Myocardial damage of the entire ventricular region in a patient with acute myocardial infarction

Document Type : Case report


1 Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan

2 Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan


Technetium-99m-pyrophosphate (99mTc-PYP) has been used, in combination with thallium-201, to estimate the site and extent of myocardial infarcts. We report a case of acute myocardial infarction with severe coronary disease in which the distribution of 99mTc-PYP was extensive. A 78-year-old man presented with dyspnea, and a diagnosis of non-ST-segment elevation acute myocardial infarction was made. Emergency coronary angiography revealed total occlusion of the proximal portion of the right coronary artery and left circumflex coronary artery with collateral flow from the left anterior descending coronary artery, which also had severe stenoses. Given his comorbidities and preferences, subsequent angioplasty was waived. Dual myocardial scintigraphic imaging, which was performed four days after admission, demonstrated slightly reduced thallium-201 uptake in the inferior wall and apex, whereas 99mTc-PYP was positive in the entire left ventricular subendocardial region and the free wall of the right ventricle. His clinical course was uneventful with conservative treatment and the patient was discharged 20 days after admission in a stable condition.


1. Werner JA, Botvinick EH, Shames DM, Parmley WW. Acute myocardial infarction: clinical application of technetium 99m stannous pyrophosphate infarct scintigraphy. West J Med. 1977 Dec; 127(6):464-78.
2. Holman BL, Lesch M, Alpert JS. Myocardial scintigraphy with technetrium-99m pyrophosphate during the early phase of acute infarction. Am J Cardiol. 1978 Jan; 41(1):39-42.
3. Willerson JT, Parkey RW, Bonte FJ, Meyer SL, Stokely EM. Acute subendocardial myocardial infarction in patients. Its detection by Technetium 99-m stannous pyrophosphate myocardial scintigrams. Circulation. 1975 Mar; 51(3):436-41.
4. Pitt B, Thrall JH. Thallium-201 versus technetium-99m pyrophosphate myocardial imaging in detection and evaluation of patients with acute myocardial infarction. Am J Cardiol. 1980 Dec 18; 46(7):1215-23.
5. Dewanjee MK, Kahn PC. Mechanism of localization of 99mTc-labeled pyrophosphate and tetracycline in infarcted myocardium. J Nucl Med. 1976 Jul; 17(7):639-46.
6. Buja LM, Parkey RW, Dees JH, Stokely EM, Harris RA Jr, Bonte FJ, et al. Morphologic correlates of technetium-99m stannous pyrophosphate imaging of acute myocardial infarcts in dogs. Circulation. 1975 Oct; 52(4):596-607.
7. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018 Oct 30; 72(18):2231-2264.
8. Kodama-Takahashi K, Ohshima K, Kurata A, Yamamoto K, Uemura S, Watanabe S, et al. Myocardial infarction in a patient with severe aortic stenosis and normal coronary arteriograms: involvement of the circumferential subendocardial wall of the left ventricle. Circ J. 2003 Oct; 67(10):891-4.
9. Yamano T, Kosugi Y, Nakamura T, Sawada T, Azuma A, Matsubara H, et al. Dual SPECT imaging with Tc-99m pyrophosphate and Tl-201 of circumferential subendocardial myocardial infarction in aortic stenosis without coronary artery stenosis. Clin Nucl Med. 2008 Jun; 33(6):416-8.
10. Taki J, Taki S, Ichiyanagi K, Akashi Y, Hisada K. Acute subendocardial infarction with diffuse intense Tc-99m PYP uptake and minimal Tl-201 abnormality. Clin Nucl Med. 1992 Aug;17(8):643-5.
11.  Hashimoto T, Kambara H, Fudo T, Tamaki S, Takatsu Y, Hattori R, et al. Significance of technetium-99m/thallium-201 overlap on simultaneous dual emission computed tomography in acute myocardial infarction. Am J Cardiol. 1988 Jun 1; 61 (15):1181-6. 
12. Schofer J, Spielmann RP, Brömel T, Bleifeld W, Mathey DG. Thallium-201/technetium-99m pyrophosphate overlap in patients with acute myocardial infarction after thrombolysis: prediction of depressed wall motion despite thallium uptake. Am Heart J. 1986 Aug; 112(2):291-5.
 13. Wackers FJ, Lie KI, Sokole EB, Res J, Van der Schoot JB, Durrer D. Prevalence of right ventricular involvement in inferior wall infarction assessed with myocardial imaging with thallium-201 and technetium- 99m pyrophosphate. Am J Cardiol. 1978 Sep; 42(3):358-62.
14. Asano H, Sone T, Tsuboi H, Sassa H, Takeshima K, Miyazaki Y, et al. Diagnosis of right ventricular infarction by overlap images of simultaneous dual emission computed tomography using technetium- 99mpyrophosphate -  and thallium-201. Am J Cardiol. 1993 Apr 15; 71(11):902-8.
 15. Haji SA, Movahed A. Right ventricular infarction--diagnosis and treatment. Clin Cardiol. 2000 Jul; 23(7):473-82.