Circulation, Vol 52, 596-607, Copyright © 1975 by American Heart Association
LM Buja, RW Parkey, JH Dees, EM Stokely, RA Harris Jr, FJ Bonte and JT Willerson
To obtain insight into the mechanism(s) responsible for the direct
visualization of acute myocardial infarcts by myocardial scintigraphy with
technetium-99m stannous pyrophosphate (99mTc-PYP), scintigraphic and
morphologic studies were performed in 22 dogs subjected to occlusion of the
proximal left anterior descending coronary artery (LAD). Grossly visible
myocardial infarcts occurred in ten of 11 dogs with LAD occlusion for one
day, five with LAD occlusion for two days, two with LAD occlusion for seven
days and two with LAD occlusion for 13 days. Rare, microscopic foci of
necrosis were observed in one dog with LAD occlusion for one day, and no
lesions were present in two dogs subjected to temporary LAD occlusion for
eight minutes and reflow for 24 hours. In the latter three dogs, 99mTc-PYP
myocardial scintigrams were negative. In the 19 dogs with gross infarcts,
99mTc-PYP myocardial scintigrams were strongly positive at one and two days
after LAD occlusion, much less positive at seven days and faintly positive
at 13 days after occlusion. Positive myocardial scintigrams in most showed
"doughnut" patterns, with marked peripheral concentration of radioactivity
around central zones of much lower activity. On histologic examination, the
one and two-day-old infarcts exhibited subendocardially located central
zones and surrounding peripheral zones, both of which showed distinctive
histopathological and histochemical features, including the selective
occurrence in the peripheral zones of calcified muscle cells with
ultrastructurally demonstrable apatite-like crystals in mitochondria.
Selective occurrence of high tissue levels of 99mTc-PYP radioactivity also
was demonstrated in the peripheral zones of four infarcts. Hearts with
older infarcts (seven and 13 days) showed progressive replacement of
necrotic myocardium by granulation tissue and progressive reduction in
calcium deposits in the areas of damage. The data obtained in this study
establish a temporal and topographical relationship between calcium
accumulation in acute myocardial infarcts and 99mTc-PYP uptake responsible
for scintigraphic detection of the lesions with this radionuclide in dogs
subjected to proximal LAD occlusion.
ARTICLES
Morphologic correlates of technetium-99m stannous pyrophosphate imaging of acute myocardial infarcts in dogs
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