electrocardiographic findings were analysed in 67 patients who had had scintigraphy to pin-point the infarct. All 67 patients were consecutively admitted because of an acute inferior wall infarction. A 12 lead electrocardiogram with four additional right precordial leads (V3R, V4R, V5R, and V6R) was routinely recorded on admission and every eight hours thereafter for three consecutive days. Thirty-six to 72 hours after the onset of chest pain a 99mtechnetium pyrophosphate scintigraphy and a dynamic flow study were performed to detect right ventricular involvement, which was found in 29 of the 67 patients (43%). ST segment elevation greater than or equal to 1 mm in leads V3R, V4R, V5R, and V6R is a reliable sign of right ventricular involvement. ST segment elevation greater than or equal to 1 mm in lead V4R was found to have the greatest sensitivity (93%) and predictive accuracy (93%). The diagnostic value of a QS pattern in lead V3R and V4R or ST elevation greater than or equal to 1 mm in lead V1 was much lower. ST segment elevation in the right precordial leads was short lived, having disappeared within 10 hours after the onset of chest pain in half of our patients with right ventricular involvement. When electrocardiograms are recorded in patients with an acute inferior wall infarction within 10 hours after the onset of chest pain, additional right ventricular infarction can easily be diagnosed by recording lead V4R.

Topics: Adult; Aged; Diphosphates; Electrocardiography; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Out of 178 consecutive patients with acute inferior wall myocardial infarction submitted to technetium-99 m pyrophosphate scintigraphy, 49 (27.5%) were found to have concomitant right ventricular infarction. Gated blood pool scans showed right ventricular abnormalities in 21 out of 26 patients who were submitted to this investigation (right ventricular asynergy: 16 cases; right ventricular dilatation: eight cases; decreased right ventricular ejection fraction: 16 cases). Complications were common in the acute stage. Shock was noted in 19 cases (eight related to bradycardia, three related to relative hypovolaemia and eight instances of true cardiogenic shock). Atrial fibrillation (seven patients), ventricular fibrillation (eight patients) and severe atrioventricular conduction disorders (13 patients) were also frequent. In spite of this, the in-hospital mortality was low: three deaths occurred (6.1%), one from heart failure, two others from posterior septal rupture. All patients were followed up for one year or more. Six additional deaths were noted (three from left cardiac failure, two from recurrent anterior wall infarction and one from massive pulmonary embolism). Clinical assessment, haemodynamic measurements and gated blood pool scans showed significant improvement of right ventricular function with return to normal in those cases with small right ventricular infarcts as judged from technetium-99 m pyrophosphate scintigraphy. In spite of the complications seen in the initial period, patients with a right ventricular infarction have a good overall prognosis and the long-term outcome, primarily determined by the left-sided lesions, is often favourable.

Topics: Adult; Aged; Blood Volume; Bradycardia; Diphosphates; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Shock, Cardiogenic; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

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

Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-pyrophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups.

Topics: Cardiac Output, Low; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Heart; Heart Ventricles; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

The clinical experience with 37 patients with acute transmural inferior wall myocardial infarction who were assessed for evidence of right ventricular involvement is reported. On the basis of currently accepted hemodynamic criteria, 29 patients (78%) had evidence suggestive of right ventricular infarction. However, only 5 (20%) of 25 patients demonstrated right ventricular uptake of technetium pyrophosphate on scintigraphy. Two-dimensional echocardiography or isotope nuclear angiography, or both, were performed in 32 patients; 20 studies (62%) showed evidence of right ventricular wall motion disturbance or dilation, or both. Twenty-one patients demonstrated a late inspiratory increase in the jugular venous pressure (Kussmaul's sign). The presence of this sign in the clinical setting of inferior wall myocardial infarction was predictive for right ventricular involvement in 81% of the patients in this study. It is suggested that right ventricular involvement in this clinical setting is common and includes not only infarction but also dysfunction without detectable infarction, which is likely on an ischemic basis.

Topics: Adult; Aged; Cardiac Output; Diphosphates; Echocardiography; Electrocardiography; Female; Heart; Heart Ventricles; Humans; Jugular Veins; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Venous Pressure

The topographic relationship between the uptake of technetium-99m pyrophosphate (PPi) and myocardial infarction delineated by 2,3,5-triphenyl tetrazolium chloride (TTC) was studied in a canine model of permanent coronary occlusion (24-48 hr). Photographs of TTC staining and scintigraphic images of PPi uptake were planimetered for infarct area. In addition, narrow tissue samples (3 X 10 mm) were taken on both sides of the TTC border and counted for PPi uptake. A significant correlation (p less than 0.001) was found between area of PPi uptake and area of myocardium unstained by TTC (r = 0.84 in epicardium and r = 0.91 in endocardium). The slope relating PPi to TTC for all infarcts was 1.01 +/- 0.11, indicating that variations in infarct size were followed equally by the two techniques. Tissue counting showed the ratio of PPi activity just inside the infarct to activity just outside the infarct to be 9.2 +/- 0.6 (mean +/- s.e.m.). Thus, PPi is distributed topographically in a manner identical to the distribution of irreversibly injured myocardium as delineated by TTC.

Topics: Animals; Diphosphates; Dogs; Female; Histocytochemistry; Male; Models, Biological; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tetrazolium Salts

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

Double-radionuclide autoradiography proved to be feasible using combinations of Tc-99m and I-125, or Tc-99m and C-14. Because of the short half-life of Tc-99m (6 hr), we first registered Tc-99m on x-ray film. Given an adequate Tc-99m:I-125 activity ratio of 20:1, the exposure duration for Tc-99m was still too short for I-125 to blacken the x-ray film. The pure emission from C-14 is completely absorbed by a thin aluminum sheet--hence no problem there. After the decay of Tc-99m, therefore, it was entirely feasible to continue autoradiography with I-125 (T1/2 = 60.2 days) or C-14 (T1/2 = 5730 yr). Based on these conditions, we applied (a) tracer microspheres labeled with I-125 and Tc-99m to define the respective perfusion areas of the left anterior descending, septal, and left circumflex coronary arteries of the beating heart, and (b) Tc-99m pyrophosphate and C-14 antipyrine to demarcate respectively the localization of the infarct-avid substance and the regional blood flow. We verified the first procedure with postmortem angiography and the second with histochemistry.

Topics: Angiography; Animals; Autoradiography; Carbon Radioisotopes; Coronary Circulation; Diphosphates; Dogs; Histocytochemistry; Iodine Radioisotopes; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Coronary Vessels; Diphosphates; Dopamine; Female; Heart; Humans; Injections, Intra-Arterial; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Nitroglycerin; Radioisotopes; Radionuclide Imaging; Streptokinase; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Diphosphates; Heart; Humans; Myocardial Infarction; Nuclear Medicine; Perfusion; Physical Exertion; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Of 114 pyrophosphate (PPi) myocardial studies, eleven were selected to assess the significance of diffuse uptake observed in the images obtained early (2-3 h) following injection and compared with delayed scintigrams at 6-24 h. From the results of the late studies the patients were divided into two groups; those with no or minimal residual activity in the delayed study (five cases) and those with approximately the same intensity of delayed scans as in the early study (six cases). No significant abnormalities in cardiac enzymes or the EKG (obtained within 24 h) were noted in the patients of the first group. Cardiac enzymes, EKG abnormalities, indicating myocardial damage, or decreased radionuclide LVEF dysfunction were found in the patients of second group. We concluded that a late image is required in a case of diffuse PPi myocardial uptake in the early image, and myocardial damage may be present if there is persistently diffuse uptake of PPi in the late image.

Topics: Diphosphates; Humans; Myocardial Infarction; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

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

The clinical presentation of a young hypertensive White man with acute high lateral non-transmural myocardial infarction (MI) is documented. This diagnosis was established on the grounds of a history of chest pain, elevated serial serum enzyme levels, technetium-99m pyrophosphate ('hot-spot') scintigraphy, exercise thallium-201 ('cold-spot') scanning, left ventricular cine angiography and selective coronary arteriography. Daily resting 12-lead ECGs failed to demonstrate unequivocal features of acute non-transmural subendocardial MI. The diagnostic difficulties facing the clinician in a case of acute MI associated with a non-diagnostic ECG are stressed, and the ECG features of acute subendocardial MI are reviewed.

Topics: Adult; Cardiac Catheterization; Cineangiography; Coronary Angiography; Diphosphates; Electrocardiography; Heart; Humans; Male; Myocardial Infarction; Physical Exertion; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Right ventricular infarction is not uncommon in patients with inferior myocardial infarcts. Phase and amplitude analysis of equilibrium gated cardiac blood pool studies is useful in documenting right ventricular damage complicating left ventricular infarction. In 15 of 37 patients with acute inferior infarction, right ventricular extension of the infarct was demonstrated by this approach, complementing the findings of infarct avid imaging with Tc-99m pyrophosphate (Tc-99m PYP).

Topics: Aged; Diphosphates; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Using equilibrium radionuclide ventriculography, the authors investigated left ventricular ejection fraction in 10 healthy men and in 57 men who had undergone their first transmural myocardial infarction (MI) 4 to 7 months earlier, were below 65 years of age and did not present signs of heart failure at the time of examination. Resting ejection fraction in healthy men amounted to 63 +/- 5%, in patients with uncomplicated MI to 54 +/- 7%, and in patients with clinical manifestations of heart failure in the acute phase to 37 +/- 8%. Patients with anteroseptal MI showed a negative correlation between the ejection fraction, on the one hand, and the sum of Q wave voltages in the precordial ECG map and the maximum value of serum creatine kinase in the acute phase of MI, on the other hand. The ejection fraction correlated with the degree of pulmonary hypertension during exercise. At work load of 50 W the ejection fraction measured in 31 patients was not significantly different shortly before discharge from hospital and 6 months after the onset of MI.

Topics: Adult; Aged; Cardiac Output; Diphosphates; Heart Ventricles; Humans; Hypertension, Pulmonary; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Stroke Volume; 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

Topics: Adult; Aged; Creatine Kinase; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Cardiology; Humans; Myocardial Infarction; Nuclear Medicine; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; 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: Female; Heart; Humans; Middle Aged; Myocardial Infarction; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Determination of lactic dehydrogenase (LDH) isoenzymes is the current method of choice for diagnosing acute myocardial infarction (AMI) greater than 48 hours old. However, other causes of enzyme elevation make the availability of an alternate method of diagnosis worthwhile. Accordingly, serial technetium-99m pyrophosphate scintigrams were obtained in 61 patients with transmural AMI and in 46 patients with subendocardial AMI. Imaging was performed in all 107 patients at the time creatine kinase isoenzyme (CK-MB) was present 37 +/- 18 hours (range 12 to 72) after the onset of AMI, and at the time CK-MB was absent 106 +/- 34 hours (range 48 to 168) after the onset of AMI. At the time CK-MB was absent, the sensitivity using either a regional or a diffuse positive scintigram was 95% (58 of 61 patients) for transmural AMI and 65% (30 of 46 patients) for subendocardial AMI. The sensitivity using a regional positive scintigram was 82% (50 of 61 patients) for transmural AMI and 37% (17 of 46 patients) for subendocardial AMI. The sensitivity using a high-grade regional positive scintigram was 36% (22 of 61 patients) for transmural AMI and 11% (5 of 46 patients) for subendocardial AMI. The specificity was 70% (143 of 204 patients) for either a regional or a diffuse abnormality, 92% (187 of 204 patients) for a regional abnormality, and 100% (204 of 204 patients) for a high-grade regional abnormality. Thus, pyrophosphate scintigraphy is useful in confirming the diagnosis of AMI, particularly transmural, greater than 48 hours old and when CK-MB has returned to normal. A positive scintigram with a high-grade regional abnormality is specific for a recent AMI and may be contributory in establishing the diagnoses when LDH isoenzymes are inconclusive.

Topics: Adult; Aged; Creatine Kinase; Female; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors; Tin Polyphosphates

Topics: Animals; Autoradiography; Diphosphates; Dogs; Histological Techniques; Myocardial Infarction; Myocardium; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Coronary Circulation; Diatrizoate Meglumine; Diphosphates; Dogs; Indium; Myocardial Infarction; Myocardium; Necrosis; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Tomography, Emission-Computed

Topics: Acute Disease; Coronary Circulation; Diphosphates; Heart Ventricles; Humans; Myocardial Infarction; Postoperative Complications; Prognosis; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Tetracyclines; Thallium; Time Factors; Tomography, Emission-Computed

Serial electrocardiography, technetium-99m pyrophosphate scintigraphy and measurement of myocardial creatine kinase (CK2) and lactic dehydrogenase isoenzyme activity (specifically the LD1 to LD2 ratio) were evaluated prospectively in 26 patients who underwent aortocoronary bypass grafting and 11 patients who underwent valvular or other thoracic surgery, as methods of diagnosing perioperative myocardial infarction. Of the 26 patients who had aorto coronary bypass grafting, 7 (group 1) had myocardial infarction perioperatively; of these, only 2 had positive results from all four diagnostic tests. The other 19 patients (group 2) had no perioperative myocardial infarction and the only diagnostic method yielding positive results was the LD1 to LD2 ratio, in 7 of the 19. In the 11 patients who did not undergo aortocoronary bypass grafting (group 3), only 1 patient had myocardial infarction perioperatively; results from the measurement of CK2 isoenzyme activity and LD1 to LD2 ratio were positive while electrocardiography and 99mTc pyrophosphate scintigraphy yielded negative results. The respective sensitivity (%) and specificity (%) of the four diagnostic methods were as follows: electrocardiography: 38, 100; 99mTc pyrophosphate scintigraphy: 88, 100; LD1 to LD2 ratio: 100, 68; CK2: 38, 100. When the CK2 criterion was redefined, using patients in group 2 as controls, the sensitivity and specificity of this method became 100 and 90 respectively. The authors conclude that 99MTc pyrophosphate scintigraphy and measurement of myocardial creatine kinase isoenzyme are of comparable value and are the most reliable indicators of perioperative myocardial infarction.

Topics: Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Isoenzymes; L-Lactate Dehydrogenase; Male; Middle Aged; Myocardial Infarction; Myocardium; Postoperative Complications; Postoperative Period; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Until recently, ECG accuracy in localizing acute myocardial infarction (AMI) could be assessed only by comparing the ECGs with autopsy findings. This approach, however, preselected patients, including only those who died. It is possible that this postmortem group of patients would be different from the whole population of patients with AMI. Myocardial imaging with 99mTc-pyrophosphate offers the advantage of directly localizing the region of injured myocardium in the acute phase of AMI. In 34 patients with confirmed AMI and focal uptake of 99mTc-pyrophosphate, serial ECGs were obtained and interpreted by two independent observers. The sensitivity and specificity of serial ECGs in determining the location of AMI in the five left ventricular (LV) wall segments were determined: (1) in the anterior wall sensitivity was 86.7% and specificity was 89.5%; (2) in the lateral wall sensitivity was 73.7% and specificity was 80.0%; (3) in the high lateral wall sensitivity was 80.0% and specificity was 87.5%; (4) in the inferior wall sensitivity was 87.5% and specificity was 100%; (5) in the "true" posterior wall sensitivity was 83.3% and specificity was 86.4%. Overall, in the 170 LV wall segments (five per patient) examined, scans localized with a sensitivity of 81.9% and a specificity of 88.8%. After four patients with LBBB were excluded, sensitivity increased to 87.1%. Overall, localization of AMI by serial ECG was accurate in 85.9% of the 34 patients included in the study.

Topics: Adult; Aged; Bundle-Branch Block; Diphosphates; Electrocardiography; False Negative Reactions; False Positive Reactions; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

Scintigraphy with 99mTc-pyrophosphate during bicycle ergometry has been undertaken in 32 patients with myocardial infarction in the early phase of its healing. There were 3 scintigraphic investigations: one during bicycle ergometry and two control ones - before and the day after the test. The determination of changes in the degree of 99mTc-pyrophosphate accumulation under the influence of the exercise in patients with myocardial infarction in the early phase of its healing permitted the authors to detect several variants in the time course of scintigraphic values. Drop or rise of concentration of the labelled pyrophosphate at the height of the bicycle ergometry test compared to the data obtained prior to it are apparently due to changed bloodflow in the focus of lesion during exercise. Changes in the character and intensity of accumulation of the radiodrug after bicycle ergometry can be explained in the majority of cases by increase of metabolic disorders in the myocardium, supervening during the exercise, and in some patients, possibly, to sustained decrease of bloodflow in the affected area of the cardiac muscle.

Topics: Adult; Aged; Diphosphates; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors; Wound Healing

Topics: Angina Pectoris; Arteriosclerosis; Coronary Disease; Diagnosis, Differential; Diphosphates; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Resolution and contrast recovery in planar nuclear images at depth with a high purity germanium (HPGe) camera has been achieved through use of a weighted back projection (WBP) method. The algorithm can be derived from Bayes' theorem using the point spread function of the camera. The variations in the formulation of WBP (one single pass and two iterative procedures) are presented with the characteristics and performance of each method. The evaluation procedure determines the behaviour of signal-to-noise ratio, contrast and texture after application of the algorithm. Both real and simulated cold lesions obtained with the HPGe camera are studied with sizes ranging from 3 mm to 17 mm and background count densities from 100 to 6400 counts cm2. Application of WBP is shown to increase spatial resolution and contrast without a concomitant reduction in signal-to-noise ratio. Images obtained with the HPGe camera and processed with WBP are presented. The algorithm has been applied to the scintillation camera, yielding significant resolution and contrast recovery despite the presence of scatter and textured noise present in the HPGe images.

Topics: Animals; Diphosphates; Heart; Humans; Mathematics; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

"Persistently abnormal" technetium-99m stannous pyrophosphate myocardial scintigrams (PPi+) appear to be associated with a relatively poor prognosis after acute myocardial infarction (AMI). To assess the incidence and implications of PPi+, we performed a retrospective analysis in 29 patients with and 25 patients without diabetes mellitus who had abnormal myocardial scintigrams within 4 days of AMI and who had follow-up scintigrams at least 3 months after hospital discharge. There were no significant differences between patients with and without diabetes as regards age, incidence of transmural or nontransmural AMI, or degree of left ventricular dysfunction after AMI. Persistently abnormal PPi+ occurred more commonly in patients with diabetes than in nondiabetic patients (18 of 29, 62%, compared to 3 of 25, 12%; p less than 0.001). Patients with chronic PPi+ had more frequent cardiac complications following hospital discharge (p less than 0.005) including death, recurrent AMI, unstable angina, and intractable congestive heart failure. Postmortem analysis in two patients with diabetes and chronic PPi+ revealed marked myocytolysis. Thus, patients with diabetes mellitus have an increased incidence of post-AMI "persistently abnormal" technetium (PPi+) scintigrams and relatively poor prognosis following myocardial infarction.

Topics: Aged; Cardiovascular Diseases; Creatine Kinase; Diabetes Complications; Diabetes Mellitus; Diphosphates; Female; Follow-Up Studies; Heart; Humans; Insulin; Male; Middle Aged; Myocardial Infarction; Myocardium; Prognosis; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aspartate Aminotransferases; Cardiac Surgical Procedures; Creatine Kinase; Diagnosis, Differential; Diphosphates; Electrocardiography; Humans; Isoenzymes; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Diphosphates; Humans; Liver; Liver Cirrhosis; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

To test the hypothesis that the relationship between infarct area (IA) and area at risk (AR) varies in different layers of the left ventricle (LV), we occluded the circumflex coronary artery for 48 h in 20 conscious dogs. AR was determined by postmortem coronary stereoarteriography, and infarct area by pathological examination. Both AR and IA were divided into four layers: posterior papillary muscle (PPM), subendocardium (Endo), midwall, and subepicardium (Epi) and quantified with planimetry. Hemodynamics and regional myocardial flow with tracer microspheres (7-10 micrometers diam) were measured before and after coronary occlusion. IA was closely correlated with AR for PPM (r = 0.96), Endo (r = 0.97), and Epi (r = 0.92). However, the slope of IA/AR for Endo (1.30 +/- 0.08) was significantly steeper (P less than 0.05) than that for Epi (0.89 +/- 0.11); furthermore, the intercepts at zero infarction for PPM (0.5 +/- 0.1% of LV), Endo (4.2 +/- 0.4%), and Epi (0.1 +/- 0.7%) were significantly different from each other. Regional blood flow measurements indicate that the differences in IA/AR in various layers reflected earlier and greater total collateral flow to the noninfarcted AR in the epicardium. Thus IA/AR for the entire LV is a composite representing separate IA/AR specific to various transmural layers of the LV. In addition, this study demonstrates that the lateral border zone between the IA and the AR is minimal (less than 3-5 mm) in the subendocardium and midwall layers of the left ventricle.

Topics: Animals; Diphosphates; Dogs; Heart Ventricles; Myocardial Infarction; Necrosis; Perfusion; Risk; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aged; Diphosphates; Endocarditis; Enterococcus faecalis; Humans; Male; Myocardial Infarction; Myocardium; Radionuclide Imaging; Streptococcal Infections; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Diphosphates; Echocardiography; Heart Function Tests; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

Topics: Aged; Diphosphates; Heart; Humans; Middle Aged; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

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

Topics: Animals; Diphosphates; Dogs; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Adult; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Diphosphates; Dogs; Iodine; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Infarct, perfusion and blood pool scintigraphy were performed in 62 patients during hospitalization for acute myocardial infarction. The largest measured infarct or perfusion image defect and left ventricular ejection fraction were related to the late prognosis determined a mean of 16 months after the event. Breakpoint values for all scintigraphic variables could separate those who were asymptomatic on follow-up from those who died. The best indicators for selection of survivors and nonsurvivors were a scintigraphic infarct size greater than or equal to 25 cm2 and a perfusion abnormality greater than or equal to 35% of the projected left ventricular area. Among patients with perfusion abnormalities above this limit, 61% died; 93% of those with small perfusion abnormalities survived. Scintigraphic measurements of relative myocardial perfusion and function best separated patients asymptomatic on follow-up from those who developed heart failure and also best identified those with an unfavorable evolution, who developed heart failure or died. Early scintigraphic parameters appeared more accurate than other clinical laboratory indicators for determining late prognosis and could be important in planning treatment after acute infarction.

Topics: Aged; Coronary Circulation; Diphosphates; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radioisotopes; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Thallium; Time Factors

Topics: Adult; Aged; Computers; Diphosphates; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Diphosphates; Heart; Humans; Models, Structural; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

The "doughnut" pattern on Tc-99m pyrophosphate (PPi) myocardial scintigraphy is characterized by a border of tracer uptake surrounding a central zone of relatively decreased activity. This pattern is generally associated with large transmural anterior myocardial infarcts (MI) caused by occlusion or critical stenosis of the left anterior descending coronary artery. Such infarcts typically involve a significant portion of the anterior wall and are associated with a complicated clinical course and poor prognosis. In order to evaluate the relationship between the presence of the doughnut pattern and left ventricular (LV) function, radionuclide ventriculography was performed within 15 days after infarction in 58 patients with transmural anterior MI. In patients without previous MI, 15/38 (39.5%) had doughnut scintigrams. These patients demonstrated significant reductions in LV ejection fraction (EF) (28 +/- 10% versus 45 +/- 12%, P less than 0.001) and normalized LV wall motion scores (29 +/- 11% versus 61 +/- 10%, P less than 0.001) when compared with patients with "nondoughnut" scintigrams. Patients with doughnut scintigrams had a significantly greater incidence of severe septal hypokinesis (P less than 0.001) and apical dyskinesis (P less than 0.03). LV end-systolic volumes were also larger in the patients with doughnut scintigrams (73 +/- 32 ml versus 40 +/- 17 mI/M2, P less than 0.005). In contrast, there was no significant difference in LVEF, normalized LV wall motion score, or LV volumes between doughnut and nondoughnut groups in patients with previous MI.

Topics: Diphosphates; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Prognosis; Radionuclide Imaging; Recurrence; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

Topics: Adult; Aged; Diagnosis, Differential; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Diphosphates; Evaluation Studies as Topic; Female; Heart; Humans; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Adult; Aged; Diphosphates; Evaluation Studies as Topic; Heart; Heart Ventricles; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Aged; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Diphosphates; Heart; Humans; Myocardial Infarction; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Diphosphates; Female; Gluconates; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

Attenuation of photons in single-photon emission tomography (SPECT) makes three-dimensional reconstruction of unknown radioactivity distributions a mathematically intractable problem. Approaches to approximate SPECT reconstruction range from ignoring the effect of photon attenuation to incorporating assumed attenuation coefficients into an iterative reconstruction procedure. We have developed a computer-based simulation method to assess the relative effectiveness of attenuation compensation procedures. The method was used to study four procedures for myocardial SPECT using an infarct-avid radiopharmaceutical, Tc-99m stannous pyrophosphate. Reconstructions were evaluated by two criteria: overall (sum-of-squares) accuracy, and accuracy of lesion sizing. For moderate- to high-contrast studies there were no significant differences among the reconstructions by either evaluation criterion; for low contrast ratios the iterative method produced lower sum-of-squares criterion; for low contrast ratios the iterative method produced lower sum-of-squares error. We conclude that the additional expense of the iterative method is not justified under the conditions of this study. The approach used here is a convenient tool for evaluating specific SPECT reconstruction alternatives.

Topics: Humans; Mathematics; Models, Structural; Myocardial Infarction; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates; Tomography, Emission-Computed

Topics: Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

The value of 0.1 mV or greater of S-T segment elevation in at least one right precordial lead (V4R to V6R) in defining right ventricular myocardial infarction was assessed prospectively in 43 subjects (33 consecutive patients with enzymatically confirmed infarction of varying type and location, 4 patients with unstable angina and 6 healthy volunteers). Patients with acute myocardial infarction were studied with radionuclide ventriculography and technetium-99m stannous pyrophosphate myocardial scintigraphy 18.2 +/- 14.3 (mean +/- standard deviation) and 85.1 +/- 18.0 hours after the onset of symptoms, respectively. Eleven patients (Group A: 9 patients with transmural inferior infarction, 1 with transmural inferolateral infarction and 1 with transmural anteroseptal infarction) demonstrated right precordial S-T segment elevation and 22 patients (Group B: 6 patients with transmural inferior infarction, 2 with transmural posterior infarction, 3 with transmural inferolateral infarction, 3 with transmural anteroseptal infarction, 3 with transmural extensive anterior infarction, 4 with subendocardial anterior infarction and 1 with unclassified infarction) did not. Right ventricular ejection fraction was significantly lower in Group A (0.47 +/- 0.11) than in Group B (0.60 +/- 0.12) (p less than 0.01). Right ventricular total wall motion score was 63.8 +/- 15.6 percent of normal in Group A versus 94.3 +/- 8.5 percent in Group B (p less than 0.001). Technetium-99m pyrophosphate uptake (2+ or greater) over the right ventricle occurred in nine patients (81.8 percent) in Group A and in one patient (4.5 percent) in Group B (p less than 0.001). No patient with unstable angina and no healthy volunteer had S-T segment elevation in a right precordial lead. S-T segment elevation of 0.1 mV or greater in one or more of leads V4R to V6R is both highly sensitive (90 percent) and specific (91 percent) in identifying acute right ventricular infarction.

Topics: Aged; Angina Pectoris, Variant; Electrocardiography; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

One hundred and three patients with myocardial infarctions were studied with 201-thallium chloride and/or 99m-technetium pyrophosphate myocardial imaging and were followed-up for an average of 23 months. There were 24 false negative cases with 201-thallium chloride, but no deaths or serious complications occurred during the follow-up period in these false negative cases. There were six patients with widened QRS complexes (more than 0.12 seconds) without bundle branch blocks and in three of them myocardial infarction was not identified by electrocardiography. However, there were large myocardial perfusion defects in the anterior-inferior wall of the left ventricle. All of this group of patients died suddenly during the follow-up period. The incidence of complications and mortality rose sharply in patients whose myocardial perfusion defects detected by thallium-201 were larger than 40% of the entire left ventricle. The myocardial infarction areas measured by 99m-technetium pyrophosphate were 28.5 +/- 9.8 cm2 in non-survivors and 16.5 +/- 1.7 cm2 in survivors. In addition, ten patients with acute myocardial infarction were studied by double scan methods with thallium-201; myocardial perfusion defect areas were reduced from 29 +/- 3% of the entire left ventricle to 19 +/- 4% by nitrate administration, indicating that there were reversibly ischemic areas in acute myocardial infarction which could be transiently reduced by nitrate. Thus, the study suggests the possibility of decreasing myocardial perfusion defects in the early phase of acute myocardial infarction, leading to a better long term prognosis for the patients.

Topics: Adult; Aged; Diphosphates; Electrocardiography; False Negative Reactions; Female; Follow-Up Studies; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Radiography; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

In 66 patients suffering on chronic stable angina pectoris myocardial scintigrams with 99mTc-pyrophosphate were evaluated. Patients who had former infarcts or infarct signs in ECG were excluded. 16 normal subjects were used as controls. In all normal subjects and in 35 patients with chronic A.P. a normal myocardial scintigram could be obtained. In the remaining 31 patients a localized myocardial tracer accumulation could be seen. There was a correlation between the tracer accumulation and the limitted left ventricular function. No correlation was found between the severity and the number of involved coronary arteries and a positive scintiphoto. The mechanism of the tracer accumulation is discussed. The results of this investigation show that a positive myocardial scintigram does not prove a myocardial infarction. It is a sign for a insufficiency of the contractility of the left ventricle, probably due to under perfusion.

Topics: Angina Pectoris; Chronic Disease; Diphosphates; Electrocardiography; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

Radionuclide imaging was useful for noninvasively visualizing a location and size of infarction in two patients with acute myocardial infarction. In one patient, inferior subendocardial myocardial infarction was detected by 99mTc-PYP myocardial scintigraphy and then inferior transmural infarction was observed as more intense radioactivity with a larger size. In the other patient with acute extensive anterior myocardial infarction, akinesis of the left ventricular wall and left ventricular aneurysm were confirmed by first-pass radionuclide angiocardiography and multigated equilibrium cardiac pool scan.

Topics: Diphosphates; Electrocardiography; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; 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: Adult; Aged; Angina Pectoris; Creatine Kinase; Diagnosis, Differential; Diphosphates; Female; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The incorporation rate of 99mTc-pyrophosphate into the myocardium was studied in 123 patients with acute myocardial infarction at different stages of the disease. The capacity of the damaged myocardium to accumulate the labelled pyrophosphate decreased with its healing. The accumulation character of the radiopharmacologic preparation also changed. The revealed phenomena are explained by the features of the 99mTc-pyrophosphate concentration mechanisms of the damaged areas of the myocardium. during the necrosis phase pyrophosphate is accumulated in the irreversibly damaged myocardial cells. The incorporation of 99mTc-pyrophosphate into the myocardium at the late stages of the disease are explained by both the presence of the necrotized cells in the myocardium and possible binding of the radiopharmacologic preparation to collagen.

Topics: Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

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

Topics: Acute Disease; Diphosphates; Heart; Humans; Myocardial Infarction; 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

Topics: Computers; Diphosphates; False Negative Reactions; False Positive Reactions; Fourier Analysis; Heart; Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

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

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

Topics: Adult; Aged; Clinical Enzyme Tests; Diphosphates; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Myoglobin; Necrosis; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Aged; Cardiac Output; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

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

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

Negative myocardial infarct scintigrams with 99mtechnetium stannous pyrophosphate (99mTc-PYP) were obtained in two patients with acute massive transmural infarct. Both patients died soon after scintigraphy. Because necropsy was performed within hours after death, we were able to correlate the distribution of the tracer within the acutely infarcted tissue with the myocardial scintigram. The clinical implication is that a single myocardial scintigram may be grossly inaccurate in detecting and quantifying infarct size. The scintigraphic findings should always be correlated with the electrocardiographic and enzymatic findings in evaluating patients with possible myocardial infarct.

Topics: Aged; Autopsy; False Negative Reactions; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Topics: Humans; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Three patients with polymyositis had elevated serum levels of creatine kinase MB isoenzyme. The presence of this isoenzyme is used extensively to diagnose myocardial infarction, but the isoenzyme is also found in sera of patients with primary muscular and neuromuscular disorders. We studied cardiac function in two of our patients with electrocardiograms, technetium stannous pyrophosphate scanning, and technetium 99m-labeled erythrocyte gated blood pool imaging and in the third patient by postmortem examination. There was no evidence of myocardial involvement to account for the high serum levels of isoenzyme. Creatine kinase MB in the sera of patients with polymyositis does not necessarily indicate myocardial necrosis.

Topics: Adult; Creatine Kinase; Dermatomyositis; Electrocardiography; Female; Humans; Isoenzymes; Middle Aged; Muscles; Myocardial Infarction; Myocardium; Radiography, Thoracic; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

We have developed a method by which any two sets of R-wave-synchronized radionuclide images may be registered, color-coded, and displayed in cinematic fashion so that the image sets are superimposed and shown simultaneously in contrasting colors. The technique has been applied to technetium-99m stannous pyrophosphate (Tc-99m PPi) and equilibrium blood-pool images. Gated Tc-99m PPi and gated blood-pool image sets (16 frames per cardiac cycle) were acquired in identical projections. Image sets were then registered, if necessary, and color-coded by a computer algorithm. Our initial experience suggests that this overlay technique may be of value to: (a) detect right ventricular infarction with greater precision; (b) provide a better estimate of anatomic location and circumferential extent of Tc-99m PPi myocardial uptake relative to the ventricular blood pool; and (c) distinguish between segmental contraction abnormalities caused by recent infarction (identified by abnormal Tc-99m PPi uptake) and segmental contraction abnormalities caused by ischemia or previous myocardial infarction.

Topics: Adult; Aged; Diagnosis, Differential; Female; Heart; Heart Function Tests; Heart Ventricles; Humans; Ischemia; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Myocardium; Polyphosphates; Radionuclide Imaging; 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

Tc-99m-stannous pyrophosphate myocardial imaging has been one of the most effective and sensitive procedures for detection of acute myocardial infarction since Bonte et al introduced it in 1974. However, many causes of false-positive studies have also been reported since then. Presented here is an abnormal case of a patient with aortic and mitral valve replacement.

Topics: Aortic Valve; Diphosphates; False Positive Reactions; Heart; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Technetium-99m hydroxymethylene diphosphonate (Tc-99M HMDP) is a new diphosphonate skeletal imaging agent. Animal studies show that Tc-99m HMDP has a higher uptake on bone and a more rapid clearance from the blood than any of the three technetium-labeled bone imaging agents in current use: Tc-99m methylene diphosphonate (DMP), Tc-99 (1-hydroxyethylidene) diphosphonate (HEDP), and Tc-99m pyrophosphate (PPi). On the basis of these animal studies, Tc-99m HMDP is a highly promising candidate for skeletal imaging.

Topics: Acute Disease; Animals; Bone and Bones; Diphosphates; Diphosphonates; Dogs; Etidronic Acid; Guinea Pigs; Injections, Intravenous; Myocardial Infarction; Organotechnetium Compounds; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Time Factors; Tissue Distribution

Technetium-99m hydroxymethylene diphosphate (Tc-HMDP) was compared with the two other diphosphonates (Tc-MDP and Tc-HEDP) and Tc-99m pyrophosphate (Tc-PPi) in a canine model of acute myocardial infarction. The TC-HMDP showed higher uptake in infarcted myocardium than the other two diphosphonates, and uptake equivalent to that of Tc-PPi.

Topics: Animals; Bone and Bones; Diphosphates; Diphosphonates; Dogs; Dose-Response Relationship, Drug; Etidronic Acid; Femur; Myocardial Infarction; Organotechnetium Compounds; Radionuclide Imaging; Ribs; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tissue Distribution

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

Topics: Cesium Radioisotopes; Diphosphates; Heart; Humans; Indium; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In order to study whether wall motion abnormalities detected by two-dimensional (2D) echocardiography can be quantified and correlated with infarct size, we compared wall motion abnormalities viewed by 2D echocardiography in experimental canine infarction with post-mortem infarct size. Nineteen mongrel dogs underwent left anterior descending coronary artery snare occlusion. They were sacrificed 6 h later. Infarct sizing was done by technetium 99-m stannous pyrophosphate scintigraphy of the excised, sliced left ventricles. Fourteen dogs had both 2D echo wall motion abnormalities and infarctions. Four dogs failed to develop infarction and had no or minimal wall motion abnormalities. Inter-observer variation in 2D echocardiographic measurements was small. Wall motion abnormalities correlated with infarct size both in the 14-dog subgroup with infarction (r = 0.75, P less than 0.003) and all the 18 dogs that completed the protocol (r = 0.87, P less than 0.001). Thus, wall motion abnormalities in experimental canine myocardial infraction can be roughly quantified by 2D echocardiography and correlated with post-mortem infarct size measured by scintigraphy.

Topics: Animals; Dogs; Echocardiography; Heart; Models, Cardiovascular; Myocardial Infarction; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

A modeling procedure, employing multiple 99mTc-PYP myocardial scintigrams, was applied to acute inferoposterior myocardial infarcts in 12 dogs. Four modeling schemes were developed, and the model volume predictions were correlated with morphometrically determined infarct masses. Correlation values ranged from r = 0.66 (p less than 0.02) to r = 0.80 (p less than 0.005), suggesting that the method may enable noninvasive quantitative sizing of acute inferoposterior myocardial infarcts.

Topics: Animals; Computers; Dogs; Models, Cardiovascular; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates

Anterior myocardial infarction (MI) was produced in conscious dogs to evaluate the relationships among: a) cardiac technetium-99m stannous pyrophosphate (TcPPi) accretion, b) creatine phosphokinase (CPK) depletion, and c) postmortem MI weight, infarct structure, and histology. In vitro, there was a close relationship between measured MI weight and MI weight calculated by the TcPPi accretion (r = 0.96) or CPK depletion (r = 0.93) in representative "cross-sectional" MI samples. Cardiac TcPPi accretion and CPK depletion showed a curvilinear relationship over the spectrum of tissue samples. Adjacent to infarcts, there was marked TcPPi uptake and modest CPK depletion where histology suggested ischemia without infarction. Within infarcts, microscopically visible calcium was rare in this series, suggesting little intracellular calcium accumulation, insensitivity of the von Kossa staining technique, and/or other cellular mechanisms to account for Tc-PPi uptake in this conscious dog model without reperfusion.

Topics: Animals; Creatine Kinase; Dogs; Myocardial Infarction; Radioactive Tracers; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates