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Myocardial kinetics of technetium-99m teboroxime in the presence of postischemic injury, necrosis and low flow reperfusion.

Abstract：

OBJECTIVES:This study evaluated technetium-99m (Tc-99m) teboroxime kinetics in postischemic and partially necrotic myocardium with complete and low flow reperfusion using an isolated perfused rat heart model. BACKGROUND:Technetium-99m teboroxime has been proposed for use in the early diagnosis of reperfusion after thrombolysis on the basis of models of myocardial necrosis with complete reperfusion. Clinically, however, reperfusion is frequently incomplete, resulting in a mixture of necrotic, ischemic and postischemic tissue. METHODS:Hearts were classified into five groups: group 1 (n = 8, control); group 2 (n = 7, 30 min of no flow with complete reperfusion); group 3 (n = 12, 60 min of no flow to induce partial necrosis, followed by complete reperfusion); group 4 (n = 8, continuous low flow without flow interruption); and group 5 (n = 9, 60 min of no flow with low flow reperfusion). Buffer containing Tc-99m teboroxime was perfused for 15 min, followed by tracerfree buffer for 35 min, to evaluate uptake and clearance, respectively. RESULTS:Uptake slopes for groups 1 to 5 were (mean +/- SD) 3.0 +/- 0.7, 2.6 +/- 0.8, 2.1 +/- 0.5, 0.8 +/- 0.2 and 0.8 +/- 0.3, respectively (p < or = 0.0005 for groups 1, 2 and 3 vs. groups 4 and 5, and p = 0.003 for group 3 vs. groups 1 and 2). Clearance curves from groups 1 to 3 were best fit by a biexponential function (p < 0.001); those from groups 4 and 5 were monoexponential. In groups 1, 2 and 3, the initial clearance rate constants (ki) (0.9 +/- 0.5 x 10(-3); 1.0 +/- 0.2 x 10(-3); 1.1 +/- 0.5 x 10(-3) s-1, respectively) and the monoexponential rate constants (Kmono) (2.0 +/- 0.3 x 10(-4); 2.2 +/- 0.4 x 10(-4); 2.1 +/- 0.2 x 10(-4) s-1, respectively) were significantly greater than those in groups 4 and 5 (0.9 +/- 0.5 x 10(-4); 1.2 +/- 0.3 x 10(-4) s-1, respectively, p < or = 0.005). CONCLUSIONS:The uptake and initial clearance kinetics of Tc-99m teboroxime depend mainly on myocardial flow in this model. The presence of partial necrosis and postischemic injury has little effect on the initial clearance but leads to some reduction in uptake at normal flow rates. Evaluation of Tc-99m teboroxime kinetics may permit early noninvasive detection of inadequate reperfusion in acute myocardial infarction.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Beanlands RS,DeKemp RA,Harmsen E,Veinot JP,Hartman NG,Ruddy TD

doi

10.1016/0735-1097(96)00159-3

subject

Has Abstract

pub_date

1996-08-01 00:00:00

pages

487-94

issue

eissn

0735-1097

issn

1558-3597

pii

0735-1097(96)00159-3

journal_volume

pub_type

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Myocardial kinetics of technetium-99m teboroxime in the presence of postischemic injury, necrosis and low flow reperfusion.