Contradictory data have been published on the relative behaviour of fatty acids and flow tracers during the subacute stage of myocardial infarction. Therefore, the present study was set up (1) to investigate the potential occurrence of mismatches between beta-methyl-iodo-phenyl pentadecanoic acid (BMIPP), a fatty acid analogue, and Sestamibi, and to describe their nature, and (2) to relate these mismatches to clinical characteristics such as whether or not thrombolysis or percutaneous transluminal coronary angioplasty (PTCA) had been performed. Twenty-six patients were studied within 2 weeks after myocardial infarction. Sestamibi and BMIPP single-photon emission tomography (SPET) were performed within 4 days of one another. Activity of both tracers was scored in 16 basal, 16 midventricular and 8 apical segments, using a four-point grading system: 3 = normal (> or = 65% of maximum activity), 2 = mildly decreased (45%-64%), 1 = moderately decreased (25%-44%), 0 = severely decreased (0%-24%). Coronary arteriography was obtained during the same hospital stay. Four hundred and seventy-seven segments out of 1040 studied were abnormal for at least one tracer: 197 with higher Sestamibi activity (group I), 226 with equal scores for Sestamibi and BMIPP (group II) and 54 with higher BMIPP activity (group III). Seventy-five percent of group I segments and 84% of group III segments were found in infarct-related artery territories. Group I segments were associated with acute thrombolysis and/or PTCA (P < 0.01), and with the absence of prior infarction in the territory of the infarct-related artery (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗

PubMed1994

Abnormal free fatty acid uptake in subacute myocardial infarction after coronary thrombolysis: correlation with wall motion and inotropic reserve.

UNLABELLED: Iodine-123-free fatty acid analogs, such as beta-methyliodophenylpentadecanoic acid (BMIPP), allow for myocardial metabolic studies with SPECT. The goal of this investigation was to determine whether BMIPP uptake can be used to differentiate viable myocardium from scar tissue soon after coronary thrombolysis for acute myocardial infarction. METHODS: BMIPP and 99mTc-sestamibi (MIBI) myocardial distribution after injection at rest were analyzed in 22 patients 4 to 10 days after coronary thrombolysis. The relative uptake of the two tracers was compared on a segmental basis to the regional wall motion and to the inotropic reserve assessed by two-dimensional echocardiography and low-dose dobutamine stimulation. RESULTS: Three segmental patterns were identified in the infarct-related coronary artery territory. Segments with normal BMIPP and MIBI uptake showed normal wall motion. Segments with more reduced BMIPP uptake than MIBI uptake (mismatching) showed either normal wall motion or demonstrated inotropic reserve during dobutamine stimulation. Segments with matched defects always showed abnormal wall motion and did not demonstrate inotropic reserve, regardless of the MIBI uptake. CONCLUSION: In patients with subacute myocardial infarction, combined imaging of BMIPP and MIBI at rest might be more sensitive than MIBI or wall motion at rest alone to demonstrate myocardial areas that have been acutely ischemic. Mismatching is due to more severely depressed fatty acid metabolism than expected on the basis of the flow and is indicative of jeopardized, but viable myocardium. In dysfunctional segments, mismatching may correspond either to stunned or to hibernating myocardium. Matched defects are associated with scar tissue.

Coronary Angiography↗

PubMed1994

Assessment of myocardial viability by sestamibi scintigraphy.

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Heart↗

PubMed1993

Regional distribution of 123I-(ortho-iodophenyl)-pentadecanoic acid and 99Tcm-MIBI in relation to wall motion after thrombolysis for acute myocardial infarction.

To characterize the myocardium after thrombolytic therapy for infarction single photon emission computed tomographic (SPECT) studies with 123I-(ortho-iodophenyl)-pentadecanoic acid (oPPA) and 99Tcm-methoxyisobutyl isonitrile (MIBI) were obtained at rest in nine patients within a fortnight after the acute event. A decreased oPPA activity compared to MIBI was observed in 15/45 segments (7/9 patients). The segments with discordant oPPA/MIBI activities showed less severe wall motion abnormalities than the segments with concordant decreased oPPA and MIBI activities (P = 0.004). A significant association was found between discordant oPPA/MIBI activities and the early evolution of wall motion following thrombolysis: discordant oPPA/MIBI activities were present in nine of the 11 segments (82%) with improved wall motion, while the wall motion of the seven segments with similar decreased oPPA and MIBI activities was unchanged or had deteriorated (P = 0.018). It is concluded that metabolic abnormalities often persist longer than perfusion and wall motion abnormalities soon after thrombolysis, and that 123I-oPPA in combination with 99Tcm-MIBI is useful to demonstrate myocardial areas which have been salvaged by thrombolysis.

Aged↗

PubMed1993

Femoral periosteal thickening in pustulotic arthroosteitis, including 3-year followup by magnetic resonance imaging.

We describe 2 female patients with femoral periosteal thickening, in association with signs of pustulotic arthroosteitis in the sternocostoclavicular region and spine. In one patient, inflammatory changes were seen in muscular tissue surrounding this area of periosteal thickening, with fibrosis in the corresponding marrow. Over a period of up to 4 years after bone biopsy, cortical hyperostosis was observed spreading over a longer segment of her femoral diaphysis, while its thickness decreased over the longterm. Bone biopsy probably contributed to the striking periosteal thickening surrounded by inflammatory lesions in the surrounding muscles of this patients.

Adult↗

PubMed1993