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European Heart Journal 1988 9(10):1088-1097;
Copyright © 1988 by the European Society of Cardiology.
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© 1988 The European Society of Cardiology

Recovery of left ventricular function after myocardial infarction can be predicted immediately after thrombolysis by semiquantitative intracoronary thallium and technetium pyrophosphate scintigraphy

J. SCHOFER, F. H. SHEEHAN, R. SPIELMANN, J. WIEGAND, R. MONTZ, P. E. REIMITZ and D. G. MATHEY

Department of Cardiology, Nuclear Medicine and Biostatistics University Hospital Eppendorf Hamburg, F.R.G.
Cardiovascular Research and Training Center, University of Washington Seattle, U.S.A.

Received 31 December 1987; revised 24 March 1988; .

Address for correspondence Joachim Schofer, M.D, Department of Cardiology. University Hospital Eppendorf. Martinistr. 52, 2000 Hamburg 20. F.R.G.

Abstract

The accuracy with which intracoronary thallium and technetium pyrophosphate scintigraphy during intra-coronary thrombolysis predicts myocardial salvage was studied in 58 patients with acute myocardial infarction by comparing the acute scintigraphic findings with subsequent left ventricular function. Scintigrams obtained before and immediately after thrombolysis were interpreted by three independent observers using a scoring system. Regional wall motion in the infarct area was determined from left ventricular (LV) cine angiograms using the center-line method.

Patients with mild hypokinesis (hypokinesis ≤ –2 SD from normal) could be distinguished from those with severe hypokinesis (hypokinesis > – 2SD) using the prethrombolysis thallium score with an accuracy of 83%. Accuracy using the post-thrombolysis score was 76%. When the post-thrombolysis thallium and technetium pyrophosphate scores were combined, differentiation was possible in 91% of all patients studied, and in 100% of patients with anterior myocardial infarction.

Thus, analysis of combined thallium and technetium phyrophosphate scintigraphy accurately predicts recovery of LV function after thrombolysis and may be helpful in deciding whether acute percutaneous transluminal coronary angioplasty or bypass surgery should be performed after thrombolysis.

Key Words: LV function • i.c. thallium • scintigraphy • thrombolysis


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