Antimyosin imaging in acute transmural myocardial infarctions: Results of a multicenter clinical trial

Lynne L. Johnson, David W. Seldin, Lewis C. Becker, Norman D. Lafrance, Henry A. Liberman, Christopher James, Jeffrey A. Mattis, Richard T. Dean, John Brown, Andrew Reiter, Valerie Arneson, Paul J. Cannon, Harvey J. Berger

Research output: Contribution to journalArticle

Abstract

Murine monoclonal antimyosin antibody has been shown experimentally to bind selectively to irreversibly damaged myocytes. To evaluate the safety and efficacy of monoclonal antimyosin for identifying acute transmural infarction, 50 patients with acute Q wave myocardial infarction were entered into a phase I/II multicenter trial involving three clinical sites. Indium-111 antimyosin was prepared from an instant kit formulation containing 0.5 mg of diethylene triamine pentaacetic acid (DTPA)-coupled Fab fragment (R11D10) and 1.2 to 2.4 mCi of indium-111. Average labeling efficiency was 92%. Antimyosin was injected 27 ± 16 h after the onset of chest pain. Planar or tomographic imaging was performed 27 ± 9 h after injection in all patients, and repeat imaging was done 24 h later in 39 patients. Of the 50 patients entered, 46 showed myocardial uptake of antimyosin (sensitivity 92%). Thirty-one of 39 planar scans performed at 24 h were diagnostic; 8 showed persistent blood pool activity that cleared by 48 h. Focal myocardial uptake of antimyosin corresponded to electrocardiographic infarct localization. No patient had an adverse reaction to antimyosin. In addition, 125 serum samples, including 21 collected >42 days after injection, were tested for human antimouse antibodies, and all samples were assessed as having undetectable titers. Intensity of antimyosin uptake was correlated with infarct location and the presence or absence of collateral vessels. There was a significant correlation between faint uptake and inferoposterior infarct location. In 21 patients who had coronary angiography close to the time of antimyosin injection, there was a significant correlation between faint tracer uptake and closed infarct-related vessel with absent collateral flow. All six patients with successful reperfusion had intense antimyosin uptake, but two with unsuccessful attempts also had intense uptake. In summary, indium-111 antimyosin scintigraphy is a safe and sensitive method for detecting and localizing acute transmural infarction.

Original languageEnglish (US)
Pages (from-to)27-35
Number of pages9
JournalJournal of the American College of Cardiology
Volume13
Issue number1
DOIs
StatePublished - Jan 1989

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Johnson, L. L., Seldin, D. W., Becker, L. C., Lafrance, N. D., Liberman, H. A., James, C., Mattis, J. A., Dean, R. T., Brown, J., Reiter, A., Arneson, V., Cannon, P. J., & Berger, H. J. (1989). Antimyosin imaging in acute transmural myocardial infarctions: Results of a multicenter clinical trial. Journal of the American College of Cardiology, 13(1), 27-35. https://doi.org/10.1016/0735-1097(89)90544-5