technetium-tc-99m-tetrofosmin and Syndrome

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

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

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 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