A reverse flow-metabolism mismatch pattern on PET is related to multivessel disease in patients with acute myocardial infarction

Hypoperfused myocardium with increased uptake of 18F-fluorodeoxyglucose (FDG) is considered to be ischemic but viable myocardium. However, the significance of a more severe defect of FDG than of 13N ammonia (NH3) (i.e., reverse flow-metabolism mismatch) is not well understood.

METHODS

To study a reverse flow-metabolism mismatch pattern, PET with NH3 and FDG under glucose loading was performed in 35 patients within 2 wk after onset of first acute myocardial infarction (AMI) and in 29 patients with old myocardial infarction (OMI). The left ventricle was divided into nine segments on a bull's eye polar map, and the mean counts of NH3 (%NH3) and FDG (%FDG) were compared for the segment with the least %NH3.

RESULTS

Ten patients in the AMI group demonstrated a marked reverse flow-metabolism mismatch pattern (greater than 10% difference between %NH3 and %FDG), whereas only 2 patients in the OMI group demonstrated the mismatch pattern (P < 0.05). Sixteen patients with AMI demonstrated %FDG > %NH3 (group 1), and 19 patients with AMI demonstrated %FDG < %NH3 (group 2). There were no significant differences in age, sex, location of infarction, diameter of stenosis of infarct-related artery or left ventricular ejection fraction between groups 1 and 2. Eleven patients in group 2 and only 3 in group 1 had multivessel disease (P < 0.02). There was no significant relationship between the number of diseased vessels and the flow-metabolism pattern in patients with OMI.

CONCLUSION

The finding of a reverse flow-metabolism mismatch on PET in the subacute phase of myocardial infarction was closely related to multivessel disease.

Chromosomal structures of bottom fermenting yeasts

A genomic comparison of bottom fermenting yeasts was performed by pulsed-field gel electrophoresis and Southern blot analysis with some S. cerevisiae gene probes. We confirmed that strains of bottom fermenting yeast have four chromosomes originating from S. bayanus. Since the structures of these chromosomes were recombined with S. cerevisiae chromosomes, these S. bayanus chromosomes could be differentiated from S. cerevisiae chromosomes using Southern hybridization. Our Southern hybridization results indicate that bottom fermenting yeasts have both chromosomes originating from both S. cerevisiae and S. bayanus. It was reconfirmed that top fermenting yeast should be classified as S. cerevisiae, based on the chromosomal structure. The chromosomal structure of S. pastorianus CBS1538, the type stain of S. pastorianus, was also investigated. This strain has chromosomes originating only from S. bayanus. S. carlsbergensis CBS1513 has chromosomes originating from both S. cerevisiae and S. bayanus. From these results, we contend that bottom fermenting yeasts should be classified as S. carlsbergensis.

Detection of a biphasic response of hibernating myocardium by dobutamine-stress electrocardiography-gated technetium-99m-tetrofosmin single photon emission computed tomography--a case report

A woman with coronary artery disease underwent a new imaging technique: dobutamine-stress electrocardiography (ECG)-gated tetrofosmin-single photon emission computed tomography (SPECT). Dobutamine-stress ECG-gated tetrofosmin-SPECT with automatic left ventricular function analysis software programs detected improvement and a biphasic response of dysfunctional myocardium during dobutamine infusion, which suggested viable but hibernating myocardium. Dobutamine-stress ECG-gated tetrofosmin-SPECT with automatic left ventricular function analysis software programs has the potential to detect viable but dysfunctional myocardium with contractile reserve.

Infrequent activation of mitogen-activated protein kinase in human colon cancers

BACKGROUND/AIMS

Mitogen-activated protein kinase (MAPK) is a downstream factor of the Ras-Raf-MAPK cascade and it is now considered to be a key molecule in signaling processes stimulated by growth factors and differentiation inducers.

METHODOLOGY

We examined MAPK activity in 21 advanced colon cancers to investigate whether the MAPK cascade might play a role in the progression of colon cancers.

RESULTS

MAPK activation (3.9-10.1-fold) was observed in 4 of 21 cases (18%), but 3 cases (75%, 3 of 4 cases) showed MAPK activation without ras mutation, thus suggesting that MAPK activation did not correlate with the presence of Ki-ras mutations in these cases. Other kinds of oncogene activation would be involved to MAPK activation in human colon cancers. In other cases MAPK activation was not detected or partly down-regulated.

CONCLUSIONS

These findings suggest that positive and negative regulation of MAPK activity are associated with loss of normal growth control and may be involved in carcinogenesis of colon cancers.

Using the spleen for time-delay correction of the input function in measuring hepatic blood flow with oxygen-15 water by dynamic PET

By the spleen, we calculated a time-delay correction of the input function for quantitation of hepatic blood flow with oxygen-15 water and dynamic positron emission tomography. The time delay (deltat) between the sample site and the spleen was calculated based on nonlinear multiple regression analysis when splenic blood flow was determined. Then hepatic blood flow was quantified by a method using the input function and incorporating deltat, which was assumed to be equal to the time delay between the sample site and the liver. Then hepatic arterial and portal blood flows were estimated separately as well as the delay time for passage within the organs of the portal circulation. The mean coefficient of variation and the mean sum of squares of errors decreased to about 70% when total hepatic blood flow was calculated from the results for regions of interest in three slices of the same liver segment. We concluded that using the spleen for time-delay correction of the input function for measuring hepatic blood flow by this method gave satisfactory results.

Chromosomal aberrations in human hepatocellular carcinomas associated with hepatitis C virus infection detected by comparative genomic hybridization

Thirty-five hepatocellular carcinomas (HCCs) associated with hepatitis C virus (HCV) were analysed by comparative genomic hybridization (CGH), to screen for changes in copy-number of DNA sequences. Chromosomal losses were noted in 1p34-36 (37%), 4q12-21 (48%), 5q13-21 (35%), 6q13-16 (23%), 8p21-23 (28%), 13q (20%), 16q (33%) and 17p13 (37%). Gains were noted in 1q (46%), 6p (20%), 8q21-24 (31%) and 17q (43%). High level gains indicative of gene amplifications were found in 7q31 (3%), 11q13 (3%), 14q12 (6%) and 17q12 (3%); amplification at 14q12 may be characteristic for HCCs. No significant difference in chromosomal aberrations was noted between carcinomas associated with HCV-infection in our study and those reported earlier in HCCs infected with hepatitis B virus (HBV), indicating that both HBV- and HCV-related carcinomas may progress through a similar cascade of molecular events.

The ubiquitous transcription factor NF-Y positively regulates the transcription of human p27Kip1 through a CCAAT box located in the 5-upstream region of the p27Kip1 gene

Abnormally low levels of the cyclin-dependent kinase inhibitor p27Kip1 are found frequently in human carcinomas, and these levels correlate directly with both histological aggressiveness and patient mortality. p27Kip1 is haplo-insufficient for tumor suppression. Thus, p27Kip1 may be a useful molecule for the development of cancer therapies. To know the possible mechanisms underlying transcriptional control, we previously cloned the promoter region of human p27Kip1 gene. We report here the characterization of the 5'-regulatory region of the human p27Kip1 gene. Promoter analysis using 5'-deletion mutants revealed that a 39-bp region between -549 and -511 was required for maximal promoter activity. Point mutation analysis revealed that a CCAAT box within this region was essential for promoter activity. Gel shift assays and cotransfection experiments using a dominant negative form of the NF-Y transcription factor showed that NF-Y directly regulates p27Kip1 transcription through this CCAAT box. This finding might provide a clue to approach the mechanism of tumorigenesis.

Sigmoidofiberscopic incision plus balloon dilatation for anastomotic cicatricial stricture after anterior resection of the rectum

We describe the procedure and examine the therapeutic efficacy of a combination of sigmoidofiberscopic incision plus balloon dilatation for tubular stricture by thick, long scar tissue at the colorectal anastomosis after anterior resection for rectal cancer. Balloon dilatation alone does not always relieve the strictures, although this method is the usual therapy for this condition. Five patients were identified in whom the stricture was not improved with balloon dilatation alone. Of these five patients, three complained of difficulty defecating, a feeling of incomplete evacuation, residual feces, and lower abdominal fullness. The remaining two patients, who had transverse colostomy to treat major leakage at the anastomosis, showed no symptoms. All five patients underwent the combination therapy described below. Two or three small radial incisions were made in the scar of the stricture with electrocautery under fiberscopic vision. Then the strictural scar was split and loosened bluntly along the incisions over a 15- to 20-minute period with a balloon dilator. This procedure was performed once or twice at a 2-week interval. In all five patients the stricture was improved according to objective criteria. There was also an improvement in the subjective symptoms suffered by three patients. The improvements were maintained over observation periods of 9 to 15 months. No complications were observed. Sigmoidofiberscopic incision plus balloon dilatation is an effective, safe therapy for cicatricial strictures after anterior resection for rectal cancer when the strictures have failed to improve following balloon dilatation alone.

Augmentation of local antitumor immunity in the liver by tumor vaccine modified to secrete murine interleukin 12

Minimal residual lesions have been a major problem in surgical management of cancer. We transfected M5076 with murine IL-12 gene by a retroviral vector, established a stable transfectant secreting IL-12 and investigated its antitumor effects on a spontaneous liver metastasis murine model of M5076 reticulum cell sarcoma. Subcutaneous vaccination of the irradiated transfectant into the remote skin following the amputation of the tumor-bearing limb improved survival when compared with the vaccination of irradiated parental cells (control). Cytotoxic activities against parental M5076 were significantly stronger in the hepatic lymphocytes from the mice vaccinated with the IL-12 transfectant than those from the control. IFN-gamma production of hepatic lymphocytes when they were cocultured with the parental cells was significantly augmented in mice vaccinated with the IL-12 transfectant compared with the control. On the other hand, both cytotoxic activity and IFN-gamma production of spleen cells in the M5076-vaccinated and transfectant-vaccinated mice were at similar levels. Immunophenotypic analysis revealed the selective increase of CD3+NK1+ population in the liver from the transfectant-vaccinated mice. These results suggest that tumor vaccines genetically modified to secrete IL-12 continuously at a relatively low level preferentially augment local antitumor activity in the liver rather than systemic immune responses. This strategy warrants further investigation as an adjuvant modality in the management of postoperative residual tumors.

Differences in the effect of iron-deficient diet on tissue weight, hemoglobin concentration and serum triglycerides in Fischer-344, Sprague-Dawley and Wistar rats

This study was designed to examine the differences in the effect of an iron-deficient diet on iron metabolism in Fischer-344 (FC), Sprague-Dawley (SD) and Wistar (WT) rats based on hemoglobin (Hb), hematocrit (Hct), serum iron levels, growth rate and organ weight. Hb concentration was higher in FC rats (14 mg/100 mL) on the initial day than in SD (10) and WT (10) rats. Although the Hb level was significantly decreased in FC rats fed an iron-deficient (ID, 8 mg/kg) diet for 33 d compared to the FC rats fed an iron-adequate (IA, 50 mg/kg) diet, the relative concentration of Hb was high in FC rats fed the ID diet as compared to the SD and WT rats fed the same diet. A similar relationship was detected between Hct and serum iron concentrations. Although serum triglycerides (TG) were significantly increased in each rat strain fed the ID diet as compared to the IA diet, the percentage of the value for the IA diet was lowest in FC rats (119%) fed the ID diet as compared to the SD (328) and WT (394) rats fed the same diet. Retroperitoneal fat pad was decreased in FC, SD and WT rats fed the ID diet as compared to the IA diet. SD rats were particularly sensitive to the reduction of retroperitoneal fat pad. The results suggested that rat strains responded differently to dietary iron inadequacy, and that FC rats were less sensitive to an iron-deficient diet as compared to the SD and WT rats.

A case of diffuse pulmonary arteriovenous fistula

A 30-year-old Japanese woman was admitted to hospital for dyspnea. She had a history of corrective surgery for a large atrial septal defect and partial anomalous pulmonary venous drainage, which had produced cyanosis in her infancy. However, her cyanosis continued postoperatively. Angiography revealed a double inferior vena cava (IVC), with the left IVC connected with the hemiazygos vein and the right IVC with the left atrium through a very small orifice. Most of the blood from the 2 IVCs flowed into the superior vena cava via the distended azygos and hemiazygos veins. Pulmonary arteriography revealed no abnormal structures. Pulmonary arterial pressure was normal. There was marked pulmonary venous oxygen desaturation. Perfusion lung scintigraphy revealed multiple segmental perfusion defects. These findings suggested the presence of diffuse microscopic pulmonary arteriovenous fistulas bilaterally in the lungs. The patient appears to be the first reported adult case of microscopic and diffuse arteriovenous fistulas. Neither resection of the arteriovenous fistulas nor corrective surgery for the diversion was indicated, and heart-lung transplantation might be the only treatment able to relieve her dyspnea.

Extensive gastrectomy and carbon-adsorbed mitomycin C for gastric cancer with peritoneal metastases. Case reports of survivors and their implications

BACKGROUND/AIMS

Extensive gastrectomy, defined as gastrectomy with complete omentectomy and extended lymphadenectomy, improves the survival of gastric cancer patients with peritoneal metastases, even though peritoneal metastasis is considered the end-stage of cancer. MMC-CH, a new dosage formulation of mitomycin C, extended the survival of rabbits with peritoneal carcinomatosis as compared to aqueous mitomycin C.

METHODOLOGY

We retrospectively reviewed 114 patients who underwent gastrectomy for gastric cancer with peritoneal metastases.

RESULTS

Six patients survived for more than 5 years after the therapy out of 63 patients treated with MMC-CH therapy and extensive gastrectomy for gastric cancer with P1, i.e., metastases to the adjacent peritoneum but no metastasis to the distant peritoneum, or P2, i.e., a few metastases to the distant peritoneum. However, there were no 5-year survivors in patients with P3, i.e., numerous metastases to the distant peritoneum, or in patients treated with incomplete omentectomy, limited lymphadenectomy and no MMC-CH therapy.

CONCLUSIONS

The results imply that gastric cancer patients with P1 or P2 have a possible chance to survive more than 5 years when treated with MMC-CH therapy and extensive gastrectomy.

Clinical application of adoptive immunotherapy and IL-2 for the treatment of advanced digestive tract cancer

BACKGROUND/AIMS

We investigated the clinical efficacy of systemic and locoregional adoptive immunotherapy (AIT) with or without interleukin-2 (IL-2) against solid metastatic lesions from digestive tract cancer, which are refractory to conventional chemotherapy or radiotherapy.

METHODOLOGY

Seven of 18 patients received hepatic arterial infusion (HAI) of lymphokine-activated killer (LAK) cells with or without IL-2 against metastatic liver tumors (local therapy group). The remaining 11 patients received systemic transfer of LAK cells with IL-2 against metastatic lesions located in organs other than the liver (systemic therapy group).

RESULTS

Three of the 7 local therapy group patients showed clinically significant tumor regressions and this was evaluated as being equivalent to partial response (PR) (response rate: 43%). Two of the 11 systemic therapy group patients showed tumor regression which was evaluated as being equivalent to either complete response (CR) or PR (response rate: 18%). These 2 effective cases in the systemic therapy group were esophageal cancer patients.

CONCLUSIONS

Locoregional AIT with or without IL-2 against liver metastases of digestive tract cancer could be an effective therapeutic modality in some patients who are refractory to conventional therapies. However, clinical efficacy of systemic AIT with IL-2 against metastases of digestive tract cancer would not be an effective modality except for the metastases of esophageal cancer.

[Development of cancer treatment practice guidelines in Japan: advantages and disadvantages]

The development of clinical practice guidelines for the systematic treatment of cancer is being promoted as a way to assist clinicians and patients. In this paper, the advantages and disadvantages of developing clinical practice guidelines for both clinicians and patients are discussed. Physicians may regard guidelines to be unrealistic, and some may even consider guidelines to be a challenge to their autonomy. However, the advantages of guidelines for the patients and clinicians exceed any disadvantages. The development of guidelines should therefore be promoted, although with consideration of both the many advantages and disadvantages for clinicians and patients.

Effects of candesartan and cilazapril on rats with myocardial infarction assessed by echocardiography

The purpose of this study was to compare the angiotensin II type 1 receptor antagonist candesartan cilexitil (candesartan) and the angiotensin-converting enzyme inhibitor cilazapril on cardiac function, assessed by Doppler echocardiography and cardiac gene expression associated with cardiac remodeling, in rats with myocardial infarction. Candesartan or cilazapril was administered after myocardial infarction. At 1 and 4 weeks after myocardial infarction, cardiac function and mRNA expression in noninfarcted myocardium were analyzed. Candesartan and cilazapril equally prevented increases in hypertrophy in noninfarcted myocardium, left ventricular dilatation, and ejection fraction at 4 weeks. The E-wave/A-wave velocity ratio and the rate of E-wave deceleration, measures of diastolic function, increased to 9.2+/-0.6 and 26.3+/-2. 6 m/s2 at 1 week after myocardial infarction. Candesartan and cilazapril, administered at a dose of 1 mg/kg per day, prevented increases in E-wave/A-wave velocity ratio and E-wave deceleration at 1 and 4 weeks. Candesartan and cilazapril significantly suppressed increased mRNA expression of beta-myosin heavy chain, alpha-skeletal actin, and atrial natriuretic peptide in noninfarcted ventricle at 1 and 4 weeks and expression of collagen I and III at 4 weeks to a similar extent. When given at a dose of 10 mg/kg per day, both candesartan and cilazapril prevented cardiac dysfunction and gene expression to the same extent as when given at 1 mg/kg per day. In conclusion, Doppler echocardiography showed that candesartan and cilazapril equally improved systolic and diastolic function and that ventricular remodeling accompanied modulation of cardiac gene expression.

Differentiation between brewing and non-brewing yeasts using a combination of PCR and RFLP

In order to differentiate brewing from non-brewing yeasts, a specific polymerase chain reaction (PCR) which targeted the open reading frame of FLO1 was employed. Non-brewing yeasts include 'non-brewing Saccharomyces yeasts' and 'non-Saccharomyces yeasts'. The molecular sizes of the PCR products differed between brewing and non-brewing Saccharomyces yeasts. No FLO1 PCR products were obtained from non-Saccharomyces yeasts. Specific PCR, using oligonucleotide primers that targeted the region between the 5S and 26S rRNA genes, could be used to differentiate brewing yeasts from some non-brewing yeasts. These PCR products were digested with restriction enzymes, Scr FI and Msp I. Different restriction profiles were obtained from brewing and non-brewing yeasts which could not be differentiated using specific PCR of rDNA. These results suggest that it is possible to identify brewing from non-brewing yeasts using specific PCR of FLO1 and rDNA, and detection of restriction fragment polymorphism of rDNA.

Right upper and middle sleeve bilobectomy with atypical pulmonary arterioplasty

We report upon a case with hypoxia as a result of a primary lung cancer affecting the middle lobe leading to occlusion of the intermediate pulmonary artery and the upper pulmonary vein, which was successfully treated by combined right upper and middle sleeve bilobectomy and atypical pulmonary arterioplasty. Our case concerning atypical bronchoangioplastic procedures supported the validity of the technique for the lung cancer in a patient without pulmonary dysfunction.

Endoscopic incision and balloon dilatation for cicatricial anastomotic strictures

BACKGROUND/AIMS

Endoscopic incision or balloon dilatation is common therapy for cicatricial anastomotic strictures after gastrointestinal surgery. These therapies are not always effective.

METHODOLOGY

There were 6 patients who failed either endoscopic incision or balloon dilatation alone and who underwent a combination of the two therapies. Two or three small radial incisions were made in the scar of the stricture with the endoscopic electrocautery under direct vision with fiberscopy. Then, the incisions were split bluntly and the stenosis was dilated over 15-20 minutes with balloon-dilator. This procedure was performed once or twice at a 2-week interval.

RESULTS

In 5 of the 6 patients, the stenosis was improved in subjective criteria and objective symptoms. In the last patient, only objective improvement was noted. There were no complications.

CONCLUSIONS

Endoscopic incision plus balloon dilatation is an effective and safe treatment for cicatricial anastomotic strictures which have failed either therapy alone.

A molecular pathway revealing a genetic basis for human cardiac and craniofacial defects

Microdeletions of chromosome 22q11 are the most common genetic defects associated with cardiac and craniofacial anomalies in humans. A screen for mouse genes dependent on dHAND, a transcription factor implicated in neural crest development, identified Ufd1, which maps to human 22q11 and encodes a protein involved in degradation of ubiquitinated proteins. Mouse Ufd1 was specifically expressed in most tissues affected in patients with 22q11 deletion syndrome. The human UFD1L gene was deleted in all 182 patients studied with 22q11 deletion, and a smaller deletion of approximately 20 kilobases that removed exons 1 to 3 of UFD1L was found in one individual with features typical of 22q11 deletion syndrome. These data suggest that UFD1L haploinsufficiency contributes to the congenital heart and craniofacial defects seen in 22q11 deletion.

[Treatment of postoperative recurrence of digestive cancers: peritonitis carcinomatosa]

Carcinomatous peritonitis is the most frequent type of recurrence observed after surgery for cancer of the digestive tract. Most patients with carcinomatous peritonitis present with bowel obstruction and/or ascites. Surgical treatment including colostomy and intestinal anastomosis and chemotherapy have been attempted in patients with carcinomatous peritonitis, although the results have not been satisfactory. New drug delivery systems, such as mitomycin C-adsorbed charcoal, anticancer drugs entrapped in microspheres, and immunoconjugates composed of anticancer drugs and antibodies, will be powerful new tools for the treatment of metastatic cancer.

The effect of tissue factor pathway inhibitor on hepatic ischemic reperfusion injury of the rat

BACKGROUND

Tissue factor (TF) is an initiation factor for blood coagulation, and its expression is induced on macrophages and endothelial cells during the inflammatory or immune responses. In a previous study, we reported the significance of TF expression in hepatic ischemic reperfusion injury using a rat model. Recently, tissue factor pathway inhibitor (TFPI) has been discovered, and the effect of TFPI has been assessed in vivo. In this study, therefore, we studied the effect of TFPI on hepatic ischemic reperfusion injury of the rat.

METHODS

After laparotomy of Lewis rats, the branches of the hepatic artery and portal vein leading to the median, left, and caudate lobes of the liver were clamped. The liver was reperfused after 120 or 180 min of ischemia. Simultaneously, recombinant human TFPI (4 mg/kg) was injected via a superiomesenteric vein. Rats were sacrificed at 5, 12, and 24 hr after reperfusion, and liver tissues were harvested. TF expression was studied by immunohistochemical staining with the monoclonal antibody (HTF-K108).

RESULTS

Survival rates over a 5-day period were examined after the ischemic time of 120 and 180 min. Seven of 10 rats in the 120-min ischemia group (n=10), and only 1 (10%) rat of 10 in the 180-min ischemia group (n=10) survived. However, by the treatment with TFPI, all of the rats in the 120-min ischemia group (n=10), and six rats in the 180-min ischemia group (n=10) survived (P<0.05). The serum concentrations of alanine aminotransferase (ALT) and thrombin-antithrombin complex (TAT) before ischemia were 30.0+/-2.3 IU/L and 4.7+/-1.4 ng/ml, respectively (n=5). These levels showed a peak at 3-5 hr after reperfusion (ALT: 13909+/-1900 IU/L, TAT: 30.4+/-7.0 ng/ml) (P<0.01). However, both peak levels were decreased by the treatment with TFPI (ALT: 6017+/-1290 IU/L, TAT: 5.4+/-2.1 ng/ml) (P<0.01). Although TF was strongly stained on endothelial cells and Kupffer cells accumulating to the site of the necrosis in the control group, the area of the necrosis and the grade of TF staining were significantly reduced in the TFPI-treated group.

CONCLUSIONS

These results indicated that TFPI strongly inhibited the injury of the ischemic reperfusion, and confirmed that TF played a pivotal role in the development of ischemic reperfusion injury.

Exercise four hour redistribution thallium-201 single photon emission computed tomography and exercise induced ST segment elevation in detecting the viable myocardium in patients with acute myocardial infarction

OBJECTIVE

To investigate the specificity and sensitivity of the combination of redistribution in exercise thallium-201 single photon emission computed tomography (SPECT) and exercise induced ST elevation for detecting the viable myocardium in patients with acute myocardial infarction.

DESIGN

37 patients were studied within seven weeks of onset of Q wave myocardial infarction (anterior in 22, inferior in 15). All patients underwent exercise four hour redistribution thallium-201 SPECT and positron emission tomography using fluorine-18-fluorodeoxyglucose (FDG) and nitrogen-13 ammonia under fasting conditions.

RESULTS

Sixteen patients showed exercise induced ST elevation >/= 1.5 mm, and 15 of these had increased FDG uptake in the infarct region. Eleven of 16 patients (10 of 11 patients with anterior infarctions) with irreversible thallium-201 defects and increased FDG uptake showed exercise induced ST elevation. The sensitivity, specificity, and predictive accuracy of redistribution, exercise induced ST segment elevation, or both for detecting increased FDG uptake were 82%, 75%, and 67% (94%, 75%, and 91% for anterior infarctions), respectively.

CONCLUSIONS

In patients with acute Q wave myocardial infarction, the combination of redistribution in exercise thallium-201 SPECT and exercise induced ST elevation can detect the viable myocardium in the infarct region with high sensitivity and specificity, especially in patients with anterior infarctions.