Author + information
- Received April 6, 1985
- Revision received August 6, 1985
- Accepted September 3, 1985
- Published online January 1, 1986.
- A. Teddy Weiss, MD, FACC,
- Jamshid Maddahi, MD, FACCa,
- Allan S. Lew, MD,
- P.K. Shah, MD, FACC,
- William Ganz, MD, FACC,
- H.J.C. Swan, MD, PhD, FACC and
- Daniels. Berman, MD, FACC
- ↵aAddress for reprints: Jamshid Maddahi, MD, Division of Cardiology, Cedars-Sinai Medical Center, PO Box 48750, Los Angeles, California 90048.
The pattern of reverse redistribution on the day 10 poststreptokinase resting thallium-201 myocardial scintigrams is a common finding in patients who have undergone streptokinase therapy in evolving myocardial infarction. To investigate this phenomenon, 67 patients who underwent streptokinase therapy were studied preand 10 days poststreptokinase therapy resting thallium-201 studies, poststreptokinase therapy resting radionuclide ventriculography and coronary arteriography (60 of the 67 patients). Of the 67 patients, 50 (75%) showed the reverse redistribution pattern on the day 10 thallium-201 study (Group I), 9 (13%) had a nonreversible defect (Group II) and the remaining 8 (12%) had a normal study or showed a reversible defect (Group III). The reverse redistribution pattern was associated with patency of the infarct-related artery (100%), quantitative improvement in resting thallium-201 defect size from day 1 to day 10 study (94%) and normal or near normal wall motion on day 10 radionuclide ventriculography (80% of segments with marked and 54% of those with mild reverse redistribution). In contrast, nonreversible defects were associated with significantly less frequent patency of the infarct-related artery (67%, p = 0.01), improvement in defect size (11%, p < 0.001) and normal or near normal wall motion (21%, p < 0.05). Group III patients were similar to Group I with respect to these variables. The quantitated thallium-201 percent washout was higher in the regions with the reverse redistribution pattern (49 ± 15%) compared with the contralateral normal zone (24 ± 15%, p < 0.001).
The findings indicate that the reverse redistribution pattern results from a higher than normal washout rate of thallium-201 and suggest that this pattern is a sign of nontransmural myocardial infarction with a patent infarct-related coronary artery.
This study was supported in part by Specialized Center of Research Grant 17651 from the National Institutes of Health, Bethesda, Maryland; a grant to Dr. Maddahi from the American Heart Association, Greater Los Angeles Affiliate; and grants to Dr. Weiss from the Harold J. Mirisch Foundation and the United Hostesses, Los Angeles, California. This paper was presented in part at the 56th Annual Scientific Sessions of the American Heart Association, Anaheim, California, November 1983.
- Received April 6, 1985.
- Revision received August 6, 1985.
- Accepted September 3, 1985.
- American College of Cardiology Foundation