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Detection of Acute Myocardial Infarction by ^99mTc-Labeled D-Glucaric Acid Imaging in Patients with Acute Chest Pain

Nuclear Medicine Service and Cardiology Unit, Department of Internal Medicine, University of Genoa Medical School, Genoa, Italy
Center for Drug Targeting and Analysis, Northeastern University, Boston
Cardiac Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
Molecular Targeting Technology Inc., Malvern, Pennsylvania
Division of Nuclear Medicine, Department of Radiology, Stanford University School of Medicine, Stanford, California

Correspondence: For correspondence and reprints contact: Giuliano Mariani, MD, Nuclear Medicine Service, DIMI, University of Genoa, Viale Benedetto XV, n. 6, 1-16132 Genoa, Italy.

ABSTRACT

Definitive diagnosis of acute myocardial infarction early in the process is often difficult. An imaging agent that localized quickly and specifically in areas of acute necrosis could provide this critical diagnostic information. To determine whether imaging with ^99mTc-labeled o-glucaric acid (GLA) could provide this information, we imaged a group of patients presenting with symptoms suggestive of acute infarction. Methods: Twenty-eight patients presenting to the emergency department with symptoms highly suggestive of acute infarction were injected with ^99mTc-GLA and imaged about 3 h later. Results: The sensitivity of lesion detection was remarkably time dependent. Fourteen patients with acute infarction injected within 9 h of onset of chest pain had positive scans, even in the presence of persistent occlusion. The remaining 14 patients had negative scans. Nine patients with negative scans had acute infarction but were injected more than 9 h after onset of chest pain. The final diagnosis in the remaining 5 patients was unstable angina (3 injected <9 h and 2 injected >9 h after onset of chest pain). Six patients were reinjected with ^99mTc-GLA 4–6 wk after their initial study to determine whether persistent positive scans occurred with this agent. All 6 had negative scans. Conclusion: This study suggests that ^99mTc-GLA localizes in zones of acute myocardial necrosis when injected within 9 h of onset of infarction.

Key Words: acute myocardial infarction • scintigraphic imaging • ^99mTc labeling • D-glucaric acid • perfusion imaging

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