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The Significance of Calcific Valvular Heart Disease in Tc-99m Pyrophosphate Myocardial Infarction Scanning: Radiographic, Scintigraphic, and Pathological Correlation

Harbor General Hospital—UCLA, Torrance, California

Correspondence: For reprints contact: James A. Jengo, Div. of Nuclear Medicine, Harbor General Hospital, 1000 W. Carson St., Torrance, CA 90509.

ABSTRACT

Technetium-99m pyrophosphate (PP_i) is currently considered the best scanning agent for the diagnosis of acute myocardial infarction. False-positive scans have been reported in association with unstable angina, alcoholic cardiomyopathy, and ventricular aneurysms. In this study, 86% of patients (12/14) with either calcific aortic or mitral valvular heart disease had positive PP_i cardiac scintiscans and the location of the PP_i uptake was limited to the calcific valve in all (9/9) of the patients who underwent valve replacement surgery. Six patients with valvular disease without radiologic evidence of calcium had negative PP_i heart images. Three of these patients had surgical valve replacement, and in none was there increased uptake in the resected valve. Seventy-five percent of the patients with calcified aortic valves had localization of the PP_i activity to the area of the aortic valve, whereas 50% of the patients with calcified mitral valves showed a diffuse pattern of uptake on the cardiac image. In vitro demonstration of increased radioactivity in surgically removed cardiac valves warrants the conclusion that Tc-99m PP_i is taken up by calcified heart valves. We conclude that while PP_i heart scanning is a sensitive indicator of acute myocardial infarction, false-positive scans can occur in the presence of calcific valvular disease, due to localization of PP_i in the calcified portion of the valve.