Interpretation of reverse redistribution of 99m Tc-tetrofosmin in patients with acute myocardial infarction

Hirata, Yoshihide; Takamiya, M; Kinoshita, Noriyuki; Yamada, Hiroyuki; Shima, Takatomo; Miyazaki, Hiroshi; Kouno, Yoshio; Sawada, Naohisa; Sakamoto, Kenzou; Sugihara, Hiroki

doi:10.1007/s00259-002-0968-1

Cited by 12 publications

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“…Reverse redistribution (RRD) was observed between the initial and delayed images of AMI on myocardial perfusion images using a 99m Tc-labeled agent with almost no clearance in normal myocardium, which is reported to reflect mitochondrial damage in myocardium [14][15][16][17]. It has also been reported that RRD can predict functional recovery in the chronic phase.…”

Section: Introductionmentioning

confidence: 91%

“…Several studies have investigated RRD in the sub-acute phase [14][15][16], though very few have investigated the relationship between RRD in the sub-acute phase and left ventricular functional recovery in the chronic phase [17].…”

Section: Introductionmentioning

confidence: 99%

“…However, these studies assessing myocardial uptake of 99m Tc-labeled agents were conducted using visual semi-quantitative analysis. Moreover, left ventricular function was assessed using left ventriculography (LVG) or echocardiography [14][15][16][17][18][19][20][21]. The findings of these studies on RRD were, therefore, not necessarily valid.…”

Section: Introductionmentioning

confidence: 99%

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The relationship between reverse redistribution of 99mTc-tetrofosmin in sub-acute phase and left ventricular functional recovery in chronic phase in patients with acute myocardial infarction

et al. 2009

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Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The relationship between reverse redistribution of 99mTc-tetrofosmin in sub-acute phase and left ventricular functional recovery in chronic phase in patients with acute myocardial infarction

et al. 2009

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We read with interest the recent paper by Hirata et al entitled "Interpretation of reverse redistribution of 99m Tc-tetrofosmin in patients with acute myocardial infarction" [1]. The authors postulate that tetrofosmin reverse redistribution (RR) in patients with recent myocardial infarction (MI) reflects salvaged myocardium and they also present a possible mechanism for this finding.

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confidence: 92%

Interpretation of reverse redistribution of 99mTc-tetrofosmin in patients with acute myocardial infarction

Athanasoulis

Zervas

2003

Eur J Nucl Med Mol Imaging

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We read with interest the recent paper by Hirata et al. entitled "Interpretation of reverse redistribution of 99m Tc-tetrofosmin in patients with acute myocardial infarction" [1]. The authors postulate that tetrofosmin reverse redistribution (RR) in patients with recent myocardial infarction (MI) reflects salvaged myocardium and they also present a possible mechanism for this finding. Regional wall motion study was performed to support this hypothesis. Although RR with a 99m Tc-labelled agent, in this clinical setting, has been previously reported [2], the tetrofosmin RR phenomenon was initially reported from our department [3,4]. Our results were included in the highlights of the EANM congress by I. Carrio in 1997 [5]. We compared early and late tetrofosmin images in thrombolysed acute MI patients with high patency grade of the infarct-related coronary artery 1 week and (in a subgroup of patients) 1 month post MI. Since early tetrofosmin images 1 week and 1 month post MI were similar and the RR found in the initial study was decreased or eliminated over 1 month of follow-up, we concluded that RR may reflect viable stunned myocardium.Although our results are in agreement with those of Hirata et al., we did not perform a wall motion study since we believe that it does not contribute in elucidating the main issue in this clinical setting, which is whether tetrofosmin RR directly reflects viable stunned myocardium or reflects other phenomena not related to the viable myocardial cells. Stunned myocardium in any case should be present and wall motion will improve over time in parallel with the decrease in the degree of the RR phenomenon. In order to explain tetrofosmin RR in this clinical setting we must examine four possible mechanisms:1. Early post-MI hyperperfusion and increased agent influx in the myocardial cells of the affected area, proportional to viability, is followed by faster wash-out. This mechanism can be excluded since tetrofosmin lacks the redistribution phenomenon observed with thallium-201.2. Tetrofosmin enters damaged cells which will undergo apoptosis. RR is produced since they cannot retain the tetrofosmin as long as normal cells. In this case the early tetrofosmin uptake in the follow-up study should be decreased proportionally to the magnitude of the RR. We also exclude this mechanism since, in a subgroup of these patients, a considerable initial RR which gradually completely recovers over time is combined with normal or near-normal early and late tetrofosmin uptake in the follow-up. Any significant decrease in early uptake between initial and follow-up study is not possible in this context and this is therefore completely uncoupled from the magnitude of the recovered RR. One such case is actually presented by Hirata et al. in Fig. 2. 3. One week post MI, although the epicardial vessel is open, the microvascular function has not yet been restored and the viable salvaged tissue is actually hypoperfused but can retain tetrofosmin like normal myocardium. An additional amount of the tetrofosmin is t...

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“…This is a reverse redistribution (RR). RR was defined as the appearance of a defect on the redistribution image in a region with normal or near-normal initial uptake of thallium in myocardial perfusion imaging [1][2][3][4], and subendocardial MI is one of the explanations for the RR. A study of RR observed with Tc99m-tetrofosmin was recently published in this journal [5] Fig .…”

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Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT

Lee

Kim

Yoon³

et al. 2010

Nucl Med Mol Imaging

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The authors report myocardial perfusion imaging of a patient showing reverse redistribution (RR) and a 64-slice multidetector-row computed tomography (MDCT) with corresponding findings. The patient had subendocardial myocardial infarction (MI) with positive electrocardiogram (EKG) findings and elevated levels of cardiac isoenzymes. Experiencing this case emphasizes the importance of complementary correlation of a new diagnostic modality that helps us to understand the nature of RR.Keywords Reverse redistribution . Myocardial perfusion imaging . 64-slice multidetector-row CT . Subendocardial MI Fig. 1 The patient was a 49-year-old man with a 1-year history of diabetes mellitus and hypertension, who was admitted with chest pain and ventricular fibrillation to rule out an acute myocardial infarction (MI). CK-MB and troponin were abnormally elevated. The electrocardiogram (EKG) after DC cardioversion shows prominent ST elevation in leads II, III, aVF, and V 5-6 , findings suggestive for subendocardial MI in the inferior wall. A coronary angiogram showed a total occlusion of the distal left circumflex artery (LCX). A followup EKG showed no Q-wave

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Interpretation of reverse redistribution of 99m Tc-tetrofosmin in patients with acute myocardial infarction

Cited by 12 publications

References 11 publications

The relationship between reverse redistribution of 99mTc-tetrofosmin in sub-acute phase and left ventricular functional recovery in chronic phase in patients with acute myocardial infarction

The relationship between reverse redistribution of 99mTc-tetrofosmin in sub-acute phase and left ventricular functional recovery in chronic phase in patients with acute myocardial infarction

Interpretation of reverse redistribution of 99mTc-tetrofosmin in patients with acute myocardial infarction

Reverse Redistribution in Myocardial Perfusion Imaging: Revisited with 64-slice MDCT

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