Document Detail

Validation of technetium-99m stannous pyrophosphate myocardial scintigraphy for diagnosing acute myocardial infarction more than 48 hours old when serum creatine kinase-MB has returned to normal.
MedLine Citation:
PMID:  6869268     Owner:  NLM     Status:  MEDLINE    
Determination of lactic dehydrogenase (LDH) isoenzymes is the current method of choice for diagnosing acute myocardial infarction (AMI) greater than 48 hours old. However, other causes of enzyme elevation make the availability of an alternate method of diagnosis worthwhile. Accordingly, serial technetium-99m pyrophosphate scintigrams were obtained in 61 patients with transmural AMI and in 46 patients with subendocardial AMI. Imaging was performed in all 107 patients at the time creatine kinase isoenzyme (CK-MB) was present 37 +/- 18 hours (range 12 to 72) after the onset of AMI, and at the time CK-MB was absent 106 +/- 34 hours (range 48 to 168) after the onset of AMI. At the time CK-MB was absent, the sensitivity using either a regional or a diffuse positive scintigram was 95% (58 of 61 patients) for transmural AMI and 65% (30 of 46 patients) for subendocardial AMI. The sensitivity using a regional positive scintigram was 82% (50 of 61 patients) for transmural AMI and 37% (17 of 46 patients) for subendocardial AMI. The sensitivity using a high-grade regional positive scintigram was 36% (22 of 61 patients) for transmural AMI and 11% (5 of 46 patients) for subendocardial AMI. The specificity was 70% (143 of 204 patients) for either a regional or a diffuse abnormality, 92% (187 of 204 patients) for a regional abnormality, and 100% (204 of 204 patients) for a high-grade regional abnormality. Thus, pyrophosphate scintigraphy is useful in confirming the diagnosis of AMI, particularly transmural, greater than 48 hours old and when CK-MB has returned to normal. A positive scintigram with a high-grade regional abnormality is specific for a recent AMI and may be contributory in establishing the diagnoses when LDH isoenzymes are inconclusive.
H G Olson; K P Lyons; S Butman; K M Piters
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  52     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1983 Aug 
Date Detail:
Created Date:  1983-08-26     Completed Date:  1983-08-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  245-51     Citation Subset:  AIM; IM    
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MeSH Terms
Creatine Kinase / blood
Middle Aged
Myocardial Infarction / blood,  enzymology,  radionuclide imaging*
Polyphosphates / diagnostic use*
Technetium / diagnostic use*
Technetium Tc 99m Pyrophosphate*
Time Factors
Tin Polyphosphates / diagnostic use*
Reg. No./Substance:
0/Isoenzymes; 0/Polyphosphates; 0/Technetium Tc 99m Pyrophosphate; 0/Tin Polyphosphates; 54627-10-0/technetium Tc 99m stannous pyrophosphate; 7440-26-8/Technetium; EC Kinase

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