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Technetium-99m pyrophosphate/thallium-201 dual-isotope SPECT imaging predicts reperfusion injury in patients with acute myocardial infarction after reperfusion

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Microcirculatory failure after reperfusion is clinically indicated to cause reperfusion injury whereas excessive intracellular calcium ion overload is experimentally proved as a key mechanism of reperfusion injury. We hypothesized that technetium-99m (99mTc) pyrophosphate (Tc-PYP) uptake in injured but viable infarct-related myocardium with preserved myocardial perfusion after reperfusion estimated by thallium-201 (201Tl) uptake would be associated with final functional recovery.

Methods

Dual-isotope Tc-PYP/201Tl single-photon emission computed tomography (SPECT) was performed 2 days after successful reperfusion therapy in patients with first acute myocardial infarction, and 50 patients (63 ± 13 years old, female 22%) with preserved 201Tl uptakes of ≥50% in reperfused myocardium was followed for 1 month. Tc-PYP uptake was assessed as the heart-to-sternum (H/S) ratio. Two-dimensional echocardiography was also performed 2 days and 1 month after reperfusion to evaluate functional recovery.

Results

High Tc-PYP uptake, defined as the H/S ratio ≥0.81, was predictive of chronic phase no functional recovery (73.7% in 14 of 19 patients with high uptake vs 16.1% in five of 31 patients without those, p < 0.0001). After adjustment for potential confounding variables, including electrocardiographic persistent ST segment elevation at 1 h after reperfusion, high Tc-PYP uptake remained independently predictive of no functional recovery with odds ratio of 8.7 (95% confidential interval = 2 to 38.7; p = 0.005).

Conclusion

High Tc-PYP uptake in reperfused but viable infarct-related myocardium was a powerful predictor of no functional recovery, which may reflect excessive intracellular calcium ion overload caused by reperfusion injury. Tc-PYP/201Tl dual-isotope SPECT imaging can provide prognostic information after reperfusion.

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Acknowledgement

The authors wish to thank the medical, technical, and laboratory staff, Dr. Noritaka Seino, of the Service of Nuclear Medicine, and Drs. Takeshi Kondou, Mitsuharu Muto, and Shigeto Tsukamoto, of the Catheterization Laboratory of Showa University Hospitals who actively participated in the data collection.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan

    Yasushi Akutsu, Kyouichi Kaneko, Yusuke Kodama, Hui-Ling Li, Hideki Nishimura, Yuji Hamazaki & Youichi Kobayashi

  2. Department of Radiology, Showa University School of Medicine, Tokyo, Japan

    Jumpei Suyama, Akira Shinozuka & Takehiko Gokan

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  1. Yasushi Akutsu
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  2. Kyouichi Kaneko
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  3. Yusuke Kodama
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Correspondence to Yasushi Akutsu.

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Akutsu, Y., Kaneko, K., Kodama, Y. et al. Technetium-99m pyrophosphate/thallium-201 dual-isotope SPECT imaging predicts reperfusion injury in patients with acute myocardial infarction after reperfusion. Eur J Nucl Med Mol Imaging 36, 230–236 (2009). https://doi.org/10.1007/s00259-008-0922-y

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