Single photon emission computed tomography with technetium-99m hexakis 2-methoxyisobutyl isonitrile in acute myocardial infarction before and after thrombolytic treatment: assessment of salvaged myocardium and prediction of late functional recovery

Division of Cardiology, Careggi Hospital, Florence, Italy.

Single photon emission computed tomography (SPECT) with technetium-99m hexakis 2-methoxyisobutyl isonitrile was investigated as a method to evaluate the results of intravenous thrombolytic treatment in 14 patients (11 men and 3 women) with acute myocardial infarction admitted to the coronary care unit within 4 h of the onset of symptoms. All patients received an injection of 740 MBq of the tracer before starting the thrombolytic therapy, and isonitrile tomography was performed 3 to 4 h later. The tomographic study was repeated 5 days after the acute event. The results of thrombolytic treatment were independently evaluated taking into account the clinical, electrocardiographic (ECG) and enzymatic data and the findings of left ventricular and coronary angiography. Furthermore, all patients were studied with two-dimensional echocardiography on admission, 5 days later and 1 month later. The site and extent of the perfusion defects on admission scintigraphy were consonant with the ECG and echocardiographic findings. A good correlation could be established between the 5 day scintigraphic estimate of infarct dimension and the enzymatic infarct size (r = 0.907, p less than 0.00002). The comparison between pre- and postthrombolytic treatment images enabled the identification of successful and unsuccessful reperfusion even in patients whose other noninvasive findings were inconclusive. Finally, the reduction in defect size predicted late functional improvement that was demonstrated by echocardiography performed 1 month later (r = 0.89, p less than 0.00005). The results of the study suggest the feasibility and the possible usefulness of isonitrile tomography in demonstrating the presence and size of myocardial damage and in assessing the extent of myocardial salvage after thrombolytic therapy in acute myocardial infarction.

This article has been cited by other articles:

				A. H. Aletras, G. S. Tilak, A. Natanzon, L.-Y. Hsu, F. M. Gonzalez, R. F. Hoyt Jr, and A. E. Arai Retrospective Determination of the Area at Risk for Reperfused Acute Myocardial Infarction With T2-Weighted Cardiac Magnetic Resonance Imaging: Histopathological and Displacement Encoding With Stimulated Echoes (DENSE) Functional Validations Circulation, April 18, 2006; 113(15): 1865 - 1870. [Abstract] [Full Text] [PDF]

				A. Natanzon, A. H. Aletras, L.-Y. Hsu, and A. E. Arai Determining Canine Myocardial Area at Risk with Manganese-enhanced MR Imaging Radiology, September 1, 2005; 236(3): 859 - 866. [Abstract] [Full Text] [PDF]

				R. Sciagra, G. Parodi, A. Pupi, A. Migliorini, R. Valenti, G. Moschi, G. M. Santoro, G. Memisha, and D. Antoniucci Gated SPECT Evaluation of Outcome After Abciximab-Supported Primary Infarct Artery Stenting for Acute Myocardial Infarction: The Scintigraphic Data of the Abciximab and Carbostent Evaluation (ACE) Randomized Trial J. Nucl. Med., May 1, 2005; 46(5): 722 - 727. [Abstract] [Full Text] [PDF]

				R. Sciagra Nitrates and Viability: A Durable Affair J. Nucl. Med., May 1, 2003; 44(5): 752 - 755. [Full Text] [PDF]

				R. Sciagra, S. Sestini, L. Bolognese, G. Cerisano, P. Buonamici, and A. Pupi Comparison of Dobutamine Echocardiography and 99mTc-Sestamibi Tomography for Prediction of Left Ventricular Ejection Fraction Outcome After Acute Myocardial Infarction Treated with Successful Primary Coronary Angioplasty J. Nucl. Med., January 1, 2002; 43(1): 8 - 14. [Abstract] [Full Text] [PDF]

				C. A. Schneider, E. Voth, S. Gawlich, F. M. Baer, M. Horst, H. Schicha, E. Erdmann, and U. Sechtem Significance of rest technetium-99m sestamibi imaging for the prediction of improvement of left ventricular dysfunction after q wave myocardial infarction: importance of infarct location adjusted thresholds J. Am. Coll. Cardiol., September 1, 1998; 32(3): 648 - 654. [Abstract] [Full Text] [PDF]

				N. Takahashi, C. P. Reinhardt, R. Marcel, and J. A. Leppo Myocardial Uptake of 99mTc-Tetrofosmin, Sestamibi, and 201Tl in a Model of Acute Coronary Reperfusion Circulation, November 15, 1996; 94(10): 2605 - 2613. [Abstract] [Full Text]

				R. Medrano, R. W. Lowry, J. B. Young, D. G. Weilbaecher, L. H. Michael, I. Afridi, Z.-X. He, J. J. Mahmarian, and M. S. Verani Assessment of Myocardial Viability With 99mTc Sestamibi in Patients Undergoing Cardiac Transplantation: A Scintigraphic/Pathological Study Circulation, September 1, 1996; 94(5): 1010 - 1017. [Abstract] [Full Text]

				M.G. Niemeyer, E.E. van der Wall, A.F.M. Kuijper, A.T. Cleophas, and E.K.J. Pauwels Nuclear Cardiology, Current Applications in Clinical Practice Angiology, July 1, 1995; 46(7): 591 - 602. [Abstract] [PDF]

				R. J. Gibbons, D. R. Holmes, G. S. Reeder, K. R. Bailey, M. R. Hopfenspirger, B. J. Gersh, and The Mayo Coronary Care Unit and Catheterization La Immediate Angioplasty Compared with the Administration of a Thrombolytic Agent Followed by Conservative Treatment for Myocardial Infarction N. Engl. J. Med., March 11, 1993; 328(10): 685 - 691. [Abstract] [Full Text]

				M. Santomauro, A. Cuocolo, L. Celentano, S. Ferraro, L. Pace, C. Pappone, G. Maddalena, M. Salvatore, and M. Chiariello Diagnosis of Coronary Artery Disease with Tc 99m-Methoxy Isobutil Isonitrile and Transesophageal Pacing Angiology, October 1, 1992; 43(10): 818 - 825. [Abstract] [PDF]

				M.G. Niemeye, E.E. Van der Wall, E.K.J. Pauwels, P.R.M. van Dijkman, J.A.K. Blokland, A. de Roos, and A.V.G. Bruschke Assessment of Acute Myocardial Infarction by Nuclear Imaging Techniques Angiology, September 1, 1992; 43(9): 720 - 733. [Abstract] [PDF]