technetium-tc-99m-tetrofosmin and Acute-Disease

Whether tachycardia-dependent paroxysmal AV block, an uncommon complication of exercise stress testing in patients with infranodal conduction disturbances, can result from acute ischemia of the conduction system is still speculative, and is based on post-hoc evidence of right coronary artery disease and abolition of block after coronary angioplasty.. In two patients, from a database of 3000 undergoing nuclear exercise stress testing, transient paroxysmal AV block developed 1-4 minutes after the injection of the radionuclide agent. Nuclear perfusion imaging demonstrated stress-induced ischemia of the posteroseptal segments, which corresponds to the anatomical region of the His bundle, and perfusion recovery in the images obtained at rest. Angiography disclosed critical narrowing of the right coronary artery in both cases.. Nuclear myocardial perfusion imaging provides noninvasive evidence that transient ischemia of the posteroseptal segment, anatomically corresponding to the His bundle, can result in paroxysmal AV block in patients with severe right coronary artery and chronic infranodal conduction disturbances. The demonstration of the underlying pathophysiological mechanism is useful for selecting the most effective treatment strategy.

Topics: Acute Disease; Aged; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Disease; Exercise; Exercise Test; Heart Block; Heart Conduction System; Humans; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Syncope; Tomography, Emission-Computed, Single-Photon

Over the last 20 years, nuclear cardiology has become a mainstay in the evaluation of ischemic heart disease. In the setting of acute coronary syndromes (myocardial infarction or unstable angina), myocardial perfusion imaging has emerged as an important tool in assessing the functional significance of angiographic coronary stenoses, evaluating the efficacy of therapeutic interventions, and risk-stratifying patients in the postinfarction period. Recent literature has demonstrated the diagnostic and prognostic value, as well as the cost-effectiveness, of perfusion imaging in acute chest pain syndromes and the diagnostic superiority of perfusion imaging compared with two-dimensional echocardiography. Acute perfusion imaging is now being included in the algorithm for the triage and management of acute chest pain syndromes. Emergency physicians are increasingly using nuclear cardiac imaging modalities for aid in the evaluation of patients who present with chest pain of uncertain origin.

Topics: Acute Disease; Algorithms; Coronary Disease; Cost-Benefit Analysis; Diagnosis, Differential; Echocardiography; Electrocardiography; Gated Blood-Pool Imaging; Humans; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Syndrome; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Triage

This study evaluated the ability of low-dose dobutamine stress 99mTc tetrofosmin (DSTF) quantitative gated single photon emission computed tomography (QGS) performed during the acute phase of myocardial infarction to predict subsequent myocardial viability and detect stunned myocardium. Twenty-four patients suffering their first acute myocardial infarction (AMI) underwent coronary angioplasty after coronary angiography (CAG) immediately following admission. Follow-up CAG and left ventriculography (LVG) were performed 10 days and 6 months later. All patients underwent DSTF QGS to measure left ventricular ejection fraction (LVEF) at rest and during dobutamine infusion (10 microg.kg(-1).min(-1)) 14 days after angioplasty. No patient suffered coronary restenosis. After 6 months, the LVEF measured by LVG improved >5% in 12 patients (group A), and did not improve in the remaining 12 patients (group B). The culprit coronary artery, the peak serum creatine phosphokinase concentration, the recanalization time, and the LVEF during the acute phase were similar in the two groups. However, the increase in the LVEF was greater in group A than in group B during dobutamine infusion (deltaLVEF) as measured by DSTF QGS (11.2+/-3.8% vs 2.9+/-4.7%, P <0.001). If a cut-off value of 6.5% for the deltaLVEF was used to predict the improvement in LVEF during the chronic phase, then the sensitivity of this test was 83.3% and its specificity was 83.3%. It is concluded that DSTF QGS during AMI can be used to predict myocardial viability and detect stunned myocardium.

Topics: Acute Disease; Aged; Aged, 80 and over; Dobutamine; Female; Follow-Up Studies; Gated Blood-Pool Imaging; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Stunning; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Stress, Physiological; Stroke Volume; Tissue Survival; Ventricular Dysfunction, Left

We assessed Takotsubo (ampulla) cardiomyopathy compared with acute coronary syndrome (ACS) using two-dimensional echocardiography and 99mTc-tetrofosmin myocardial SPECT.. We examined 10 patients with Takotsubo cardiomyopathy and 16 with ACS at the time of emergency admission (acute phase), at three to nine days after the attack (subacute phase) and at one month after the attack (chronic phase). The left ventricle was divided into nine regions on echocardiograms and SPECT images, and the degree of abnormalities in each region was scored in five grades from normal (0) to severely abnormal (4).. Coronary angiography revealed total or subtotal occlusion in patients with ACS but no stenotic legions in those with Takotsubo cardiomyopathy. The amount of ST segment elevation (mm) was 7.9 +/- 3.4 in patients with Takotsubo cardiomyopathy and 7.3 +/- 3.7 in those with ACS (N.S.). Abnormal wall motion scores on echocardiograms were 13.8 +/- 4.4, 4.4 +/- 3.8 and 1.8 +/- 2.3 during the acute, subacute and chronic phases in patients with Takotsubo cardiomyopathy, and 13.9 +/- 4.0, 11.7 +/- 3.7, 7.6 +/- 4.2, respectively in patients with ACS. The value of MB fraction of creatine phosphokinase (IU/l) was 34 +/- 23 in patients with Takotsubo cardiomyopathy and 326 +/- 98 in those with ACS (p < 0.001). Abnormal myocardial perfusion scores on 99mTc-tetrofosmin myocardial SPECT were 11.4 +/- 3.2, 3.2 +/- 3.3 and 0.7 +/- 1.1 during the acute, subacute and chronic phases respectively, in patients with Takotsubo cardiomyopathy, and 15.8 +/- 4.1, 13.5 +/- 4.4, 8.2 +/- 4.4, respectively, in those with ACS. The numbers of myocardial segments that did not uptake 99mTc-tetrofosmin during the acute phase were 0.5 +/- 0.8 and 3.6 +/- 2.8 in patients with Takotsubo cardiomyopathy and ACS, respectively.. Impaired coronary microcirculation might be a causative mechanism of Takotsubo cardiomyopathy.

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiomyopathies; Coronary Disease; Diagnosis, Differential; Female; Heart Ventricles; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Syndrome; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

The state of no-reflow (i.e. inadequate myocardial tissue perfusion despite normal arterial flow proven in angiography after pharmacological or mechanical interventions) is considered to be a marker of a poor prognosis. Although the Thrombolysis in Myocardial Infarction (TIMI) flow grade is a valuable and widely used qualitative measure in angiography trials, it is limited by its subjective and categorical nature. Recently, the TIMI frame count method (TFC) was proposed for detecting no-reflow. In our study we aimed to compare TFC values with myocardial perfusion single photon emission computed tomography (SPECT) findings to investigate the additional role of the former method in the evaluation of no-reflow. Twenty patients (16 men and four women; mean age 58+/-9 years) with first acute myocardial infarction were included in the study after thrombolytic therapy. Coronary angiography (CAG) was performed 5-7 days later. The TIMI flow grade and TFC values were determined in angiography examinations. A TIMI flow of less than grade 3 and a TFC value >27 were considered to be pathologically decreased for coronary artery blood flow. Tc tetrofosmin myocardial rest SPECT was carried out 24 h after coronary angiography. SPECT images were scored on a four-point scale in 20 myocardial segments and the total defect score was calculated from the sum of defect scores in 20 segments. Wall motion was assessed using the wall motion score index in echocardiography (ECWSI). The occurrence rates of angiographic no-reflow, pathological TFC and perfusion defects in SPECT were calculated as 40% (8/20), 47% (8/17; non-measurable in three patients with TIMI grade 0), and 55% (11/20), respectively. Perfusion defects were present and the TIMI frame count value was increased in all patients with angiographic no-reflow (TIMI grade <3). The occurrence rate of perfusion defects and increased TFC was equal (42%) in all 12 patients having TIMI grade 3 flow. Increased TFC was demonstrated in four of five patients having perfusion defects and TIMI grade 3 flow (80% compatibility with SPECT). TIMI frame count and ECWSI values were significantly higher in patients having perfusion defects than in patients with normal perfusion ( <0.05). It is concluded that the TIMI frame count is a valuable method in the detection of patients with TIMI grade 3 flow, with no-reflow, and increases the specificity of coronary angiography in the evaluation of the response to thrombolytic therapy. A pathologicall

Topics: Acute Disease; Aged; Coronary Angiography; Coronary Circulation; Creatine Kinase; Echocardiography; Female; Humans; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion Injury; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Thrombolytic Therapy; Tissue Plasminogen Activator; Tomography, Emission-Computed, Single-Photon

To avoid the haemorrhagic risk of unnecessary thrombolysis in acute myocardial infarction (MI), early and precise diagnosis of spontaneous recanalization (SR) of the infarct-related artery is required. To clarify the accuracy of technetium-99m tetrofosmin myocardial single-photon emission tomography (SPET) in the detection of SR in patients with acute anterior MI, electrocardiography (ECG), echocardiography and 99mTc-tetrofosmin SPET imaging were performed in 49 patients with acute anterior MI before emergency coronary angiography. Defect score was calculated as the sum of the perfusion defects of each segment: from 3 (complete defect) to 0 (normal perfusion). Echocardiographic asynergic score (the sum of asynergic grades) and the greatest ST elevation of the 12-lead ECG on admission were also measured. SR was defined as Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow on emergency coronary angiography. Defect score in 11 patients with SR (9.2 +/- 3.7) was significantly lower than that in 38 patients without SR (18.5 +/- 5.0) (P < 0.001), whereas there were no significant differences in asynergic score and ST elevation between the two groups. From the receiver operating characteristic curves, the optimal cut-off points of defect score, asynergic score and ST elevation for the detection of SR were calculated to be 12, 13 and 3.5, respectively. The sensitivity and specificity of the scintigraphic defect score (91% and 89%) were significantly higher than those of the asynergic score (64% and 68%) and ST elevation (73% and 71%). Thus, 99mTc-tetrofosmin SPET imaging on admission is a very accurate method for the detection of SR in patients with acute anterior MI.

Topics: Acute Disease; Aged; Aged, 80 and over; Coronary Angiography; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Heart; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Neovascularization, Physiologic; Organophosphorus Compounds; Organotechnetium Compounds; Perfusion; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

Previous studies have indicated that iodine-123 labelled beta-methyliodophenyl pentadecanoic acid (BMIPP), an iodinated fatty acid analogue, can identify persistent alteration of fatty acid metabolism after restoration of blood flow. To assess whether fatty acid imaging can delineate areas at risk following successful revascularization in patients with acute myocardial infarction (AMI), BMIPP findings at 1 week post AMI were compared with perfusion imaging before and after revascularization therapy. Sixty-five patients with AMI underwent technetium-99m tetrofosmin single-photon emission tomography (SPET) before m (TF0) and 1 week (TF1) after successful revascularization therapy. BMIPP SPET was also performed under a fasting state at 1 week (BM1) post AMI. The extent scores were calculated from the defect scores in 20 segments. The BM1 score (7.7 +/- 3.9) was similar to the TF0 score (8.8 +/- 4.2) (r = 0.86, P < 0.0001), but significantly higher than the TF1 score (5.8 +/- 3.9) (P < 0.0001). A significant correlation was observed between the BM1 score and TF0 score (r = 0.86, P < 0.0001). Among a total of 1300 segments, the BM1 score was identical to the TF0 score in 1156 (88.9%). These data indicate that the ability of BMIPP imaging at 1 week post AMI to identify areas at risk is similar to that of tetrofosmin perfusion imaging in the acute phase. This may be due to the impairment of fatty acid uptake and metabolism reflecting prior severe ischaemic insult which persists at least 1 week after recovery of perfusion in the acute phase of AMI.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Coronary Circulation; Fatty Acids; Female; Humans; Image Processing, Computer-Assisted; Iodine Radioisotopes; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Risk Assessment; Tomography, Emission-Computed, Single-Photon

The use of cadmium-zinc-telluride-based scanners may increase the clinical feasibility of simultaneous dual-isotope imaging. In the current study, we sought to investigate a potential acquisition time in simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging using a Discovery NM/CT 670 cadmium-zinc-telluride.. Simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-isotope imaging was performed in 29 patients who had undergone primary percutaneous coronary intervention for acute myocardial infarction. Referenced images with an acquisition time of 65 s/view (16.25 min) were reframed to produce images with acquisition times of 33, 16, and 8 s/view. The values for the quantitative-gated single-photon emission computed tomography (SPECT) and the quantitative perfusion SPECT were compared.. The quantitative-gated SPECT values for images with 33, 16, and 8 s/views showed good consistency with those for 65 s/view (the lower 95% confidence intervals for the intraclass correlation were ≥0.80). The quantitative perfusion SPECT values for Tc-tetrofosmin images with 33, 16, and 8 s/views also showed good consistency with those for 65 s/view; however, the quantitative perfusion SPECT values for I-β-methyl-p-iodophenyl pentadecanoic acid images with an acquisition time of 8 s/view were not consistent with the reference acquisition time of 65 s/view.. The quantitative-gated SPECT and quantitative perfusion SPECT values obtained from images with shorter acquisition times correlated with the values obtained from images with a reference acquisition time of 65 s/view; however, tracer-specific predisposition should be considered. These findings suggest that it is possible to reduce acquisition time when performing simultaneous Tc-tetrofosmin/I-β-methyl-p-iodophenyl pentadecanoic acid dual-tracer imaging with the novel cadmium-zinc-telluride scanner.

Topics: Acute Disease; Cadmium; Fatty Acids; Female; Humans; Image Processing, Computer-Assisted; Iodobenzenes; Male; Middle Aged; Myocardial Infarction; Organophosphorus Compounds; Organotechnetium Compounds; Percutaneous Coronary Intervention; Tellurium; Time Factors; Tomography, Emission-Computed, Single-Photon; Zinc

It is well known that silent myocardial ischemia (SMI) often complicates patients with cerebral infarction and that stroke patients often die of ischemic heart disease. Therefore, it is considered important to treat myocardial ischemia in stroke patients. This study investigated SMI complicating Japanese patients with fresh stroke, using (99m)Tc-tetrofosmin myocardial scintigraphy with pharmacologic stress testing to elucidate their clinical manifestations. This study included 41 patients (26 men, mean age 76.0 ± 10.7 years) with acute cerebral infarction and no history of coronary artery disease. All patients underwent (99m)Tc-tetrofosmin myocardial scintigraphy with intravenous administration of adenosine to diagnose SMI. Of the 41 patients, myocardial ischemia was confirmed in 17 patients (41.5%). Atherosclerotic etiology was the major cause of stroke in the ischemia(+) group and embolic origin was the major cause in the ischemia(-) group. Patients with myocardial ischemia had a higher incidence of diabetes mellitus (52.9 vs 20.8%; P = 0.0323) and more than two conventional cardiovascular risk factors (64.7 vs 25.0%; P = 0.0110) compared with the nonischemic patients. Infarction subtype of atherosclerotic origin was an independent positive predictor of asymptomatic myocardial ischemia in patients with stroke. These findings indicate that the prevalence of asymptomatic myocardial ischemia is relatively high, especially in patients with stroke of atherosclerotic origin. Therefore, it is beneficial for us to narrow the target population who are at the highest risk when screening for SMI in Japanese patients with acute cerebral infarction.

Topics: Acute Disease; Adenosine; Aged; Cerebral Infarction; Coronary Angiography; Diagnosis, Differential; Exercise Test; Female; Follow-Up Studies; Humans; Incidence; Japan; Male; Myocardial Ischemia; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radiopharmaceuticals; Retrospective Studies; Risk Factors; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

To investigate the cardioprotective effect of intravenous nicorandil before primary percutaneous coronary intervention (PCI) on preservation of myocardial viability, we studied 199 consecutive patients with acute myocardial infarction.. Nicorandil was given intravenously on admission (before primary PCI). Echocardiography and technetium-99m tetrofosmin perfusion imaging were performed before and 1 month after primary PCI. Echocardiographic asynergic score before primary PCI was used to define the size of risk area, whereas the sum of scintigraphic defect grade before primary PCI was used to estimate myocardial viability within the area at risk. The change (before primary PCI and 1 month after primary PCI) in asynergic score and scintigraphic salvage index were calculated.. Patients were divided into nicorandil (n=101) and control (n=98) groups. Although asynergic score before primary PCI was not different between the two groups (nicorandil=3.5+/-2.1 and control=3.9+/-1.5), myocardial viability was preserved in nicorandil group (defect score=11.0+/-4.0) than that in control group (defect score=14.0+/-4.7, P<0.0001). Multivariate analysis revealed that the presence of antegrade flow (P=0.015) and nicorandil (P<0.0001) were independently associated with preserved myocardial viability before primary PCI. Moreover, the greater reduction in asynergic score (66+/-41 vs. 49+/-23%, P=0.0006) and larger salvage index (65+/-25 vs. 53+/-26%, P=0.0015) were observed in nicorandil group compared with the control group.. Intravenous administration of nicorandil before primary PCI preserved myocardial viability within the risk area, which leads to greater myocardial salvage and better functional recovery after primary PCI.

Topics: Acute Disease; Aged; Angioplasty, Balloon, Coronary; Female; Humans; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Myocardium; Nicorandil; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents

Emergency department (ED) patients with chest pain (CP) and a nondiagnostic electrocardiogram (ECG) present difficult management decisions. The purpose of this study was to investigate the utility of resting radionuclide SPECT myocardial perfusion imaging (SPECT MPI)-including an overnight delayed image acquisition protocol-in identifying patients presenting to the ED with CP at risk for cardiac events.. Patients presenting to the ED with CP and a nondiagnostic ECG were prospectively enrolled and underwent chest pain center evaluation. All patients also underwent resting gated SPECT MPI using (99m)Tc-tetrofosmin tracer. Patients presenting on weeknights between 12 am and 6 am had tracer injection in the ED with image acquisition delayed until later in the morning. Patients were monitored for a 30-d occurrence of cardiac events.. Over a 16-mo period, 479 patients were enrolled and completed follow-up. For the prediction of 30-d cardiac events, resting SPECT MPI demonstrated a sensitivity and a specificity of 76.9% and 92.4%, respectively. Positive and negative predictive values were 22.2% and 99.3%, respectively. Among the 3 patients with a normal perfusion scan who suffered cardiac events, all had tracer injection several hours after resolution of CP. The overnight delayed image acquisition protocol provided a negative predictive value of 100% for the 44 patients whose image acquisition was delayed until the following morning.. A normal resting SPECT MPI in ED patients presenting with CP predicts a very low occurrence of 30-d cardiac events. A delayed image acquisition protocol did not decrease the accuracy of SPECT MPI. Such a protocol may be useful in increasing the availability of this imaging modality.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Chest Pain; Electrocardiography; Female; Gated Blood-Pool Imaging; Heart Diseases; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Pain Clinics; Perfusion; Radioisotopes; Radiopharmaceuticals; Rest; Risk Assessment; Risk Factors; Sensitivity and Specificity; Time; Tomography, Emission-Computed, Single-Photon

A 58-year old woman had felt some chest pains on effort for several days. She was admitted to the emergency room with severe and refractory chest pain after exercise. Electrocardiogram showed marked ST-segment elevations in II, III, aVF and V1-6 electrodes. Echocardiogram revealed neither wall motion asynergy in the left ventricle nor abnormal pericardial effusion. Chest X-ray showed normal findings, and mild elevation of C-reactive protein was observed in the blood chemistry data. Her chest pain was relieved by nitroglycerin administration. Emergent technetium-99m-tetrofosmin myocardial imaging did not show any abnormal perfusion in the left ventricle. However, an abnormal extra-cardiac mediastinal accumulation was detected in the planar image. Contrast-enhanced chest CT scanning also demonstrated an inhomogeneously enhanced tumor in the anterior superior mediastinum. The tumor was surgically removed and was finally diagnosed as an invasive thymoma. Technetium-99m-tetrofosmin scintigraphy happened to provide useful information for diagnosing acute pericarditis with mediastinal tumor.

Topics: Acute Disease; Female; Heart; Humans; Incidental Findings; Mediastinal Neoplasms; Middle Aged; Myocardium; Neoplasm Invasiveness; Organophosphorus Compounds; Organotechnetium Compounds; Pericarditis; Radionuclide Imaging; Radiopharmaceuticals; Thymoma

The value of stress harmonic power Doppler imaging (HPDI) for the evaluation of myocardial perfusion has never been assessed in patients after acute coronary syndrome (ACS).. To evaluate the agreement between stress HPDI and single photon emission computed tomography (SPECT) imaging for the assessment of myocardial perfusion after unstable angina or myocardial infarction.. Thirty patients with a recent ACS underwent HPDI and SPECT. Images were obtained at rest and during dipyridamole infusion (0.56 mg/kg over 4 min). Apical two- and four-chamber views were used for HPDI. Ten myocardial segments were scored for myocardial perfusion. Semiquantitative and quantitative video intensity analysis with background subtraction were performed.. Concordance by patients between quantitative HPDI and SPECT was 76% (kappa=0.40, Phi=0.46) for normal versus abnormal perfusion. When semiquantitative analysis was used, concordance was 72% (kappa=0.42, Phi=0.46). Agreement between methods was best in the left anterior descending artery territory for quantitative (80%) (kappa=0.60, Phi=0.60) and semiquantitative analysis (78%) (kappa=0.51, Phi=0.60) for normal versus abnormal perfusion. Discrepancies between HPDI and SPECT were most important in the circumflex territory, with a concordance of 59% (kappa=0.22) for identification of normal perfusion versus irreversible and reversible defects.. These results suggest that HPDI can detect myocardial perfusion at rest and during pharmacological stress in patients after a recent ACS. Given the suboptimal agreement with SPECT, further advances are required before the routine use of contrast echocardiography is possible for the assessment of myocardial perfusion.

Topics: Acute Disease; Aged; Aged, 80 and over; Contrast Media; Coronary Circulation; Coronary Disease; Echocardiography; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Polysaccharides; Radiopharmaceuticals; Research Design; Syndrome; Tomography, Emission-Computed, Single-Photon

We studied the causative mechanism of ampulla (Takotsubo) cardiomyopathy.. We examined 7 patients with ampulla cardiomyopathy by means of coronary angiography, two-dimensional echocardiography and 99Tc-tetrofosmin myocardial SPECT at the time of emergency admission (acute phase), at 3 to 5 days after the attack (subacute phase) and at 1 month after the attack (chronic phase). The left ventricle was divided into 9 regions on two-dimensional echocardiograms and 99mTc-tetrofosmin myocardial SPECT images, then the degree of abnormalities in each region was scored in four grades from normal (0) to severely abnormal (3). We injected nicorandil into the coronary arteries and determined the elevation in the ST segment before and after administration.. Coronary angiography did not show stenotic lesions in any patient. The acute, subacute and chronic phase myocardial perfusion scores on 99mTc-tetrofosmin myocardial SPECT were 11.2 +/- 3.4, 2.7 +/- 2.3 and 0.4 +/- 0.5, respectively, and wall motion scores on echocardiograms were 13.0 +/- 3.6, 4.4 +/- 2.2 and 0.6 +/- 0.6, respectively, indicating improvement in all scores during the subacute phase (p < 0.01). The elevation in the ST segment (mm) on the electrocardiogram was improved from 8.3 +/- 2.7 to 4.9 +/- 1.9 after the administration of nicorandil (p < 0.05).. These findings indicated that coronary microvascular spasm is one causative mechanism of ampulla cardiomyopathy.

Topics: Acute Disease; Aged; Cardiomyopathies; Chronic Disease; Coronary Angiography; Coronary Vasospasm; Echocardiography; Electrocardiography; Female; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon