Rest-redistribution thallium-201 scintigraphy to determine myocardial viability early after myocardial infarction.
OBJECTIVE
This study attempted to determine the utility of early rest-redistribution thallium-201 imaging in detecting residual myocardial viability after myocardial infarction.


BACKGROUND
The early detection of myocardial viability after myocardial infarction would have clinical relevance.


METHODS
Thirty-one patients with acute myocardial infarction had early (mean [+/- SD] 2 +/- 1 day) rest-redistribution thallium-201 imaging followed by radionuclide and coronary angiography. Late studies included stress-redistribution-reinjection thallium-201 imaging or radionuclide angiography, or both. Viability was defined by the rest thallium-201 scan as an initial mild rest defect or any defect that demonstrated redistribution.


RESULTS
Group 1 (n = 15) was predicted to have viable and Group 2 (n = 16) nonviable myocardium in the infarct zone. Group 1 patients were more likely to have a patent infarct-related artery (15 of 15 vs. 10 of 16, p < 0.03), higher initial ejection fraction (61 +/- 12% vs. 53 +/- 9%, p < 0.05), higher infarct wall motion score (p < 0.0001) and fewer abnormal thallium-201 segments (p < 0.0001). On follow-up studies, ejection fraction improved in Group 1 (from 57 +/- 13% to 66 +/- 10%, p < 0.05, n = 9) and deteriorated in Group 2 (from 53 +/- 10% to 46 +/- 8%, p < 0.05, n = 13). On late stress testing with thallium-201 reinjection, Group 1 patients had fewer abnormal segments (p < 0.03) and higher infarct zone counts during exercise (p < 0.05) and after reinjection (p < 0.05) than Group 2 patients.


CONCLUSIONS
If confirmed by larger studies, early rest-redistribution thallium-201 imaging may be a useful technique for identifying residual viability after myocardial infarction.
Lomboy
C T
CT
Department of Internal Medicine, Medical College of Pennsylvania, Allegheny General Hospital, Pittsburg 15212.
Schulman
D S
DS
Grill
H P
HP
Flores
A R
AR
Orie
J E
JE
Granato
J E
JE
D000368:Aged; D000704:Analysis of Variance; D017023:Coronary Angiography; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000628:therapy; D011446:Prospective Studies; D011875:Radionuclide Angiography / Q000706:statistics & numerical data; D012146:Rest; D018709:Statistics, Nonparametric; D013794:Thallium Radioisotopes; D013997:Time Factors
D013794:Thallium Radioisotopes