Twenty-four-hour Tl-201 delayed scan underestimates myocardial viability in patients with acute myocardial infarction after percutaneous transluminalcoronary angioplasty

Background: Myocardial viability in area at risk of acute myocardial infarc tion (AMI) after reperfusion therapy may be underestimated by the 24-hour i mages due to reverse redistribution (r-RD). Methods: Subjects were 37 AMI patients in whom Tc-99m pyrophosphate (PYP)/T I-201 dual-isotope SPECT was positive. The 24-hour delayed scan was perform ed with only a Tl window. One month later, follow up rest Tl SPECT was perf ormed to evaluate myocardial viability. In early (at PYP/Tl-201 dual-isotop e SPECT), 24-hour, and one month follow up Tl studies, Tl uptake in the are a of AMI was scored into four grades: 3 as normal to 0 as severely reduced. The scores were evaluated. Results: Among the 37 AMI lesions, there were 16 r-RD, 3 RD, 16 fixed defec t (FD) and 2 normal (positive PYP and normal Ti). Mean T1 scores were early ; 1.4 +/- 1.1, 24-hr; 0.9 +/-0.9 and one month; 1.3 +/- 1.1. The 24-hour T1 score was lower than the early and one month Tl scores (p < 0.01). Conclusion: Reverse redistribution is frequently observed in an area at ris k where PYP SPECT was positive. Nuclear medicine physicians should be aware of the existence of frequent r-RD in Tl scan to avoid the underestimation of myocardial viability in the acute phase after PTCA.