Exercise four hour redistribution thallium-201 single photon emission computed tomography and exercise induced ST segment elevation in detecting the viable myocardium in patients with acute myocardial infarction

Objective To investigate the specificity and sensitivity of the combination of redistribution in exercise thallium-201 single photon emission computed tomography (SPECT) and exercise induced ST elevation for detecting the viable myocardium in patients with acute myocardial infarction. Design 37 patients were studied within seven weeks of onset of Q wave myocardial infarction (anterior in 22, inferior in 15). All patients underwent exercise four hour redistribution thallium-201 SPECT and positron emission tomography using fluorine-18-fluorodeoxyglucose (FDG) and nitrogen-13 ammonia under fasting conditions. Results Sixteen patients showed exercise induced ST elevation ⩾ 1.5 mm, and 15 of these had increased FDG uptake in the infarct region. Eleven of 16 patients (10 of 11 patients with anterior infarctions) with irreversible thallium-201 defects and increased FDG uptake showed exercise induced ST elevation. The sensitivity, specificity, and predictive accuracy of redistribution, exercise induced ST segment elevation, or both for detecting increased FDG uptake were 82%, 75%, and 67% (94%, 75%, and 91% for anterior infarctions), respectively. Conclusions In patients with acute Q wave myocardial infarction, the combination of redistribution in exercise thallium-201 SPECT and exercise induced ST elevation can detect the viable myocardium in the infarct region with high sensitivity and specificity, especially in patients with anterior infarctions.

[1]  F. Fazio,et al.  Specificity and sensitivity of exercise-induced ST segment elevation for detection of residual viability: comparison with fluorodeoxyglucose and positron emission tomography. , 1995, Journal of the American College of Cardiology.

[2]  S. Chierchia,et al.  Assessment of residual tissue viability by exercise testing in recent myocardial infarction: comparison of the electrocardiogram and myocardial perfusion scintigraphy. , 1992, Journal of the American College of Cardiology.

[3]  F. Fazio,et al.  Nonuniformity in myocardial accumulation of fluorine-18-fluorodeoxyglucose in normal fasted humans. , 1991, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[4]  Y. Yonekura,et al.  Metabolic activity in the areas of new fill-in after thallium-201 reinjection: comparison with positron emission tomography using fluorine-18-deoxyglucose. , 1991, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[5]  S L Bacharach,et al.  Identification of viable myocardium in patients with chronic coronary artery disease and left ventricular dysfunction. Comparison of thallium scintigraphy with reinjection and PET imaging with 18F-fluorodeoxyglucose. , 1991, Circulation.

[6]  V. Dilsizian,et al.  Enhanced detection of ischemic but viable myocardium by the reinjection of thallium after stress-redistribution imaging. , 1990, The New England journal of medicine.

[7]  A. Fischman,et al.  Comparison of thallium redistribution with rest "reinjection" imaging for the detection of viable myocardium. , 1990, The American journal of cardiology.

[8]  R. Ajisaka,et al.  Mechanisms of stress-induced ST elevation and negative T-wave normalization studied by serial cardiokymogram in patients with a previous myocardial infarction. , 1990, The American journal of cardiology.

[9]  P. Rigo,et al.  Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography. , 1990, Journal of the American College of Cardiology.

[10]  R. Gropler,et al.  Nonuniformity in myocardial accumulation of fluorine-18-fluorodeoxyglucose in normal fasted humans. , 1990, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[11]  M. Kilbourn,et al.  Direct simultaneous production of [15O]water and [13N]ammonia or [18F]fluoride ion by 26 MeV proton irradiation of a double chamber water target. , 1990, International journal of radiation applications and instrumentation. Part A, Applied radiation and isotopes.

[12]  Y. Yonekura,et al.  Positron emission tomography using fluorine-18 deoxyglucose in evaluation of coronary artery bypass grafting. , 1989, The American journal of cardiology.

[13]  M. Phelps,et al.  PET detection of viable tissue in myocardial segments with persistent defects at T1-201 SPECT. , 1989, Radiology.

[14]  D. Berman,et al.  Late reversibility of tomographic myocardial thallium-201 defects: an accurate marker of myocardial viability. , 1988, Journal of the American College of Cardiology.

[15]  E. Depuey,et al.  Incomplete redistribution in delayed thallium-201 single photon emission computed tomographic (SPECT) images: an overestimation of myocardial scarring. , 1988, Journal of the American College of Cardiology.

[16]  D. Haines,et al.  Exercise-induced ST segment elevation 2 weeks after uncomplicated myocardial infarction: contributing factors and prognostic significance. , 1987, Journal of the American College of Cardiology.

[17]  M. Cohen,et al.  Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. , 1986, Circulation.

[18]  M Schwaiger,et al.  Reversibility of cardiac wall-motion abnormalities predicted by positron tomography. , 1986, The New England journal of medicine.

[19]  K. Hamacher,et al.  Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. , 1986, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[20]  J. Schofer,et al.  Scintigraphic evidence of the "no reflow" phenomenon in human beings after coronary thrombolysis. , 1985, Journal of the American College of Cardiology.

[21]  H. Gewirtz,et al.  Role of myocardial ischemia in the genesis of stress-induced S-T segment elevation in previous anterior myocardial infarction. , 1983, The American journal of cardiology.

[22]  K. Fox,et al.  Significance of exercise induced ST segment elevation in patients with previous myocardial infarction. , 1983, British heart journal.

[23]  E. Raftery,et al.  Exercise-induced ST segment elevation. Electrocardiographic, angiographic, and scintigraphic evaluation. , 1980, British heart journal.

[24]  D. Kelly,et al.  Exercise‐induced ST‐segment Elevation: Correlation of Thallium‐201 Myocardial Perfusion Scanning and Coronary Arteriography , 1980, Circulation.

[25]  A. Ticzon,et al.  S-T segment elevation during exercise: electrocardiographic and arteriographic correlation in 38 patients. , 1980, The American journal of cardiology.

[26]  B. Chaitman,et al.  Clinical and Angiographic Correlates of Exercise‐induced ST‐segment Elevation: Increased Detection with Multiple ECG Leads , 1980, Circulation.

[27]  J. Ritchie,et al.  Thallium-201 myocardial imaging: a comparison of the redistribution and rest images. , 1979, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[28]  P. Cannon,et al.  Comparison of Single-Dose and Double-Dose Thallium-201 Myocardial Perfusion Scintigraphy for the Detection of Coronary Artery Disease and Prior Myocardial Infarction , 1978, Circulation.

[29]  T. Ryan,et al.  ST Segment Changes Post-Infarction: Predictive Value for Multivessel Coronary Disease and Left Ventricular Aneurysm , 1978, Circulation.

[30]  G A Beller,et al.  Differentiation of Transiently Ischemic from Infarcted Myocardium by Serial Imaging after a Single Dose of Thallium‐201 , 1977, Circulation.

[31]  R. Chahine,et al.  The Clinical Significance of Exercise‐induced ST‐segment Elevation , 1976, Circulation.

[32]  R. Frye,et al.  A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. , 1975, Circulation.