[Myocardial contractility and viability. A radionuclide tomography study using technetium-99m labeled isonitriles]. / Contractilidad y viabilidad miocárdicas. Estudio mediante tomogammagrafía con isonitrilos marcados con tecnecio-99m.

BACKGROUND: There are comparatively few studies evaluating the patterns of myocardial viability and its relation with contractility in patients with coronary artery disease. The aim of the present study was to quantify the viable and nonviable myocardium, using 99m-technetium isonitriles SPET, as related with left ventricular regional wall motion abnormalities. METHOD: 61 consecutive patients with coronary artery disease were investigated. The severity and extension of the defects were evaluated using a qualitative and quantitative analysis of the 99mTc-isonitriles SPET and compared with ventricular wall motion in contrast ventriculography. An uptake level of 40% of peak uptake or higher was considered as indicating viable myocardium. RESULTS: Of the 244 evaluated regions (4 per patient), 72 (29%) had normal perfusion, 100 (41%) were ischemic, 25 (10%) had a mild irreversible defect and 47 (19%) had a severe irreversible defect. Wall motion was normal in 176 regions (72%), 29 (12%) were hypokinetic, and 39 (16%) were akinetic of dyskinetic. The amount of viable myocardium in akinetic and dyskinetic regions (64.8%) was significantly different (p < 0.05) from that in hypokinetic (86.1%) and normokinetic (98.8%) regions. Visual assessment of uptake underestimated myocardial viability, as quantitative analysis disclosed that in 61% of akinetic and dyskinetic regions with severe irreversible defects there was more than 50% of viable myocardium. CONCLUSIONS: In 61% of akinetic and dyskinetic regions with a severe irreversible defect in perfusion scintigraphy positive viability criteria were found. Therefore, visual assessment of the myocardial perfusion studies using 99mTc-MIBI SPET underestimates viable myocardium. Tomographic studies with quantification of the uptake and defect extension are required for a proper evaluation of viable myocardium.

Radiopharmacological studies of 99mTc-CPI: experience with isolated rat atrial tissue.

Extraction, washout and chemical integrity of technetium(I) hexakis (2-carbomethoxy-2-isocyano propane), (99mTc-CPI) were evaluated in isolated contractile rat atrial tissue. 99mTc-CPI accumulated linearly over time at 32 degrees C with uptakes that were both concentration dependent and temperature sensitive. Uptake rates also increased with contractile strength, indicating a dependence of retention on metabolic status of the tissue. Retention indices showed that percent washout of 99mTc-CPI was much slower than control studies with 99mTcO4. HPLC analysis of retained radioactive products in atrial tissue showed most of the activity present as the 99mTc-CPI complex (75%). These observations in isolated rat atrial tissue help explain the interspecies differences in biodistribution of 99mTc-CPI and support the membrane potential dependent model for uptake and retention of technetium isonitrile complexes.