Significance of Tc-99m pyrophosphate accumulation in unstable angina

Tc-99m pyrophosphate (PYP) and Tl-201 simultaneous dual energy single photon emission computed tomography (SPECT) were performed in 33 patients with clinically unstable angina. According to the presence or absence of PYP accumulation in the myocardium, the patients were classified as PYP (+) group (n=22) and PYP (-) group (n=11). Clinical features, types of unstable angina, ECG changes, and serial creatine kinase (CK) data were compared in the two groups. The 'new angina at rest' type of unstable angina was more significantly common in the PYP (+) group (16/22) than the PYP (-) group (2/11). The remaining 6 patients in the PYP (+) group and 2 patients in the PYP (-) group had 'angina of effort with changing pattern'. There was a significant difference in the occurrence of ST elevation and ST depression between the group: 59% in the PYP (+) group vs. 18% in the PYP (-) group for ST elevation and 23% in the PYP (+) group vs. 64% in the PYP (-) group for ST depression. The PYP (+) group showed significant improvement in ejection fraction in the stable state (57±12%) as compared with the unstable state (62±11%), although there was no difference between the stable and unstable state in the PYP (-) group. Although wall motion abnormality index (WMI) was poorer in the PYP (+) group than the PYP (-) group, it improved to the same degree as the PYP (-) group one month later. These data suggest that the area showing PYP (+) may reflect stunned myocardium and that Tc-99m PYP accumulation may correlate with clinical features of unstable angina. (N.K.)