Relation of thallium uptake to morphologic features of chronic ischemic heart disease: evidence for myocardial remodeling in noninfarcted myocardium
Jamshid Shirani, MD, FACCa,
Jaetae Lee, MD ,
Rebecca Quigg, MD, FACC,
Ruth Pick, MD ,
Stephen L. Bacharach, PhD and
Vasken Dilsizian, MD, FACC ||
a Albert Einstein College of Medicine, New York, New York, USA
Kyungpook National University Hospital, Taegu, South Korea
Columbia Michael Reese Hospital and Medical Center, Chicago, Illinois, USA
Department of Nuclear Medicine, National Institutes of Health, Bethesda, Maryland, USA
|| Cardiology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
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Figure 1 Illustration of how short-axis tomograms of gross pathology (A), histomorphology (B) and thallium uptake (C) were compared in each patient along with the segmentation scheme.
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Figure 2 Relation between volume fraction of collagen and segmental wall thickness. There is an inverse relationship between percent collagen replacement and degree of reduction in wall thickness.
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Figure 3 Bar graphs showing mean volume fraction of collagen in the four groups of myocardial segments defined by the pattern of thallium uptake on stress-redistribution-reinjection imaging. Percent collagen replacement is significantly lower in the normal thallium segments than it is in the reversible and mild-to-moderate and severe irreversible segments.
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Figure 4 In this example, correlation between thallium scintigraphy, gross pathology and histomorphology is shown. Thallium stress, redistribution and reinjection images are shown at the top with corresponding gross pathology and histomorphology of a midventricular slice on the bottom. On the thallium study, there are extensive thallium abnormalities in the anterior, septal and inferolateral regions during stress. On the redistribution image, there is partial reversibility of the anterior region, complete reversibility of the septum and irreversible defect in the inferolateral region. After thallium reinjection, there is complete reversibility of the septal and anterior regions with persistent irreversible defect in the inferolateral region. On gross pathology, there is white fibrotic myocardium in the inferolateral region, and histomorphologic analysis shows a significant amount of red-stained collagen intermixed within normal looking myocytes in the same area.
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Figure 5 Histomorphologic analysis of infarcted and noninfarcted segments. Microscopic sections from the infarcted (A) and noninfarcted (B) segments stained with picrosirius red are shown. On the top panels, dark red stained areas represent collagen replacement, and in the lower panels, green/yellow areas represent birefringence of collagen under polarized light. The infarcted segment (transmural scar by gross pathology) demonstrates morphologically normal appearing myocytes that could not be detected by thallium scintigraphy or by gross pathology. Conversely, a microscopic section from the noninfarcted segment (normal by gross pathology) shows layers of collagen within normal appearing myocytes that could not be detected by thallium scintigraphy or gross pathology.
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Figure 6 Mean volume fraction of collagen in the noninfarcted segments of the 13 patients with chronic ischemic heart disease and the 13 age-matched control hearts are shown. Percent collagen is significantly lower in the normal control hearts when compared with the noninfarcted segments of the chronic ischemic hearts.
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