Circulation, Vol 82, 1424-1437, Copyright © 1990 by American Heart Association
AJ Sinusas, KA Trautman, JD Bergin, DD Watson, M Ruiz, WH Smith and GA Beller
Serial myocardial imaging with technetium-99m methoxyisobutyl isonitrile
(99mTc-MIBI) has been proposed for evaluating myocardial salvage after
reperfusion. To define 99mTc-MIBI uptake before and after reperfusion, 17
open-chest dogs underwent 3 hours of left anterior descending artery
occlusion and 3 hours of reperfusion. 99mTc-MIBI was injected during
occlusion (group 1) or after 90 minutes of reperfusion (group 2).
Myocardial 99mTc-MIBI activity was correlated with microsphere flow during
occlusion and reperfusion. Anatomic risk area and infarct area were defined
by postmortem vital staining and correlated with the perfusion defects
defined by analysis of 99mTc-MIBI macroautoradiographs and gamma camera
images of myocardial slices. The left ventricle was divided into 96
segments for gamma well counting. Flow and 99mTc-MIBI activity were
normalized to nonischemic values. Myocardial segments were grouped, based
on occlusion flow, into zones: severely ischemic (less than or equal to 30%
nonischemic), moderately ischemic (greater than 30%, less than or equal to
60% nonischemic), mildly ischemic (greater than 60%, less than or equal to
90% nonischemic), and nonischemic (greater than 90%, less than or equal to
120% nonischemic). Among dogs injected with 99mTc-MIBI during coronary
occlusion (group 1), myocardial 99mTc-MIBI activity correlated linearly
with occlusion flow for both endocardial (r = 0.91) and transmural (r =
0.91) segments. The risk area defined by 99mTc-MIBI autoradiography (group
1) correlated with the postmortem risk area (rho = 0.94) but was 29%
smaller than the anatomic risk area (p = 0.03), reflecting the contribution
of collateral flow. Among dogs injected with 99mTc-MIBI after reperfusion
(group 2), myocardial 99mTc-MIBI did not correlate with reperfusion flow in
either endocardial or transmural segments. Among group 2 dogs, myocardial
99mTc-MIBI activity was significantly less than reperfusion flow at the
time of injection in the severely ischemic (25 +/- 5% versus 74 +/- 24%
nonischemic, p = 0.002), moderately ischemic (54 +/- 12% versus 96 +/- 15%
nonischemic, p = 0.001), and mildly ischemic (84 +/- 6% versus 93 +/- 3%
nonischemic, p = 0.002) zones. The defect area defined by 99mTc-MIBI
autoradiography (group 2) correlated very closely with the postmortem
infarct area (rho = 0.98). Thus, the myocardial uptake of 99mTc-MIBI during
coronary occlusion correlates with occlusion flow and reflects the "area at
risk." When 99mTc-MIBI was given after 90 minutes of reperfusion following
3 hours of coronary occlusion, the myocardial activity was significantly
reduced compared with reperfusion flow in both necrotic and perinecrotic
regions, reflecting myocardial viability more than the degree of
reperfusion.
ARTICLES
Quantification of area at risk during coronary occlusion and degree of myocardial salvage after reperfusion with technetium-99m methoxyisobutyl isonitrile
Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
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