Document Detail

Evaluation of no-reflow phenomenon using 201TlCl/123I-BMIPP dual-isotope myocardial SPECT.
MedLine Citation:
PMID:  17106176     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We assessed the usefulness of (201)thallous chloride (TlCl)/(123)I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) dual-isotope single-photon emission computed tomography (SPECT) to identify the "no-reflow phenomenon," defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction.
METHODS: (201)TlCl/(123)I-BMIPP SPECT was performed in 73 patients within approximately 1 week of initial acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). We divided the left ventricular myocardium into 17 segments on each SPECT image and scored tracer accumulation in each segment with a five-point scoring system according to the American Heart Association criteria. Total severity scores were calculated by summing the scores for all 17 segments. The mismatch ratio between myocardial perfusion and metabolism was derived from the (201)TlCl and (123)I-BMIPP total severity scores: mismatch ratio=((123)I-BMIPP total severity score -(201)TlCl total severity score)/(123)I-BMIPP total severity score. Patients were classified according to Thrombolysis in Myocardial Infarction (TIMI) flow grade as having TIMI reflow grade 0-I (TIMI 0-I reflow group; n=11), II (TIMI II reflow group; n=17) and III (TIMI III reflow group; n=45). The TIMI III reflow group was subdivided into two groups with (201)TlCl total severity scores of < or =13 (TIMI III (A) reflow group; n=36) and > or =14 (TIMI III (B) reflow group; n=9), respectively.
RESULTS: The mismatch ratios in the TIMI II (0.4 +/- 0.3) and TIMI III (0.4 +/- 0.2) reflow groups were significantly higher than that in the TIMI 0-1 reflow group (0.1 +/- 0.1, p<0.05). Although coronary angiography revealed TIMI III flow after reperfusion, the mismatch ratios in the TIMI III (B) reflow group (0.2 +/- 0.1) and in the TIMI 0-I reflow group (0.1 +/- 0.1) were significantly lower than that in the TIMI III (A) reflow group (0.4 +/- 0.2, p<0.01), reflecting noneffective recanalization (so called no-reflow phenomenon).
CONCLUSION: (201)TlCl/(123)I-BMIPP dual-isotope myocardial SPECT reveals the biochemical degree of the no-reflow phenomenon, whereas coronary angiography shows recanalized vascular flow only. Dual-isotope myocardial SPECT might be useful for evaluating reperfusion therapy.
Yasuhiro Shimizu; Shin-ichiro Kumita; Keiichi Cho; Masahiro Toba; Sunao Mizumura; Keiji Tanaka; Teruo Takano; Tatsuo Kumazaki
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of Nippon Medical School = Nippon Ika Daigaku zasshi     Volume:  73     ISSN:  1345-4676     ISO Abbreviation:  J Nippon Med Sch     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-11-19     Completed Date:  2007-02-09     Revised Date:  2012-09-25    
Medline Journal Info:
Nlm Unique ID:  100935589     Medline TA:  J Nippon Med Sch     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  258-64     Citation Subset:  IM    
Department of Clinical Radiology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
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MeSH Terms
Aged, 80 and over
Coronary Angiography
Coronary Circulation / physiology*
Fatty Acids / diagnostic use*
Iodine Radioisotopes / diagnostic use*
Iodobenzenes / diagnostic use*
Middle Aged
Myocardial Infarction / physiopathology,  radionuclide imaging*
Thallium / diagnostic use*
Thallium Radioisotopes / diagnostic use*
Tomography, Emission-Computed, Single-Photon / methods*
Reg. No./Substance:
0/Fatty Acids; 0/Iodine Radioisotopes; 0/Iodobenzenes; 0/Thallium Radioisotopes; 116754-87-1/iodofiltic acid; 7440-28-0/Thallium; 7791-12-0/thallium chloride

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