Evaluation of salvaged myocardium after acute myocardial infarction using single photon emission computed tomography after 201Tl-glucose-insulin infusion.
BACKGROUND
GIK-201Tl imaging reportedly improves the detection of viable myocardium, so the present study evaluated whether it can detect myocardial viability after acute myocardial infarction (AMI).


RESULTS
Resting 201Tl and 99mTc-pyrophosphate (PYP) dual single photon emission computed tomography (SPECT) and 201Tl SPECT after 201Tl with GIK (10% glucose, insulin 5 U, and KCl 10 mmol) infusion (GIK-201Tl) were performed in 25 AMI patients within 10 days of admission. GIK-201Tl SPECT images were obtained immediately and 4 h after infusion. Left ventriculography (LVG) was performed within 3 weeks and at 6 months when follow-up 201Tl SPECT was also performed. From 20 SPECT segments, both the summed defect score (RDS) and the number of defect segments (ES) were calculated. The infarcted area was defined as 99mTc-PYP uptake segments. Wall motion was estimated in 7 LVG segments. The ES of R-201Tl (5.5 +/- 2.8), immediate GIK-201Tl (4.0 +/- 2.3), and 4-h GIK-201Tl (5.6 +/- 2.7) were lower than that of 99mTc-PYP (7.5 +/- 4.1) (p<0.05), and the ES had significantly declined 6 months later on 201Tl (3.5 +/- 2.8) (p<0.05). Although the RDS of R-201Tl (11.3 +/- 7.9) and 4-h GIK-201Tl (11.2 +/- 6.3) were greater than at the 6-month 201Tl (7.1 +/- 6.5), immediate GIK-201Tl (7.4 +/- 6.5) was equivalent to follow-up 201Tl. The sensitivity of immediate GIK-201Tl was highest among the imaging methods.


CONCLUSIONS
To detect myocardial viability after AMI, early imaging with GIK-201Tl is more useful than resting 201Tl imaging.
Toyama
Takuji
T
Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Hoshizaki
Hiroshi
H
Seki
Ryotaro
R
Isobe
Naoki
N
Adachi
Hitoshi
H
Naito
Shigeto
S
Oshima
Shigeru
S
Taniguchi
Koichi
K
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015637:Gated Blood-Pool Imaging; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D017682:Myocardial Stunning / Q000000981:diagnostic imaging* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D011188:Potassium / Q000008:administration & dosage / Q000009:adverse effects; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012146:Rest; D015607:Stents; D016698:Technetium Tc 99m Pyrophosphate; D013794:Thallium Radioisotopes / Q000008:administration & dosage; D015899:Tomography, Emission-Computed, Single-Photon
D002314:Cardioplegic Solutions; D007328:Insulin; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; C030396:glucose-insulin-potassium cardioplegic solution; D016698:Technetium Tc 99m Pyrophosphate; D005947:Glucose; D011188:Potassium