Reverse redistribution of thallium-201: A sign of nontransmural myocardial infarction with patency of the infarct-related coronary artery

Abstract

The pattern of reverse redistribution on the day 10 poststreptokinase resting thallium-201 myocardial scintigrams is a common finding in patients who have undergone streptokinase therapy in evolving myocardial infarction. To investigate this phenomenon, 67 patients who underwent streptokinase therapy were studied pre- and 10 days poststreptokinase therapy resting thallium-201 studies, poststreptokinase therapy resting radionuclide ventriculography and coronary arteriography (60 of the 67 patients). Of the 67 patients, 50 (75%) showed the reverse redistribution pattern on the day 10 thallium-201 study (Group I), 9 (13%) had a nonreversible defect (Group II) and the remaining 8 (12%) had a normal study or showed a reversible defect (Group III). The reverse redistribution pattern was associated with patency of the infarct-related artery (100%), quantitative improvement in resting thallium-201 defect size from day 1 to day 10 study (94%) and normal or near normal wall motion on day 10 radionuclide ventriculography (80% of segments with marked and 54% of those with mild reverse redistribution). In contrast, nonreversible defects were associated with significantly less frequent patency of the infarct-related artery (67%, p = 0.01), improvement in defect size (11%, p less than 0.001) and normal or near normal wall motion (21%, p less than 0.05). Group III patients were similar to Group I with respect to these variables. The quantitated thallium-201 percent washout was higher in the regions with the reverse redistribution pattern (49 +/- 15%) compared with the contralateral normal zone (24 +/- 15%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Reverse Redistribution Phenomenon on Rest 99mTc-Tetrofosmin Myocardial Single Photon Emission Computed Tomography Involves Impaired Left Ventricular Contraction in Patients With Acute Myocardial Infarction

“…Takeishi et al 9 had a comparable result for LV wall motion evaluated by contrast left ventriculography in the regions with the 99m Tc-sestamibi RR phenomenon, and both those studies had findings that were similar to those observed in regions with RR on 201 Tl scintigraphy. [10][11][12][13][14][15] In contrast, in the present study, the mean %CI after exercise in the regions with the RR phenomenon was as bad as that in the regions with a fixed defect, indicating that myocardial contraction after exercise in such regions was severely weakened. Even in the regions with the RR phenomenon and relatively better initial %uptake of 99m Tc-tetrofosmin (>70%), LV wall thickening was as poor as in the regions with a fixed defect.…”

“…[4][5][6] Several investigators have reported that in patients with acute myocardial infarction (AMI) after reperfusion therapy, myocardial imaging with 99m Tc-tetrofosmin or 99m Tcsestamibi shows a reverse redistribution (RR) phenomenon, 7-9 similar to that observed on 201 Tl scintigraphy in such patients. [10][11][12][13][14][15] The clinical significance of the RR of 201 Tl has been vigorously investigated, 10-15 compared with that on 99m Tc-tetrofosmin scintigraphy, which has not been fully elucidated. Thus, we used ECG-gated myocardial SPECT to investigate this issue in patients with AMI from the viewpoint of LV wall thickening after exercise.…”

Contractile Reserve, Thallium-201 Reverse Redistribution and Mismatch Between Perfusion and Metabolism in Reperfused Infarct-related Myocardium With Delayed and Incomplete Functional Recovery

“…Recent studies have reported that reverse redistribution depends on the preserved regional flow by either through patent coronary arteries or collaterals in patients following thrombolytic therapy. 16) One of the mechanisms of reverse redistribution is a faster washout of thallium-201 in this area than the normal remote areas, which may result from the higher blood flow supplied by the patent coronary artery in the reperfused areas than the normal blood flow. 16) On the other hand, impaired free fatty acid metabolism is correlated with ischemia-induced cardiac dysfunction.…”

Stress Testing and Its Role in Coronary Artery Disease

“…This phenomenon is thought to be related to hyperemic blood flow that causes enhanced uptake of thallium on initial post-stress images, and a more rapid clearance of thallium, producing the appearance of a perfusion abnormality (Weiss, 1986). Reverse redistribution is consistent with viable myocardium.…”