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Circulation, Vol 55, 294-302, Copyright © 1977 by American Heart Association
GM Pohost, LM Zir, RH Moore, KA McKusick, TE Guiney and GA Beller
Myocardial 201Tl uptake and regional blood flow by the microsphere
technique were determined in anesthetized dogs undergoing either 20 min of
coronary occlusion and 100 min of reperfusion (N = 10) or 120 min of
occlusion (N = 4). In both groups, 201Tl was injected intravenously after
10 min of occlusion. In transiently occluded dogs, regional flow at the
time of 201Tl administration was reduced to 8 +/- 3% of normal flow in
endocardial layers of the central ischemic zone. After 100 min of
reperfusion, flow values were not significantly different from normal.
201Tl activity after reperfusion rose to 56 +/- 5% of normal, demonstrating
that redistribution of the radionuclide occurred during the reflow period.
In animals with persistent occlusion, there was a significant relationship
between 201Tl uptake and flow (r = 0.95) and no evidence of redistribution
of 201Tl during the two hour occlusion period. In another five dogs
receiving 201Tl, serial gamma camera images obtained during reperfusion
showed increasing uptake of the tracer in apical defects which returned to
normal by 4 hours of reflow. Thirteen patients with stable angina received
2 mCi of 201Tl intravenously at peak exercise, and multiple gamma camera
images obtained serially. All demonstrated zones of diminished 201Tl uptake
10 min after exercise. Defects which partially or completely disappeared
within 1-6 hours postexercise corresponded to areas supplied by coronary
arteries with significant stenoses. Persistent defects were present in
regions of old myocardial infarction. Six additional patients with acute
myocardial infarction demonstrated 201Tl myocardial defects which showed no
significant change over 6 hours. Thus, redistribution of 201Tl into
ischemic myocardium was demonstrated during transient coronary occlusion in
dogs and after exercise stress in man. Sequential imaging after a single
dose of 201Tl at the time of exercise may provide a means for
distinguishing between transient perfusion abnormalities or ischemia and
myocardial infarction of scar.
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Differentiation of transiently ischemic from infarcted myocardium by serial imaging after a single dose of thallium-201
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