Circulation, Vol 64, 610-618, Copyright © 1981 by American Heart Association
AM Grunwald, DD Watson, HH Holzgrefe Jr, JF Irving and GA Beller
The initial myocardial uptake of thallium-201 depends on myocardial blood
flow distribution. The phenomenon of delayed thallium redistribution after
transiently or chronically altered myocardial perfusion has been described.
The net myocardial accumulation of thallium-201 after injection depends
upon the net balance between continuing myocardial extraction from low
levels of recirculating thallium in the blood compartment and the net rate
of efflux of thallium from the myocardium into the extracardiac blood pool.
These experiments were designed to measure separately the myocardial
extraction and intrinsic myocardial efflux of thallium-201 at normal and at
reduced rates of myocardial blood flow. The average myocardial extraction
fraction at normal blood flow in 10 anesthetized dogs was 82 +/- 6% (+/-
SD) at normal coronary arterial perfusion pressures and increased
insignificantly, to 85 +/- 7%, at coronary perfusion pressures of 10--35 mm
Hg. At normal coronary arterial perfusion pressures in 12 additional dogs,
the intrinsic thallium washout in the absence of systemic recirculation had
a half-time (T 1/2) of 54 +/- 7 minutes. The intrinsic cellular washout
rate began to increase as distal perfusion pressures fell below 60 mm Hg
and increased markedly to a T 1/2 of 300 minutes at perfusion pressures of
25--30 mm Hg. A second, more rapid component of intrinsic thallium washout
(T 1/2 2.5 minutes) representing approximately 7% of the total initially
extracted myocardial thallium was observed. The faster washout component is
presumed to be due to washout of interstitial thallium unextracted by
myocardial cells, whereas the slower component is presumed due to
intracellular washout. The net clearance time of thallium measured after
i.v. injection is much longer than the intrinsic myocardial cellular
washout rate because of continuous replacement of myocardial thallium from
systemic recirculation. Myocardial redistribution of thallium-201 in states
of chronically reduced perfusion cannot be the result of increased
myocardial extraction efficiency, but rather, is the result of the slower
intrinsic cellular washout rate at reduced perfusion levels.
ARTICLES
Myocardial thallium-201 kinetics in normal and ischemic myocardium
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