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Localization of 99mTc-Sn-pyrophosphate in left ventricular aneurysms.

Concentration of 99mTc-pyrophosphate (99mTc-PPi) in the area of left ventricular aneurysms is discussed. In three cases clinical, laboratory, and electrocardiographic (ECG) evidence did not indicate that these patients currently had an acute myocardial infarction, but each patient had a clinical history and an ECG picture compatible with an old myocardial infarction. Cardiac catheterization revealed a large left ventricular aneurysm in all three cases. The reason for the preferential uptake of the radionuclide in the area of these aneurysms is not certain at this time.

Diphosphates↗

[Scanning of the myocardium with pyrophosphate-technetium 99m. 367 cases].

Pyrophosphate-99m Tc injected intravenously is almost invariably fixed in the infarcted zone in transmural infarctions less than 8 days old. Fixation occurs in only 2/3 of cases of rudimentary infarction. The degree of fixation is more or less proportional to the size of the peak of creatine phosphokinase. After the 8th day following infarction, fixation is slight or nil. It is inconstant in pre-infarction syndrome or simple angina. This examination complements clinical, electrocardiographic and enzyme findings, in particular in the case of difficult diagnosis.

Angina Pectoris↗

The significance of calcific valvular heart disease in Tc-99m pyrophosphate myocardial infarction scanning: radiographic, scintigraphic, and pathological correlation.

Technetium-99m pyrophosphate (PPi) is currently considered the best scanning agent for the diagnosis of acute myocardial infarction. False-positive scans have been reported in association with unstable angina, alcoholic cardiomyopathy, and ventricular aneurysms. In this study, 86% of patients (12/14) with either calcific aortic or mitral valvular heart disease had positive PPi cardiac scintiscans and the location of the PPi uptake was limited to the calcific valve in all (9/9) of the patients who underwent valve replacement surgery. Six patients with valvular disease without radiologic evidence of calcium had negative PPi heart images. Three of these patients had surgical valve replacement, and in none was there increased uptake in the resected valve. Seventy-five percent of the patients with calcified aortic valves had localization of the PPi activity to the area of the aortic valve, whereas 50% of the patients with calcified mitral valves showed a diffuse pattern of uptake on the cardiac image. In vitro demonstration of increased radioactivity in surgically removed cardiac valves warrants the conclusion that Tc-99m PPi is taken up by calcified heart valves. We conclude that while PPi heart scanning is a sensitive indicator of acute myocardial infarction, false-positive scans can occur in the presence of calcific valvular disease, due to localization of PPi in the calcified portion of the valve.

Adolescent↗

Comparison of Tc-99m methylene diphosphonate with Tc-99m pyrophosphate in the detection of acute myocardial infarction: concise communication.

Myocardial scans were obtained in ten patients with proven myocardial infarction. Scintigraphy on consecutive days was performed with technetium-99m methylene diphosphonate and technetium-99m pyrophosphate. Images obtained with the two tracers were generally equal in quality. Those with PPi exhibited denser uptake, while background activity was lower with MDP.

Diphosphates↗

99mTc-pyrophosphate bone scans in patients with metastatic carcinoid tumors.

Three patients with foregut (bronchial), hindgut (rectal) or (ovarian) carcinoid tumors had symptomatic bone metastasis with abnormal 99m Tc pyrophosphate bone scans and bone roentgenograms. Six patients with midgut (small intestine or caecal) carcinoid) carcinoid tumors who had no symptoms of bone metastasis had no evidence of bone metastasis on bone scan or bone roentgenographic examination. This study supports the clinical impression that patients with midget carcinoid tumors have a low incidence of bone metastasis.

Bone Neoplasms↗

Kinetics of various 99mTc-Sn-pyrophosphate compounds in the rat. I. In vivo studies.

The kinetic data of two different 99mTc-Sn-pyrophosphate compounds (compound A and B) were evaluated in non-adult rats. Only compound A concentrated in bone. Both compounds dispersed rapidly in the intravascular as well as the extravascular space. The plasma protein bond of both compounds increased with time after injection and impaired both the renal clearance of both compounds and the bone clearance of compound A. The renal clearance of both compounds was somewhat above that of 51Cr-EDTA. It is concluded that compound A and B is mainly excreted by glomerular filtration. About one fourth of the glomerular filtrate of compound B is reabsorbed and accumulated by the tubular cells.

Animals↗

[Comparative kinetic studies of Mg2+-activated hydrolysis of tripolyphosphate and pyrophosphate by inorganic pyrophosphatase].

Computer analysis of P3 and pyrophosphate conversion rate dependence on substrate and metal-activator concentrations reveals the identity of kinetic patterns. Dissociation and catalytical constants for the enzyme combinations with two types of metal-substrates complexes, MS and M2S, at pH 9.0 are by one to two orders of magnitude "poorer" for P3 as compared to PPi. Optimal pH value for the hydrolysis of P3 is by 2 units higher than this for the hydrolysis of PPi. pH profiles for the kinetic parameters in the pH range 8.0--9.5 differ considerably for the two substrates, presumably due to the existence of additional catalitically important ionisations in the reaction with P3.

Diphosphates↗

Clinical comparison of technetium-99m diphosphonate and pyrophosphate in bone scintigraphy: concise communication.

Thirty patients had bone scintigraphy with both Tc-99m pyrophosphate (Tc-PPi) and Tc-99m diphosphonate (Tc-HEDP). The images were given a composite rating for quality and the basis of three sets of criteria, and were also compared for the number of lesions detected by each agent. The two agents provided no difference in scan quality. Nevertheless, in ten of the 30 patients, at least two of the three readers detected with Tc-HEDP lesions that were not seen with Tc-PPi, and in two such cases all three readers considered the Tc-PPi scan normal. In another of these ten, two of three readers felt the Tc-PPi image was norm, whereas all three detected the lesion with Tc-HEDP. The reverse never occurred (P less than 0.01).

Bone Neoplasms↗

Tc-99m pyrophosphate muscle labeling in McArdle syndrome.

This paper reports the findings on two patients with McArdle syndrome (myophosphorylase deficiency) in whom conventional bone scans with Tc-99m pyrophosphate revealed intense muscle labeling following exercise tests. The temporal pattern observed was similar to that seen with other types of muscle damage. The prolonged cramps often occurring with this entity appears to produce muscle damage that is readily demonstrable using conventional bone-scanning techniques.

Adult↗

Correlations of Tc-99m pyrophosphate myocardial scintigraphy and the results of coronary-artery bypass surgery.

This study indicates that abnormal myocardial scintigrams with Tc-99m pyrophosphate tend to improve after coronary-artery bypass surgery, frequently changing from positive to normal. The significance of this change is uncertain. It does not correlate well with the clinical state but may simply reflect the natural course of myocardial scintigraphy in response to hospitalization, medical management, and presumably improved myocardial oxygenation. Postoperative myocardial scintigrams are useful in detecting perioperative infarction. ECG interpretation may be difficult in the immediate postoperative period and, in three cases, there were scintigraphic criteria of perioperative infarction without diagnostic changes on ECG. Patients with positive preoperative scintigrams, especially in association with Functional Class IV angina, are at increased risk during coronary-artery bypass surgery.

Coronary Artery Bypass↗

The specificity of pyrophosphate myocardial scintigrams in patients with prior myocardial infarction: concise communication.

Fifty-five patients with old (9 days to 10 yr) transmural infarcts but with no evidence of recent infarction, were imaged with Tc-99m pyrophosphate. Discrete uptake was rare in the setting of an old infarct. Diffuse uptake was neither sensitive to, nor specific for, acute infarction. Prior infarction will rarely cause diagnostic error if the discrete pattern is required for a positive diagnosis.

Acute Disease↗

Differential proteolysis of the subunits of pyrophosphate-dependent 6-phosphofructo-1-phosphotransferase.

Antibodies against the alpha (Mr 67,000) and beta (Mr 60,000) subunits of wheat seedling Fru-2,6-P2-stimulated pyrophosphate-dependent 6-phosphofructo-1-phosphotransferase (PFP) were used to probe the subunit structures of several partially purified plant PFPs after tryptic digestion. Antisera to the alpha and beta subunits of wheat seedling PFP cross-reacted with the corresponding alpha and beta subunits of PFP preparations from wheat germ, potato tubers, and lettuce leaves. With the mung bean PFP, both antisera reacted with a protein band of Mr 60,000. A protein band corresponding to the Mr 67,000 alpha subunit was not detected in the mung bean PFP preparation. Tryptic digestion of wheat seedling and potato tuber PFPs resulted in the preferential cleavage of the alpha subunit. The trypsinized PFP retained most of its Fru-2,6-P2-stimulated activity but not its basal activity. The proteolyzed enzyme also exhibited a 2-fold increase in Ka for Fru-2,6-P2. Studies with the mung bean enzyme revealed that the anti-alpha immunoreactive component was more sensitive to trypsinization than the anti-beta immunoreactive component of the Mr 60,000 protein band. Thus, the Mr 60,000 protein band of the mung bean PFP appears to be heterogeneous and contains both alpha and beta-like proteins. The above observations indicate that the alpha and beta subunits of PFP are two distinct polypeptides and that alpha acts as a regulatory protein in regulating both the catalytic activity and the Fru-2,6-P2-binding affinity of the beta subunit.

Antibodies↗

[Prognostic significance of follow-up scintigraphy with 99m Tc-pyrophosphate in myocardial infarction (author's transl)].

Using 99m Tc-pyrophosphate there is a positive visualization of a transmural myocardial infarction by a localized tracer activity outside of the skeletal system. The uptake of the tracer in the infarcted area is expressed as percentage of the accumulation over the sternum. It reaches a maximum 48-60 hours after infarct onset and then recedes gradually but not strictly linearly. On the occasion of a control scintigraphy 3-4 weeks after the myocardial infarction and after full mobilization 56 per cent of the investigated patients showed a variable decrease of the tracer activity. On 44 per cent the tracer activity in the infarcted area remained unchanged or even increased slightly, though the infarction could be excluded. At the same time performed haemodynamic investigations with measuring the pulmonary artery pressure at rest and under stress conditions showed a good correlation between the persistence of the tracer activity in the infarcted area and the amount of the pulmonary pressure at rest and during stress, manifesting left ventricular function. So the result of a control scintigraphy 3-4 weeks after myocardial infarction allows to draw prognostic inferences about the further course of the disease.

Blood Pressure↗

The formation of enzyme-bound and medium pyrophosphate and the molecular basis of the oxygen exchange reaction of yeast inorganic pyrophosphatase.

Yeast inorganic pyrophosphatase, with 10 mM 32Pi and 10 mM Mg2+ present at pH 7.3 TO 7.6, rapidly forms enzyme-bound pyrophosphate equivalent to about 5% of the total catalytic sties on the two enzyme subunits. The enzyme thus appears to bind PPi so as to favor thermodynamically its formation from Pi. The enzyme catalyzes a measurable equilibrium formation of free PPi at a much slower rate. Under similar conditions, the enzyme catalyzes a rapid exchange of oxygen atoms between Pi and water with the relative activation by metals being Mg2+ greater than Zn2+ greater than Co2+ greater than Mn2+. Millisecond mixing and quenching experiments demonstrate that the rate of formation and cleavage of the enzyme-bound PPi is rapid enough to explain most or all of the oxygen exchange reaction.

Cations, Divalent↗

Preoperative and postoperative technetium-99m pyrophosphate myocardial scintigraphy in the assessment of operative infarction in coronary artery surgery.

The incidence of operative myocardial infarction was assessed by electrocardiogram (ECG) and technetium-99m pyrophosphate (99mTc-PyP) myocardial scintigrams in 89 consecutive patients undergoing coronary artery bypass grafting (CABG). Myocardial scintigrams were performed on the day before operation and repeated 2 to 3 days postoperatively. All patients survived operation, with three in-hospital deaths not related to myocardial infarction (mortality rate 3 percent). Operative infarction was assessed to have occurred in four of 89 patients (4 percent). Two had new Q waves and positive scintigrams; one, major ST-T wave changes and a positive scintigram; and the fourth, new Q waves without a positive scintigram. Three further patients (3 percent) had Q waves and positive scintigrams postoperatively, but myocardial infarction was evolving before anesthesia and operation. Twenty-seven of 89 patients (30 percent) were found to have abnormal scintigrams preoperatively. In two patients, both operated upon with evolving myocardial infarction, the scintigram was worse postoperatively. In 13 patients the scintigram was improved after operation. In 12 patients (13 percent) the abnormal preoperative scintigram was unchanged after operation. Preoperative and postoperative myocardial scintigrams and ECG's must be compared to assess the incidence of operative myocardial infarction in patients undergoing CABG.

Adult↗

[Clinical comparison of the kinetics of 99mTc pyrophosphate and 99mTc methylene diphosphonate (author's transl)].

In a series of 10 patients the hematic and plasmatic clearances of 99mTc-pyrophosphate (PYP) and 99mTc-metylene-diphosphonate (MDP) have been studied. The analysis of the results shows that the elimination both hematic and plasmatic of MDP is significantly faster than that of PYP. Moreover the plasmatic elimination of PYP is faster than its hematic elimination. This fact is probably due to a partial absorption of the radionuclide on the surface of the red cells. No significant differences result in the urinary elimination of both radionuclides. As a consequence the MDP has a lower fundus activity and a lower irradiation dose to the blood and to the whole body. For those reasons this radionuclide is proposed as the preferred agent in bones scintigraphy.

Diphosphates↗

Electric and flow birefringence properties of myosin in aqueous urea and sodium pyrophosphate.

The electric dipole moment of rabbit skeletal myosin was estimated from the electric and flow birefringence properties. Myosin formed small polydisperse aggregates (0.2-1.1 microM in length) with an apparent electric dipole moment of 5,000-20,000 Debye in aqueous urea or sodium pyrophosphate at low ionic strength. Permanent dipole moment contributed substantially to the apparent dipole moment. An anti-parallel association of myosin was suggested from the dependence of the apparent dipole moment on myosin concentration. Some interactions between myosin and C-protein were detected in 1 M urea by flow birefringence and analytical ultracentrifugation studies. The apparent dipole moment of myosin aggregates was less dependent on myosin concentration in the presence of C-protein.

Animals↗