High prevalence of (99m)tc-tetrofosmin reverse perfusion pattern in patients with myocardial infarction and angiographically smooth coronary arteries.
BACKGROUND
There are no published data in the literature on the scintigraphic perfusion pattern in patients with myocardial infarction (MI) and normal coronary arteries (NCA).


OBJECTIVE
To evaluate myocardial perfusion imaging in a series of patients with MI and NCA.


METHODS
Twenty-seven patients who had developed a MI and had NCA were studied. As a control group we included 27 patients with a recent MI and coronary artery disease (CAD). All patients underwent stress/rest tetrofosmin myocardial perfusion SPECT within 6 months from MI.


RESULTS
In patients with NCA tetrofosmin stress images revealed 41 hypoperfused segments in 17 patients (63%). On rest images, 13 segments remained unchanged, 4 showed partial reperfusion, 10 normalized and 14 worsened. Additionally, there were 18 new hypoperfused segments in nine patients. Therefore, perfusion worsened at rest in 18 patients (67%) (32 segments). Overall, at rest there were 49 hypoperfused segments in 22 patients (81%). In patients with CAD, stress images revealed 71 hypoperfused segments. On rest images, 39 segments remained unchanged, 16 showed partial reperfusion and 12 normalized. Four segments worsened at rest and only four patients (15%) showed new perfusion defects at rest.


CONCLUSIONS
Myocardial perfusion with tetrofosmin might appear considerably worse at rest than at stress in patients with MI and NCA. Specifically, a reverse perfusion pattern in the infarct area is a frequent finding and is likely to be due to residual tissue viability. We postulate that in these patients the hyperemic response to exercise may mask resting underperfusion areas.
Division of Cardiology, University of Milano-Bicocca, Istituto Scientifico/Università H San Raffaele, Milano, Italy. fragasso.gabriele@hsr.it
Gabriele
G
Fragasso
Sergio L
SL
Chierchia
Flaviano
F
Dosio
Enrico
E
Rossetti
Luigi
L
Gianolli
Maria
M
Picchio
Alberto
A
Margonato
Ferruccio
F
Fazio
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D009336:Necrosis; D015588:Observer Variation; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D015899:Tomography, Emission-Computed, Single-Photon
D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C078700:technetium tc-99m tetrofosmin