Clinical implications of the technetium-99m stannous pyrophosphate myocardial scintigraphic "doughnut" pattern in patients with acute myocardial infarcts.

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Abstract
Patients (45) with acute myocardial infarcts had 99mTc stannous pyrophosphate (99mTc-PYP) myocardial scintigrams with radionuclide uptake localized to the anterior or lateral wall of the left ventricle in a pattern resembling a doughnut (intense peripheral uptake and relatively less central uptake). Of these patients, 67% developed left ventricular failure with infarction and 26 with acute anterior or lateral myocardial infarcts were compared because 99mTc-PYP scintigrams were more homogeneously positive. There were no significant differences in age, sex or ECG location of infarction. In-hospital left ventricular failure in Killip classes II, III or IV was more common in the group with doughnut scintigrams. Estimates of infarct size by scintigraphic planimetry and analysis of peak serum creatine kinase levels indicated larger infarcts in the group with doughnut scintigrams. A doughnut 99mTc-PYP myocardial scintigraphic pattern identifies a relatively large myocardial infarct that is probably associated with developing or worsening left ventricular failure. Knowledge of etiologic factors involved and of the mechanism of filling in of the central defect of this doughnut in some patients, may clarify certain aspects of the pathophysiology of acute myocardial infarcts.