Extent of myocardial damage in regions with reverse redistribution at 3 h and at 24 h on 201Tl SPET: evaluation based on regional myocardial oxidative metabolism

Reverse Redistribution Phenomenon on Rest 99mTc-Tetrofosmin Myocardial Single Photon Emission Computed Tomography Involves Impaired Left Ventricular Contraction in Patients With Acute Myocardial Infarction

The purpose of this study was to investigate the clinical significance of the reverse redistribution (RR) phenomenon on technetium-99m ((99m)Tc)-tetrofosmin myocardial single photon emission computed tomography (SPECT) performed at rest. Twenty-five patients underwent myocardial SPECT 3 weeks after the onset of acute myocardial infarction. Myocardial images were acquired at 40 min (early) and 4 h (delayed) after the injection of 740 MBq of (99m)Tc-tetrofosmin. The regional myocardial uptake of the tracer in 26 segments of the left ventricular (LV) wall was visually scored from 0 (no activity) to 3 (normal activity), and then the RR was defined as a decrease of more than 1 point in the activity score on the delayed image compared with that on the early image. Regions with an activity score of 3 on both the early and delayed images were defined as normal, and those with a score of 0 or 1 on the early image were considered to have a fixed defect. The regional myocardial (99m)Tc-tetrofosmin uptake and washout rate were also quantitatively assessed in each region. In addition, exercise stress electrocardiograph-gated SPECT with (99m)Tc-tetrofosmin was performed within 1 week of the rest study, and the percent count increase (%CI) during myocardial contraction in each corresponding region was studied. RR was observed in 18 of the 25 patients. The regional washout rate of (99m)Tc-tetrofosmin was significantly higher in the RR regions (45.0+/-3.8%) than in either the normal regions (36.4+/-4.1%, p<0.001) or in those with a fixed defect (39.7+/-3.9%, p<0.001). The %CI in the RR regions (10.4+/-10.4%) was significantly less than that in the normal regions (23.5+/-10.1%, p<0.001); however, no significant difference was found between the RR regions and those with a fixed defect (8.0+/-7.2%). In patients with acute myocardial infarction, the regions showing the RR phenomenon on (99m)Tc-tetrofosmin SPECT have severely impaired LV wall contraction after exercise.

The heart and pulmonary vasculature in scleroderma: clinical features and pathobiology

For nearly 50 years there have been concerns that scleroderma affects the heart. The two main mechanisms that are thought to be involved are; a fibrotic process secondary to myocardial Raynaud phenomenon (RP) or an immune-mediated myocarditis. In the past year several studies have been published that confirm the frequent occurrence of subclinical cardiac abnormalities in scleroderma. These studies do not tend to support the myocardial RP theory and raise doubts about the prognostic significance of these minor abnormalities. Involvement of the lungs in the form of pulmonary hypertension affects between 7-50% of patients with scleroderma. Until the past year this has been regarded by most as an untreatable condition associated with an inexorable decline. Epoprostenol therapy has now been proven beneficial in a randomized clinical trial, and several other agents show promise in the treatment of this condition. Furthermore, it is becoming apparent that lung transplantation is as successful in patients with scleroderma, as it is in primary pulmonary hypertension.

Detection of myocardial viability using rest-redistribution thallium-201 imaging in a stress 99Tcm-tetrofosmin/rest thallium-201 dual-isotope protocol

This study investigated the utility of optional thallium-201 (201Tl) imaging for detecting myocardial viability in the stress 99Tcm-tetrofosmin/rest 201Tl dual-isotope protocol. Seventy-nine patients with old myocardial infarction and 25 patients with acute myocardial infarction underwent acquisition of three consecutive 201Tl images (early, intermediate and delayed) using the dual-isotope protocol. A polar map was created and defect scores (extent and severity) were determined by comparison with normal control data. Fluorodeoxyglucose positron emission tomography was also performed in 16 patients with old myocardial infarction. In patients with old infarction, the severity score decreased significantly from the early to the intermediate images, and decreased further on the delayed images. In patients with acute infarction, the score increased from the early to the intermediate images, but not on the delayed images. Regional uptake on the delayed images showed a better correlation with the fluorodeoxyglucose images than that on the early images. Redistribution on the delayed images was exclusively observed in the myocardial segments with less uptake than that estimated by fluorodeoxyglucose. In conclusion, addition of delayed 201Tl imaging to the dual-isotope protocol could improve the sensitivity for detecting myocardial viability.