Clinicopathologic study of persistently positive technetium-99m stannous pyrophosphate myocardial scintigrams and myocytolytic degeneration after myocardial infarction.

Buja, L. Maximilian; Poliner, L. R.; Parkey, Robert W.; Pulido, J I; Hutcheson, D. P.; Platt, Melvin R.; Mills, Lawrence J.; Bonte, Frederick J.; Willerson, James T.

doi:10.1161/01.cir.56.6.1016

Cited by 64 publications

(17 citation statements)

References 29 publications

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“…Eighty-two percent of the patients with positive scintigrams during unstable angina had prior myocardial infarctions, compared with 55% of the patients with negative scintigrams. Patients with persistently positive scintigrams after acute myocardial infarction have a more fulminant clinical course than patients with negative scintigrams.39 41 Patients with persistently positive scintigrams have an increased incidence of cardiac death, nonfatal myocardial infarction and hospitalization for unstable angina and congestive heart failure.39 Buja et al41 and Cowley et al42 suggested that persistently positive scintigrams may be due to slow ongoing necrosis in the area of previous infarction. Patients who had a myocardial infarction within 3 months before admission were excluded from this study.…”

Section: Methodsmentioning

confidence: 99%

The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.

Olson¹,

Lyons²,

Aronow³

et al. 1981

Circulation

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Section: Methodsmentioning

confidence: 99%

The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.

Olson¹,

Lyons²,

Aronow³

et al. 1981

Circulation

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“…The other phenomenon illustrated in this report relative to the need for serial 99111'fc_PYP myocardial imaging in patients with chest pain js that of the "persistently positive" 99111'fc_PyP myocardial scintigram (5,11). We and others (5,11) have shown that in selected patient series approximately 40% of individuals retain "persistently positive" 99mTc_PYP myocardial scintigrams for at least 3 months after infarction.…”

Section: Discussionmentioning

confidence: 61%

“…Our experience with the 99mTc_PYP myocardial imaging technique in patients with chest pain now involves mort' than 3,500 patients (8,12,13,18,19).Almost all acute transmural and nontransmural myocardial infarcts in patients can be identified with this imaging technique (5,8,12,13,18,19) if serial myocardial imaging is utilized. However, since it requires 10-12 h for a 99l11'fc_pyp myocardial scintigram to become abnormal after infarction it seems reasonable to assume (although it is not yet proved) that this period is necessary in order for collateral coronary blood flow adjustments to occur providing perfusion to the damaged myocardial regions and allowing extensive calcium deposition in irreversibly damaged myocardial cells and the delivery of 99111'fc_ PyP to the injured region.…”

Section: Discussionmentioning

confidence: 99%

“…Post mortem pathophysiological correlates in patients that had "persistently positive" 998lTc_PYP myocardial scintigrams during life suggest that continued cellular evolution of myocardial injury is responsible for the persistently abnormal scintigrams in at least some patients (5). The other possible explanation for persistently abnormal 99IDTc_PYP myocardial scintigrams is dystrophic cardiac calcification in the myocardial regions that are irreversibly damaged but to date we have been unable to document this as the mechanism in the patients that have been evaluated (5). However, larger numbers of patients with "persistently positive" 99IDTc_PYP myocardial scintigrams need to be studied to allow one to determine whether the initial clinical and anatomical correlations that we have made will also apply to larger numbers of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The 99"'Tc_PYP scintigrams tend to fade or become negative 6-7 days after infarction in patients and 10-14 days after experimental infarction in canine models (2,3,4,6,12,IS,18,19). The evolution of a negative 99"'Tc_PYP myocardial scintigram in patients and experimental animals correlates temporally and topographically with resorption and replacement of calcium and inflammatory infIltrate with scar tissue in the region of the myocardial infarct (3,4,5).…”

Section: Introdudionmentioning

confidence: 96%

See 2 more Smart Citations

Technetium‐99m stannous pyrophosphate myocardial scintigraphy: Serial imaging to detect myocardial infarcts in patients

Falkoff

Parkey

Bonte

et al. 1978

Clinical Cardiology

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Summary:Typically, technetium-99m stannous pyrophosphate ~9"'Tc-PYP) myocardial scintigrams become abnormal within 10-12 h following acute myocardial infarction. Ordinarily, the 99mTc_PYP scintigrams become increasingly abnormal between 24 and 72 h follOwing the infarct and then become normal 6-7 days after the event. However, occasional patients and their 99mTc_PYP myocardial scintigrams deviate from this expected pattern by initially developing an abnormal 99mTc_PYP scintigram as late as 4-5 days following an acute myocardial infarction. Others retain "persistently abnormal" 99"'Tc_PYP myocardial scintigrams after their myocardial infarcts. The clinical importance and potential prognostic importance of these deviations from the expected patterns with 99"'Tc_PYP myocardial imaging are discussed and the need for serial myocardial imaging is emphasized.

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“Flipped” lactic dehydrogenase pattern in acute coronary insufficiency

Weinberger

Rotenberg

Sagie

et al. 1986

Clinical Cardiology

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Summary: Serum lactic dehydrogenase (LDH) isoenzymes were measured 24, 48, and 72 hours after admission in 85 patients with acute coronary insufficiency (ACI) and 10 patients with stable angina pectoris who served as controls. The above patients did not develop myocardial infarction according to the criteria of development of new Q waves or elevation of cardiac enzymes. In 15 patients with ACI a "flipped" LDH pattern (LDH, > LDH2) was found in the presence of normal total LDH activity and normal creatine kinase-MB. The values of LDH 1 :2 ratio ranged between 1.02 and I . 13 (normal values 0.45-0.75). In the 10 control patients, normal levels of total LDH and normal LDH enzyme distribution and creatine kinase-MB were found. A possible explanation for the flipped LDH pattern in the ACI patients (indicating some myocardial damage) could be myocytolysis and coagulation necrosis found on postmortem examinations. The conclusion of our study is that LDH isoenzymes should be measured in patients with ACI to determine the LDH 1.2 ratio. The finding of B "flipped" LDH pattern demonstrating myocardial damage, lacking in stable angina, may also be helpful in patients who developed the clinical picture of ACI more than 24 hours before arrival at the hospital, since by that time the creatine kinase-MB may have already returned to nonnal. An additional advantage of measuring LDH isoenzymes in these patients may be that patients with "Hipped" LDH pattern may need a longer rest and earlier coronary angiographic evaluation.

show abstract

Clinicopathologic study of persistently positive technetium-99m stannous pyrophosphate myocardial scintigrams and myocytolytic degeneration after myocardial infarction.

Cited by 64 publications

References 29 publications

The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.

The high-risk angina patient. Identification by clinical features, hospital course, electrocardiography and technetium-99m stannous pyrophosphate scintigraphy.

Technetium‐99m stannous pyrophosphate myocardial scintigraphy: Serial imaging to detect myocardial infarcts in patients

“Flipped” lactic dehydrogenase pattern in acute coronary insufficiency

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