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European Heart Journal 1996 17(6):951-961;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Morphological bases for thallium-201 uptake in cardiac imaging and correlates with myocardial blood flow distribution

R. De Maria*,, O. Parodi*, G. Baroldi*, G. Sambuceti*, R. Testa*, L. Oltrona{dagger}, M. Grassi{ddagger}, M. Parolini*, M. Barberis§, R. Sara, C. De Vita{dagger} and A. Pellegrini||

*C. N. R. Clinical Physiology Institute, Section of Milano Milano, Italy
{dagger}Department of Cardiology Milano, Italy
{ddagger}Anesthesiology Service Milano, Italy
§Institute of Pathology Milano, Italy
Nuclear Medicine Service Milano, Italy
||Cardiac Surgery Division Niguarda Hospital Milano, Italy

Received 10 November 1995; accepted 13 November 1995.

Correspondence: Renata De Maria, CNR Institute of Clinical Physiology-Section of Milan, Niguarda Hospital, Piazza Ospedale Maggiore, 3, 20162 Milano, italy

Abstract

To determine the morphological bases of thallium-201 myocardial distribution in chronic cardiac dysfunction and their relation to myocardial blood flow, myocardial slices from ten excised hearts of five chronic ischaemic heart disease patients and five idiopathic dilated cardiomyopathy patients, were imaged on a gamma camera to quantitate the uptake of thallium-201, injected 4h before surgery, and myocardial blood flow from distribution of technetium-99m-labelled human albumin microspheres injected during surgery. Tracer distribution was correlated with histologically assessed myocardial fibrosis and myocytolysis.

Thallium-201 uptake was inversely related to fibrosis (r= –0·73, in ischaemic heart disease, r= –0·65 in idiopathic dilated cardiomyopathy). In ischaemic heart disease, myocardial blood flow was related neither to thallium-201 uptake (r=–0·41) nor to the extent of fibrosis (r=–0·48). In this group, segments with normal or mildly reduced thallium-201 uptake showed significantly lower fibrosis than those with moderate or severe uptake defects (5±7% and 7±11% vs 33±14% and 42±12%, respectively, P<0·0001.

In a clinical model of chronic ischaemic dysfunction, despite severely depressed myocardial blood flow, extensive areas of myocardium devoid of significant structural impairment are present. Thallium-201 uptake effectively discriminates regions with preserved viability from those with relevant myocardial damage.

Key Words: Myocardial viability • radioisotopes • pathology • myocardial blood flow


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