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(Circulation. 1997;96:2332-2338.)
© 1997 American Heart Association, Inc.

Articles

Myocardial ^99mTc-Tetrofosmin Uptake During Adenosine-Induced Vasodilatation With Either a Critical or Mild Coronary Stenosis

Comparison With ²⁰¹Tl and Regional Myocardial Blood Flow

David K. Glover, ME; Mirta Ruiz, MD; Joo Y. Yang, MD; William H. Smith, MS; Denny D. Watson, PhD; ; George A. Beller, MD

From the Experimental Cardiology Laboratory, Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville.

Correspondence to David K. Glover, Experimental Cardiology Laboratory, Cardiovascular Division, Department of Medicine, University of Virginia, Health Sciences Center Box 158, Charlottesville, VA 22908. E-mail dglover{at}virginia.edu

Background Clinical studies have shown a comparable coronary stenosis detection rate between ^99mTc-tetrofosmin and ²⁰¹Tl but with smaller defect magnitudes for ^99mTc-tetrofosmin. The goals of this study were to measure the first-pass extraction fraction (EF) of ^99mTc-tetrofosmin in canine myocardium and to compare ^99mTc-tetrofosmin with ²⁰¹Tl uptake during adenosine-induced vasodilatation in dogs with various degrees of coronary stenosis.

Methods and Results EF was calculated in 4 anesthetized, open-chest dogs after intracoronary administration of ¹²⁵I-labeled albumin and ^99mTc-tetrofosmin. In another 16 dogs with either critical (n=6) or mild (n=10) left anterior descending coronary artery (LAD) stenoses, ²⁰¹Tl and ^99mTc-tetrofosmin were administered during adenosine infusion (250 µg · kg^-1 · min^-1). Dogs were killed 5 minutes later, and tracer activities were determined by ex vivo imaging of heart slices and by well counting. Mean ^99mTc-tetrofosmin EF was 54.0±3.7%. In the 6 critical-stenosis dogs, the LAD-to-left circumflex artery (LCx) microsphere flow ratio was 0.22±0.02 with adenosine. The LAD-to-LCx activity ratios were 0.37±0.04 for ²⁰¹Tl and 0.67±0.05 for ^99mTc-tetrofosmin (P<.01). For the 10 mild-stenosis dogs, the LAD-to-LCx flow ratio was 0.44±0.05. The ²⁰¹Tl activity ratio was 0.58±0.04, compared with 0.81±0.04 for ^99mTc-tetrofosmin (P<.01). Thus, in both groups, ^99mTc-tetrofosmin uptake underestimated the flow disparity more than ²⁰¹Tl. Similarly, magnitudes of ex vivo image defects were significantly greater for ²⁰¹Tl than for ^99mTc-tetrofosmin in both groups.

Conclusions In this canine model, relative underperfusion with adenosine stress is better resolved with ²⁰¹Tl than with ^99mTc-tetrofosmin and may be explained by the lower EF for ^99mTc tetrofosmin. With clinical imaging, greater ²⁰¹Tl attenuation and redistribution may lessen this advantage.

Key Words: adenosine • technetium • thallium

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