Progressive failure of coronary flow during reperfusion of myocardial infarction: Documentation of the no reflow phenomenon with positron emission tomography

Journal Article · Sat Sep 01 04:00:00 EDT 1990 · Journal of the American College of Cardiology; (USA)

DOI:https://doi.org/10.1016/0735-1097(90)90362-S· OSTI ID:6620272

Jeremy, R W; Links, J M; Becker, L C ^[1]

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1. Johns Hopkins Medical Institutions, Baltimore, MD (USA)

During reperfusion of a myocardial infarct, development of microvascular occlusion may result in regional hypoperfusion (no reflow) despite a patent infarct-related artery. This study examined the extent and time course of no reflow with use of rubidium-82 positron emission tomography. In 12 anesthetized dogs, the left anterior descending coronary artery was occluded for 90 min and then freely reperfused. Regional myocardial perfusion was imaged by serial rubidium-82 positron emission tomography during coronary occlusion and every 30 min during reperfusion. After 4 h of reperfusion, infarct size and no reflow zone were measured postmortem by triphenyltetrazolium and thioflavin staining, respectively. Perfusion defects evident on rubidium-82 images during coronary occlusion rapidly resolved during the early reflow period. However, a recurrent perfusion defect appeared after 1 to 2 h of reflow in all dogs. The severity of recurrent perfusion defects progressed with time; after 5 min of reflow, relative perfusion in the left anterior descending artery territory was 97 +/- 6% of that in the normal circumflex artery region, but perfusion decreased progressively to 68 +/- 5% after 2 h (p less than 0.05) and to 55 +/- 4% after 4 h of reperfusion (p less than 0.05 versus 2 h). As measured by radioactive tracer microspheres, endocardial blood flow decreased similarly in the postischemic left anterior descending artery region from 1.2 +/- 0.2 ml/min per g after 5 min of reflow to 0.4 +/- 0.1 ml/min per g after 3 h of reflow (p less than 0.01). Residual infarct perfusion, measured by rubidium-82 after 4 h of reflow, was related to both infarct size (r = -0.88) and the extent of the no reflow zone (r = -0.84) in the postmortem left ventricular sections. Thus, serial positron emission tomography with rubidium-82 demonstrates a progressive loss of infarct perfusion.

• OSTI ID: 6620272
• Journal Information: Journal of the American College of Cardiology; (USA), Journal Name: Journal of the American College of Cardiology; (USA) Vol. 16:3; ISSN 0735-1097; ISSN JACCD
• Country of Publication: United States
• Language: English

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550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
ALKALI METAL ISOTOPES
ANIMALS
ARTERIES
BETA DECAY RADIOISOTOPES
BETA-PLUS DECAY RADIOISOTOPES
BLOOD FLOW
BLOOD VESSELS
BODY
CARDIOVASCULAR DISEASES
CARDIOVASCULAR SYSTEM
COMPUTERIZED TOMOGRAPHY
CORONARIES
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DISEASES
DOGS
ELECTRON CAPTURE RADIOISOTOPES
EMISSION COMPUTED TOMOGRAPHY
HEART
HOURS LIVING RADIOISOTOPES
INTERMEDIATE MASS NUCLEI
ISOTOPES
MAMMALS
MICROSPHERES
MINUTES LIVING RADIOISOTOPES
MYOCARDIAL INFARCTION
NUCLEI
ODD-ODD NUCLEI
ORGANS
PERFUSED ORGANS
POSITRON COMPUTED TOMOGRAPHY
RADIOISOTOPES
RUBIDIUM 82
RUBIDIUM ISOTOPES
TOMOGRAPHY
VERTEBRATES