The importance of the incidental thyroid gland uptake during Tc-99m MIBI myocardial perfusion scintigraphy.

OBJECTIVE: The purpose of study was to investigate whether incidental thyroid gland uptake had an important during Tc-99m sestamibi (MIBI) myocardial perfusion scintigraphy (SPECT). PATIENTS AND METHODS: In the presented study, 968 consecutive patients were evaluated for the presence or absence of thyroid gland uptake in the raw data of the Tc-99m MIBI SPECT. All of the patients had thyroid gland uptake of the Tc-99m MIBI underwent laboratory evaluation of thyroid function, ultrasonographic imaging, and hystopathological examination. RESULTS: The thyroid gland uptake was detected in 14 of 968 (1.4%) consecutive patients during the evaluation of raw images of Tc-99m MIBI SPECT studies. Among these 14 patients, 4 had subacute thyroiditis, 7 multinodular goiter, 3 Graves disease by ultrasonographic imaging and hystopathological examination. TSH levels of all of these patients were < 0.01 U/ml. CONCLUSIONS: Tc-99m MIBI uptake by thyroid gland has been explained with associated clinical thyrotoxicosis. Although the primary goal of myocardial perfusion imaging is the evaluation of myocardial perfusion, the interpretation of myocardial perfusion imaging should not be limited to the heart. Because, it is possible to observe extracardiac radioactivity accumulation, which may then lead to the diagnosis of a noncardiac disease during this detailed examination.

Ischaemia-modified albumin elevation after percutaneous coronary intervention reflects albumin concentration rather than ischaemia.

BACKGROUND: Percutaneous coronary intervention (PCI) is accepted as a model of myocardial ischaemia in studies of ischaemia markers, especially of ischaemia-modified albumin (IMA). However, there is concern that IMA levels may reflect changes in albumin concentrations rather than myocardial ischaemia also during PCI. METHODS: Twenty-one consecutive patients (17 men and 4 women) undergoing single-vessel percutaneous coronary angioplasty were enrolled in the study. IMA and albumin levels were measured together with myoglobin, creatine kinase 2 and cardiac troponin I, before (Group 1), immediately after (Group 2) and 6 h after (Group 3) the procedure of PCI. RESULTS: The IMA levels of Group 2 were significantly higher than those of Group 1 and Group 3 (P < 0.05 for both). However, correction of IMA by multiplying with the (individual albumin concentration of the patient/median albumin concentration of Group 1) ratio gave no statistical differences between the groups (P > 0.05). There were strong negative correlations between IMA levels and albumin concentrations within individual groups (r = -0.757, P < 0.001; r = -0.712, P < 0.001; and r = -0.705, P < 0.001 for Group 1, Group 2 and Group 3, respectively). CONCLUSION: The results confirm the close dependency of IMA results on albumin concentrations. Therefore, IMA results reflect albumin concentrations rather than myocardial ischaemia also in PCI. This situation and lack of standard reference materials for the albumin cobalt binding assay can lessen the diagnostic performance of IMA.

Predictors of left ventricular thrombus formation in patients with anterior myocardial infarction: role of activated protein C resistance.

BACKGROUND: Left ventricular mural thrombus formation is a well-recognised consequence of acute anterior myocardial infarction. The vast majority of left ventricular thromboses occur in patients with anterior myocardial infarction and depressed left ventricular function. OBJECTIVE: To evaluate the factors predicting left ventricular thrombus formation in patients similar for left ventricular function and left ventricular score indexes. METHODS: We evaluated 45 consecutive patients who met the inclusion criteria of anterior myocardial infarction resulting in apical, anterior or septal asynergy (akinesia, dyskinesia), without non-Q-wave myocardial infarction, dilated cardiomyopathy, or renal or hepatic dysfunction. Patients were divided into two groups: group I with, and group II without, left ventricular mural thrombus. The groups were compared for clinical, echocardiographic and hematologic parameters (activated protein C resistance (APC-R), protein S and antithrombin III). RESULTS: Smoking and ACP-R were significantly greater in group I than in group II (P < 0.05 and P < 0.005 respectively). Multivariate regression analysis showed that APC-R was an independent risk factor for left ventricular thrombus formation in the patient group selected. Antithrombin III and protein S concentrations were not statistically different between two groups. All other clinical and echocardiographic characteristics of the patients were similar in both groups. CONCLUSION: APC-R is an independent risk factor for left ventricular thrombosis in patients with anterior myocardial infarction resulting in septal or anterior and apical akinesia or dyskinesia.