Dual radionuclide study of myocardial infarction. Relationships between myocardial uptake of potassium-43, technetium-99m stannous pyrophosphate, regional myocardial blood flow and creatine phosphokinase depletion.

Abstract

SUMMARY The dual radionuclide myocardial distributions of imaging agents potassium43 (49K) and technetium-99m stannous pyrophosphate were studied in a 24-hour closed chest canine infarct preparation. In multiple myocardial biopsies in 20 dogs, tissue levels of both radionuclides were compared to either an index of tissue viability (myocardial creatine phosphokinase [CPK] depletion), or to estimates of regional myocardial blood flow as measured by the microsphere technique.Myocardial 4K uptake in the ischemic and infarcted zone correlated well with both CPK depletion (r = 0.73) and microsphere estimates of relative blood flow. The correlation with microspheres was excellent in the transmural sample (r = 0.93) as well as endocardial (r= 0.97) and epicardial (r = 0.86) portions.On the other hand, "tmTc-PYP myocardial uptake did not correlate with the extent of CPK depletion. Maximal uptake was frequently noted in border zones with only moderate CPK depletion, NONINVASIVE RADIONUCLIDE IMAGING techniques can visualize acute myocardial infarction in two general ways. On the one hand, a myocardial radionuclide distribution may be obtained with maximal incorporation in normal myocardium and minimal uptake in the region of the infarct. Imaging of such a distribution would demonstrate the zone of infarction and/or ischemia as a "cold spot," or region of relatively reduced myocardial radioactive tracer accumulation. Radioactive potassium and its analogs, rubidium, cesium, and thallium have been utilized for such studies.'-' Alternatively, certain radioactive tracers maximally concentrate in infarcted and/or ischemic myocardium, such that the region of infarction is visualized as a "hot spot," or "positive" zone of increased radionuclide accumulation. Prototype "positive" infarct imaging radionuclides include technetium-99m labelled stannous pyrophosphate, tetracycline, and glucoheptonate."-' Simultaneous assessment of an infarction with both types of externally detected radionuclide myocardial distributions might allow Received August 6, 1975; revision accepted for publication October 14, 1975. while lesser degrees of "9mTc-PYP uptake were noted in the central infarct zone where CPK activity was lowest. The relationship of ""mTc-PYP uptake to microsphere regional flow estimates demonstrated that '9mTc-PYP uptake was maximal at flows of 0.3 to 0.4 of normal. At lower flows, '9mTc-PYP uptake fell toward normal levels. A similar relationship was noted between the distributions of 99MTc-PYP and "K. In relatively high flow border segments (. 0.80 of normal), abnormal '9mTc-PYP uptake of five to six times normal persisted. The transmural distribution of "mTc-PYP demonstrated that in low flow regions 99mTc-PYP uptake was primarily epicardial, while in the higher flow ischemic periphery of the infarct endocardial uptake predominated. Thus, while there is a direct correlation between cationic "K myocardial uptake and regional myocardial viability and blood flow, no such direct relationship exists for 99mTc-PYP. This is in pa...

Sites and Mechanisms of Localization of Technetium-99m Phosphorus Radiopharmaceuticals in Acute Myocardial Infarcts and other Tissues

“…These findings were interpreted as supporting the proposed role of tissue calcification in concentration of the agent, but as not excluiding the possibility of other mechanisms (3)(4)(5)(6). Other reports (7)(8)(9)(10)(11)(12)(13)(14)(15)(16) have confirmed the dependence of 99mTc-P concentration on the presence of myocardial necrosis, and the importance of blood flow for modulating the level of 99mTc-P uiptake. Previous studies from our own and other laboratories, however, have not resolved certain important questions regarding 99mTc-P uptake after myocardial injury.…”

Correlation of ^99mTc-Pyrophosphate Myocardial Accumulation with Left Ventricular Wall Motion Abnormalities

“…The initial hypothesis that the " mTc-pyrophosphate lo calizes as a hydroxyapatite crystalline structure within the mitochondria of the dying myocardial cells (11,33) has not yet been proven and there is some evidence in the literature to suggest that this may not be the only mechanism (9,12,21,38). This radionuclide is capable of binding to connective tissue as well as mineral elements such as calcium (21).…”

Imaging of Acute Myocardial Infarction and Reperf usion

“…99mTc uptake is maximal in myocardial regions with moderate CBF reductions, i.e. around 30-40% of the flow rates in nonischemic areas [ 15]. In myocardial zones with severe flow reductions or in regions with mildly reduced flow levels, 99mTc PYP uptake occurs with less avidity.…”