(Circulation. 1995;91:1016-1021.)
© 1995 American Heart Association, Inc.
Articles |
Residual 201Tl Activity in Irreversible Defects as a Marker of Myocardial Viability
Clinicopathological Study
Presented in part at the 66th Scientific Sessions of the American Heart Association, Atlanta, Ga, November 8-11, 1993.
From the Department of Cardiology (R.Z., B.R., J.Z., W.K.), the Institute of Pathology (G.M., M.G.), the Institute for Forensic Medicine (G.Z.), and the Departments of Nuclear Medicine (B.B.) and Cardiac Surgery (S.H.), Ruprecht-Karls-University, Heidelberg, and the Department of Cardiology (H.T.), University of Gießen (Germany).
Correspondence to Rainer Zimmermann, MD, Department of Cardiology, Ruprecht-Karls-University, Bergheimer Str 58, D-69115 Heidelberg, FRG.
Background The objective of the present study was to characterize the relation between the residual 201Tl activity in irreversible perfusion defects and the extent of irreversible myocardial damage indicated by the volume fraction of myocardial interstitial fibrosis in patients with chronic coronary artery disease.
Methods and Results Stress planar 201Tl scintigraphy
with tracer reinjection at rest was performed in 37 patients with
75% stenosis of the left anterior descending coronary artery, and
anteroseptal 201TI activity was quantified by
computer-assisted placement of regions of interest from the serial
myocardial images. During coronary artery bypass grafting (performed
within 6±3 weeks after scintigraphy), two transmural biopsy specimens
were taken from the anterior wall of the left ventricle and the amount
of interstitial fibrosis was assessed by use of light microscopic
morphometry. A wide spectrum of interstitial fibrosis was obtained,
ranging from 15 vol% to 60 vol%. Interstitial fibrosis was similar in
patients with reversible (n=11) or irreversible (n=15) tracer
defects
in conventional stress-redistribution images. However, interstitial
fibrosis was significantly lower in patients who had enhanced regional
201Tl activity after tracer reinjection compared with those
who did not have enhancement of tracer activity after reinjection
(28±8 vol%, n=7, versus 41±12 vol%, n=8;
P=.031). The
correlation between relative poststenotic 201Tl activity
and interstitial fibrosis after tracer reinjection was significantly
improved compared with conventional redistribution images
(r=-.622 versus r=-.851,
n=15;
P<.01).
Conclusions The present data demonstrate that the level of regional 201Tl activity in redistribution and, in particular, reinjection images is significantly related to the mass of preserved viable myocytes in poststenotic left ventricular myocardium. Therefore, the residual 201Tl activity provides information about viability within irreversible perfusion defects and may itself serve as marker of myocardial viability.
Key Words: coronary disease • myocardium • imaging • stenosis
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