DEMONSTRATION OF VIABLE, STUNNED MYOCARDIUM WITH TECHNETIUM-99M-SESTAMIBI

Delayed improvement of left ventricular contractile function in the se tting of acute ischemia followed by reperfusion (''stunned myocardium' ') has been observed in a number of clinical scenarios, and may have i mportant clinical implications. At present, there are no widely accept ed techniques available to demonstrate its presence. We report a case in which a rest Tc-99m-sestamibi scan performed 12 hr after thrombolyt ic therapy in the setting of acute myocardial infarction demonstrated viable myocardium in a region that was akinetic by contrast ventriculo graphy. After surgical revascularization, follow-up Tc-99m-sestamibi i mages showed normal perfusion and radionuclide ventriculography demons trated normal left ventricular function. Demonstration of preserved Tc -99m-sestamibi myocardial uptake in the infarct zone despite an extens ive region of akinesis by contrast ventriculography predicted the reco very of left ventricular function after revascularization in this case . This suggests that perfusion imaging with Tc-99m-sestamibi early aft er myocardial reperfusion can detect stunned myocardium and thus facil itate the decisionmaking process regarding management of such patients .