Particulate myocardial perfusion scintigraphy: Its clinical usefulness in evaluation of coronary artery disease

Kirk, Gerald A.; Adams, Ralph; Jansen, Carl; Judkins, Melvin P.

doi:10.1016/s0001-2998(77)80009-3

Cited by 19 publications

(3 citation statements)

References 34 publications

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“…The study of flow distribution in the heart is best performed using microspheres 8-101 in diameter which are distributed as red cells. Particles of macroaggregated albumin have been used in studies of myocardial perfusion (Ashburn, Braunwald, Simon, Peterson & Gault, 1971), and the technique can be used to assess left ventricular function following coronary by-pass surgery (Kirk, Adams, Jansen & Judkins, 1977). The measurement of an organ blood flow is based on:…”

Section: Radioactive Microspheresmentioning

confidence: 99%

Methods for the assessment of the effects of drugs on coronary blood flow in man.

Swanton¹,

Coltart²

1978

Brit J Clinical Pharma

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The methods currently available for measurement of coronary blood flow in man are reviewed and their advantages and limitations discussed. Most of the techniques are invasive and involve cardiac catheterization. The least invasive isotope techniques are either not quantitative or involve expensive equipment not available in many centres. Two of the most suitable methods for assessing the effects of drugs on coronary flow are coronary sinus thermodilution and isotope washout curves using 133xenon or [125I]‐iodo‐antipyrine. The ideal technique for measuring coronary blood flow has yet to be developed.

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Section: Radioactive Microspheresmentioning

confidence: 99%

Methods for the assessment of the effects of drugs on coronary blood flow in man.

Swanton¹,

Coltart²

1978

Brit J Clinical Pharma

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“…To increase the sensitivity of detection of collateral flow, intracoronary injections of radiolabeled microspheres or macroaggregated albumin particles (MAA) can be used. [11][12][13][14][15][16][17][18][19][20] Recent developments in interventional cardiology, including percutaneous transluminal coronary angioplasty (PTCA)2'-23 and the intracoronary infusion of streptokinase (ICSK)2128 in the setting of acute myo-THERAPY AND PREVENTION-ANGIOPLASTY cardial infarction, now provide a cohort of patients who undergo controlled and immediate dynamic changes in their coronary circulation and a new opportunity to study coronary collateral blood flow. The purpose of this study was to assess the effects of PTCA and ICSK on relative myocardial perfusion and the coronary collateral circulation with the use of sequential MAA injections.…”

mentioning

confidence: 99%

The effects of coronary angioplasty and reperfusion on distribution of myocardial flow.

Wahr¹,

Ports²,

Botvinick³

et al. 1985

Circulation

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To assess the effects of angioplasty (PTCA) and intracoronary streptokinase (ICSK) on relative myocardial perfusion, we administered 99mTc-macroaggregated albumin (MAA) to the uninvolved coronary artery before successful PTCA in 33 patients and before successful infusion of ICSK in eight patients and of`'In-MAA into the same vessel after the intervention. In 10 patients who underwent PTCA, MAA was injected into the involved, instrumented coronary artery. Computerprocessed images were acquired in registry and compared. Similar scintigraphic studies were performed in six control patients and in 11 in whom planned interventions were not performed or were unsuccessful. The specific stimuli to collateral formation and their exact role in the preservation of myocardial viability and function in patients with severe coronary artery disease are only suspected. Two important factors contributing to our incomplete understanding of coronary collaterals relate to the relative insensitivity of coronary angiography for visualization of collaterals and our prior inability to make instantaneous alterations in the pattern of coronary blood flow. To increase the sensitivity of detection of collateral flow, intracoronary injections of radiolabeled microspheres or macroaggregated albumin particles (MAA) can be used. 11-20 Recent developments in interventional cardiology, including percutaneous transluminal coronary angioplasty (PTCA)2'-23 and the intracoronary infusion of streptokinase (ICSK)2128 in the setting of acute myo-

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“…7 [21][22][23][24][25][26] Since these particles lodge in the coronary microcirculation, the presence of radioactivity throughout the myocardium has been equated with tissue viability. [21][22][23]25 Although previous studies have suggested that perfusion defects in patients with chronic stable angina represent fibrosis,7 21 the significance of perfusion abnormalities in patients with unstable angina is not well understood. Par-ticularly, the relationship of perfusion defects to segmental left ventricular contraction abnormalities and their potential for reversibility after coronary artery bypass surgery has not been demonstrated.…”

mentioning

confidence: 99%

Improvement of myocardial perfusion and left ventricular function after coronary artery bypass grafting in patients with unstable angina.

Kolibash¹,

Goodenow²,

Bush³

et al. 1979

Circulation

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SUMMARY Changes in myocardial perfusion and left ventricular function were evaluated pre-and postoperatively (3-6 months) in 14 patients with unstable angina who underwent coronary artery bypass surgery. Perfusion was studied with intracoronary and intragraft injections of radiolabeled macroaggregated albumin particles. Of 20 abnormal perfusion areas identified preoperatively, 13 demonstrated improved perfusion postoperatively. Segmental analysis of the left ventriculogram demonstrated improved wall motion in 29 abnormally contracting segments; 18 normalized. Areas which showed improvement of left ventricular perfusion were invariably associated with improvement of left ventricular wall motion. Five patients showed improvement in perfusion and contraction in areas of apparent old myocardial infarction.Thirteen of the 14 patients had significantly less angina whether or not there was evidence of improved perfusion. However, only those patients who demonstrated improved perfusion had a significant improvement in their treadmill exercise tolerance postoperatively. Thus, patients with unstable angina have perfusion defects which may be reversed as a result of saphenous vein graft surgery. Reversal of these perfusion abnormalities results in improved left ventricular performance and better exercise tolerance postoperatively.CORONARY ARTERY BYPASS SURGERY has an important and widespread role in the treatment of coronary artery disease.1'3 Of particular significance to many investigators is the preoperative detection of ischemic, but viable, myocardium and the ultimate effects of revascularization upon improvement of left ventricular perfusion and function.4-5 Perhaps this problem is best exemplified in those patients with unstable angina who have poorly contracting areas of the ventricle which are being supplied by vessels with highly stenotic lesions. The recent reports of resting perfusion abnormalities in this group of patients6' 7 further raises the question whether these areas represent viable (reversibly damaged) myocardium or nonviable (irreversibly damaged) myocardium.Various techniques using intervention ventriculography have been used to identify potentially viable myocardium.8320 Another method used to differentiate between viable and nonviable myocardial tissue is the use of direct intracoronary instillation of radiolabeled, macroaggregated albumin particles.7 21-26Since these particles lodge in the coronary microcirculation, the presence of radioactivity throughout the myocardium has been equated with tissue viability. ticularly, the relationship of perfusion defects to segmental left ventricular contraction abnormalities and their potential for reversibility after coronary artery bypass surgery has not been demonstrated. If such perfusion defects do not always imply infarction, myocardial revascularization would be expected to correct the ischemia by improving blood flow, resulting in concomitant relief of angina and improvement of left ventricular performance. There have been relatively few studies exam...

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Particulate myocardial perfusion scintigraphy: Its clinical usefulness in evaluation of coronary artery disease

Cited by 19 publications

References 34 publications

Methods for the assessment of the effects of drugs on coronary blood flow in man.

Methods for the assessment of the effects of drugs on coronary blood flow in man.

The effects of coronary angioplasty and reperfusion on distribution of myocardial flow.

Improvement of myocardial perfusion and left ventricular function after coronary artery bypass grafting in patients with unstable angina.

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