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In Vivo Detection of Cell Death in the Area at Risk in Acute Myocardial Infarction

¹ Department of Nuclear Medicine, University Hospital Maastricht, Maastricht, The Netherlands
² Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands
³ Department of Clinical Pharmacy, University Hospital Maastricht, Maastricht, The Netherlands
⁴ Department of Biochemistry, University Hospital Maastricht, Maastricht, The Netherlands
⁵ Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands

View larger version (13K): [in a new window]   FIGURE 1. Time line of study protocol. Numbers of patients studied are in parentheses.

View larger version (98K): [in a new window]   FIGURE 2. (A) Area at risk: 99mTc-MIBI injected before reperfusion. Reconstructed myocardial images of patient 2 after injection of 99mTc-MIBI in cardiovascular emergency room. Short-axis images show anteroseptal defect; vertical long-axis images, anteroapical defect; and horizontal long-axis images, apicoseptal defect. (B) Detection of cell death: 99mTc-annexin A5 after reperfusion. Reconstructed myocardial images of patient 2, 15 h after injection of 99mTc-BTAP-anxA5. Short-axis images show increased activity anteroseptally; vertical long-axis images, anteroapical hot spot; and horizontal long-axis images, increased apicoseptal activity. (C) 99mTc-annexin A5 uptake in area at risk: combination of parts A and B. Left 2 columns show 99mTc-MIBI activity; right 2 columns, 99mTc-annexin A5. (D) Acute inferior MI of patient 5: combination of some reconstructed images of 99mTc-MIBI activity (left 2 columns) and 99mTc-annexin A5. ANT = anterior; INF = inferior; LA = long axis or left atrium; LAT = lateral; LV = left ventricle; RA = right atrium; RV = right ventricle; SEPT = septal; Vert = vertical; Horz = horizontal.

View larger version (13K): [in a new window]   FIGURE 3. 99mTc-MIBI defects (n = 6) expressed as percentage of left ventricle both in acute phase and in subacute phase of MI.

View larger version (75K): [in a new window]   FIGURE 4. Repeated studies of 1 patient. (A) Combination of acute 99mTc-MIBI and 99mTc-annexin A5 uptake in area at risk on day 1 in patient studied several times. 99mTc-MIBI defect in anteroseptal and apical region (left 2 columns) correlates well with 99mTc-annexin A5 activity (right 2 columns). (B) 99mTc-annexin A5 activity compared on days 1 and 4 of acute MI. 99mTc-annexin A5 activity is already reduced after 4 d (right 2 columns), compared with day 1 (left 2 columns). L indicates liver activity; s indicates spleen activity. (C) 201Tl images (right 2 columns) clearly show complete recovery of area at risk seen on 99mTc-MIBI scan as performed at onset of MI (left 2 columns). ANT = anterior; INF = inferior; LA = long axis or left atrium; LAT = lateral; LV = left ventricle; RA = right atrium; RV = right ventricle; SEPT = septal; Vert = vertical; Horz = horizontal.