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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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