Dual isotope thallium and indium antimyosin SPECT imaging to identify acute infarct patients at further ischemic risk

Lynne L. Johnson, David W. Seldin, Andrew M. Keller, Robert M. Wall, Ketan Bhatia, Clifton Bingham, Mary E. Tresgallo

Research output: Contribution to journalArticle

Abstract

Forty-two patients (28 men and 14 women) with acute myocardial infarction (35 Q, seven non-Q wave) were injected with 2.0 mCi indium 111-labeled antimyosin (AM) monoclonal antibody (111In AM) within 48 hours of the onset of chest pain. Forty-eight hours later (72-96 hours after onset of chest pain), patients were injected with 2.2 mCi thallium 201, and two sets of single-photon emission computed tomography (SPECT) images were obtained simultaneously using dual energy windows set for the 247 keV indium photopeak and the 70 keV thallium peak. Seventeen patients had repeat scans at 4 hours. 111In AM uptake and 201Tl defects were localized to one or more of 24 coronal and sagittal segments. Scans with only 201Tl defects and corresponding 111In AM uptake were classified as matches; scans with unmatched 201Tl defects in addition to matching regions corresponding to electrocardiographic infarct location were classified as mismatches; and scans with 201Tl and 111In AM uptake in the same segments were classified as overlap. Scan patterns were correlated with clinical evidence for residual ischemia occurring within 6 weeks of infarct and including infarct extension, recurrent angina, and positive predischarge low-level or 6-week symptom-limited stress tests and with coronary anatomy. Fourteen patients had only matching patterns (group 1), 23 had mismatches (group 2), and five had 201Tl-111In overlap as the predominant pattern. None of the patients in group 1 had previous myocardial infarction; in each, the matched area corresponded to the Q wave location on electrocardiogram, and none had further in-hospital ischemic events or positive stress tests. In contrast, nine patients in group 2 had previous myocardial infarction, and 16 of the 23 went on to have further evidence of ischemia. There was a significant correlation between further ischemic events and mismatching 201Tl-111In AM activity (p201Tl and 111In AM, performed 72-96 hours postinfarct, might be useful for identifying patients with benign in-hospital courses and those with myocardium at further ischemic risk.

Original languageEnglish (US)
Pages (from-to)37-45
Number of pages9
JournalCirculation
Volume81
Issue number1
StatePublished - Jan 1990
Externally publishedYes

Fingerprint

Thallium
Single-Photon Emission-Computed Tomography
Isotopes
Myocardial Infarction
Chest Pain
Exercise Test
Ischemia
Indium
imciromab pentetate
Anatomy
Myocardium
Electrocardiography
Monoclonal Antibodies

Keywords

  • Antimyosin
  • Indium
  • Monoclonal antibodies
  • Myocardial infarction
  • Thallium
  • Tomography

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Johnson, L. L., Seldin, D. W., Keller, A. M., Wall, R. M., Bhatia, K., Bingham, C., & Tresgallo, M. E. (1990). Dual isotope thallium and indium antimyosin SPECT imaging to identify acute infarct patients at further ischemic risk. Circulation, 81(1), 37-45.

Dual isotope thallium and indium antimyosin SPECT imaging to identify acute infarct patients at further ischemic risk. / Johnson, Lynne L.; Seldin, David W.; Keller, Andrew M.; Wall, Robert M.; Bhatia, Ketan; Bingham, Clifton; Tresgallo, Mary E.

In: Circulation, Vol. 81, No. 1, 01.1990, p. 37-45.

Research output: Contribution to journalArticle

Johnson, LL, Seldin, DW, Keller, AM, Wall, RM, Bhatia, K, Bingham, C & Tresgallo, ME 1990, 'Dual isotope thallium and indium antimyosin SPECT imaging to identify acute infarct patients at further ischemic risk', Circulation, vol. 81, no. 1, pp. 37-45.
Johnson, Lynne L. ; Seldin, David W. ; Keller, Andrew M. ; Wall, Robert M. ; Bhatia, Ketan ; Bingham, Clifton ; Tresgallo, Mary E. / Dual isotope thallium and indium antimyosin SPECT imaging to identify acute infarct patients at further ischemic risk. In: Circulation. 1990 ; Vol. 81, No. 1. pp. 37-45.
@article{e4d6ccb70b8049b8897885d5bf20fa58,
title = "Dual isotope thallium and indium antimyosin SPECT imaging to identify acute infarct patients at further ischemic risk",
abstract = "Forty-two patients (28 men and 14 women) with acute myocardial infarction (35 Q, seven non-Q wave) were injected with 2.0 mCi indium 111-labeled antimyosin (AM) monoclonal antibody (111In AM) within 48 hours of the onset of chest pain. Forty-eight hours later (72-96 hours after onset of chest pain), patients were injected with 2.2 mCi thallium 201, and two sets of single-photon emission computed tomography (SPECT) images were obtained simultaneously using dual energy windows set for the 247 keV indium photopeak and the 70 keV thallium peak. Seventeen patients had repeat scans at 4 hours. 111In AM uptake and 201Tl defects were localized to one or more of 24 coronal and sagittal segments. Scans with only 201Tl defects and corresponding 111In AM uptake were classified as matches; scans with unmatched 201Tl defects in addition to matching regions corresponding to electrocardiographic infarct location were classified as mismatches; and scans with 201Tl and 111In AM uptake in the same segments were classified as overlap. Scan patterns were correlated with clinical evidence for residual ischemia occurring within 6 weeks of infarct and including infarct extension, recurrent angina, and positive predischarge low-level or 6-week symptom-limited stress tests and with coronary anatomy. Fourteen patients had only matching patterns (group 1), 23 had mismatches (group 2), and five had 201Tl-111In overlap as the predominant pattern. None of the patients in group 1 had previous myocardial infarction; in each, the matched area corresponded to the Q wave location on electrocardiogram, and none had further in-hospital ischemic events or positive stress tests. In contrast, nine patients in group 2 had previous myocardial infarction, and 16 of the 23 went on to have further evidence of ischemia. There was a significant correlation between further ischemic events and mismatching 201Tl-111In AM activity (p201Tl and 111In AM, performed 72-96 hours postinfarct, might be useful for identifying patients with benign in-hospital courses and those with myocardium at further ischemic risk.",
keywords = "Antimyosin, Indium, Monoclonal antibodies, Myocardial infarction, Thallium, Tomography",
author = "Johnson, {Lynne L.} and Seldin, {David W.} and Keller, {Andrew M.} and Wall, {Robert M.} and Ketan Bhatia and Clifton Bingham and Tresgallo, {Mary E.}",
year = "1990",
month = "1",
language = "English (US)",
volume = "81",
pages = "37--45",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Dual isotope thallium and indium antimyosin SPECT imaging to identify acute infarct patients at further ischemic risk

AU - Johnson, Lynne L.

AU - Seldin, David W.

AU - Keller, Andrew M.

AU - Wall, Robert M.

AU - Bhatia, Ketan

AU - Bingham, Clifton

AU - Tresgallo, Mary E.

PY - 1990/1

Y1 - 1990/1

N2 - Forty-two patients (28 men and 14 women) with acute myocardial infarction (35 Q, seven non-Q wave) were injected with 2.0 mCi indium 111-labeled antimyosin (AM) monoclonal antibody (111In AM) within 48 hours of the onset of chest pain. Forty-eight hours later (72-96 hours after onset of chest pain), patients were injected with 2.2 mCi thallium 201, and two sets of single-photon emission computed tomography (SPECT) images were obtained simultaneously using dual energy windows set for the 247 keV indium photopeak and the 70 keV thallium peak. Seventeen patients had repeat scans at 4 hours. 111In AM uptake and 201Tl defects were localized to one or more of 24 coronal and sagittal segments. Scans with only 201Tl defects and corresponding 111In AM uptake were classified as matches; scans with unmatched 201Tl defects in addition to matching regions corresponding to electrocardiographic infarct location were classified as mismatches; and scans with 201Tl and 111In AM uptake in the same segments were classified as overlap. Scan patterns were correlated with clinical evidence for residual ischemia occurring within 6 weeks of infarct and including infarct extension, recurrent angina, and positive predischarge low-level or 6-week symptom-limited stress tests and with coronary anatomy. Fourteen patients had only matching patterns (group 1), 23 had mismatches (group 2), and five had 201Tl-111In overlap as the predominant pattern. None of the patients in group 1 had previous myocardial infarction; in each, the matched area corresponded to the Q wave location on electrocardiogram, and none had further in-hospital ischemic events or positive stress tests. In contrast, nine patients in group 2 had previous myocardial infarction, and 16 of the 23 went on to have further evidence of ischemia. There was a significant correlation between further ischemic events and mismatching 201Tl-111In AM activity (p201Tl and 111In AM, performed 72-96 hours postinfarct, might be useful for identifying patients with benign in-hospital courses and those with myocardium at further ischemic risk.

AB - Forty-two patients (28 men and 14 women) with acute myocardial infarction (35 Q, seven non-Q wave) were injected with 2.0 mCi indium 111-labeled antimyosin (AM) monoclonal antibody (111In AM) within 48 hours of the onset of chest pain. Forty-eight hours later (72-96 hours after onset of chest pain), patients were injected with 2.2 mCi thallium 201, and two sets of single-photon emission computed tomography (SPECT) images were obtained simultaneously using dual energy windows set for the 247 keV indium photopeak and the 70 keV thallium peak. Seventeen patients had repeat scans at 4 hours. 111In AM uptake and 201Tl defects were localized to one or more of 24 coronal and sagittal segments. Scans with only 201Tl defects and corresponding 111In AM uptake were classified as matches; scans with unmatched 201Tl defects in addition to matching regions corresponding to electrocardiographic infarct location were classified as mismatches; and scans with 201Tl and 111In AM uptake in the same segments were classified as overlap. Scan patterns were correlated with clinical evidence for residual ischemia occurring within 6 weeks of infarct and including infarct extension, recurrent angina, and positive predischarge low-level or 6-week symptom-limited stress tests and with coronary anatomy. Fourteen patients had only matching patterns (group 1), 23 had mismatches (group 2), and five had 201Tl-111In overlap as the predominant pattern. None of the patients in group 1 had previous myocardial infarction; in each, the matched area corresponded to the Q wave location on electrocardiogram, and none had further in-hospital ischemic events or positive stress tests. In contrast, nine patients in group 2 had previous myocardial infarction, and 16 of the 23 went on to have further evidence of ischemia. There was a significant correlation between further ischemic events and mismatching 201Tl-111In AM activity (p201Tl and 111In AM, performed 72-96 hours postinfarct, might be useful for identifying patients with benign in-hospital courses and those with myocardium at further ischemic risk.

KW - Antimyosin

KW - Indium

KW - Monoclonal antibodies

KW - Myocardial infarction

KW - Thallium

KW - Tomography

UR - http://www.scopus.com/inward/record.url?scp=0025166490&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025166490&partnerID=8YFLogxK

M3 - Article

C2 - 2297842

AN - SCOPUS:0025166490

VL - 81

SP - 37

EP - 45

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 1

ER -