Technetium stannous pyrophosphate myocardial scintigrams in patients with chest pain of varying etiology.

Abstract

Technetium-99m stannous pyrophosphate was utilized for myocardial imaging in 202 patients admitted to the hospital with chest pain of uncertain etiology. One hundred and one patients had clinical and evolved electrocardiographic and enzymatic evidence of acute myocardial infarction. Ninety-six of these 101 patients had increased myocardial uptake of the technetium stannous pyrophosphate and positive myocardial scintigrams; there was nearly precise correlation between the ECG and myocardial imaging localization of the area of infarction for acute transmural myocardial infarctions. In the five patients with negative myocardial images the scintigrams were obtained after seven or more days had elapsed following the myocardial infarction. In the remaining 101 patients no clinical, ECG, or enzymatic evidence of infarction developed; 92 of these patients had negative myocardial scintigrams. Seven of the remaining nine patients were admitted with "unstable angina pectoris", and despite the absence of diagnostic ECG and enzyme evolution each of these patients had faintly and diffusely positive myocardial scintigrams. The remaining two patients had positive myocardial scintigrams but no definite ECG or enzymatic evidence of acute myocardial infarction. Thus the technetium pyrophosphate imaging technique appears safe, inexpensive and to correlate well with ECG and enzyme identification of the presence of infarction and with ECG localization of myocardial infarction. In addition the positive myocardial scintigrams in some patients with "unstable angina" suggest that there may be limited myocardial necrosis that is ordinarily undetected by ECG and enzymes in these patients. The incidence of false positive and false negative scintigrams appears to be small.

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

“…A total of 20 mongrel dogs were anesthetized with intravenous pentobarbital sodium (30 mg/ kg) and subjected to thoracotomy. The proximal left anterior 1 Abbreviations utsed in this paper: 1311-HSA, human serum albumin labeled with iodine-131; LAD, left anterior descending coronary artery; 99ffTc-P, technetium-99m-labeled, phosphorus-based radiopharmaceuticals; 99mTc-EHDP, 99mTc-stannous ethane-l-hydroxy-1,1, diphosphonate; 99mTcO4; free pertechnetate ion; 99mTc-PYP, 99mTc-stannous pyrophosphate; 3H-EHDP, tritiated EHDP. descending coronary artery (LAD) was dissected free 1 to 2 cm from its origin and suture ligated.…”

“…The Journlal of Clinical In1vestigationi V7ollumite 60 September 1977 724-740 INTRODUCTION Myocardial scintigraphy with technetium-99m-labeled, phosphortus-based radiopharmaceuticals (99nTc-P)l has been shown to be an accurate noninvasive test for the diagnosis of acute myocardial infarction (1). Bonte and associates first showed that the 99mTc-P bone scanning agents concentrate in areas of acute myocardial infarction, and suggested that this phenomenon was related to labeling of calcium deposits in the infarcts (2).…”

A Tale of Two Diseases

“…Lymphocyte activation may be due in part to the release of myocardial antigens during episodes of small myocardial necrosis, common in severe unstable angina. 22 Thus, the significance of the transient change of immune markers observed in the subacute phase of unstable angina is unclear; further studies, including a larger number of patients, should address this issue.…”

Pathophysiology of technetium-99m stannous pyrophosphate and thallium-201 scintigraphy of acute anterior myocardial infarcts in dogs.

“…Cold spot scintigraphy of acute myocardial infarcts has been performed with radionuclides of potassium and its analogues, including rubidium, cesium, and thallium (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Hot spot scintigraphy has been performed with gallium-67 citrate (11) as well as technetium-99m tetracycline (12,13), technetium-99m glucoheptonate (14)(15)(16), and various phosphate compounds labeled with technetium-99m (16)(17)(18), including technetium-99m stannous pyrophosphate (`mTc-PYP).1 Furthermore, an extensive clinical experience has now been compiled with WmTc-PYP (10,(18)(19)(20) …”