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

Chronic exertional compartment syndrome (CECS) of the leg is a common, painful condition related to exercise and associated with increased muscle compartment pressure (CP). Invasive methods are currently the method of choice for diagnosing the condition. We investigated the use of Tc-99m-tetrofosmin perfusion single-photon emission computed tomography (SPECT) as a diagnostic tool compared with the gold standard, muscle CP measurement. In 14 subjects perfusion SPECT and CP were measured before and immediately after exercise leading to pain in the lower legs. Six subjects had increased pressures indicating the presence of CECS. In three (50%) of these muscular hypoperfusion was observed by perfusion SPECT. In eight subjects with normal CPs SPECT suggested muscular hypoperfusion. Because of the low diagnostic rates, sensitivity 50% and specificity 63%, Tc-99m-tetrofosmin perfusion SPECT seems not to be a useful method for diagnosing CECS.

Topics: Adult; Chronic Disease; Compartment Syndromes; Female; Humans; Leg; Male; Middle Aged; Muscle, Skeletal; Organophosphorus Compounds; Organotechnetium Compounds; Physical Exertion; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Transducers, Pressure

Cell therapy has recently been introduced to treat patients with refractory angina. Because most studies have only included short-term follow-up, the effects of cell therapy over a longer period are unknown.. In 25 patients (mean age 64 +/- 10 years, 21 men) with refractory angina, a total of 84 +/- 29 x 10(6) bone marrow-derived mononuclear cells was injected intramyocardially in regions with ischemia on technetium-99m tetrofosmin single-photon emission computed tomography. Anginal symptoms and quality of life were evaluated at baseline and at 3, 6, and 12 months. Gated single-photon emission computed tomography was performed at baseline and at 3 and 12 months to assess myocardial perfusion and left ventricular function.. Bone marrow cell injection was performed without any complication. At 7 months, one patient died of intracranial hemorrhage. Canadian Cardiovascular Society class improved from 3.4 +/- 0.5 to 2.3 +/- 0.6 at 3 months, 2.4 +/- 0.6 at 6 months, and 2.7 +/- 0.8 at 12 months (P < .01). Quality of life improved from 53% +/- 10% to 71% +/- 11% at 3 months, 72% +/- 14% at 6 months, and 68% +/- 14% at 12 months (P < .01). The number of segments with ischemia per patient decreased from 4.7 +/- 3.3 to 2.1 +/- 2.6 at 3 months and 1.6 +/- 2.5 at 12 months (P < .01). Left ventricular ejection fraction increased from 47% +/- 13% to 53% +/- 17% at 3 months and 51% +/- 17% at 12 months (P < .01). Regional wall motion improved from 5.9 +/- 1.7 to 6.6 +/- 2.2 mm at 3 months and 6.4 +/- 2.0 mm at 12 months (P = .01).. Autologous bone marrow cell injection in patients with ischemia is safe and results in a sustained beneficial effect on anginal symptoms, myocardial perfusion, and left ventricular function.

Topics: Aged; Angina Pectoris; Bone Marrow Transplantation; Chronic Disease; Coronary Circulation; Female; Follow-Up Studies; Heart; Humans; Injections; Male; Middle Aged; Monocytes; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Transplantation, Autologous; Treatment Outcome; Ventricular Function, Left

We investigated efficacy and safety of implantation of autologous bone marrow mononuclear cells plus platelets, including endothelial progenitor cells (EPCs), for recovering refractory chronic peripheral arterial disease (PAD) using visual and quantitative analyses by 99mTc-tetrofosmin (TF) perfusion scintigraphy, and also investigated various quantitative assessments objectively. We performed 12 consecutive cases and 19 limbs and hands with severe chronic PAD that were almost Fontaine class IV (11/12 cases, about 92%) in this trial. This treatment was very effective in relieving severe pain of PAD, especially for Buerger's disease. We used a visual analog scale (VAS) for measurement of pain level. The maximum pain level before implantation was 66.5+/-5.0 mm, and it decreased to 12.1+/-2.2 mm after implantation (p < 0.001). Rest pain in legs and fingers was resolved in 11 cases (11/12 cases, 92%). All patients could measure pain-free walking time on a treadmill, which improved remarkably (140+/-53 s before implantation vs. 451+/-74 s after implantation, p = 0.034). Resting ankle brachial pressure index (ABI) in legs implanted with bone marrow mononuclear cells was also improved (0.65+/-0.08 before implantation vs. 0.73+/-0.07 after implantation, p = 0.055). According to 99mTc-TF perfusion scintigraphy, the proximal area (region from knee to ankle) was 1.32+/-0.10 before implantation versus 1.56+/-0.11 after implantation (p = 0.007). 99Tc-TF perfusion scintigraphy in the distal area (region from ankle to end of toes, or from wrist to end of fingers) was 0.79+/-0.06 before implantation versus 0.83+/-0.06 after implantation (p = 0.29). Ischemic legs and hands that were injected showed increased perfusion blood flow. 99mTc-TF perfusion scintigraphy was effective to estimate visual and quantitative analysis of collateral vessels in neovascularization. We were successful with this new treatment for the most severe, chronic PAD that was not curable by any of the current treatments. Thus, this therapeutic angiogenesis could be a new strategy for saving severe ischemic limbs and hands.

Topics: Aged; Arteriosclerosis Obliterans; Bone Marrow Cells; Bone Marrow Transplantation; Chronic Disease; Diabetic Angiopathies; Female; Gangrene; Humans; Male; Middle Aged; Neovascularization, Physiologic; Organophosphorus Compounds; Organotechnetium Compounds; Peripheral Vascular Diseases; Radionuclide Imaging; Radiopharmaceuticals; Thromboangiitis Obliterans

Currently, with the rapidly increasing number of patients with heart failure due to chronic coronary artery disease, the need for viability studies to guide treatment in these patients is increasing. The most accurate method for viability assessment is metabolic imaging with (18)F-FDG with PET or SPECT. To obtain excellent image quality in all patients, the (18)F-FDG studies should be performed during hyperinsulinemic euglycemic clamping. However, this approach is time-consuming and is not feasible in busy nuclear medicine laboratories. Recently, the use of a nicotinic acid derivative, acipimox, has been suggested, but limited data are available on the image quality of the (18)F-FDG studies using this approach.. We evaluated the feasibility and image quality of (18)F-FDG SPECT (with dual-isotope simultaneous acquisition (DISA) using (99m)Tc-tetrofosmin to assess perfusion) after acipimox administration in 50 nondiabetic patients. The image quality of both (18)F-FDG and (99m)Tc-tetrofosmin was assessed visually and quantitatively using myocardium-to-blood-pool (M/B) ratios as a measure of target-to-background ratio. The image quality and diagnostic value of DISA (99m)Tc-tetrofosmin SPECT was compared with standard (99m)Tc-tetrofosmin SPECT at baseline.. After acipimox administration, the plasma levels of free fatty acids were extremely low (68 +/- 89 nmol/L). No severe side effects were observed, only paroxysmal flushing. The (18)F-FDG image quality was good in 46 patients (92%) and moderate but still interpretable in the other 4 patients (8%). The clinical information of the baseline (99m)Tc-tetrofosmin SPECT was retained in the DISA (99m)Tc-tetrofosmin SPECT images because we did observe no substantial fill-in of perfusion defects by high (18)F-FDG uptake in the same segment.. Cardiac (18)F-FDG SPECT after acipimox is safe and resulted consistently in good image quality; this simple approach may be the method of choice for routine cardiac metabolic imaging.

Topics: Administration, Oral; Chronic Disease; Coronary Artery Disease; Echocardiography; Feasibility Studies; Female; Fluorodeoxyglucose F18; Heart; Humans; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Pyrazines; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Ventricular Dysfunction, Left

The purpose of this study was to clarify the diagnostic value of identifying viable myocardium using 99mTc-Tetrofosmin scintigraphy. Twenty-one patients with chronic coronary artery disease were studied using 201Tl exercise myocardial scintigraphy with reinjection and 99mTc-Tetrofosmin exercise myocardial scintigraphy. All patients had a history of old myocardial infarction. For 99mTc-Tetrofosmin scintigraphy, 222 MBq of 99mTc-Tetrofosmin was injected during exercise, and exercise images were obtained 20 min thereafter. There hours later, 666 MBq of 99mTc-Tetrofosmin was injected at rest, and images were obtained 40 min and 220 min later. Myocardial viability in the 99mTc-Tetrofosmin scintigraphy was estimated as fill-in findings (FF) or over 50% of %RI uptake (%TF) in the rest image. Myocardial viability in the 201Tl scintigraphy was estimated as redistribution (RD), fill-in findings in the reinjection image (FR) or over 50% of %RI uptake in the reinjection image (% TL). Sixteen of the 21 patients (76%) who underwent 201Tl scintigraphy (RD 10, FR 3, %TL 3 cases) and 15 of the 21 patients (71%) who underwent 99mTc-Tetrofosmin scintigraphy (FF 11, %TF 4 cases) had viable myocardium in the infarcted area. A comparison between the 99mTc-Tetrofosmin rest images obtained 40 min after the injection and that of 220 min revealed no redistribution findings. The %RI uptake of the infarcted area in the resting 99mTc-Tetrofosmin image (47 +/- 16%) was slightly lower than that in the 201Tl reinjection image (52 +/- 16%). In conclusion, viable myocardium was as clearly identified by 99mTc-Tetrofosmin, as by 201Tl scintigraphy.

Topics: Aged; Chronic Disease; Coronary Disease; Exercise Test; Female; Heart; Humans; Image Enhancement; Injections, Intravenous; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Thallium Radioisotopes; Tissue Survival

To evaluate the prognostic value of exercise myocardial scintigraphy in patients undergoing incomplete revascularization by means of percutaneous coronary intervention (PCI) with at least a residual chronic total occlusion (CTO) left untreated.. Of 569 consecutive patients with multivessel disease undergoing myocardial scintigraphy after incomplete revascularization by PCI between March 1997 and December 2004, 126 (79% male, 64+/-10 years) with >or= 1 residual CTO fulfilled the eligibility criteria and entered in the study. Hard events defined as cardiac death and myocardial infarction, soft events defined as incidence of unstable angina and PCI procedures, and their composite were assessed at a median follow-up period of 44 months.. Hard events were observed in six patients (4.8%). All of them had severely abnormal perfusion defects detected by myocardial scintigraphy. Soft events occurred in 0 (0%), 10 (7.9%), and 15 (11.9%) patients with normal, mildly abnormal, and severely abnormal perfusion, respectively. In the Kaplan-Meier analysis, the log-rank test was statistically significant across patients stratified by summed stress score either in terms of hard, soft and hard, or soft events. Univariate and multivariate Cox proportional-hazards showed an incremental significant information when the scintigraphic variables were added to clinical, angiographic, left ventricular ejection fraction, and Duke treadmill score, for prediction of the composite of hard and soft cardiac events (P < 0.006).. Among patients with a residual CTO left untreated after PCI, myocardial perfusion imaging provides significant independent information concerning the subsequent risk of cardiac events.

Topics: Aged; Angioplasty, Balloon, Coronary; Chronic Disease; Coronary Angiography; Coronary Circulation; Coronary Occlusion; Exercise Test; Female; Follow-Up Studies; Heart Diseases; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Radiopharmaceuticals; Risk Assessment; Tomography, Emission-Computed, Single-Photon

Hyperbaric oxygenation (HBO) is a medical treatment of a patient with 100% oxygen inspiration under the pressure higher than atmospheric in a special unit designed to let the whole patient's body rest in a chamber. The aim of the study was to determine the effect of the application of HBO treatment on the patient's lower extremities with chonic inoperabile occlusive disease by measning the parameters of perfusion scintigraphy (perfusion reserve, relative perfusion).. This investigation included 22 patients (19 males and 3 famales). Following clinical assessment of lower extremities condition according to the skin appearance and its adnexa, claudication distance was performed. Clinical condition was graded by the use of 5-point nominal scale. In all of the patients 99mTc-tetraphosmine lower extremities scintigraphy was done ten days prior to the treatment start and ten days after the treatment with HBO. Lower legs were imaged from the posterior view. Prior to imaging the patients were obligatory lying approximately half an hour.. In 18 (86%) of the patients there was an improvement manifested as better subjective condition and better skin and its adnexa appearance. Following HBO treatment there was a statistically significant change in collecting the radiopharmac at rest. This finding indicates an increased viability of muscles as well as an increased perfusion reserve. Perfusion reserve mean values increased from 39.99 to 50.86%, and from 38.46 to 49.33% for the right and the left lower leg, respectively. This parameter clearly indicates favorable effects of HBO treatment pertaining neoangiogenesis and, consequently, increased viability of the lower leg muscles. It was also obvious in visual analysis of the obtained images.. The obtained results confirm that muscle perfusion measured by the parameters of perfusion scintigraphy using 9mTc-tetrophosmine (perfusion reserve, relative perfusion) in patients with inoperabile occlusive disease of the lower leg arteries significantly increases after the application of HBO treatment.

Topics: Aged; Arterial Occlusive Diseases; Chronic Disease; Female; Humans; Hyperbaric Oxygenation; Lower Extremity; Male; Organophosphorus Compounds; Organotechnetium Compounds; Perfusion Imaging; Radiopharmaceuticals; Regional Blood Flow

Bone marrow cell injection has been introduced to treat patients with ischemic heart disease. However, focal application of bone marrow cells may generate an arrhythmogenic substrate.. To assess the electrophysiological and arrhythmogenic effects of intramyocardial bone marrow cell injection in patients with chronic myocardial ischemia.. Bone marrow was aspirated in 20 patients (65+/-11 years, 19 male) with drug-refractory angina and myocardial ischemia. Electroanatomical mapping (NOGA, Biosense-Webster, Waterloo, Belgium) was performed during mononuclear cell isolation. Areas for cell injection were selected based on the localization of ischemia on SPECT. These areas were mapped in detail to evaluate local bipolar electrogram duration, amplitude and fragmentation. Mononuclear cells were injected in the ischemic area with the NOGA system. SPECT and electroanatomical mapping were repeated at 3 months. Holter monitoring was repeated at 3 and 6 months.. SPECT revealed a decrease in the number of segments with ischemia (3.5+/-2.5 vs. 1.1+/-1.0 at 3 months; P<0.01) and an increased left ventricular ejection fraction (44+/-13% vs. 49+/-17% at 3 months; P=0.02). The number of ventricular premature beats remained unchanged (10+/-24x10(2)/24h vs. 8+/-23x10(2)/24h at 3 months (P=NS) and 12+/-30x10(2)/24h at 6 months (P=NS)). At 3 months follow-up, bone marrow cell injection did not prolong electrogram duration (15.9+/-4.6 ms vs. 15.6+/-4.0 ms; P=NS), decrease electrogram amplitude (3.8+/-1.5 mV vs. 3.8+/-1.5 mV; P=NS), or increase fragmentation (2.0+/-0.5 vs. 1.9+/-0.4; P=NS).. Intramyocardial bone marrow cell injection does not increase the incidence of ventricular arrhythmias and does not alter the electrophysiological properties of the injected myocardium.

Topics: Aged; Angina Pectoris; Body Surface Potential Mapping; Bone Marrow Transplantation; Chronic Disease; Electrocardiography, Ambulatory; Electrophysiologic Techniques, Cardiac; Female; Follow-Up Studies; Heart Rate; Humans; Incidence; Male; Middle Aged; Myocardial Ischemia; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Research Design; Stroke Volume; Tachycardia, Sinus; Tachycardia, Ventricular; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Ventricular Premature Complexes

Intramyocardial injection of bone marrow cells has been proposed as a new therapeutic option for patients with chronic ischemic heart disease. We investigated whether autologous bone marrow-derived mononuclear cell injection into the myocardium of patients with drug-refractory ischemia reduces anginal symptoms, improves left ventricular (LV) function, increases myocardial perfusion, and alters the extent of scar tissue.. In 25 patients (mean age +/- SD, 64 +/- 10 y; 21 male) with drug-refractory angina pectoris (Canadian Cardiovascular Society [CCS] class III-IV), despite optimized medical therapy and without options for conventional revascularization, bone marrow was aspirated from the iliac crest. Mononuclear cell injections were targeted at myocardial regions with stress-induced ischemia on gated (99m)Tc-tetrofosmin SPECT. Anginal symptoms were reassessed at 3- and 6-mo follow-up. At baseline and 3-mo follow-up, gated (99m)Tc-tetrofosmin SPECT and (18)F-FDG SPECT were performed to assess LV function, LV volumes, myocardial perfusion (stress and rest, 17-segment model), and extent of scar tissue.. Mean CCS score improved from 3.4 +/- 0.6 at baseline to 2.3 +/- 0.6 at 3 mo (P < 0.01) and remained unchanged at 6 mo (2.3 +/- 0.6; P < 0.01 vs. baseline and P = not significant [NS] vs. 3 mo). Gated (99m)Tc-tetrofosmin SPECT demonstrated an increased LV ejection fraction (from 47.6% +/- 13.5% to 54.1% +/- 16.9%; P < 0.01) and a reduced LV end-systolic volume (from 81 +/- 68 mL to 75 +/- 70 mL; P < 0.01). Segmental regional wall thickening increased from 34% +/- 12% at baseline to 39% +/- 17% at 3-mo follow-up (P = 0.01). The number of segments with stress-inducible ischemia per patient decreased from 4.6 +/- 3.2 to 2.0 +/- 2.6 (P < 0.01). Both segmental stress and segmental rest score improved, although the improvement in stress score was more pronounced (decrease in segmental stress score 0.22 +/- 0.20 vs. decrease in segmental rest score 0.04 +/- 0.06; P < 0.01). Myocardial perfusion improved in 53% of the injected segments and in 13% of the noninjected segments (P < 0.01). The percentage of myocardial segments with some extent of scar remained unchanged at 3-mo follow-up (13% vs. 12%; P = NS).. Autologous bone marrow-derived mononuclear cell injection in patients with drug-refractory angina and chronic ischemia improves anginal symptoms, increases LV function, and predominantly enhances myocardial stress perfusion in injected segments, whereas the extent of myocardial scar tissue remains unchanged.

Topics: Aged; Angina Pectoris; Bone Marrow Transplantation; Chronic Disease; Drug Resistance; Fluorodeoxyglucose F18; Humans; Injections; Leukocytes, Mononuclear; Male; Middle Aged; Myocardial Ischemia; Myocardial Reperfusion; Myocardium; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Transplantation, Autologous; Ventricular Function, Left

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

To investigate the role of technetium-99m (99mTc) tetrofosmin single-photon emission Computed Tomography (SPECT) associated with nitrate administration in the detection of hypoperfused but still viable myocardium in patients with chronic coronary artery disease and left ventricular (LV) dysfunction.. Twenty-two patients (mean age 54 +/- 11 years) with coronary artery disease, previous myocardial infarction and LV dysfunction (LV ejection fraction 38 +/- 13%) were examined. On different days all patients underwent 99mTc tetrofosmin (740 MBq) SPECT under control conditions at rest and after sublingual nitroglycerin administration (10 mg). Regional tetrofosmin activity was quantitatively measured in 22 myocardial segments per patient. In each segment, tracer uptake was expressed as a percentage of the region with the peak activity.. Under control conditions, 267 myocardial segments (55%) showed normal tetrofosmin uptake (> 70% of peak activity), 107 segments (22%) showed a moderate reduction (51-70%) and 110 segments (23%) a severe reduction (< or = 50%) in tracer uptake. Among the 110 segments with a severe reduction in tetrofosmin uptake, 20 (18%) showed increased tracer uptake > or = 10% of after nitrate administration (from 44 +/- 5% to 58 +/- 3%, p < 0.0001). The remaining 90 (82%) segments with a severe reduction in tetrofosmin uptake did not show any change after nitroglycerin administration (from 38 +/- 9% to 39 +/- 8%, p = ns).. In patients with chronic coronary artery disease and LV dysfunction, tetrofosmin cardiac SPECT associated with sublingual nitrate administration allows the detection of severely hypoperfused but still viable myocardium.

Topics: Adult; Aged; Chronic Disease; Heart; Hemodynamics; Humans; Male; Middle Aged; Myocardial Ischemia; Nitroglycerin; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Time Factors; Tomography, Emission-Computed, Single-Photon; Vasodilator Agents; Ventricular Dysfunction, Left

Topics: Chronic Disease; Diagnosis, Differential; Female; Humans; Lung; Lung Neoplasms; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Pneumonia; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon