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Sample records for patients underwent myocardial

  1. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

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    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  2. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  3. Effect of preinfarction angina pectoris on long-term survival in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention.

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    Taniguchi, Tomohiko; Shiomi, Hiroki; Toyota, Toshiaki; Morimoto, Takeshi; Akao, Masaharu; Nakatsuma, Kenji; Ono, Koh; Makiyama, Takeru; Shizuta, Satoshi; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Horie, Minoru; Kimura, Takeshi

    2014-10-15

    The influence of preinfarction angina pectoris (AP) on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains controversial. In 5,429 patients with acute myocardial infarction (AMI) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto AMI Registry, the present study population consisted of 3,476 patients with STEMI who underwent primary PCI within 24 hours of symptom onset and in whom the data on preinfarction AP were available. Preinfarction AP defined as AP occurring within 48 hours of hospital arrival was present in 675 patients (19.4%). Patients with preinfarction AP was younger and more often had anterior AMI and longer total ischemic time, whereas they less often had history of heart failure, atrial fibrillation, and shock presentation. The infarct size estimated by peak creatinine phosphokinase was significantly smaller in patients with than in patients without preinfarction AP (median [interquartile range] 2,141 [965 to 3,867] IU/L vs 2,462 [1,257 to 4,495] IU/L, p <0.001). The cumulative 5-year incidence of death was significantly lower in patients with preinfarction AP (12.4% vs 20.7%, p <0.001) with median follow-up interval of 1,845 days. After adjusting for confounders, preinfarction AP was independently associated with a lower risk for death (hazard ratio 0.69, 95% confidence interval 0.54 to 0.86, p = 0.001). The lower risk for 5-year mortality in patients with preinfarction AP was consistently observed across subgroups stratified by total ischemic time, initial Thrombolysis In Myocardial Infarction flow grade, hemodynamic status, infarct location, and diabetes mellitus. In conclusion, preinfarction AP was independently associated with lower 5-year mortality in patients with STEMI who underwent primary PCI. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Role of myocardial perfusion scintigraphy post invasive coronary angiography in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Harisankar, C.N.B.; Mittal, Bhagwant Rai; Kamaleshwaran, K.K.; Bhattacharya, Anish; Singh, Baljinder; Mahajan, Rajiv

    2010-01-01

    The presence of severe hypokinesia or akinesia and near complete stenotic lesions on coronary angiography, in a patient with acute myocardial infarction raises a question of viability in the involved territory and its response to revascularization. The decision of revascularization can be effectively taken after myocardial perfusion scintigraphy (MPS). Aim: To evaluate the role of MPS in patients with acute or recent myocardial infarction after invasive coronary angiography. Materials and Methods: Thirty-five patients (27 Males, 8 Females; Mean age 54 years) with acute myocardial infarction, who underwent invasive angiography, were included prospectively. Invasive angiography was attempted during the episode of acute chest pain in 20 patients. Fifteen patients underwent angiography without MPS because of non-availability of MPS at the time of initial presentation in the referring hospital. Revascularization was deferred because of complete/near complete block of artery with hypokinesia/akinesia of the distal LV segments in 32/35 patients and 50 to 70% block in 3/35. These patients were subjected to MPS. Results: Twenty patients underwent stress MPS and 15 underwent nitrate-augmented rest re-distribution study (RR study). Imaging was performed using the hybrid SPECT/CT system. The average defect size of the perfusion defect was 34% (5 - 57% range). Sixteen patients (46%) had fixed perfusion defects. Reversible ischemia was present in 19 (54%). Ten patients had a 10% of the LV myocardium, and underwent the invasive revascularization procedure. Conclusion: MPS is invaluable in patients who have total/near total occlusion of the coronary artery and distal segment hypokinesia or akinesia on invasive angiography. One in four patients, deemed to have non-viable myocardium, underwent an invasive revascularization after undergoing MPS. (author)

  5. Impact of high-density lipoprotein 3 cholesterol subfraction on periprocedural myocardial injury in patients who underwent elective percutaneous coronary intervention.

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    Harada, Kazuhiro; Kikuchi, Ryosuke; Suzuki, Susumu; Tanaka, Akihito; Aoki, Toshijiro; Iwakawa, Naoki; Kojima, Hiroki; Hirayama, Kenshi; Mitsuda, Takayuki; Sumi, Takuya; Negishi, Yosuke; Ishii, Hideki; Murohara, Toyoaki

    2018-02-02

    Periprocedural myocardial injury (PMI) is a major complication of percutaneous coronary intervention (PCI) and is associated with atherosclerotic coronary plaque and worse clinical outcomes. High-density lipoprotein cholesterol (HDL-C) is a protective factor for cardiovascular disease. However, the role of HDL-C subfractions, such as HDL2 cholesterol (HDL2-C) or HDL3 cholesterol (HDL3-C), in cardiovascular disease remains unclear. The purpose of the study was to investigate the relationship between HDL2-C and HDL3-C subfractions and the incidence of PMI in patients who underwent elective PCI. We enrolled 129 patients who underwent elective PCI for stable angina pectoris. PMI was defined as an increase in high-sensitivity troponin T levels > 5 times the upper normal limit (> 0.070 ng/mL) at 24 h after PCI. Serum HDL-C subfractions (HDL2-C and HDL3-C) were assessed using ultracentrifugation in patients with and those without PMI. HDL3-C levels were significantly lower in patients with PMI than in those without (15.1 ± 3.0 mg/dL vs. 16.4 ± 2.9 mg/dL, p = 0.016) and had an independent and inverse association with PMI (odds ratio, 0.86; 95% confidence interval, 0.74-0.99; p = 0.038). When divided by the cut-off value of HDL3-C for PMI (14.3 mg/dL), the incidence of PMI was significantly higher in low HDL3-C patients than in high HDL3-C patients (51.2% vs. 30.2%, p = 0.020). HDL3-C was an independent inverse predictor of PMI in patients who underwent elective PCI.

  6. The impact of exercise myocardial perfusion SPECT imaging on the selection of patients for coronary angiography

    International Nuclear Information System (INIS)

    Song Liping; He Zuoxiang; Liu Xiujie; Shi Rongfang; Liu Yunzhong; Tian Yueqin; Zhang Xiaoli; Qin Xuewen; Chen Jilin; Gao Runlin

    2001-01-01

    Objective: Exercise 99 Tc m -MIBI myocardial perfusion SPECT is accurate for the diagnosis of coronary artery disease (CAD). This study assessed the impact of exercise myocardial perfusion imaging on the selection of patients for coronary angiography. Methods: 2188 consecutive patients who underwent exercise myocardial perfusion SPECT in authors' department in 1999 were retrospectively analyzed. Among them, 1807 were men, 381 women (average age: 53.5 +- 7.2 years). Overall, exercise myocardial SPECT was normal in 1731 patients, abnormal in 359 cases, and equivocal in 98 patients. There were 141 patients who underwent CAG within 60 days after myocardial SPECT. Results: Overall, 12% of the patients with abnormal SPECT imaging underwent coronary angiography, but only 5% of the patients with a normal SPECT imaging did (P < 0.001). Among these 141 patients who underwent coronary angiography, significant coronary stenosis was present in 91% of the patients who had had an abnormal SPECT imaging, but only 8% of those who had had a normal SPECT imaging (P < 0.001). In those patients who underwent coronary angiography, revascularization rate was 25% for the patients with abnormal SPECT imaging, but only 1% for the patients with a normal SPECT imaging. Conclusion: The results of exercise myocardial perfusion SPECT have a significant impact on the selection of patients for coronary angiography and revascularization

  7. Different Causes of Death in Patients with Myocardial Infarction Type 1, Type 2, and Myocardial Injury.

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    Lambrecht, Sascha; Sarkisian, Laura; Saaby, Lotte; Poulsen, Tina S; Gerke, Oke; Hosbond, Susanne; Diederichsen, Axel C P; Thygesen, Kristian; Mickley, Hans

    2018-05-01

    Data outlining the mortality and the causes of death in patients with type 1 myocardial infarction, type 2 myocardial infarction, and those with myocardial injury are limited. During a 1-year period from January 2010 to January 2011, all hospitalized patients who had cardiac troponin I measured on clinical indication were prospectively studied. Patients with at least one cardiac troponin I value >30 ng/L underwent case ascertainment and individual evaluation by an experienced adjudication committee. Patients were classified as having type 1 myocardial infarction, type 2 myocardial infarction, or myocardial injury according to the criteria of the universal definition of myocardial infarction. Follow-up was ensured until December 31, 2014. Data on mortality and causes of death were obtained from the Danish Civil Registration System and the Danish Register of Causes of Death. Overall, 3762 consecutive patients were followed for a mean of 3.2 years (interquartile range 1.3-3.6 years). All-cause mortality differed significantly among categories: Type 1 myocardial infarction 31.7%, type 2 myocardial infarction 62.2%, myocardial injury 58.7%, and 22.2% in patients with nonelevated troponin values (log-rank test; P causes, vs 42.6% in patients with type 2 myocardial infarction (P = .015) and 41.2% in those with myocardial injury (P causes of death did not differ substantially between patients with type 2 myocardial infarction and those with myocardial injury. Patients with type 2 myocardial infarction and myocardial injury exhibit a significantly higher long-term mortality compared with patients with type 1 myocardial infarction . However, most patients with type 1 myocardial infarction die from cardiovascular causes in contrast to patients with type 2 myocardial infarction and myocardial injury, in whom noncardiovascular causes of death predominate. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Characteristics of 201Tl myocardial SPECT and left ventriculography in patients with acute diagonal branch myocardial infarction

    International Nuclear Information System (INIS)

    Tanaka, Takeshi; Aizawa, Tadanori; Katou, Kazuzo; Ogasawara, Ken; Kirigaya, Hajime

    1993-01-01

    Characteristics of 201 Tl myocardial SPECT and ventriculography were studied in 13 patients with acute diagonal branch myocardial infarction. Rest 201 Tl myocardial SPECT and left ventriculography were underwent in chronic phase. In 5 patients electrocardiogram (ECG) changes in acute phase were not definite. In 6 patients it was difficult to identify the obstructed coronary artery with coronary angiography in acute phase. Mean value of maximum creatine phosphokinese (CPK) was 854 (458-1,774) U/l. It seemed to be difficult to diagnose acute diagonal branch myocardial infarction with ECG and/or coronary angiography. In all patients defects were noted on 201 Tl SPECT. Defects were small and noted in the central anterior wall and not in the septum. In 2 patients defects were noted at apex. In left ventriculography dyskinetic motion was noted in 10 patients; one patient showed apical aneurysm and 3 patients showed anterior wall aneurysm. In 3 patients anterior wall showed akinesis. It was concluded that 201 Tl myocardial SPECT were useful for detecting diagonal branch lesion. In case of diagonal branch myocardial infarction size of defects were small and defects were not noted in the septum, however aneurysmal motion was frequently noted. (author)

  9. Assessment of myocardial viability using multidetector computed tomography in patients with reperfused acute myocardial infarction

    International Nuclear Information System (INIS)

    Kim, T.; Choi, B.J.; Kang, D.K.; Sun, J.S.

    2012-01-01

    Aim: To assess the prognostic value of 64-section multidetector computed tomography (MDCT) to predict follow-up myocardial dysfunction and functional recovery after reperfusion therapy in patients with acute myocardial infarction (MI) as defined by echocardiography. Materials and methods: After reperfusion therapy for acute MI, 71 patients underwent two-phase contrast-enhanced MDCT and follow-up echocardiography. MDCT findings were compared with echocardiographic findings using kappa statistics. The areas under the receiver operating characteristic curves (AUCs) and the odds ratios (ORs) of early perfusion defects (EPD), delayed enhancement (DE), and residual perfusion defects (RPD) for predicting follow-up myocardial dysfunction and functional recovery were calculated on a segmental basis. Results: The presence of transmural EPD (EPD TM ) or RPD showed good agreement (k = 0.611 and 0.658, respectively) with follow-up myocardial dysfunction, while subendocardial EPD (EPD sub ) or subendocardial DE (DE sub ) showed fair agreement with follow-up myocardial dysfunction (k = 0.235 and 0.234, respectively). The AUC of RPD (0.796) was superior (p TM (0.761) and DE TM (0.771). The presence of EPD TM , DE TM , and RPD were significant, independent positive predictors of follow-up myocardial dysfunction (OR = 6.4, 1.9, and 9.8, respectively). EPD TM was a significant, independent negative predictor of myocardial functional recovery (OR = 0.13). Conclusion: Abnormal myocardial attenuation on two-phase MDCT after reperfusion therapy may provide promising information regarding myocardial viability in patients with acute MI.

  10. Myocardial Scintigraphy in the Evaluation of Cardiac Events in Patients without Typical Symptoms

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    Smanio, Paola Emanuela Poggio, E-mail: pgmsmanio@gmail.com; Silva, Juliana Horie; Holtz, João Vitor; Ueda, Leandro; Abreu, Marilia; Marques, Carlindo; Machado, Leonardo [Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil Mailing (Brazil)

    2015-08-15

    Cardiovascular disease is a leading cause of death in the world and in Brazil. Myocardial scintigraphy is an important noninvasive method for detecting ischemia in symptomatic patients, but its use in asymptomatic ones or those with atypical symptoms is yet to be defined. To verify the presence of major cardiac events in asymptomatic patients or those with atypical symptoms (atypical chest pain or dyspnea) that underwent myocardial scintigraphy (MS), over a period of 8 years. Secondary objectives were to identify cardiac risk factors associated with myocardial scintigraphy abnormalities and possible predictors for major cardiac events in this group. This was a retrospective, observational study using the medical records of 892 patients that underwent myocardial scintigraphy between 2005 and 2011 and who were followed until 2013 for assessment of major cardiac events and risk factors associated with myocardial scintigraphy abnormalities. Statistical analysis was performed by Fisher’s exact test, logistic regression and Kaplan-Meyer survival curves, with statistical significance being set at p ≤ 0.05. Of the total sample, 52.1% were men, 86.9% were hypertensive, 72.4% had hyperlipidemia, 33.6% were diabetic, and 12.2% were smokers; 44.5% had known coronary artery disease; and 70% had high Framingham score, 21.8% had moderate and 8% had low risk. Of the myocardial scintigraphies, 58.6% were normal, 26.1% suggestive of fibrosis and 15.3% suggestive of ischemia. At evolution, 13 patients (1.5%) had non-fatal myocardial infarction and six individuals (0.7%) died. The group with normal myocardial scintigraphy showed longer period of time free of major cardiac events, non-fatal myocardial infarction (p = 0.036) and death. Fibrosis in the myocardial scintigraphy determined a 2.4-fold increased risk of non-fatal myocardial infarction and five-fold higher risk of death (odds ratio: 2.4 and 5.7, respectively; p = 0.043). The occurrence of major cardiac events in 8 years

  11. NT-pro-BNP is associated with inducible myocardial ischemia in mildly symptomatic type 2 diabetic patients

    NARCIS (Netherlands)

    Wiersma, Jacobijne J.; van der Zee, P. Marc; van Straalen, Jan P.; Fischer, Johan C.; van Eck-Smit, Berthe L. F.; Tijssen, Jan G. P.; Trip, Mieke D.; Piek, Jan J.; Verberne, Hein J.

    2010-01-01

    Baseline levels of N-terminal fragment of the brain natriuretic peptide prohormone (NT-pro-BNP) are associated with myocardial ischemia in non-diabetic patients with stable angina pectoris. A total of 281 patients with diabetes mellitus type 2 and stable angina pectoris underwent myocardial

  12. Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

    International Nuclear Information System (INIS)

    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B

    2004-01-01

    Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP

  13. Detection of myocardial ischemia with myocardial perfusion SPECT in patients with diabetes mellitus

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    Seo, J. H.; Jeong, S. Y.; Bae, J. H.; Anh, B. C.; Lee, J.; Lee, K. B [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2004-07-01

    Diabetes mellitus(DM) is a critical disease associated with higher rates of cardiovascular morbidity and mortality. Atherosclerosis accounts for 65-80% of all deaths in diabetic patients and patients with DM are known to show high prevalence of coronary artery diseases(CAD). We evaluated the incidence of scintigraphic evidence of CAD in diabetic patients and results were compared with cardiovascular symptoms and clinical factors. 169 patients with DM(mean age 629years, 68 males) were referred for evaluation of CAD between Jan 2002 and Dec 2003. 101(60%) patients were with chest pain and 68(40%) were asymptomatic. Patients underwent exercise(n=6) or adenosine stress(n=163) SPECT myocardial perfusion imaging(MPI). Exclusion criteria included history of documented myocardial infarction, prior revascularization, clinically significant valvular heart disease, left-bundle branch block on rest ECG. We evaluated symptoms associated with cardiac problem and other clinical and laboratory data to reveal correlation with presence of CAD. MPI were assessed visually and semi-quantitatively with C-Equal program. Myocardial ischemia was detected in 52(31%) patients. Among them, 41 had 1-vessel and 9 had 2-vessel disease. In 52 patients with ischemia, 28(54%) were male and 24(46%) were female. 20/68(29%) asymptomatic and 32/101(32%) symptomatic patients had ischemia. Higher prevalence of neuropathy, hypertension, higher blood glucose level, HbA1c and CRP was noted in patients with myocardial ischemia. Serum levels of cholesterol and LDL was not significantly different between patients with ischemia and with normal MPI findings. Abnormal MPI findings were not related with gender and age. These results show a high prevalence of abnormal MPI results in diabetic patients regardless of symptoms. Screening stress MPI in diabetic patients should be indicated irrespective of symptoms, especially in patients with neuropathy, hypertension, higher level of blood glucose, or increased CRP.

  14. Myocardial perfusion SPECT imaging in patients with myocardial bridging

    International Nuclear Information System (INIS)

    Fang Wei; Qiu Hong; Yang Weixian; Wang Feng; He Zuoxiang

    2008-01-01

    Objective: Stress myocardial perfusion SPECT imaging was used to assess myocardial ischemia in patients with myocardial bridging. Methods: Ninety-six patients with myocardial bridging of the left anterior descending artery documented by coronary angiography were included in this study. All under- went exercise or pharmacological stress myocardial perfusion SPECT assessing myocardial ischemia. None had prior myocardial infarction. One year follow-up by telephone interview was performed in all patients. Results The mean stenotic severity of systolic phase on angiography was (65 ± 19)%. In the SPECT study, 20 of 96 (20.8%) patients showed abnormal perfusion. This percentage was significantly higher than that of stress electrocardiogram (ECG). The higher positive rate of SPECT perfusion images was showed in the group of patients with severe systolic narrowing (≥75%) than that with mild-to-moderate systolic narrowing (50% vs 6.3%, P<0.001). The prevalence of abnormal image was significantly higher in ELDERLY PEOPLE; patients with STT change on rest ECG than in those with normal rest ECG (54.2% vs 9.7%, P<0.001). During follow-up, one patient with abnormal SPECT perfusion image sustained angina and accepted percutaneous coronary intervention, and no cardiac event occurred in patients with normal images. Conclusions: Stress myocardial perfusion SPECT imaging can be used effectively for assessing myocardial ischemia and has potential prognostic value for patients with myocardial bridging. (authors)

  15. Myocardial perfusion SPECT in diabetic patients for detection of coronary artery disease

    International Nuclear Information System (INIS)

    Saeed, M.A.; Fatima, S.; Fatmi, S.; Kureshi, S.

    2003-01-01

    The aim of this study was to evaluate the efficacy of myocardial SPECT perfusion scan in the diagnosis of coronary artery disease in diabetic patients. A total number of thirty diabetic patients (21 males, 9 females) were included in the study. All the patients had strong risk-factors for coronary artery disease (strong family history, chronic smokers, hyperlipidemia, history of chest pain). All patients underwent coronary angiography and stress/rest myocardial perfusion SPECT scans with Tc-99m MIBI (two days protocol). Twenty two patients had significant coronary artery stenosis and 8 had normal coronary arteries. Myocardial perfusion scintigraphy (MPS) was positive in 19 subjects out of the 22 patients with significant stenosis (Sensitivity 86.4%) and negative (false negative) in only three. Out of 8 patients with normal angiography 7 had normal MPS (Specificity 87.5%) whereas only one patient revealed abnormality in the myocardial perfusion study. When compared with coronary angiography the positive predictive value and negative predictive value for Tc-99m MIBI myocardial perfusion scan was 86.4% and 87.5% respectively. In conclusion, Tc-99m MIBI myocardial perfusion scintigraphy is a useful screening modality for the detection of coronary artery disease in diabetic patients. (author)

  16. Myocardial Scintigraphy in the Evaluation of Cardiac Events in Patients without Typical Symptoms

    Directory of Open Access Journals (Sweden)

    Paola Emanuela Poggio Smanio

    2015-01-01

    Full Text Available Background: Cardiovascular disease is a leading cause of death in the world and in Brazil. Myocardial scintigraphy is an important noninvasive method for detecting ischemia in symptomatic patients, but its use in asymptomatic ones or those with atypical symptoms is yet to be defined. Objective: To verify the presence of major cardiac events in asymptomatic patients or those with atypical symptoms (atypical chest pain or dyspnea that underwent myocardial scintigraphy (MS, over a period of 8 years. Secondary objectives were to identify cardiac risk factors associated with myocardial scintigraphy abnormalities and possible predictors for major cardiac events in this group. Methods: This was a retrospective, observational study using the medical records of 892 patients that underwent myocardial scintigraphy between 2005 and 2011 and who were followed until 2013 for assessment of major cardiac events and risk factors associated with myocardial scintigraphy abnormalities. Statistical analysis was performed by Fisher’s exact test, logistic regression and Kaplan-Meyer survival curves, with statistical significance being set at p ≤ 0.05. Results: Of the total sample, 52.1% were men, 86.9% were hypertensive, 72.4% had hyperlipidemia, 33.6% were diabetic, and 12.2% were smokers; 44.5% had known coronary artery disease; and 70% had high Framingham score, 21.8% had moderate and 8% had low risk. Of the myocardial scintigraphies, 58.6% were normal, 26.1% suggestive of fibrosis and 15.3% suggestive of ischemia. At evolution, 13 patients (1.5% had non-fatal myocardial infarction and six individuals (0.7% died. The group with normal myocardial scintigraphy showed longer period of time free of major cardiac events, non-fatal myocardial infarction (p = 0.036 and death. Fibrosis in the myocardial scintigraphy determined a 2.4-fold increased risk of non-fatal myocardial infarction and five-fold higher risk of death (odds ratio: 2.4 and 5.7, respectively; p = 0

  17. SURGERY OF SYMPTOMATIC MYOCARDIAL BRIDGING

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    N. Maghamipour N. Safaei

    2007-06-01

    Full Text Available Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD may be associated with myocardial ischemia. In symptomatic myocardial bridging unresponsive to medical treatment, surgical unroofing of the left LAD can be performed. Little information is available about the long-term prognosis of patients with this coronary anomaly after the surgical unroofing, so we decided to evaluate the result of this operation. A total of 26 patients underwent surgical unroofing of myocardial bridging. Patients had a myocardial bridge of at least 3 cm in length in the middle of LAD and with more than 70% compression during systole. Unroofing was performed with cardiopulmonary bypass in 16 and with off pump technique in 10 patients. In 6 patients repeat angiographies for control of myotomy were done. In one of them a nonsignificant 20% narrowing was seen. Postoperative scintigraphic and angiographic studies demonstrated restoration of coronary flow and myocardial perfusion without residual myocardial bridges under beta-stimulation in 24 patients. Two patients had residual narrowing. With off pump technique, 1 patient had perforation of the right ventricle and 1 patient underwent reoperation because of incomplete unroofing during the first operation. None of the patients with cardiopulmonary bypass technique had residual chest pain or other complications. Surgical unroofing of myocardial bridging with the aid of cardiopulmonary bypass is a safe and easy procedure with low operative risk and with excellent functional results.

  18. Role of myocardial perfusion SPECT in asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Cho, I.; Chun, K.; Won, K.; Lee, H.; Park, J.; Shin, D.; Kim, Y.; Shim, B.; Lee, J.

    2002-01-01

    Purpose: It is important that early diagnosis and treatment of coronary artery disease in diabetic patients, but there are few reports on the prevalence of stress-induced myocardial perfusion abnormalities and the rates of cardiac event in patients with type 2 diabetes. We evaluated the scan findings on gated myocardial perfusion SPECT in asymptomatic diabetic patients. Methods: We performed pharmacological stress test and gated perfusion SPECT in 69 diabetic patients without cardiovascular symptom (mean age: 65 year, male 31 and female 38). Patients underwent two-day imaging protocol and stress study was performed injection of Tc-99m MIBI during adenosine infusion. We followed up these patients by reviewing medical records. Results: Fifty-two of 69 patients (74.5%) showed normal scan findings and 17 patients (24.6%) showed reversible or fixed perfusion defects. Three of 52 patients with normal scan findings showed decreased LV ejection fraction and decreased wall motion. Twenty-three patients with normal scan findings were possible to follow up for more than 1yr (mean time: 18.3±3.3 mo.) and they all had no cardiac event. Three patients with reversible perfusion defects were performed coronary angioplasty. Conclusion: Myocardial perfusion SPECT is a noninvasive method and maybe useful in early diagnosis and predicting prognosis in diabetic patients

  19. Association between aortic valve calcification and myocardial ischemia, especially in asymptomatic patients.

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    Yamazato, Ryo; Yamamoto, Hideya; Tadehara, Futoshi; Teragawa, Hiroki; Kurisu, Satoshi; Dohi, Yoshihiro; Ishibashi, Ken; Kunita, Eiji; Utsunomiya, Hiroto; Oka, Toshiharu; Kihara, Yasuki

    2012-08-01

    Aortic valve calcification (AVC) is recognized as a manifestation of systemic arteriosclerosis. However, it is unclear whether AVC is associated with myocardial ischemia. Stress myocardial perfusion SPECT (MPS) is widely used for the diagnosis of myocardial ischemia. However, routine MPS is not recommended, particularly in asymptomatic patients. Accordingly, we investigated the hypothesis that the presence of AVC is strongly associated with inducible myocardial ischemia, even among asymptomatic patients. We investigated 669 consecutive patients who underwent both adenosine stress (201)Tl MPS and echocardiography. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS). We defined the presence of myocardial ischemia as SDS ≥ 3 and moderate to severe ischemia as SDS ≥ 8. We classified the severity of AVC according to the number of affected aortic leaflets. We also compared the mean SDS and the prevalence of SDS ≥ 3 and SDS ≥ 8 among patients stratified by the severity of AVC. The presence of AVC was significantly associated with myocardial ischemia (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.10-2.23; P = 0.013) and moderate to severe ischemia (OR, 2.16; 95% CI, 1.26-3.80; P = 0.0061). In 311 asymptomatic patients, AVC was strongly associated with moderate to severe ischemia (OR, 4.31; 95% CI, 1.67-12.8; P = 0.0043). However, the SDS value and the prevalence of SDS ≥ 3 and SDS ≥ 8 did not increase with increasing number of affected aortic leaflets. The presence of AVC may be associated with the presence of myocardial ischemia, particularly in asymptomatic patients. However, we found no association between the extent of AVC and inducible myocardial ischemia. The presence of AVC may be a useful anatomic marker to help identify patients at high risk of myocardial ischemia, particularly asymptomatic patients.

  20. Patterns of disturbed myocardial perfusion in patients with coronary artery disease. Regional myocardial perfusion in angina pectoris

    International Nuclear Information System (INIS)

    Selwyn, A.P.; Forse, G.; Fox, K.; Jonathan, A.; Steiner, R.

    1981-01-01

    Fifty patients who presented with angina pectoris were studied to examine the disturbances of regional myocardial perfusion during stress. Each patient underwent 16-point precordial mapping of the ECG during an exercise test, and coronary and left ventricular angiography. Regional myocardial perfusion was assessed using an atrial pacing test and a short-lived radionuclide, krypton-81m. Eleven patients had negative exercise tests and uniform increases in myocardial activity of krypton-81m of 98 +/- 18.0% during pacing. Ten patients performed 30,000-43,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and increases in myocardial activity of krypton-81m to remote and jeopardized myocardium at the onset of pacing. However, further pacing produced a decrease in activity in the affected segment of 68.0 +/- 9.0% accompanied by ST-segment depression and angina. Twelve patients achieved 26,000-32,000 J in positive exercise tests and had significant coronary artery disease. Atrial pacing produced increased activity of krypton-81m to remote myocardium. The jeopardized segment at first showed no change and then a decrease in regional activity of krypton-81m (89.0 +/- 17%) accompanied by ST-segment depression and chest pain. Seventeen patients achieved only 7000-22,000 J in positive exercise tests. These patients showed abnormal coronary anatomy and developed decreases in regional activity of krypton-81m to the affected segment of myocardium starting at the onset of atrial pacing and decreasing by 88 +/- 0 7.0% below control. We conclude that different patterns of disturbed myocardial distribution of krypton-81m are present during stress-induced ischemia in patients with coronary artery disease. There was a close temporal relationship between these disturbances and ST-segment depression

  1. Prevalence of myocardial ischaemia as assessed with myocardial perfusion scintigraphy in patients with diabetes mellitus type 2 and mild anginal symptoms

    International Nuclear Information System (INIS)

    Wiersma, Jacobijne J.; Trip, Mieke D.; Piek, Jan J.; Tijssen, Jan G.P.; Verberne, Hein J.; Eck-Smit, Berthe L.F. van; Holt, Wik L. ten

    2006-01-01

    To determine the prevalence and predictors of reversible myocardial perfusion defects, indicative of myocardial ischaemia, in patients with mild, stable anginal complaints [Canadian Cardiovascular Society classification (CCS) I-II/IV] and diabetes mellitus type 2 (T2DM). A total of 329 patients with T2DM and stable, mild anginal symptoms (CCS I-II/IV) underwent myocardial perfusion scintigraphy. Perfusion images were assessed using a five-point (semi)-quantitative scoring system according to a 17-segment myocardial model. One-hundred and fifty-six (47%) patients showed reversible myocardial perfusion defects defined as a summed difference score of ≥3. Male gender [odds ratio (OR) 2.28, 95% CI 1.4-3.71, p=0.001], previous myocardial infarction (MI) without revascularisation (OR 3.04, 95% CI 1.28-7.24, p=0.01), and the use of two or more classes of anti-anginal medication (OR 2.36, 95% CI 1.48-3.76, p<0.001) were independent predictors for the presence of reversible defects. By contrast, lipid-lowering therapy reduced the possibility of reversible perfusion defects (OR 0.56, 95% CI 0.33-0.95, p=0.03). Approximately half of the patients with mild, stable angina pectoris and T2DM showed evidence of myocardial ischaemia. Male gender, previous MI and the use of anti-anginal medication were positive predictors and lipid-lowering therapy was a negative predictor for the results of the scintigraphic stress test. (orig.)

  2. Prevalence of myocardial ischaemia as assessed with myocardial perfusion scintigraphy in patients with diabetes mellitus type 2 and mild anginal symptoms

    Energy Technology Data Exchange (ETDEWEB)

    Wiersma, Jacobijne J.; Trip, Mieke D.; Piek, Jan J.; Tijssen, Jan G.P. [Academic Medical Center, Department of Cardiology, Amsterdam (Netherlands); Verberne, Hein J.; Eck-Smit, Berthe L.F. van [Academic Medical Center Amsterdam, Department of Nuclear Medicine, Amsterdam (Netherlands); Holt, Wik L. ten [Amstelland Hospital, Department of Cardiology, Amstelveen (Netherlands)

    2006-12-15

    To determine the prevalence and predictors of reversible myocardial perfusion defects, indicative of myocardial ischaemia, in patients with mild, stable anginal complaints [Canadian Cardiovascular Society classification (CCS) I-II/IV] and diabetes mellitus type 2 (T2DM). A total of 329 patients with T2DM and stable, mild anginal symptoms (CCS I-II/IV) underwent myocardial perfusion scintigraphy. Perfusion images were assessed using a five-point (semi)-quantitative scoring system according to a 17-segment myocardial model. One-hundred and fifty-six (47%) patients showed reversible myocardial perfusion defects defined as a summed difference score of {>=}3. Male gender [odds ratio (OR) 2.28, 95% CI 1.4-3.71, p=0.001], previous myocardial infarction (MI) without revascularisation (OR 3.04, 95% CI 1.28-7.24, p=0.01), and the use of two or more classes of anti-anginal medication (OR 2.36, 95% CI 1.48-3.76, p<0.001) were independent predictors for the presence of reversible defects. By contrast, lipid-lowering therapy reduced the possibility of reversible perfusion defects (OR 0.56, 95% CI 0.33-0.95, p=0.03). Approximately half of the patients with mild, stable angina pectoris and T2DM showed evidence of myocardial ischaemia. Male gender, previous MI and the use of anti-anginal medication were positive predictors and lipid-lowering therapy was a negative predictor for the results of the scintigraphic stress test. (orig.)

  3. Homocysteine plasma levels in patients suspected coronary artery disease: Relation to myocardial perfusion image

    International Nuclear Information System (INIS)

    Yao, Z.Y.; He, Q.; Qu, W.

    2002-01-01

    Purpose: Although there is considerable epidemiologic evidence for a relationship between plasma homocysteine (Hcy) levels and coronary artery disease (CAD), not all studies, especially prospective ones have shown such a relationship. The purpose of this study was to investigate a possible association between Hcy plasma levels and myocardial perfusion defect by SPECT in patients suspected CAD. Methods and Materials: A cohort of 238 patients suspected CAD (age: 60.65±10.43, male to female: 172: 66) was examined for Hcy, tetrahydrofolic acid (FH4), vitamine B12 and coronary angiography (CAG). Furthermore, 42 patients also underwent 99m Tc-MIBI myocardial perfusion images (MPI) to assess the myocardial perfusion. Results: There were 69 patients with normal CAG and 63, 60, 42 and 4 patients with 1 vessel, two vessel, 3 vessel and left main coronary stenosis. The plasma Hcy of this group was significantly increased, p 0.05. In patients with >=3 segments myocardial perfusion defect, 10 of them had normal Hcy, and 7 with hyperhomocysteinemia, in patients with 0.05). Conclusion: Our data may indicate that hyperhomocysteinemia represents an independent risk factor in patients with high possibility of CAD rather than a mark of myocardial ischemia or coronary stenosis

  4. Myocardial performance and perfusion during exercise in patients with coronary artery disease caused by Kawasaki disease

    International Nuclear Information System (INIS)

    Paridon, S.M.; Ross, R.D.; Kuhns, L.R.; Pinsky, W.W.

    1990-01-01

    For a study of the natural history of coronary artery lesions after Kawasaki disease and their effect on myocardial blood flow reserve with exercise, five such patients underwent exercise testing on a bicycle. Oxygen consumption, carbon dioxide production, minute ventilation, and electrocardiograms were monitored continuously. Thallium-201 scintigraphy was performed for all patients. One patient stopped exercise before exhaustion of cardiovascular reserve but had no evidence of myocardial perfusion abnormalities. Four patients terminated exercise because of exhaustion of cardiovascular reserve; one had normal cardiovascular reserve and thallium scintiscans, but the remaining patients had diminished cardiovascular reserve. Thallium scintigrams showed myocardial ischemia in two and infarction in one. No patient had exercise-induced electrocardiographic changes. These results indicate that patients with residual coronary artery lesions after Kawasaki disease frequently have reduced cardiovascular reserve during exercise. The addition of thallium scintigraphy and metabolic measurements to exercise testing improved the detection of exercise-induced abnormalities of myocardial perfusion

  5. Adenosine stress and exercise 99Tcm-MIBI myocardial perfusion imaging in the diagnosis and risk stratification of patients with unstable angina

    International Nuclear Information System (INIS)

    Jia Peng; Guo Wanhua; Xu Shoulin; Feng Xuefeng

    2008-01-01

    Objective: The aim of this study was to evaluate the clinical value of adenosine stress or exercise 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging in the diagnosis and risk stratification of patients with unstable angina. Methods: Eighty-seven hospitalized patients with unstable angina [54 men and 33 women, aged of (56.5±12.5) years] underwent adenosine stress or exercise myocardial perfusion imaging and coronary angiography. Patients were followed up. Results: Fifty-seven patients had abnormal myocardial perfusion imaging and significant coronary artery stenosis. Ten patients had abnormal myocardial perfusion imaging but normal coronary angiography. Eight patients had normal myocardial perfusion imaging but significant coronary artery stenosis. Twelve patients had normal myocardial perfusion imaging and normal coronary angiography. Patients with abnormal myocardial perfusion imaging had worse prognosis. There was relationship between cardiac events and the extent and severity of myocardial ischemia. Conclusion: Adenosine stress and exercise myocardial perfusion imaging is of important clinical value in the diagnosis and risk stratification of patients with unstable angina. (authors)

  6. Significance of abnormal myocardial perfusion scintigraphy in young adult patients with SLE

    International Nuclear Information System (INIS)

    Zakavi, S.R.; Kakhki, V.R.D.; Sadeghi, R.; Jokar, M.H.; Khazaei, G.

    2009-01-01

    Detection of subclinical coronary artery disease (CAD) is a potential challenge in patients with systemic lupus erythematosus (SLE) and it is suggested that myocardial perfusion single photon emission computerized tomography (SPECT) is more sensitive than exercise test in this setting. However, the significance of perfusion abnormalities in SLE patients is not well known. In this study, we evaluated the prognostic significance of myocardial perfusion defects in patients with SLE. Patients with proven diagnosis of SLE admitted to the hospital due to noncardiac problems with no history of CAD were studied. All patients underwent 99m Tc-methoxyisobutylisonitrile (MIBI) myocardial perfusion scan using dipyridamole as pharmacological stress. All patients were followed up by reviewing patients file in lupus clinic and any minor or major cardiac events were recorded. Eighteen female and two male patients with mean age of 28.2±12.05 years were included. Six patients had mild reversible perfusion defects with mean summed difference score of 2.5±1.0. Pattern of reverse redistribution (reverse fill-in) was noted in three patients. Eleven patients had normal myocardial perfusion. Hypokinesia was noted in three patients on gated images. One patient with abnormal perfusion died 21 days after imaging due to on-cardiac cause. Nineteen patients were followed for a mean time of 39.2±16.0 months. No major or minor cardiac events were noted during follow-up. Three patients (one with abnormal perfusion) had at least one readmission during follow-up period. Our study showed that myocardial perfusion abnormalities are fairly frequent in SLE patients but the defects are generally mild and do not advocate an adverse prognosis. (author)

  7. Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors.

    Science.gov (United States)

    Arenillas, Juan F; Candell-Riera, Jaume; Romero-Farina, Guillermo; Molina, Carlos A; Chacón, Pilar; Aguadé-Bruix, Santiago; Montaner, Joan; de León, Gustavo; Castell-Conesa, Joan; Alvarez-Sabín, José

    2005-06-01

    Optimization of coronary risk evaluation in stroke patients has been encouraged. The relationship between symptomatic intracranial atherosclerosis and occult coronary artery disease (CAD) has not been evaluated sufficiently. We aimed to investigate the prevalence of silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis and to identify factors associated with its presence. From 186 first-ever transient ischemic attack or ischemic stroke patients with intracranial stenoses, 65 fulfilled selection criteria, including angiographic confirmation of a symptomatic atherosclerotic stenosis and absence of known CAD. All patients underwent a maximal-stress myocardial perfusion single-photon emission computed tomography (SPECT). Lipoprotein(a) [Lp(a)], C-reactive protein, and homocysteine (Hcy) levels were determined before SPECT. Stress-rest SPECT detected reversible myocardial perfusion defects in 34 (52%) patients. Vascular risk factors associated with a pathologic SPECT were hypercholesterolemia (P=0.045), presence of >2 risk factors (P=0.004) and high Lp(a) (P=0.023) and Hcy levels (P=0.018). Ninety percent of patients with high Lp(a) and Hcy levels had a positive SPECT. Existence of a stenosed intracranial internal carotid artery (ICA; odds ratio [OR], 7.22, 2.07 to 25.23; P=0.002) and location of the symptomatic stenosis in vertebrobasilar arteries (OR, 4.89, 1.19 to 20.12; P=0.027) were independently associated with silent myocardial ischemia after adjustment by age, sex, and risk factors. More than 50% of the patients with symptomatic intracranial atherosclerosis and not overt CAD show myocardial perfusion defects on stress-rest SPECT. Stenosed intracranial ICA, symptomatic vertebrobasilar stenosis and presence of high Lp(a) and Hcy levels may characterize the patients at a higher risk for occult CAD.

  8. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

    Energy Technology Data Exchange (ETDEWEB)

    Oki, Glaucia Celeste Rossatto [Clinica Diagnoson and Hospital Aristides Maltez, Salvador, BA (Brazil). Servicos de Medicina Nuclear; Pavin, Elizabeth Joao; Parisi, Maria Candida R. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Endocrinology; Coelho, Otavio Rizzi; Almeida, Raitany C. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Cardiology; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario, E-mail: cdramos@unicamp.br [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Radiology. Service of Nuclear Medicine; Camargo, Edwaldo Eduardo [Hospital Sirio-Libanes, Campinas, SP (Brazil). Service of Nuclear Medicine

    2013-01-15

    Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with {sup 99m}Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

  9. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Oki, Glaucia Celeste Rossatto; Pavin, Elizabeth Joao; Parisi, Maria Candida R.; Coelho, Otavio Rizzi; Almeida, Raitany C.; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario; Camargo, Edwaldo Eduardo

    2013-01-01

    Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with 99m Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

  10. Predictive value of myocardial perfusion scintigraphy after stress in patients without previous myocardial infarction

    International Nuclear Information System (INIS)

    Tuner, D.A.; Battle, W.E.; Deshmukh, H.; Colandrea, M.A.; Snyder, G.J.; Fordham, E.W.; Messer, J.V.

    1978-01-01

    Seventy-five patients who had chest pain but no history or ECG evidence of myocardial infarction (MI) underwent myocardial-stress perfusion scintigraphy (MSPS) with thallium-201, treadmill-stress testing (TST), and coronary cineangiography (CA). The sensitivities of MSPS and TST for coronary stenosis greater than or equal to 75 percent were 68 percent and 71 percent, respectively; their specificities were 97 percent and 79 percent, respectively (0.1 greater than p greater than 0.05). When the character of a patient's chest pain is considered, Bayesian analysis leads to the following conclusions: MSPS can be useful in pre-CA screening of patients with chest pain but no MI if their pain is thought to be of uncertain or nonischemic origin; the sensitivity of Tl-201 MSPS is not sufficient for pre-CA screening of patients without MI who have typical or atypical angina pectoris; the sensitivity of MSPS would have to be approximately 95 percent in order for the test to be useful in pre-CA screening of patients who have atypical angina pectoris; MSPS may be superior to TST in these applications; and it is not clear that there is any advantage in combining MSPS and TST into a single screening test rather than using MSPS alone

  11. Patient satisfaction with coronary CT angiography, myocardial CT perfusion, myocardial perfusion MRI, SPECT myocardial perfusion imaging and conventional coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Feger, S.; Rief, M.; Zimmermann, E.; Richter, F.; Roehle, R. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Dewey, M. [Freie Universitaet Berlin, Department of Radiology, Charite - Universitaetsmedizin Berlin Campus Mitte, Humboldt-Universitaet zu Berlin, Berlin (Germany); Institut fuer Radiologie, Berlin (Germany); Schoenenberger, E. [Medizinische Hochschule Hannover, Department of Medicine, Hannover (Germany)

    2015-07-15

    To evaluate patient acceptance of noninvasive imaging tests for detection of coronary artery disease (CAD), including single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), stress perfusion magnetic resonance imaging (MRI), coronary CT angiography (CTA) in combination with CT myocardial stress perfusion (CTP), and conventional coronary angiography (CCA). Intraindividual comparison of perception of 48 patients from the CORE320 multicentre multinational study who underwent rest and stress SPECT-MPI with a technetium-based tracer, combined CTA and CTP (both with contrast agent, CTP with adenosine), MRI, and CCA. The analysis was performed by using a validated questionnaire. Patients had significantly more concern prior to CCA than before CTA/CTP (p < 0.001). CTA/CTP was also rated as more comfortable than SPECT-MPI (p = 0.001). Overall satisfaction with CT was superior to that of MRI (p = 0.007). More patients preferred CT (46 %; p < 0.001) as a future diagnostic test. Regarding combined CTA/CTP, CTP was characterised by higher pain levels and an increased frequency of angina pectoris during the examination (p < 0.001). Subgroup analysis showed a higher degree of pain during SPECT-MPI with adenosine stress compared to physical exercise (p = 0.016). All noninvasive cardiac imaging tests are well accepted by patients, with CT being the preferred examination. (orig.)

  12. Clinical Characteristics and Findings of 99mTc-MIBI Heart SPECT in Patients with Acute Myocardial Infarction with Normal Coronary Arteriography

    International Nuclear Information System (INIS)

    Park, Myung Jae; Choi, Tae Youl; Kim, Deong Yoon; Kang, Heung Sun; Choue, Chung Whee; Kim, Kwon Sam; Kim, Kwang Won; Kim, Myung Shick; Song, Jung Sang; Bae, Jong Hoa

    1993-01-01

    Among 64 patients with acute myocardial infarction who underwent coronary angiography, 7 patients (10.9%)showed normal coronary artery. Six patients were men and 1 patient was female. The mean age of patients were 31.1 ± 3.9 years. Among the risk factors of coronary heart disease, smoking was most probable factor in patients with acute myocardial infarction with normal coronary angiography. 99m Tc-MIBI heart SPECT performed 5 of 7 patients and showed that it could be used in diagnosis, localization, extent of infarct area in patients with acute myocardial infarction with normal coronary angiography. But follow up 99m Tc-MIBI heart SPECT study will be needed to define the ability of myocardial viability in this patients.

  13. Prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Zhu Mei; Pan Zhongyun; Lin JInghui; Zhang Chunli; Nie Tao; Wang Yanfu

    1998-01-01

    Purpose: To evaluate the prognostic value of abnormal exercise myocardial perfusion imaging and its types in patients with coronary artery disease (CAD). Methods: 69 patients with CAD underwent exercise myocardial perfusing imaging and exercise ECG test. The images of all of them were abnormal. 45 patients were angiographically proved CAD. Follow-up period ranged from 6∼110 months and even longer than 12 months for patients with no cardiac events (CE). Results: CE occurred in 15 patients during the follow-up period. The CE incidence was 8.7% per year. Cox regression analysis revealed that there was a good correlation between the number of myocardial segments with reversible defects and future CE. Comparing the results of 13 patients with small extent irreversible defects with the data obtained from normal subjects reported previously, there was no significant difference between two no-CE rates (x 2 = 0.09, P>0.05). Conclusions: Normal myocardial images and irreversible defects involving rather small areas predicted an excellent prognosis. The better predictor of future CE is the quantity of myocardial segments with reversible defect

  14. Evaluation of myocardial involvement in Duchenne's progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Kawai, Naoki; Sotobata, Iwao; Okada, Mitsuhiro

    1985-01-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. A qualitative analysis was performed from five projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in the LV posterolateral or posterior wall (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle involvements or thoracic deformities assessed by transmission computed tomography. Extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. Progression of the myocardial scintigraphic abnormalities were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies over 2 to 3 years. It was concluded that thallium myocardial perfusion imaging is a useful clinical technique to assess myocardial involvement in Duchenne's progressive muscular dystrophy. (author)

  15. NT-pro-BNP is associated with inducible myocardial ischemia in mildly symptomatic type 2 diabetic patients.

    Science.gov (United States)

    Wiersma, Jacobijne J; van der Zee, P Marc; van Straalen, Jan P; Fischer, Johan C; van Eck-Smit, Berthe L F; Tijssen, Jan G P; Trip, Mieke D; Piek, Jan J; Verberne, Hein J

    2010-11-19

    Baseline levels of N-terminal fragment of the brain natriuretic peptide prohormone (NT-pro-BNP) are associated with myocardial ischemia in non-diabetic patients with stable angina pectoris. A total of 281 patients with diabetes mellitus type 2 and stable angina pectoris underwent myocardial perfusion scintigraphy (MPS). Myocardial ischemia on MPS was present in 140 (50%) patients. These ischemic patients had significantly higher NT-pro-BNP levels compared with patients without ischemia: 183 pg/ml (64-324 pg/ml) vs. 88 pg/ml (34-207 pg/ml), respectively (ppro-BNP ≥180 pg/ml was an independent predictor of the presence of myocardial ischemia (OR 2.36, 95%CI 1.40-3.97, p=0.001). Possible confounding factors such as age and creatinine clearance were of no influence on the predictive value in this specific patient population. These findings strengthen the idea that NT-pro-BNP may be of value in the early detection of diabetic patients with hemodynamic significant coronary artery disease. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  16. Relationship between HgbA1c and myocardial blood flow reserve in patients with type 2 diabetes mellitus: noninvasive assessment using real-time myocardial perfusion echocardiography.

    Science.gov (United States)

    Huang, Runqing; Abdelmoneim, Sahar S; Nhola, Lara F; Mulvagh, Sharon L

    2014-01-01

    To study the relationship between glycosylated hemoglobin (HgbA1c) and myocardial perfusion in type 2 diabetes mellitus (T2DM) patients, we prospectively enrolled 24 patients with known or suspected coronary artery disease (CAD) who underwent adenosine stress by real-time myocardial perfusion echocardiography (RTMPE). HgbA1c was measured at time of RTMPE. Microbubble velocity (β min(-1)), myocardial blood flow (MBF, mL/min/g), and myocardial blood flow reserve (MBFR) were quantified. Quantitative MCE analysis was feasible in all patients (272/384 segments, 71%). Those with HgbA1c > 7.1% had significantly lower βreserve and MBFR than those with HgbA1c ≤ 7.1% (P relationship was not significant (r = -0.117, P = 0.129). Using a MBFR cutoff value > 2 as normal, HgbA1c > 7.1% significantly increased the risk for abnormal MBFR, (adjusted odds ratio: 1.92, 95% CI: 1.12-3.35, P = 0.02). Optimal glycemic control is associated with preservation of MBFR as determined by RTMPE, in T2DM patients at risk for CAD.

  17. Evaluation of left ventricular myocardial function in patients with coronary artery disease and myocardial dysfunction before and after coronary artery bypass grafting by cine magnetic resonance imaging

    International Nuclear Information System (INIS)

    Juergens, K.U.; Renger, B.; Reimer, P.; Tombach, B.; Heindel, W.; Wichter, T.; Bruns, H.J.; Vahlhaus, C.; Janssen, F.W.; Breithardt, G.

    2001-01-01

    Purpose: To evaluate left ventricular (LV) myocardial function in ten patients with coronary artery disease (CAD) preoperatively and 6 months after coronary bypass grafting (CABG) by cardiac MRI. Material and methods: Ten patients (mean 65.2±5.9 years) with angiographically proven CAD and an indication for elective CABG underwent prospective evaluation of global LV function and regional wall motion by Cine-MRI at rest using a multiphase FLASH-2D sequence following regions of interest (ROI)-defined diagnostics of regional myocardial wall motion by means of levocardiography. Within the ROIs a total of 613 LV myocardial segments were analyzed preceding and following surgical revascularization. Results were compared with the data of 10 healthy volunteers. Results: Preoperatively, patients showed reduced stroke volume and ejection fraction compared with volunteers (p [de

  18. Myocardial revascularization in patient with situs inversus totalis: case report

    Directory of Open Access Journals (Sweden)

    Soncini da Rosa George Ronald

    2002-01-01

    Full Text Available This is a report of an unusual case of a patient, with dextrocardia and a "situs inversus totalis". She presented angina pectoris during an ECG stress test. The coronary arteriography revealed severe obstruction in the main left coronary artery. The patient underwent coronary artery bypass grafting surgery. We did not find a similar case in the national medical literature. The myocardial revascularization performed utilizing the right mammary artery for anterior descending artery and saphenous vein grafts for first diagonal branch and first marginal branch.

  19. Long-term mortality in patients with diabetes mellitus type 2 after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Miljković Dušan

    2014-01-01

    Full Text Available Introduction. Myocardial infarction is the most common cause of death in patients with diabetes, and several studies have shown that people with diabetes have twice the risk of dying from a heart attack compared to non diabetics. Objective. The aim of this study was to determine the mortality of patients that have survived acute myocardial infarction, in population of patients with diabetes mellitus and without diabetes. Method. The study included 135 patients recovered from myocardial infarction, of whom 51 (37.8% had type 2 diabetes mellitus, and 84 (62.2% were without diabetes, mean age 55,4±9,6 years. All patients underwent a complete cardiac and hemodynamic testing, cardiac catheterization with selective coronary angiography, and in most patients the aortocoronary bypass revascularization or percutaneous coronary intervention. Start of follow-up was the date of acute myocardial infarction. The study included only patients who survived at least one month after acute myocardial infarction. All patients with diabetes and without diabetes were monitored for an average of 84 months, i.e. 7 years. Results. The average age of patients with diabetes and myocardial infarction was 57.1±8.7 years, and of patients with myocardial infarction without diabetes 54.5 ± 9.6 years (t=1.62; p>0.05. Among patients with diabetes 14 (27.5% were women and 37 (72.5% were men, and in non-diabetics 15 (17.9% were women and 69 (82.1% were men (χ2=1.66; p>0.05. In the follow-up period died 15 (29.4% patients with diabetes, and 7 (8.3% patients without diabetes. Mortality in patients with diabetes and myocardial infarction was significantly higher than the mortality of patients with myocardial infarction without diabetes (χ2=11.2; p0.05. In the group of 27 patients who were treated with insulin, died five (18.5% and in the group of 24 patients on oral therapy died 10 (41.7%. There was no significant difference in mortality in patients with diabetes treated with

  20. Prognostic importance of silent myocardial ischemia detected by intravenous dipyridamole thallium myocardial imaging in asymptomatic patients with coronary artery disease

    International Nuclear Information System (INIS)

    Younis, L.T.; Byers, S.; Shaw, L.; Barth, G.; Goodgold, H.; Chaitman, B.R.

    1989-01-01

    One hundred seven asymptomatic patients who underwent intravenous dipyridamole thallium imaging were evaluated to determine prognostic indicators of subsequent cardiac events over an average follow-up period of 14 +/- 10 months. Univariate analysis of 18 clinical, scintigraphic and angiographic variables revealed that a reversible thallium defect, a combined fixed and reversible thallium defect, number of segmental thallium defects and extent of coronary artery disease were significant predictors of subsequent cardiac events. Of the 13 patients who died or had a nonfatal infarction, 12 had a reversible thallium defect. Stepwise logistic regression analysis selected a reversible thallium defect as the only significant predictor of cardiac events. When death or myocardial infarction was the outcome variable, a combined fixed and reversible thallium defect was the only predictor of outcome. In patients without previous myocardial infarction, the cardiac event rate was significantly greater in those with an abnormal versus normal thallium scan (55% versus 12%, p less than 0.001). Thus, intravenous dipyridamole thallium scintigraphy is a useful noninvasive test to risk stratify asymptomatic patients with coronary artery disease. A reversible thallium defect most likely indicates silent myocardial ischemia in a sizable fraction of patients in this clinical subset and is associated with an unfavorable prognosis

  1. Characteristics of myocardial perfusion imaging and coronary artery angiography in patients of NIDDM complicated with AMI

    International Nuclear Information System (INIS)

    Zhao Peiqin; Zhao Jinhua; Qin Mingzhao; Dai HaoJie; Zhang Runwu; Xiao Fen

    2001-01-01

    Objective: To investigate the characteristic changes of myocardial perfusion imaging and coronary artery angiography in patients of acute myocardial infarction (AMI) with underlined type 2 diabetes mellitus. Methods: 25 type 2 diabetes mellitus patients were enrolled for having clinical manifestation of AMI. Ten inpatients with AMI of simple coronary heart disease origin were served as controls. All subjects underwent both myocardial perfusion imagings (resting and nitroglycerine invention) and coronary artery angiography. Results: Compared to controls (40%), type 2 diabetes mellitus + AMI group had higher rate of multivessel disease (60%). For type 2 diabetes mellitus + AMI patients, 129/400 segments (32.25%) showed fixed defect, 25/160 segments (15.62%) in controls. Conclusions: For type 2 diabetes mellitus + AMI group, myocardial perfusion defects are widely distributed and multivessel or severe stenosis is more often presented. Good correlation exists between abnormal segments and angiographic lesions in both the number of segments involved and the severity of the lesions. Radionuclide myocardial perfusion is therefore considered a useful screening test not inferior to angiography, especially for those who are not tolerant enough to undergoing angiography

  2. Is chronic ST segment elevation a marker of myocardial non viability in patients with Q wave anteroseptal MI? Correlation with myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Padma, S.; Zachariah, M.; Haridas, K.K.

    2004-01-01

    Persistence of ST segment elevation for more than 2-4 weeks in patients with acute antero septal transmural myocardial infarction (ASMI) is considered to be a specific marker of left ventricular aneurysm. Objective: We attempted to assess the face value of this statement by correlating the findings of 99m Tc Sestamibi Myocardial perfusion SPECT (MPSPECT), one of the most specific modalities of myocardial viability assessment with resting 12 lead ECG. METHOD: 240 ASMI patients (192:48 Male: Female pts, age range 36-71 yrs Mean 51±8 yrs) referred for risk stratification to our department between Jan 02 -Jan 04 were retrospectively analysed. The baseline demographic details and LV systolic function parameters were more or less the same for all these patients. The mean LV EF at rest was 40±6 %. All these patients fulfilled the following inclusion criteri 1) Patients with Q Wave ASMt more than 1 month old, 2) ECG at rest showing sinus rhythm, QRS 1.5 mm. Patients with atrial arrhythmias and bundle branch block were excluded. All these patients underwent same day rest stress gated 99m Tc MIBI/ tetrofosmin MPSPECT on a dual head variable angle gamma camera. Patients performed either conventional treadmill stress or taken up for pharmacological stress. LAD territory myocardial segments (i.e. apex, anterior, septal) were evaluated for the presence of reversible ischaemia / viable myocardium. Images were visually interpreted and using a 16 segment myocardial model quantification was also performed. Presence of reversible perfusion defects, uptake of MIBI at rest more than 40 % and myocardial systolic wall thickening (count increase by at least 10% during systole) were considered as markers of viability. Results' Patients were categorized into two groups. ST elevation positive i.e. patients with rest ST elevation > 1.5 mm (137 pts 57%) and ST elevation negative (103 pts 37%) by the rest ECG criteria. In ST positive group, 47/137 pts (34%) showed viability (mean viable

  3. Is chronic st segment elevation a marker of myocardial non viability in patients with Q wave anteroseptal mi? - correlation with myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Padma, S; Zachariah, M.; Haridas, K K

    2004-01-01

    Persistence of ST segment elevation for more than 2-4 weeks in patients with acute antero septal transmural myocardial infarction (ASMI) is considered to be a specific marker of left ventricular aneurysm. Objective: We attempted to assess the face value of this statement by correlating the findings of 99m -Tc Sestamibi Myocardial perfusion SPECT (MPSPECT), one of the most specific modalities of myocardial viability assessment with resting 12 lead ECG. Method: 240 ASMI patients (192:48 Male: Female pts, age range 36-71 yrs Mean 51±8 yrs) referred for risk stratification to our department between Jan 02 -Jan 04 were retrospectively analysed. The baseline demographic details and LV systolic function parameters were more or less the same for all these patients. The mean LV EF at rest was 40±6 %. All these patients fulfilled the following inclusion criteria: 1) Patients with Q Wave ASMI more than l month old, 2) ECG at rest showing sinus rhythm, QRS 1.5 mm. Patients with atrial arrhythmias and bundle branch block were excluded. All these patients underwent same day rest stress gated 99m Tc MIBI/ tetrofosmin MPSPECT on a dual head variable angle gamma camera. Patients performed either conventional treadmill stress or taken up for pharmacological stress. LAD territory myocardial segments (i.e. apex, anterior, septal) were evaluated for the presence of reversible ischaemia/viable myocardium. Images were visually interpreted and using a 16 segment myocardial model quantification was also performed. Presence of reversible perfusion defects, uptake of MIBI at rest more than 40% and myocardial systolic wall thickening (count increase by at least 10% during systole) were considered as markers of viability. Results: Patients were categorized into two groups. ST elevation positive i.e. patients with rest ST elevation > 1.5 mm (137 pts 57%) and ST elevation negative (103 pts 37%) by the rest ECG criteria. In ST positive group, 47/137 pts (34%) showed viability (mean viable

  4. Dual-isotope myocardial imaging: feasibility, advantages and limitations. Preliminary report on 231 consecutive patients

    International Nuclear Information System (INIS)

    Weinmann, P.; Foult, J.M.; Le Guludec, D.; Tamgac, F.; Rechtman, D.; Neuman, A.; Caillat-Vigneron, N.; Moretti, J.L.

    1994-01-01

    Two hundred and thirty-one patients underwent dual-isotope myocardial imaging (rest thallium-201 followed by stress technetium-99m sestamibi). The feasibility of the procedure was excellent: camera scheduling flexibility was improved and the duration of the procedure was less than that of a classical stress-redistribution procedure. Interpretation of defects due to image attenuation was facilitated by the different attenuation properties of 201 Tl and 99m Tc-sestamibi in 11 of 19 patients. 201 Tl cross-over on 99m Tc was found to be 15% ± 3% with doses of 201 Tl and 99m Tc-sestamibi of 3 and 10 mCi, respectively, and 7% ± 2% with doses of 3 and 20 mCi. This protocol should preferentially be reserved for patients with a history of myocardial infarction and/or a basal left ventricular dysfunction, in whom assessment of myocardial viability is of major interest. (orig./MG)

  5. Myocardial contusion in patients with blunt chest trauma as evaluated by thallium 201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Bodin, L.; Rouby, J.J.; Viars, P.

    1988-01-01

    Fifty five patients suffering from blunt chest trauma were studied to assess the diagnosis of myocardial contusion using thallium 201 myocardial scintigraphy. Thirty-eight patients had consistent scintigraphic defects and were considered to have a myocardial contusion. All patients with scintigraphic defects had paroxysmal arrhythmias and/or ECG abnormalities. Of 38 patients, 32 had localized ST-T segment abnormalities; 29, ST-T segment abnormalities suggesting involvement of the same cardiac area as scintigraphic defects; 21, echocardiographic abnormalities. Sixteen patients had segmental hypokinesia involving the same cardiac area as the scintigraphic defects. Fifteen patients had clinical signs suggestive of myocardial contusion and scintigraphic defects. Almost 70 percent of patients with blunt chest trauma had scintigraphic defects related to areas of myocardial contusion. When thallium 201 myocardial scintigraphy directly showed myocardial lesion, two-dimensional echocardiography and standard ECG detected related functional consequences of cardiac trauma

  6. Diagnostic value of exercise induced 18F-FDG myocardial metabolism scintigraphy in myocardial ischemia

    International Nuclear Information System (INIS)

    Shen Rui; He Zuoxiang; Shi Rongfang; Liu Xiujie; Tian Yueqin; Guo Feng; Wei Hongxing; Wu Yongjian; Qin Xuewen; Gao Runlin

    2006-01-01

    Objective: To evaluate the feasibility and diagnostic accuracy of exercise induced myocardial imaging with 18 F-fluorodeoxyglucose (FDG) in myocardial ischemia. Methods: Twenty-six patients with known or suspected coronary artery, disease (CAD) and with no prior myocardial infarction underwent simultaneous myocardial perfusion and metabolism imaging following intravenous injection of 99 Tc m -methoxy-isobutylisonitrile ( 99 Tc m -sestamibi) and 18 F-FDG at peak exercise. Subsequently rest perfusion imaging and coronary angiography (CAG) were performed in all patients. Exercise 18 F-FDG myocardial imaging was compared with 99 Tc m -sestamibi imaging and CAG. Results: In 22 patients with ≥50% narrowing over l coronary artery, 18 had perfusion abnormalities (sensitivity 82%), whereas 20 had abnormal myocardial 18 F-FDG uptake (sensitivity 91%, P>0.05). Patients with reversible (12 cases) or partial reversible (3 cases) perfusion abnormalities had increased myocardial 18 F-FDG uptake in abnormal perfusion segments. Compared with CAG, perfusion defect was seen in myocardial segments corresponding to 25 vascular territories of 51 vessels with ≥50% narrowing in 22 patients in 99 Tc m -sestamibi imaging (sensitivity 49%), whereas increased 18 F-FDG uptake was seen in 34 vascular territories (sensitivity 67%, P=0.008). Conclusions: Exercise induced myocardial ischemia can be imaged directly with 18 F-FDG. Combined exercise 18 F-FDG and 99 Tc m -sestamibi imaging provides a better assessment of exercise-induced myocardial ischemia as compared with exercise-rest perfusion imaging. (authors)

  7. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Mandurino-Mirizzi, Alessandro; Crimi, Gabriele; Raineri, Claudia; Pica, Silvia; Ruffinazzi, Marta; Gianni, Umberto; Repetto, Alessandra; Ferlini, Marco; Marinoni, Barbara; Leonardi, Sergio; De Servi, Stefano; Oltrona Visconti, Luigi; De Ferrari, Gaetano M; Ferrario, Maurizio

    2018-05-01

    Elevated serum uric acid (eSUA) was associated with unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). However, the effect of eSUA on myocardial reperfusion injury and infarct size has been poorly investigated. Our aim was to correlate eSUA with infarct size, infarct size shrinkage, myocardial reperfusion grade and long-term mortality in STEMI patients undergoing primary percutaneous coronary intervention. We performed a post-hoc patients-level analysis of two randomized controlled trials, testing strategies for myocardial ischemia/reperfusion injury protection. Each patient underwent acute (3-5 days) and follow-up (4-6 months) cardiac magnetic resonance. Infarct size and infarct size shrinkage were outcomes of interest. We assessed T2-weighted edema, myocardial blush grade (MBG), corrected Thrombolysis in myocardial infarction Frame Count, ST-segment resolution and long-term all-cause mortality. A total of 101 (86.1% anterior) STEMI patients were included; eSUA was found in 16 (15.8%) patients. Infarct size was larger in eSUA compared with non-eSUA patients (42.3 ± 22 vs. 29.1 ± 15 ml, P = 0.008). After adjusting for covariates, infarct size was 10.3 ml (95% confidence interval 1.2-19.3 ml, P = 0.001) larger in eSUA. Among patients with anterior myocardial infarction the difference in delayed enhancement between groups was maintained (respectively, 42.3 ± 22.4 vs. 29.9 ± 15.4 ml, P = 0.015). Infarct size shrinkage was similar between the groups. Compared with non-eSUA, eSUA patients had larger T2-weighted edema (53.8 vs. 41.2 ml, P = 0.031) and less favorable MBG (MBG < 2: 44.4 vs. 13.6%, P = 0.045). Corrected Thrombolysis in myocardial infarction Frame Count and ST-segment resolution did not significantly differ between the groups. At a median follow-up of 7.3 years, all-cause mortality was higher in the eSUA group (18.8 vs. 2.4%, P = 0.028). eSUA may affect myocardial

  8. Relationships of elevated systemic pentraxin-3 levels with high-risk coronary plaque components and impaired myocardial perfusion after percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction.

    Science.gov (United States)

    Kimura, Shigeki; Inagaki, Hiroshi; Haraguchi, Go; Sugiyama, Tomoyo; Miyazaki, Toru; Hatano, Yu; Yoshikawa, Shunji; Ashikaga, Takashi; Isobe, Mitsuaki

    2014-01-01

    We aimed to assess the relationships of pentraxin-3 (PTX3) with coronary plaque components and myocardial perfusion after percutaneous coronary intervention (PCI) in order to clarify the mechanisms underlying the prognostic function of PTX3 in ST-elevation acute myocardial infarction (STEMI) patients. We enrolled 75 STEMI patients who underwent pre-PCI virtual histology (VH)-intravascular ultrasound. Relationships of the systemic pre-PCI PTX3 level with coronary plaque components and post-PCI myocardial blush grade (MBG) were evaluated. Lesions with elevated pre-PCI PTX3 (median ≥3.79ng/ml) had higher frequencies of VH-derived thin-cap fibroatheroma (65.8% vs. 24.3%, P2 on admission (hazard ratio, 5.356; 95% CI, 1.409-20.359; P=0.014) as independent predictors of adverse cardiac events during follow-up. Systemic pre-PCI PTX3 was associated with high-risk plaque components and impaired post-PCI myocardial perfusion. Thus, PTX3 may be a reliable predictor of outcome in STEMI patients.

  9. Detection of periodontal bacteria in thrombi of patients with acute myocardial infarction by polymerase chain reaction.

    Science.gov (United States)

    Ohki, Takahiro; Itabashi, Yuji; Kohno, Takashi; Yoshizawa, Akihiro; Nishikubo, Shuichi; Watanabe, Shinya; Yamane, Genyuki; Ishihara, Kazuyuki

    2012-02-01

    Numerous reports have demonstrated that periodontal bacteria are present in plaques from atherosclerotic arteries. Although periodontitis has recently been recognized as a risk factor for coronary artery disease, the direct relationship between periodontal bacteria and coronary artery disease has not yet been clarified. It has been suggested that these bacteria might contribute to inflammation and plaque instability. We assumed that if periodontal bacteria induce inflammation of plaque, the bacteria would be released into the bloodstream when vulnerable plaque ruptures. To determine whether periodontal bacteria are present in thrombi at the site of acute myocardial infarction, we tried to detect periodontal bacteria in thrombi of patients with acute myocardial infarction by polymerase chain reaction (PCR). We studied 81 consecutive adults with ST-segment elevation acute myocardial infarction who underwent primary percutaneous coronary intervention (PCI). All patients underwent removal of thrombus with aspiration catheters at the beginning of percutaneous coronary intervention, and a small sample of thrombus was obtained for PCR. The detection rates of periodontal bacteria by PCR were 19.7% for Aggregatibacter actinomycetemcomitans, 3.4% for Porphyromonas gingivalis, and 2.3% for Treponema denticola. Three species of periodontal bacteria were detected in the thrombi of patients with acute myocardial infarction. This raises the possibility that such bacteria are latently present in plaque and also suggests that these bacteria might have a role in plaque inflammation and instability. Copyright © 2012 Mosby, Inc. All rights reserved.

  10. The clinical application value of myocardial perfusion imaging in evaluating coronary artery myocardial bridge patients with symptoms

    International Nuclear Information System (INIS)

    Wang Yuetao; Fu Ning; Ding Xuemei; Lu Cunzhi; Zhu Feng; Wang Guanmin; Huang Yijie; Wang Linguang

    2008-01-01

    Objective: Myocardial bridge is a common inborn coronary artery anomaly, myocardial bridge may be associated with myocardial ischemia. Only a few patients with coronary artery myocardial bridge were evaluated with nuclear medicine techniques. The aim of this study was to investigate the role of nuclear cardiology with myocardial perfusion technique in symptomatic myocardial bridge patients. Methods Nineteen myocardial bridge patients with the symptoms of chest pain and chest distress were analyzed retrospectively. 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion images (both exercise and rest) were performed in all. Imaging results were compared with the results of movement electrocardiogram (ECG) and coronary arteriography. The t test or χ 2 test was used to statistically analyze the data with Stata 7.0 software. Results: Of the 19 patients, 18 patients had myocardial bridge locating at the left anterior descending artery, 1 patient at the left anterior descending and left circumflex artery, the mean angiographic systolic occlusion within the myocardial bridge was (65.4 ± 22.1)%. Of these 19 patients, Exercise-rest 99 Tc m -MIBI myocardial perfusion imaging defined positive myocardial ischemia in 10 and negative in 9 patients. Of the 10 patients with 99 Tc m -MIBI myocardial perfusion imaging defined myocardial ischemia, 8 had reversible radioactive defect of partial anterior wall and (or) apex, 1 had reversible defect of post lateral wall and post septal wall, and 1 had reversible defect of inferior wall. The positive predictive value of myocardial perfusion imaging was 52.6% (10/19), which was higher than movement ECG [21.1% (4/19), χ 2 = 4.07, P 99 Tc m -MIBI myocardial periusion imaging defined myocardial ischemia. Six cases with Grade II stenosis, two were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial ischemia. Eight cases with Grade III stenosis, seven were 99 Tc m -MIBI myocardial perfusion imaging defined myocardial

  11. Advanced myocardial tissue characterisation by a multi-component CMR protocol in patients with rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Greulich, Simon; Kaesemann, Philipp; Patrascu, Alexandru; Sechtem, Udo; Mahrholdt, Heiko [Robert-Bosch-Medical Center Stuttgart, Division of Cardiology, Stuttgart (Germany); Mayr, Agnes [University Hospital Innsbruck, Division of Radiology, Innsbruck (Austria); Kitterer, Daniel; Latus, Joerg; Braun, Niko; Alscher, M.D. [Robert-Bosch-Medical Center Stuttgart, Division of Nephrology, Department of Internal Medicine, Stuttgart (Germany); Henes, Joerg [University Hospital Tuebingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), Tuebingen (Germany); Vecchio, Francesco [Robert-Bosch-Medical Center Stuttgart, Division of Cardiology, Stuttgart (Germany); Universita degli Studi di Roma ' ' Tor Vergata' ' , Division of Cardiology, Rome (Italy); Greiser, Andreas; Groeninger, Stefan [Siemens Healthcare GmbH, Erlangen (Germany); Romeo, Francesco [Universita degli Studi di Roma ' ' Tor Vergata' ' , Division of Cardiology, Rome (Italy)

    2017-11-15

    Rheumatoid arthritis (RA) patients are at increased risk of suffering from adverse cardiovascular events. Cardiovascular magnetic resonance (CMR) mapping techniques might be appropriate tools to complement late gadolinium enhancement (LGE) for the assessment of myocardial involvement. This study aimed to perform advanced myocardial tissue characterisation in RA patients by a multicomponent CMR protocol. 22 RA patients were prospectively enrolled and underwent CMR, including LGE and T1/T2 mapping sequences; 20 volunteers served as controls. Mean LV-EF was 66%; prevalence of LGE was 18%. RA patients had increased native T1 (985 vs. 959 ms, p = 0.03), expanded extracellular volume (ECV) (27 vs. 25%, p = 0.02) and higher T2 values (52 vs. 49 ms, p < 0.001) compared to controls irrespective of the presence of LGE. T2 mapping showed the highest prevalence of values beyond the 95% percentile of controls. RA patients demonstrated higher T1, ECV and T2 values compared to controls, with most significant differences for T2. Since these results seem to be independent of the presence of LGE, advanced myocardial tissue characterisation including CMR mapping techniques in addition to LGE-CMR might be useful in the evaluation of myocardial involvement in RA patients. (orig.)

  12. Assessment of myocardial viability in patients with myocardial infarction using twenty-four hour thallium-201 late redistribution imaging

    International Nuclear Information System (INIS)

    Yang Xiangjun; He Yongming; Zhang Bin; Wu Yiwei; Hui Jie; Jiang Tingbo; Song Jianping; Liu Zhihua; Jiang Wenping

    2006-01-01

    Rest thallium-201 ( 201 Tl) myocardial perfusion imaging has been widely used for evaluation of myocardial ischemia/viability after myocardial infarction, but the ideal timing for imaging after injection to maximally estimate viability is not well established. Thirty-six patients with myocardial infarction underwent the initial, 3 h, and 24 h redistribution imaging after intravenous injection of 148-185 MBq 201 Tl. The initial and 3 h images, the initial and 24 h images, and the 3 and 24 h images were compared double-blinded. Out of the 184 abnormal segments based on the initial imaging, 56 (30%) segments improved by at least 1 grade on the 3 h imaging while 78 (42%) segments improved by at least 1 grade on the 24 h imaging. The 24 h late imaging detected more viable myocardium than the 3 h imaging did, with a significant difference (χ 2 =5.680, p=0.017). There were 158 abnormal segments on the 3 h imaging, with average 28% (44) segments improved by at least 1 grade on the 24 h imaging. There were 128 initial abnormal segments with no improvement on the 3 h imaging. Out of these segments, the 24 h late redistribution imaging detected additional redistribution in 26 segments, taking up 20%. Twenty-four hour late 201 Tl imaging will demonstrated additional redistribution in patients who have incompletely reversible defects on early redistribution imaging at 3 h. (author)

  13. Diabetes patients show different time-course of myocardial perfusion improvement after coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Lee, J. J.; Seok, J. W.; Eo, J. S.

    2005-01-01

    Diabetes mellitus is an independent risk factor of cardiovascular disease. Diabetes is known to cause microangiopathy. The microangiopathy is hardly detectable on the coronary angiography. Myocardial perfusion imaging shows the resultant perfusion status which reflects the microangiopathy. For patients who underwent revascularization, the microangiopathy could affect the myocardial perfusion improvement. Diabetes patients probably experience the different myocardial perfusion improvement as compared to the non-diabetes patients although they have similar angiographic findings. The aim of this study is to find out whether there is a time-course difference of perfusion improvement between the diabetes and non diabetes patients who showed patent angiographic findings after coronary artery grafting surgery (CABG). A total of 129 patients who underwent coronary artery bypass grafting surgery were enrolled in this study. Myocardial SPECTs performed at previous, short-term (3 month), and mid-term (1 year) to CABG. One-year follow up angiography was done 411±121 days after surgery. Graft patency was determined according to the FitzGibbon et al. Segments were assigned to vascular territories using a 20 segment model. The segments of excellent patency were included in this study. Time course differences of concerned segments were analyzed using RMANOVA. The number of segments enrolled was 764 of diabetes and 1083 of non-diabetes. At short-term follow up, reversibility score was 2.8±8.1% in diabetes and 0.3±7.5% in non-diabetes. At long-term follow up, reversibility score was 1.8±8.0% in diabetes and 0.1±7.3% in non-diabetes. The time-course of reversibility score was significantly different between the diabetes and non diabetes (p<0.001) Diabetic segments showed high residual reversibility score than non-diabetic segments after CABG although the angiographic finding was patent in both groups. This result is maybe attributable to microangiopathy induced by diabetes

  14. Outcome of Patients With Adenosine-Induced ST Segment Depression and Normal Myocardial Perfusion

    International Nuclear Information System (INIS)

    El-Refaei, S.; Selim, M.

    2011-01-01

    The aim of the present study was to determine the outcome of patients with normal MPS and adenosine-induced ST segment depression. A total of 1867 patients underwent adenosine Tc99m-tetrofosmin MPS in nuclear medicine unit in Saudi German Hospital, Saudi Arabia, between January 2004 and May 2008. Their ECGs were checked for ST segment depression during adenosine infusion. All patients with ≥ 1 mm horizontal or down-sloping ST segment depression or≥ 1.5 mm up-sloping ST segment depression were included in the study. Fifty-six patients met our inclusion criteria, of which 45 (80%) were females. During the follow-up period, a total of 15 of patients ended up doing coronary angiography, either for high clinical suspicion or following a second positive MPS performed 6-18 months after the first study. Seven of them were positive for coronary artery disease and were subsequently treated with revascularization procedure, and 8 returned either normal angiography or non-obstructive coronary artery disease. Male diabetic smoking patients were more prevalent and underwent revascularization. The patients were followed up for a mean of 22.8 ±7.8 months. No cardiac deaths or myocardial infarctions were reported. It could be concluded that adenosine-induced ST segment depression in patients with normal myocardial perfusion was a benign finding and did not increase the very low risk of cardiac events in those patients. However, male smokers and/or diabetics might need further investigation. This suggestion needs further evaluation

  15. Prognostic value of gated 201Tl myocardial perfusion SPECT imaging in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Li Zicheng; Chen Xiaoming; Xu Hao

    2006-01-01

    Objective: To study the prognostic value of gated 201 Tl myocardial perfusion SPECT imaging in patients with coronary artery disease and assessment of therapy strategy for the individual patient. Methods: Eighty-four patients underwent rest and exercise stress 201 Tl gated myocardial perfusion SPECT imaging and were followed up for (32.92 ± 16.77) months. Images were studied using 17 segments and 1 to 4 scoring. Global summed stress score (SSS), summed rest score (SRS) and summed difference score (SDS=SSS-SRS) were also calculated. Post-stress and rest ejection fraction (EF) were automatically measured. Results: Nine cardiac events occurred (3.90% per year). SSS, SDS, SRS and EF were the independent predictors of cardiac events (P 201 Tl myocardial perfusion SPECT imaging can provide prognostic assessment for the patients with coronary artery disease and guide in selection of therapeutic strategy. Among all of the indices SSS is the best predictors of cardiac events. (authors)

  16. Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients

    Directory of Open Access Journals (Sweden)

    Laura M. T. Neves

    2014-03-01

    Full Text Available Background: Reduced respiratory muscle endurance (RME contributes to increased dyspnea upon exertion in patients with cardiovascular disease. Objective: The objective was to characterize ventilatory and metabolic responses during RME tests in post-myocardial infarction patients without respiratory muscle weakness. Method: Twenty-nine subjects were allocated into three groups: recent myocardial infarction group (RG, n=9, less-recent myocardial infarction group (LRG, n=10, and control group (CG, n=10. They underwent two RME tests (incremental and constant pressure with ventilatory and metabolic analyses. One-way ANOVA and repeated measures one-way ANOVA, both with Tukey post-hoc, were used between groups and within subjects, respectively. Results: Patients from the RG and LRG presented lower metabolic equivalent and ventilatory efficiency than the CG on the second (50± 06, 50± 5 vs. 42± 4 and third part (50± 11, 51± 10 vs. 43± 3 of the constant pressure RME test and lower metabolic equivalent during the incremental pressure RME test. Additionally, at the peak of the incremental RME test, RG patients had lower oxygen uptake than the CG. Conclusions : Post-myocardial infarction patients present lower ventilatory efficiency during respiratory muscle endurance tests, which appears to explain their inferior performance in these tests even in the presence of lower pressure overload and lower metabolic equivalent.

  17. Off-pump myocardial revascularisation in an octogenarian patient with dextrocardia and situs inversus.

    Science.gov (United States)

    Ennker, I C; Pietrowski, D; Ennker, J

    2006-01-01

    Dextrocardia associated with situs inversus totalis is a rare condition and there are few reports of myocardial revascularisation in such patients. An 82-year-old woman with dextrocardia and situs inversus totalis underwent successful off-pump coronary artery bypass grafting using internal mammary arteries. The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus. However, for a right-handed surgeon the operation was easier standing on the left side of the patient.

  18. Relationship between the mismatch of 123I-BMIPP and 201Tl myocardial single-photon emission computed tomography and autonomic nervous system activity in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Yamanaka, Hiroyuki; Suzuki, Takeshi; Kishida, Hiroshi; Nagasawa, Koichi; Takano, Teruo

    2006-01-01

    The purpose of this study was to elucidate the relationship between the mismatch of thallium-201 (Tl) and iodine-123-beta-methyl-iodophenyl-pentadecanoic acid (BMIPP) myocardial single-photon emission computed tomography (SPECT) and autonomic nervous system activity in myocardial infarction (MI) patients. The subjects were 40 patients (34 males, 6 females) who underwent examinations by 123 I-BMIPP and 201 Tl myocardial SPECT imaging and 24-hour Holter monitoring within a 3-day period 3 weeks after the onset of their first MI. R-R intervals were analyzed every hour over a period of 24 hours by fast Fourier transformation (FFT). High frequency (HF) and low frequency (LF) were defined as markers of cardiac vagal activity in the former and the LF/HF ratio as sympathetic activity. Greater or more extensive decreases in the BMIPP image than that in the Tl image were defined as a positive mismatch. Patients were divided into positive and negative mismatch groups of 20 patients each. There were no significant differences between the 2 groups in age, sex, site of infarction, max CK (creatine kinase), max CK-MB, or left ventricular ejection fraction. The incidences of clinical signs suggesting residual myocardial ischemia were significantly greater in the positive than in the negative mismatch group (P 123 I-BMIPP and 201 Tl myocardial SPECT 3 weeks after a first acute myocardial infarction with uncomplicated moderate or severe heart failure and decreased heart rate variability are related to residual myocardial ischemia. A combined assessment of heart rate variability in 24 hour Holter electrocardiogram (ECG) monitoring and perfusion-metabolism mismatch in 123 I-BMIPP and 201 Tl myocardial SPECT is useful for determining residual myocardial ischemia in the follow-up of those with acute myocardial infarction. (author)

  19. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Kim, Eun Kyoung; Choi, Jin-Ho; Song, Young Bin; Hahn, Joo-Yong; Chang, Sung-A; Park, Sung-Ji; Lee, Sang-Chol; Choi, Seung-Hyuk; Choe, Yeon Hyeon; Park, Seung Woo; Gwon, Hyeon-Cheol

    2016-01-01

    Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007). In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. ST segment elevation after myocardial infarction: Viability or ventricular dysfunction? Comparison with myocardial scintigraphy

    International Nuclear Information System (INIS)

    Chalela, William Azem; Soares, J. Jr.; Meneghetti, J.C.; Olivera, C.G.; Moffa, P.J.; Falcao, A.M.; Ramires, J.A.F.

    2004-01-01

    The detection of viable myocardium after myocardial infarction is an important indication for revascularization. We compared exercise-induced ST segment elevation with reversibility at Thallium-201 SPECT scintigraphy and regional wall motion assessment by ventriculography. Thirty two patients with previous myocardial infarction and with left ventricular ejection fraction of < 50% were studied. Patients underwent coronary angiography and Thallium-201 SPECT scintigraphy with re-injection protocol before and after coronary artery bypass graft surgery. Group I comprised 11 patients with ST segment elevation during treadmill stress testing. Group II comprised 21 patients without ST segment elevation. Minimal or moderate hypokinesis was present in 2 patients of Group I and in 4 patients of Group II. Nine patients of Group I and 17 patients of Group II had severe hypokinetic, akinetic or dyskinetic myocardium. Scintigraphy revealed reversibility in the myocardial infarction area in 4 patients from Group I (36.4%) and 11 (52.4%) patients from Group II. Improvement in perfusion after coronary artery bypass grafting was observed in 4 patients from Group I and 8 patients from Group II. Sensitivity, specificity, accuracy, and positive and negative predictive values of ST segment elevation were 33.3, 70.6, 55.2, 44.5 and 60% respectively. It was concluded that exercise-induced ST segment elevation after myocardial infarction is present more frequently in cases of severe regional myocardial dysfunction. (author)

  1. Clinical evaluation of 99Tcm-MIBI myocardial perfusion imaging for the detection of coronary artery disease in patients with metabolic syndrome

    International Nuclear Information System (INIS)

    Tian Yueqin; Wei Hongxing; Guo Xinhua; Guo Feng; He Zuoxiang

    2008-01-01

    Objective: Metabolic syndrome is a combination of medical disorders that consist of a collection of independent factors at risk of developing coronary artery disease. The purpose of this study was to evaluate the value of 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging for the diagnosis of coronary artery disease in patients with metabolic syndrome. Methods: A total of 251 patients [mean age (59 ± 10) years, 179 men, 72 women] were included in this study. All patients underwent exercise and rest 99 Tc m -MIBI myocardial perfusion imaging and coronary angiography. Results: Of the 163 patients with significant coronary artery stenosis, 116 showed abnormal 99 Tc m -MIBI myocardial perfusion imaging; and among the 88 patients with normal coronary angiography, 82 showed normal myocardial perfusion imaging. The sensitivity, specificity and accuracy of 99 Tc m -MIBI myocardial perfusion imaging for coronary artery disease detection were 71% (116/163), 93% (82/88) and 79% (198/251), respectively. The positive and negative predictive values were 95% (116/122) and 64% (82/129), respectively. Conclusion: 99 Tc m -MIBI myocardial perfusion imaging has important clinical value for detecting coronary artery disease in patients with metabolic syndrome. (authors)

  2. Evaluation of myocardial abnormalities in collagen diseases by thallium-201 myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamano, Shigeru; Kagoshima, Tadashi; Sugihara, Kiyotaka (Nara Medical Univ., Kashihara (Japan)) (and others)

    1993-12-01

    This study was performed to evaluate myocardial abnormalities in patients with collagen diseases by exercise and rest thallium-201 myocardial scintigrams. A total of 65 patients without ischemic ECG changes, consisting of 18 with systemic lupus erythematosus (SLE), 18 with polymyositis (PM), 8 with progressive systemic sclerosis (PSS), and 21 with Sjoegren's syndrome (SjS), was enrolled in this study. Reversible exercise-induced defects scintigraphically suggesting myocardial ischemia were noted in 8 cases of SLE, 4 cases of PM, 4 cases of PSS, and 3 cases of SjS. Nineteen patients had exercise-induced defects and underwent cardiac catheterization, 8 of whom had normal coronary angiograms. Fixed hypoperfusion areas were observed in one case of SLE, 6 cases of PM and 3 cases of SjS. Rest thallium-201 myocardial scintigram disclosed hypoperfusion areas which were not induced by exercise in 2 cases of SLE, 3 cases of PM, one case of PSS and 5 cases of SjS. Echocardiogram showed no significant differences in ejection fraction and % fractional shortening between the disease groups and healthy control group. These findings suggest that patients with collagen diseases have abnormalities of coronary circulation at the level of the intramural vasculature before cardiac function impairment, myocardial fibrosis and functional abnormalities at the cell membrane. (author).

  3. Myocardial involvement in diabetic patients evaluated by exercise thallium-201 scintigraphy and cardiac catheterization

    International Nuclear Information System (INIS)

    Mizuno, Sumio; Genda, Akira; Nakayama, Akira; Igarashi, Yutaka; Takeda, Ryoyu

    1985-01-01

    To evaluate myocardial involvement in diabetes mellitus, we studied 39 patients with negative double-Master's test and without hypertension by exercise thallium-201 (Tl-201) myocardial scintigraphy using a bicycle ergometer. Among the 39 patients, 12 (30.8 %) showed filling defects in the scintigrams (positive cases), including eight with stress-induced defects and four with fixed defects. The positive cases had higher scores of diabetic complications (3.6 +- 2.4 vs 2.1 +- 1.8; p < 0.05) and longer durations of diabetes as compared with those of the negative cases. The frequency of insulin therapy was also greater in the positive cases. Eleven patients (5 positive and 6 negative cases) who underwent cardiac catheterization had no significant stenotic lesions of their coronary arteries. However, all of the positive cases showed abnormal wall motion, mainly hypokinesis, by left ventriculography (LVG). The abnormalities of the LVG corresponded to the findings of the scintigrams (i.e. filling defects and decrease in washout ratios by circumferential profile analysis). These results suggest that in some diabetics myocardial involvement exists in the early stage without overt cardiac disease and exercise Tl-201 scintigraphy is useful in detecting pre-clinical cardiomyopathy. Cardiomyopathy in diabetics seems to be due to disturbances of the myocardial microcirculation. (author)

  4. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro

    1983-01-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy. (author)

  5. Evaluation of myocardial involvement in Duchenne progressive muscular dystrophy with thallium-201 myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kawai, Naoki; Yamamoto, Shuhei; Okada, Mitsuhiro (Nagoya Univ. (Japan). Faculty of Medicine)

    1983-12-01

    Myocardial involvement in progressive muscular dystrophy of the Duchenne type was evaluated in 19 patients using thallium-201 myocardial perfusion imaging. The qualitative analysis was performed in anterior, 3 left anterior oblique and left lateral projection images by three experienced physicians. Distinct perfusion defects were shown in 13 patients, especially in LV posterolateral or posterior walls (11 patients). There was no significant relationship between the presence of perfusion defects and the skeletal muscle changes or thoracic deformities assessed by transmission computed tomography. Slightly increased thallium-201 activity in RV free wall and lungs was shown in nine and one patient, respectively. The extensive perfusion defects were shown in 2 patients who died of congestive heart failure 1 to 2 years after the scintigraphic study. The myocardial scintigraphic changes were considered to be minimal in 7 of 9 patients who underwent two serial scintigraphic studies in 2 to 3 years. It was concluded that the thallium myocardial perfusion imaging was a useful clinical technique to evaluate the cardiomyopathy in Duchenne progressive muscular dystrophy.

  6. The clinical value of adenosine triphosphate stress myocardial perfusion tomography for detecting coronary artery disease

    International Nuclear Information System (INIS)

    Yao Zhiming; He Qing; Qu Wanying; Yu Xue; Han Lijun; Yu Zhiguo; Li Wei; Zeng Xuezhai; Zhu Ming; Zhao Hongshan

    2002-01-01

    Objective: To study the clinical value of adenosine triphosphate stress myocardial perfusion tomography imaging (ATP-MPI) in detection of coronary artery disease (CAD). Methods: There were 278 patients underwent ATP-MPI, 51 patients of them also underwent coronary angiography (CAG). Seventy-three patients underwent stress-rest myocardial perfusion tomography imaging with multi-stage submaximal exercise test (ST-MPI) and CAG serving as control group. Results: 1) Side effects: there were 11 different symptoms and atrioventricular conduction block (10 patients), sinoatrial conduction block (2 patients) occurred during ATP stress. Allopathy or interruption of ATP stress did not happen. 2) The sensitivity and specificity of ATP-MPI in detection of CAD were 97.1% and 82.4%, respectively, and those in detection of ≥50% narrowing coronary artery were 91.0% and 94.7%, respectively. 3) In patients without myocardial infarction, the sensitivity and specificity of ATP-MPI in detection of myocardial ischemia were comparable to those of ST-MPI. Conclusion: ATP-MPI is an accurate, safe modality and is comparable to ST-MPI in the detection of CAD

  7. Tl myocardial SPECT demonstrates importance of collateral circulation in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Hattori, Fukunori

    1997-01-01

    The influence of collateral circulation on the preservation of myocardial viability and the efficacy of drug therapy and PTCA were evaluated by exercise 201 Tl myocardial SPECT before and after treatment. Thirty-five patients with a history of myocardial infarction resulting from total or subtotal obstruction of the responsible coronary artery were divided into four groups, according to the method of the treatment and the degree of collateral blood flow. Patients in groups A and B received drug therapy and displayed developed and undeveloped collateral circulation, respectively. Groups C and D received PTCA and displayed developed and undeveloped collateral circulation, respectively. Tl myocardial SPECT was performed before treatment to record the extent of redistribution to the occluded region, the degree of myocardial viability and the nature and extent of the ischemic lesion. In group A, myocardial perfusion improved, although redistribution remained in all cases, while in group B, 4 of 7 cases improved after drug therapy. In group C, myocardial perfusion improved in all cases, and redistribution disappeared in 7 of 12 cases. 5 of 6 cases improved in group D after PTCA. After drug therapy, the %Tl uptake in the infarcted region improved significantly in initial and delayed images of patients in group A. The differences in initial and delayed images in group B before and after drug therapy were not significant. In contrast, groups C and D both registered significant improvement in initial and delayed images after PTCA. The washout rate improved significantly in groups A, C and D after their respective treatments. These results suggest that developed collateral circulation helps to preserve myocardial viability in cases of myocardial infarction. Myocardial perfusion improved after drug therapy in cases with developed collateral circulation, and in patients with developed and undeveloped collateral circulation receiving PTCA. (K.H.)

  8. Clinical Characteristics and Outcomes of Patients with Myocardial Infarction, Myocardial Injury, and Nonelevated Troponins

    DEFF Research Database (Denmark)

    Sarkisian, Laura; Saaby, Lotte; Poulsen, Tina S

    2016-01-01

    BACKGROUND: Cardiac troponins have emerged as the preferred biomarkers for detecting myocardial necrosis and diagnosing myocardial infarction. However, current cardiac troponin assays do not discriminate between ischemic and nonischemic causes of myocardial cell death. Thus, when an increased...... troponin value is encountered in the absence of obvious myocardial ischemia, a careful search for other clinical conditions is crucial. METHODS: In 2010 to 2011, we prospectively studied hospitalized patients who had cardiac troponin I measured on clinical indication. An acute myocardial infarction...... was diagnosed in cases of a cardiac troponin I increase or decrease pattern with at least 1 value >30 ng/L (99th percentile) together with myocardial ischemia. Myocardial injury was defined as cardiac troponin I values >30 ng/L, but without signs or symptoms indicating overt cardiac ischemia. Patients with peak...

  9. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock.

    Science.gov (United States)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J; Noc, Marko; Goslar, Tomaž; Felix, Stephan B; Maier, Lars S; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe

    2017-12-21

    In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial. In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke. At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups. Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those

  10. Evaluation of left ventricular function in patient with old myocardial infarction by 201-thallium myocardial scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Kanji; Shimohara, Yasuaki; Ito, Misao; Okada, Keisei [Kure Kyosai Hospital, Hiroshima (Japan); Kodama, Kazunori

    1984-08-01

    Correlation between the ratio of myocardial defect calculated by 201-thallium myocardial scintigraphy and the left ventricular ejection fraction (LVEF) obtained by gated blood pool scintigraphy and the maximum level of creatine phosphokinase (CPK) was studied in 70 patients with old myocardial infarction. There was a significant correlation between the defect ratio and the LVEF or CPK level in patients with anterior or septal myocardial infarction. In all patients with inferior myocardial infarction in whom no defect was seen, the LVEF was more than 40%. However, no distinct correlation between the defect ratio and the LVEF or CPK level was obtained in cases of inferior myocardial infarction.

  11. Diagnosis of coronary artery disease using myocardial perfusion SPECT in patients with diabetes mellitus: analysis of risk factors

    International Nuclear Information System (INIS)

    Seo, Ji Hyoung; Kang, Seong Min; Bae, Jin Ho; Jeong, Shin Young; Lee, Sang Woo; Yoo, Jeong Soo; Ahn, Byeong Cheol; Lee, Jae Tae

    2006-01-01

    Diabetes mellitus is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. 203 diabetic patients (64 male, mean age 64.1 ± 9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36 ± 18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the occurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events

  12. Diagnosis of coronary artery disease using myocardial perfusion SPECT in patients with diabetes mellitus: analysis of risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Ji Hyoung; Kang, Seong Min; Bae, Jin Ho; Jeong, Shin Young; Lee, Sang Woo; Yoo, Jeong Soo; Ahn, Byeong Cheol; Lee, Jae Tae [Kyungpook National University, Daegu, (Korea, Republic of)

    2006-06-15

    Diabetes mellitus is a critical disease with higher rates of cardiovascular morbidity and mortality due to myocardial ischemia and infarction. There is growing interest in how to determine high-risk patients who are candidates for screening testing. This study was performed to evaluate the incidence of coronary artery disease (CAD) in diabetic patients detected by Tc-99m MIBI myocardial perfusion SPECT (MPS) and to assess risk factors of CAD and cardiac hard events. 203 diabetic patients (64 male, mean age 64.1 {+-} 9.0 years) who underwent MPS were included between Jan 2000 and July 2004. Cardiac death and nonfatal myocardial infarction (MI) were considered as hard events, and coronary angioplasty and bypass surgery >60 days after testing were considered as soft events. The mean follow-up period was 36 {+-} 18 months. Patients underwent exercise (n=6) or adenosine stress (n=197) myocardial perfusion SPECT. Perfusion defects on MPS were detected in 28.6% (58/203) of the patients. There was no cardiac death but 11 hard events were observed. The annual cardiac hard event rate was 1.1%. In univariate analysis of clinical factors, typical anginal pain, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were significantly associated with the occurrence of hard events. Anginal pain, peripheral vascular disease, and resting ECG abnormality remained independent predictors of nonfatal MIs with multivariate analysis. Abnormal SPECT results were significantly associated with high prevalence of hard events but not independent predictors on uni- and multivariate analyses. patients who were male, had longer diabetes duration (especially over 20 years), peripheral vascular disease, peripheral polyneuropathy, or resting ECG abnormality had higher incidence of CAD. Among clinical factors in diabetic patients, typical angina, peripheral vascular disease, peripheral polyneuropathy, and resting ECG abnormality were strong predictors of hard events.

  13. [Clinical significance of myocardial 123I-BMIPP imaging in patients with myocardial infarction].

    Science.gov (United States)

    Narita, M; Kurihara, T; Shindoh, T; Honda, M

    1997-03-01

    In order to clarify the characteristics of fatty acid metabolism in patients with myocardial infarction (MI), we performed myocardial imaging with 123I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) and we compared these findings with exercise stress (Ex) and resting myocardial perfusion imaging with 99mTc-methoxyisobutylisonitrile (MIBI) and left ventricular wall motion index (WMI) which were obtained by left ventriculography. We studied 55 patients with MI, 14 patients with recent MI (RMI) and 41 patients with old MI (OMI), and myocardial images were divided into 17 segments and myocardial uptake of the radionuclide was graded from 0 (normal) to 3 (maximal abnormality). In 28 patients we compared segmental defect score (SDS) with WMI which were obtained by centerline method at the corresponded segments. As a whole, the mean total defect scores (TDSs) of BMIPP and Ex were similar and they were greater than the mean TDS of resting perfusion. In 30 patient (55%) TDS of BMIPP was greater than that of TDS of resting perfusion. In 24 patients perfusion abnormality developed by Ex and the location of BMIPP abnormality coincided with the abnormality of Ex. But in the other 6 patients Ex did not induce any abnormality and they were all RMI and infarcted coronary artery was patent. However in the group with TDS of BMIPP identical to TDS of resting perfusion (25 patients), 92% did not show myocardial perfusion abnormality after Ex. In the comparison of SDS and WMI, myocardial segments were divided into 3 groups; both SDSs of BMIPP and resting perfusion were normal or borderline abnormality (Group 1, 82 segments), SDS of resting perfusion was normal or borderline and SDS of BMIPP was definitely abnormal (Group 2, 10 segments) and both SDSs of BMIPP and resting perfusion were definitely abnormal (Group 3, 48 segments). In Group 1, WMS (-0.41 +/- 0.77) was significantly (p acid metabolism may appear in viable myocardium such as jeopardized myocardium and myocardium which

  14. Myocardial infarction after dipyridamole-assisted thallium-201 imaging

    International Nuclear Information System (INIS)

    Biddle, P.; Lanspa, T.J.; Mohiuddin, S.M.; Malesker, M.A.; Hilleman, D.E.

    1989-01-01

    A 77-year-old woman with suspected coronary artery disease underwent an oral dipyridamole/thallium-201 myocardial imaging study. Approximately 75 minutes after ingestion of dipyridamole 300 mg suspension, the patient developed chest pain, hypotension, nausea, and diaphoresis. An electrocardiogram revealed ST-T wave changes suggestive of inferior ischemia. Appropriate therapeutic measures, including aminophylline and nitroglycerin, were instituted. Delayed thallium images revealed reversible ischemia in the anteroseptal and posterobasal regions with a fixed defect in the inferobasal region. Cardiac enzyme studies were also indicative of acute myocardial injury. The patient subsequently underwent coronary arteriography and four-vessel coronary artery bypass grafting and was discharged without further complication. This report raises concerns about the potential danger of dipyridamole in patients with severe coronary artery stenosis and collateral circulation. Prophylactic aminophylline should be considered in these patients

  15. Delayed percutaneous coronary intervention in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Zhu Weiming; Tian Fang; Shi Li; Lan Xi

    2004-01-01

    Objective: To observe the clinical effects, safeness and prognosis of delayed percutaneous coronary intervention (PCI) for infarct related artery (IRA) in post-infarct patients. Methods: In total 53 patients with acute myocardial infarction (AMI) underwent delayed PCI within 5-15 days after the acute event. Conventional treatment (including thrombolytic therapy) was given in all patients as they were admitted. Results: Intervention was performed in 68 branches of IRA were, including 64 cases of PTCA followed by stent implantation and 4 cases of direct stent implantation. In total 68 stents were implanted. The TIMI classification was improved from the pre-PCI 0-2 to post-PCI 3. No patient died during the treatment. No repeated AMI, post-infarct angina and repeated recanalization happened in the hospitalization. A 5-48 month follow up showed there was 1 death (1.9%), 1 case of repeated myocardial infarction (1.9%), 3 cases of unstable angina (5.7%), 2 cases of repeated PCI and 1 case of CABG. The rate of repeated recanalization was 5.7%. Seven patients (13.2%) were admitted for the second time, who survived 6-48 months after the intervention. Conclusion: Delayed PCT can obviously improve the short and long term prognosis as well as the life quality of patients with AMI, which is a safe interventional procedure

  16. Association Between Early Q Waves and Reperfusion Success in Patients With ST-Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Topal, Divan Gabriel; Lønborg, Jacob; Ahtarovski, Kiril Aleksov

    2017-01-01

    BACKGROUND: Pathological early Q waves (QW) are associated with adverse outcomes in patients with ST-segment-elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) may therefore be less beneficial in patients with QW than in patients without QW. Myocardial salvage......: The ECG was assessed before primary PCI for the presence of QW (early) in 515 STEMI patients. The patients underwent a cardiac magnetic resonance imaging scan at day 1 (interquartile range [IQR], 1-1) and again at day 92 (IQR, 89-96). Early QW was observed in 108 (21%) patients and was related to smaller...... index and microvascular obstruction (MVO) are markers for reperfusion success. Thus, to clarify the benefit from primary PCI in STEMI patients with QW, we examined the association between baseline QW and myocardial salvage index and MVO in STEMI patients treated with primary PCI. METHODS AND RESULTS...

  17. Defect images in stress thallium-201 myocardial scintigraphy in patients with complete left bundle branch block. Comparison of exercise stress and pharmacological stress

    International Nuclear Information System (INIS)

    Sasaki, Hideki; Shimizu, Mitsuyuki; Ogawa, Kazuhiko; Okazaki, Fumiko; Mizokami, Tsuneo; Kusaka, Masafumi; Uehara, Yoshiki; Taniguchi, Ikuo; Mochizuki, Seibu

    2007-01-01

    Stress thallium-201 ( 201 Tl) myocardial scintigraphy can demonstrate perfusion abnormalities, especially in the septum in patients with complete left bundle branch block (CLBBB) even with angiographically normal coronary arteries. Differences in the images between exercise and pharmacological stress 201 Tl myocardial scintigraphy were evaluated in patients with CLBBB and normal coronary arteries. Forty-five patients with CLBBB underwent exercise stress using treadmill or pharmacological (adenosine triphosphate) stress 201 Tl myocardial scintigraphy from October 1997 to February 2003. Patients with myocardial diseases were excluded, such as cardiomyopathy and coronary artery diseases detected by echocardiography and/or cardiac catheterization. The myocardial segment was classified according to the American Heart Association style for coronary artery disease. Peak blood pressure levels and heart rates were significantly higher in the exercise stress group than in the pharmacological stress group (p 201 Tl myocardial scintigraphy according to the stress method. Moreover, defects also occurred in areas other than the septum. Blood pressure and heart rate were involved in the mechanisms of defects in left bundle branch block. (author)

  18. Off-pump supra-arterial myotomy for myocardial bridging.

    Science.gov (United States)

    Crespo, Alejandro; Aramendi, José I; Hamzeh, Gadah; Voces, Roberto

    2008-09-01

    We report the results of surgery and midterm outcome in two patients with symptomatic myocardial bridging who underwent off-pump supra-arterial myotomy. Both patients were operated upon through a median sternotomy. The anterior wall of the heart was exposed in the same manner as in off-pump CABG. The left anterior descending coronary artery is unroofed from its myocardial bridge with the aid of a heart stabilizer and a blower. Neither heparin nor blood transfusion was required. Both patients survived the operation and are asymptomatic. Postoperative coronary angiogram showed good resolution of the muscle bridge in one patient. We conclude that in symptomatic patients with myocardial bridging despite medical therapy, surgical myotomy can be considered an adequate therapy. It can be safely done off-pump.

  19. Prognostic value of thallium-201 myocardial perfusion imaging in patients with unstable angina who respond to medical treatment

    International Nuclear Information System (INIS)

    Brown, K.A.

    1991-01-01

    Although the prognostic value of thallium-201 imaging is well established, its ability to risk stratify patients who present with unstable angina is unclear. Fifty-two consecutive patients admitted with unstable angina who responded to medical treatment and underwent stress thallium-201 imaging within 1 week of discharge were studied. Patients were followed up for 39 +/- 11 months. Cardiac events included cardiac death (n = 3), nonfatal myocardial infarction (n = 4) and admission for unstable angina or revascularization (n = 17). The ability of thallium-201 data (redistribution, fixed defects, normal) to predict cardiac events was compared with clinical data (age, gender, prior myocardial infarction, anginal syndrome, rest and stress electrocardiogram) and cardiac catheterization data using logistic regression. Thallium-201 redistribution was the only significant predictor of cardiac death or nonfatal myocardial infarction (p less than 0.05). The number of myocardial segments with thallium-201 redistribution (p less than 0.0005) and a history of prior myocardial infarction (p less than 0.05) were the only significant predictors of all cardiac events. Cardiac death or nonfatal myocardial infarction occurred more frequently in patients with thallium-201 redistribution (6 [26%] of 23) than in those without redistribution (1 [3%] of 29, p less than 0.05). Similarly, total cardiac events developed more frequently in patients with thallium-201 redistribution (p less than 0.001). Stress thallium-201 imaging has important prognostic value in patients admitted with unstable angina who respond to medical therapy and can identify subgroups at high versus low risk for future cardiac events

  20. Detecting Regional Myocardial Abnormalities in Patients With Wolff-Parkinson-White Syndrome With the Use of ECG-Gated Cardiac MDCT.

    Science.gov (United States)

    Lee, Hye-Jeong; Uhm, Jae-Sun; Joung, Boyoung; Hong, Yoo Jin; Hur, Jin; Choi, Byoung Wook; Kim, Young Jin

    2016-04-01

    Myocardial dyskinesia caused by the accessory pathway and related reversible heart failure have been well documented in echocardiographic studies of pediatric patients with Wolff-Parkinson-White (WPW) syndrome. However, the long-term effects of dyskinesia on the myocardium of adult patients have not been studied in depth. The goal of the present study was to evaluate regional myocardial abnormalities on cardiac CT examinations of adult patients with WPW syndrome. Of 74 patients with WPW syndrome who underwent cardiac CT from January 2006 through December 2013, 58 patients (mean [± SD] age, 52.2 ± 12.7 years), 36 (62.1%) of whom were men, were included in the study after the presence of combined cardiac disease was excluded. Two observers blindly evaluated myocardial thickness and attenuation on cardiac CT scans. On the basis of CT findings, patients were classified as having either normal or abnormal findings. We compared the two groups for other clinical findings, including observations from ECG, echocardiography, and electrophysiologic study. Of the 58 patients studied, 16 patients (27.6%) were found to have myocardial abnormalities (i.e., abnormal wall thinning with or without low attenuation). All abnormal findings corresponded with the location of the accessory pathway. Patients with abnormal findings had statistically significantly decreased left ventricular function, compared with patients with normal findings (p syndrome. These abnormal findings might reflect the long-term effects of dyskinesia, suggesting irreversible myocardial injury that ultimately causes left ventricular dysfunction.

  1. MYOCARDIAL BRIDGING - CLINICAL AND ANGIOGRAPHIC PROFILE IN LAST 5 YEARS; A STUDY OF 129 CASES

    Directory of Open Access Journals (Sweden)

    Abhilash S P

    2010-11-01

    Full Text Available Aims of study : To assess the clinical and angiographical profile of myocardial bridging from consecutive coronary angiograms done over last 5 years at Medical college, Thiruvananthapuram. To assess the risk of cardiovascular events and the risk of accelerated atherosclerosis in isolated myocardial bridging. Methods : Consecutive coronary angiograms done at Medical college Thiruvananthapuram from 04/02/2005 to 31/03/2010 were reviewed for myocardial bridging. A total of 10492 coronary angiograms were reviewed. Myocardial bridges with systolic lumen reduction of more than 50% were considered for analysis. Quantitative coronary angiography (QCA was used for analysis. Clinical presentation as well as correlation with structural heart disease and coronary heart disease was assessed. Results: Incidence of myocardial bridges was 1.23%. Of the 129 patients with myocardial bridges 63 ( 48.8% had associated significant coronary artery disease. Remaining 66 (51.2% patients presented with isolated bridges. Out of these 66 patients with isolated myocardial bridges, 7 (10.6% patients presented with acute myocardial infarction and 3 (4.5% presented with cardiac arrhythmias. Of the 63 patients with significant coronary disease 11 (17.5% patients had single vessel disease and they had the culprit lesion and myocardial bridge seen in the same vessel. Most common location of myocardial bridge was mid LAD (64.9% followed by distal LAD (23.8%. Length of bridge was 20 mm in 35.7%. Mean percentage of systolic obliteration by the bridge was 74.5%. 100% systolic obliteration was seen in 7.79% of isolated bridges and in 9.79% of bridges with CAD. Among 120 rhuematic heart disease patients who underwent coronary angiogram, 10 (8.3% patients had myocardial bridging. 12.1% of all HCM patients who underwent coronary angiograms had myocardial bridging. Conclusion: Myocardial bridging can be lethal- can accelerate atherosclerosis, can precipitate acute MIs and life

  2. Evaluation of myocardial abnormalities in patients with collagen diseases by thallium-201 myocardial scintigram

    Energy Technology Data Exchange (ETDEWEB)

    Yamano, Shigeru (Nara Medical Univ., Kashihara (Japan))

    1992-08-01

    This study was performed to evaluate myocardial lesions in patients with collagen diseases by rest and exercise thallium-201 myocardial scintigraphies. A total of 76 patients without ischemic ECG changes, consisting of 27 cases of systemic lupus erythematosus (SLE), 17 cases of polymyositis or dermatomyositis (PM[center dot]DM), 11 cases of progressive systemic sclerosis (PSS), and 21 cases of Sjoegren's syndrome (SjS), were enrolled in this study. Reversible exercise-induced defects suggesting myocardial ischemia were noted in 12 cases of SLE, 5 cases of PM[center dot]DM, 3 cases of PSS, and 3 cases of SjS. Of the 23 patients who had exercise-induced defects, 9 patients showed normal coronary angiograms by cardiac catheterization. Fixed hypoperfusion areas were observed in 5 cases of SLE, 6 cases of PM[center dot]DM, 4 cases of PSS and 3 cases of SjS. Rest thallium-201 myocardial scintigraphy disclosed hypoperfusion areas, which were not induced by exercise, in 1 case of SLE, 4 cases of PM[center dot]DM, 1 case of PSS and 5 cases of SjS. Endomyocardial biopsy was performed on 20 patients. Myocardial lesions in PM[center dot]DM and PSS were more severe and wide spread than in SLE. Ejection fraction and fractional shortening evaluated by echocardiography had no significant differences between each disease group and the healthy control group. These findings suggest that patients with collagen diseases show the presence of abnormalities of coronary circulation at the level of the intramyocardial vasculature in the stage before impairment of cardiac function, myocardial fibrosis and functional abnormalities of the cell membrane level that were not dependent on myocardial ischemia. (author).

  3. Prevalence and predictors of an abnormal stress myocardial perfusion study in asymptomatic patients with type 2 diabetes mellitus

    International Nuclear Information System (INIS)

    Scholte, Arthur J.H.A.; Schuijf, Joanne D.; Wall, Ernst E. van der; Bax, Jeroen J.; Kharagjitsingh, Antje V.; Dibbets-Schneider, Petra; Stokkel, Marcel P.

    2009-01-01

    The purpose of this study was to evaluate the prevalence of an abnormal stress myocardial perfusion study in a cohort of truly asymptomatic patients with type 2 diabetes mellitus using myocardial perfusion imaging by means of single photon emission computed tomography (SPECT). Secondly, we determined which clinical characteristics may predict an abnormal stress myocardial perfusion study in this population. A total of 120 asymptomatic patients (mean age 53±10 years) with type 2 diabetes mellitus and one or more risk factors for coronary artery disease were prospectively recruited from an outpatient diabetes clinic. All patients underwent myocardial perfusion imaging by means of adenosine 99m Tc sestamibi SPECT. Images were evaluated for the presence of perfusion abnormalities as well as other nonperfusion abnormalities that may indicate extensive ischaemia, including left ventricular dysfunction (defined as a left ventricular ejection fraction <45%), transient ischaemic dilatation and adenosine-induced ST segment depression. Multivariable analysis was performed using a backward selection strategy to identify potential predictors for an abnormal stress myocardial perfusion study. Finally, all patients were followed up for 12 months to determine the occurrence of cardiovascular events: (1) cardiac death, (2) nonfatal myocardial infarction, (3) unstable angina requiring hospitalization, (4) revascularization, or (5) stroke. Of the 120 patients, 40 (33%) had an abnormal stress study, including myocardial perfusion abnormalities in 30 patients (25%). In 10 patients (8%), indicators of extensive (possibly balanced ischaemia) were observed in the absence of abnormal perfusion. The multivariable analysis identified current smoking, duration of diabetes and the cholesterol/high-density lipoprotein (HDL) ratio as independent predictors of an abnormal stress study. During a follow-up period of 12 months six patients (5%) had a cardiovascular event. The current study revealed

  4. Prevalence and predictors of an abnormal stress myocardial perfusion study in asymptomatic patients with type 2 diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Scholte, Arthur J.H.A.; Schuijf, Joanne D.; Wall, Ernst E. van der; Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, PO Box 9600, Leiden (Netherlands); Kharagjitsingh, Antje V. [Medisch Centrum Haaglanden, Department of Internal Medicine, The Hague (Netherlands); Dibbets-Schneider, Petra; Stokkel, Marcel P. [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands)

    2009-04-15

    The purpose of this study was to evaluate the prevalence of an abnormal stress myocardial perfusion study in a cohort of truly asymptomatic patients with type 2 diabetes mellitus using myocardial perfusion imaging by means of single photon emission computed tomography (SPECT). Secondly, we determined which clinical characteristics may predict an abnormal stress myocardial perfusion study in this population. A total of 120 asymptomatic patients (mean age 53{+-}10 years) with type 2 diabetes mellitus and one or more risk factors for coronary artery disease were prospectively recruited from an outpatient diabetes clinic. All patients underwent myocardial perfusion imaging by means of adenosine {sup 99m}Tc sestamibi SPECT. Images were evaluated for the presence of perfusion abnormalities as well as other nonperfusion abnormalities that may indicate extensive ischaemia, including left ventricular dysfunction (defined as a left ventricular ejection fraction <45%), transient ischaemic dilatation and adenosine-induced ST segment depression. Multivariable analysis was performed using a backward selection strategy to identify potential predictors for an abnormal stress myocardial perfusion study. Finally, all patients were followed up for 12 months to determine the occurrence of cardiovascular events: (1) cardiac death, (2) nonfatal myocardial infarction, (3) unstable angina requiring hospitalization, (4) revascularization, or (5) stroke. Of the 120 patients, 40 (33%) had an abnormal stress study, including myocardial perfusion abnormalities in 30 patients (25%). In 10 patients (8%), indicators of extensive (possibly balanced ischaemia) were observed in the absence of abnormal perfusion. The multivariable analysis identified current smoking, duration of diabetes and the cholesterol/high-density lipoprotein (HDL) ratio as independent predictors of an abnormal stress study. During a follow-up period of 12 months six patients (5%) had a cardiovascular event. The current study

  5. Use of resting myocardial scintigraphy during chest pain to exclude diagnosis of acute myocardial infarction

    International Nuclear Information System (INIS)

    Barbirato, Gustavo Borges; Azevedo, Jader Cunha de; Felix, Renata Christian Martins; Correa, Patricia Lavatori; Volschan, Andre; Viegas, Monica; Pimenta, Lucia; Dohmann, Hans Fernando Rocha; Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco

    2009-01-01

    Background: Images of myocardial perfusion taken during an episode of chest pain have been used for patients in the emergency department. Objective: To evaluate the operating characteristics of 99m Tc-Tetrofosmin scintigraphy during an episode of chest pain to exclude the diagnosis of cute myocardial infarction. Methods: One hundred and eight patients admitted with chest pain, or up to four hours after the end of symptoms and non diagnostic electrocardiogram, underwent resting scintigraphy and measurement of troponin I concentrations. Patients with a history of myocardial infarction (MI) were not excluded (24 patients). Troponin I concentrations were determined at admission and 6 hours later. Nuclear physicians performed a blind analysis of the images, and myocardial infarction was confirmed whenever troponin I level increase was three times that of the control. Results: Resting perfusion image was abnormal in all 6 patients with MI. Only 1 patient had a normal image and increased troponin levels. Fifty-five patients had positive images without MI, and 46 patients had normal images and troponin levels. The prevalence of the disease was 6.5%. The sensitivity and specificity of the resting images during an episode of chest pain to diagnose MI was 85.7% and 45.5%, respectively. The negative predictive value was 97.7%. Conclusion: Patients undergoing chest pain protocol with SPECT showed an excellent negative predictive value to exclude diagnosis of myocardial infarction. These results suggest that resting perfusion image is an important tool at the chest pain unit. (author)

  6. T1 and T2 mapping for evaluation of myocardial involvement in patients with ANCA-associated vasculitides.

    Science.gov (United States)

    Greulich, Simon; Mayr, Agnes; Kitterer, Daniel; Latus, Joerg; Henes, Joerg; Steubing, Hannah; Kaesemann, Philipp; Patrascu, Alexandru; Greiser, Andreas; Groeninger, Stefan; Braun, Niko; Alscher, M Dominik; Sechtem, Udo; Mahrholdt, Heiko

    2017-01-06

    Myocardial involvement in AAV patients might be silent, presenting with no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-EF). Since up to 50% of deaths in these patients may be due to myocardial involvement, a reliable diagnostic tool is warranted. In contrast to LGE-CMR, which has its strengths in detecting focal inflammatory or fibrotic processes, recent mapping techniques are able to detect even subtle, diffuse inflammatory or fibrotic processes. Our study sought to investigate ANCA (antineutrophil cytoplasmic antibody) associated vasculitides (AAV) patients for myocardial involvement by a cardiovascular magnetic resonance (CMR) protocol, including late gadolinium enhancement (LGE) and mapping sequences. Thirty seven AAV patients were prospectively enrolled and underwent CMR imaging. Twenty healthy volunteers served as controls. Mean LV-EF was 64%; LGE prevalence of the AAV patients was 43%. AAV patients had higher median native T1 (988 vs. 952 ms, p T2 (53 vs. 49 ms, p T2 in AAV patients showed the highest prevalence of abnormally increased values beyond the 95% percentile of controls. AAV patients demonstrated increased T1, ECV, and T2 values, with native T1 and T2 showing the highest prevalence of values beyond the 95% percentile of normal. Since these findings seem to be independent of LGE, mapping techniques may provide complementary information to LGE-CMR in the assessment of myocardial involvement in patients with AAV.

  7. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    Energy Technology Data Exchange (ETDEWEB)

    Weininger, Markus [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, SC (United States); Ramachandra, Ashok [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Fink, Christian [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany); Rowe, Garrett W.; Costello, Philip [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Henzler, Thomas [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States); Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University (Germany)

    2012-12-15

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

  8. Adenosine-stress dynamic real-time myocardial perfusion CT and adenosine-stress first-pass dual-energy myocardial perfusion CT for the assessment of acute chest pain: Initial results

    International Nuclear Information System (INIS)

    Weininger, Markus; Schoepf, U. Joseph; Ramachandra, Ashok; Fink, Christian; Rowe, Garrett W.; Costello, Philip; Henzler, Thomas

    2012-01-01

    Purpose: Recent innovations in CT enable the evolution from mere morphologic imaging to dynamic and functional testing. We describe our initial experience performing myocardial stress perfusion CT in a clinical population with acute chest pain. Methods and materials: Myocardial stress perfusion CT was performed on twenty consecutive patients (15 men, 5 women; mean age 65 ± 8 years) who presented with acute chest pain and were clinically referred for stress/rest SPECT and cardiac MRI. Prior to CT each patient was randomly assigned either to Group A or to Group B in a consecutive order (10 patients per group). Group A underwent adenosine-stress dynamic real-time myocardial perfusion CT using a novel “shuttle” mode on a 2nd generation dual-source CT. Group B underwent adenosine-stress first-pass dual-energy myocardial perfusion CT using the same CT scanner in dual-energy mode. Two experienced observers visually analyzed all CT perfusion studies. CT findings were compared with MRI and SPECT. Results: In Group A 149/170 myocardial segments (88%) could be evaluated. Real-time perfusion CT (versus SPECT) had 86% (84%) sensitivity, 98% (92%) specificity, 94% (88%) positive predictive value, and 96% (92%) negative predictive value in comparison with perfusion MRI for the detection of myocardial perfusion defects. In Group B all myocardial segments were available for analysis. Compared with MRI, dual-energy myocardial perfusion CT (versus SPECT) had 93% (94%) sensitivity, 99% (98%) specificity, 92% (88%) positive predictive value, and 96% (94%) negative predictive value for detecting hypoperfused myocardial segments. Conclusion: Our results suggest the clinical feasibility of myocardial perfusion CT imaging in patients with acute chest pain. Compared to MRI and SPECT both, dynamic real-time perfusion CT and first-pass dual-energy perfusion CT showed good agreement for the detection of myocardial perfusion defects.

  9. Quantitative analysis of exercise 201Tl myocardial emission CT in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Okada, Mitsuhiro; Kawai, Naoki; Yamamoto, Shuhei

    1984-01-01

    The clinical usefulness of quantitative analysis of exercise thallium-201 myocardial emission computed tomography (ECT) was evaluated in coronary artery disease (CAD). The subjects consisted of 20 CAD patients and five normal controls. All CAD patients underwent coronary angiography. Tomographic thallium-201 myocardial imaging was performed with a rotating gamma camera, and long-axial and short-axial myocardial images of the left ventricle were reconstructed. The tomographic images were interpreted quantitatively using circumferential profile analysis. Based on features of regional myocardial thallium-201 kinetics, two types of abnormalities were studied: (1) diminished initial distribution (stress defect) and (2) slow washout of thallium-201, as evidenced by patients' initial thallium-201 uptake and 3-hour washout rate profiles which fell below the normal limits, respectively. Two diagnostic criteria including the stress defect and a combination of the stress defect and slow washout were used to detect coronary artery lesions of significance (>=75 % luminal narrowing). The ischemic volumes were also evaluated by quantitative analysis using thallium-201 ECT. The diagnostic accuracy of the stress defect criterion was 95 % for left anterior descending, 90 % for right, and 70 % for left circumflex coronary artery lesions. The combined criteria of the stress defect and slow washout increased detection sensitivity with a moderate loss of specificity for identifying individual coronary artery lesion. A relatively high diagnostic accuracy was obtained using the stress defect criterion for multiple vessel disease (75 %). Ischemic myocardial volume was significantly larger in triple vessel than in single vessel disease (p < 0.05) using the combined criteria. It was concluded that quantitative analysis of exercise thallium-201 myocardial ECT images proves useful for evaluating coronary artery lesions. (author)

  10. Reverse redistribution phenomenon on rest 99mTc-tetrofosmin myocardial single photon emission computed tomography involves impaired left ventricular contraction in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Kurokawa, Kazuyuki; Ohte, Nobuyuki; Miyabe, Hiromichi; Akita, Sachie; Yajima, Kazuhiro; Hayano, Junichiro; Kimura, Genjiro

    2003-01-01

    The purpose of this study was to investigate the clinical significance of the reverse redistribution (RR) phenomenon on technetium-99m ( 99m Tc)-tetrofosmin myocardial single photon emission computed tomography (SPECT) performed at rest. Twenty-five patients underwent myocardial SPECT 3 weeks after the onset of acute myocardial infarction. Myocardial images were acquired at 40 min (early) and 4 h (delayed) after the injection of 740 MBq of 99m Tc-tetrofosmin. The regional myocardial uptake of the tracer in 26 segments of the left ventricular (LV) wall was visually scored from 0 (no activity) to 3 (normal activity), and then the RR was defined as a decrease of more than 1 point in the activity score on the delayed image compared with that on the early image. Regions with an activity score of 3 on both the early and delayed images were defined as normal, and those with a score of 0 or 1 on the early image were considered to have a fixed defect. The regional myocardial 99m Tc-tetrofosmin uptake and washout rate were also quantitatively assessed in each region. In addition, exercise stress electrocardiograph-gated SPECT with 99m Tc-tetrofosmin was performed within 1 week of the rest study, and the percent count increase (%CI) during myocardial contraction in each corresponding region was studied. RR was observed in 18 of the 25 patients. The regional washout rate of 99m Tc-tetrofosmin was significantly higher in the RR regions (45.0±3.8%) than in either the normal regions (36.4±4.1%, p 99m Tc-tetrofosmin SPECT have severely impaired LV wall contraction after exercise. (author)

  11. Influence of angiographic collateral circulation on myocardial perfusion in patients with chronic total occlusion of a single coronary artery and no prior myocardial infarction.

    Science.gov (United States)

    Aboul-Enein, Fatma; Kar, Saibal; Hayes, Sean W; Sciammarella, Maria; Abidov, Aiden; Makkar, Raj; Friedman, John D; Eigler, Neal; Berman, Daniel S

    2004-06-01

    The functional role of various angiographic grades for coronary collaterals remains controversial. The aim of this study was to assess the influence of the Rentrop angiographic grading of coronary collaterals on myocardial perfusion in patients with single-vessel chronic total occlusion (CTO) and no prior myocardial infarction (MI). The study included 56 patients with single-vessel CTO and no prior MI who underwent rest-stress myocardial perfusion SPECT and coronary angiography within 6 mo. All patients had angiographic evidence of coronary collaterals. Patients were divided according to the Rentrop classification: Group I had grade 1 or 2 (n = 25) and group II had grade 3 collaterals (n = 31). Group I had a higher frequency of resting regional wall motion abnormalities on left ventriculography (52.6% vs. 19.2% [P = 0.019]). The mean perfusion scores of the overall population showed severe and extensive stress perfusion defects (summed stress score of 14.1 +/- 7.1 and summed difference score of 12.9 +/- 6.9) but minimal resting perfusion defects (summed rest score of 1.0 +/- 2.7). No perfusion scores differed between the 2 groups. The perfusion findings suggested that chronic stunning rather than hibernation is the principal cause of regional wall motion abnormalities in these patients. In the setting of single-vessel CTO and no prior MI, coronary collaterals appear to protect against resting perfusion defects. Excellent angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defects.

  12. Limited diagnostic accuracy of gated myocardial perfusion SPECT for wall motion analysis in patients with asymmetric septal hypertrophy

    International Nuclear Information System (INIS)

    Seo, J.H.; Ahn, B.C.; Bae, J.H.; Jeong, S.Y.; Lee, J.; Lee, K.B.

    2004-01-01

    Objective: Although gated SPECT(G-SPECT) using Tc-99m MIBI is well-known diagnostic modality in the evaluation of myocardial perfusion and wall motion analysis, there were limited reports for subjects with asymmetric septal hypertrophy (ASH). This study was performed to evaluate the clinical usefulness of G-SPECT for assessments of myocardial perfusion and wall motion analysis in patients with ASH on 2D-echocardiography(Echo). Methods: Thirty patients (male 18, 59 12 years) with ASH on Echo (septal wall thickness 13 mm and 1.3 times as thick as that of posterior wall) underwent Tc-99m MIBI G-SPECT. Two studies were performed within one month. No patient had experienced any significant cardiac event, nor had changed medical and surgical therapy during the studies. Functional parameters of the left ventricle were acquired with QGS software(AutoQUANTTM). Three experts performed visual interpretation for the presence of septal thickening and perfusion abnormalities on G-SPECT and two experienced cardiologists measured dimension, thickness and wall motion of the left ventricle on Echo. Results: Mean septum thickness measured by Echo was 1.90 0.50 cm, and the septum/posterior wall thickness ratio was 1.85 0.51. On visual SPECT analysis, 14 patients (46.7%) were interpreted as with thickened septum and 17 patients (57%) as with abnormal perfusion. All 3 patients who underwent coronary angiography showed significant luminal stenosis and also had perfusion abnormalities on SPECT. On Echo, only one patient showed septal hypokinesia, who showed anteroseptal infarction on SPECT, and the others showed normal septal wall motion. But 13 patients (54%) among 24 patients showed septal hypokinesia on G-SPECT. Patients with thickened septum on SPECT had thicker septum (2.3 vs 1.6 cm) and higher septum/posterior wall thickness ratio (2.2 vs 1.6) on Echo, compared with patients without septal thickening on SPECT. Conclusions: Although G-SPECT could proffer diagnostic accuracy for

  13. Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy.

    Science.gov (United States)

    Eftekhari, Mohammad; Anbiaei, Robabeh; Zamani, Hanie; Fallahi, Babak; Beiki, Davood; Ameri, Ahmad; Emami-Ardekani, Alireza; Fard-Esfahani, Armaghan; Gholamrezanezhad, Ali; Seid Ratki, Kazem Razavi; Roknabadi, Alireza Momen

    2015-01-01

    Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right-sided cancer. To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring) were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT) to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions) over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol) was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed) and 36 patients with right-sided cancer (controls)] were enrolled. Dose-volume histogram (DVH) [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46). In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03) and anterolateral (17.1% versus 2.8%, P=0.049) walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS) of>3 was observed in twelve cases (34.3%), while in five of the controls (13.9%),(Odds ratio=1.3). There was no significant difference between the groups regarding left ventricular ejection fraction. The risk of radiation induced myocardial perfusion abnormality in patients treated with CRT on the

  14. Assessment of myocardial fatty acid metabolism in patients with angina pectoris and diabetes mellitus using 123I-BMIPP myocardial scintigraphy

    International Nuclear Information System (INIS)

    Ito, Kazuki; Tanabe, Takuji; Yuba, Tatsuya; Doue, Tomoki; Adachi, Yoshihiko; Katoh, Shuuji; Sugihara, Hiroki; Azuma, Akihiro; Nakagawa, Masao

    2001-01-01

    We studied the effect of myocardial ischemia and diabetes mellitus (DM) on the myocardial fatty acid metabolism using 123 I-BMIPP myocardial scintigraphy. We performed 123 I-BMIPP myocardial scintigraphy in 50 patients with myocardial ischemia and without DM (AP), in 30 patients with myocardial ischemia and DM (AP+DM), 12 patients with DM and without myocardial ischemia (DM), and in 10 normal subjects (N). Myocardial uptake rate of 123 I-BMIPP was obtained using the time activity curve. Myocardial washout rate of 123 I-BMIPP was calculated using the polar images of early and delayed SPECT images. Myocardial uptake rate of 123 I-BMIPP (%) were AP: 4.9±0.6, AP+DM: 5.5±0.5, DM 5.7±0.5 and N: 5.0±0.4. 123 I-BMIPP myocardial uptake rate was increased in AP+DM and DM. 123 I-BMIPP myocardial washout rate (%) were AP: 30.2±4.3, AP+DM: 24.5±3.9, DM: 16.1±2.8 and N: 19.4±3.2. 123 I-BMIPP myocardial washout rate was increased in AP and AP+DM. 123 I-BMIPP myocardial washout rate was increased particularly in patients with multi-vessels disease. 123 I-BMIPP myocardial washout rate was decreased in DM. The present study suggested that diabetes mellitus increased myocardial fatty acid uptake and decreased myocardial fatty acid washout, and that myocardial ischemia increased myocardial fatty acid washout. (author)

  15. Clinical significance of myocardial 123I-BMIPP imaging in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Shindoh, Takashi; Honda, Minoru

    1997-01-01

    We studied 55 patients with myocardial infarction (MI), 14 patients with recent MI (RMI) and 41 patients with old MI (OMI), and myocardial images were divided into 17 segments and myocardial uptake of the radionuclide was graded from 0 (normal) to 3 (maximal abnormality). In 28 patients we compared segmental defect score (SDS) with wall motion index (WMI) which were obtained by centerline method at the corresponded segments. As a whole, the mean total defect scores (TDSs) of BMIPP and exercise stress (Ex) were similar and they were greater than the mean TDS of resting perfusion. In 30 patient TDS of BMIPP was greater than that of TDS of resting perfusion. In 24 patients perfusion abnormality developed by Ex and the location of BMIPP abnormality coincided with the abnormality of Ex. But in the other 6 patients Ex did not induce any abnormality and they were all RMI and infarcted coronary artery was patent. However in the group with TDS of BMIPP identical to TDS of resting perfusion (25 patients), 92% did not show myocardial perfusion abnormality after Ex. In the comparison of SDS and WMI, myocardial segments were divided into 3 groups; both SDSs of BMIPP and resting perfusion were normal or borderline abnormality (Group 1, 82 segments), SDS of resting perfusion was normal or borderline and SDS of BMIPP was definitely abnormal (Group 2, 10 segments) and both SDSs of BMIPP and resting perfusion were definitely abnormal (Group 3, 48 segments). In Group 1, WMS was significantly greater than those of Group 2 and Group 3. But there was no difference between Group 2 and 3. These findings suggested that in the segments with mismatch between BMIPP and resting perfusion reflects stunned myocardium. (K.H.)

  16. Gadolinium-DTPA-enhanced magnetic resonance imaging and functional outcome in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Kitamura, Jun; Shimada, Toshio; Murakami, Yo; Ochiai, Koichi; Inoue, Shin-ichi; Ishibashi, Yutaka; Kinoshita, Yoshihisa; Sano, Kazuya; Murakami, Rinji

    1999-01-01

    This study was designed to test the hypothesis that Gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA)-enhanced magnetic resonance images (MRI) reflect the severity of ischemic injury during the acute and chronic phases of myocardial infarction (MI). Twenty-nine patients with their first acute MI underwent Gd-DTPA-enhanced MRI in the first week (4.2±0.3 days) and at 1 month after onset. Pairs of left ventriculograms were compared with Gd-DTPA-enhanced magnetic resonance images, classified into 3 pattern groups: hyper-enhancement, with and without a central hypo-enhanced region (P1 and P2, respectively), and non-enhancement (P3). In the acute phase of MI, P1 was found in 10, P2 in 11, and P3 in 8 patients. One month later, the image pattern had changed from P1 to P2 in a single patient, from P2 to P3 in 4 patients, and had remained identical in the others. Patients with P3 showed improvement of anterior wall motion in the 1-month follow-up study, and had higher TIMI flow grades and lower peak creatine kinase values than those without recovery. Thus, Gd-DTPA-enhanced magnetic resonance images, closely reflecting the severity of myocardial injury, are useful in predicting myocardial functional recovery after MI. (author)

  17. Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease.

    Science.gov (United States)

    Jiang, Wei; Samad, Zainab; Boyle, Stephen; Becker, Richard C; Williams, Redford; Kuhn, Cynthia; Ortel, Thomas L; Rogers, Joseph; Kuchibhatla, Maragatha; O'Connor, Christopher; Velazquez, Eric J

    2013-02-19

    The goal of this study was to evaluate the prevalence and clinical characteristics of mental stress-induced myocardial ischemia. Mental stress-induced myocardial ischemia is prevalent and a risk factor for poor prognosis in patients with coronary heart disease, but past studies mainly studied patients with exercise-induced myocardial ischemia. Eligible patients with clinically stable coronary heart disease, regardless of exercise stress testing status, underwent a battery of 3 mental stress tests followed by a treadmill test. Stress-induced ischemia, assessed by echocardiography and electrocardiography, was defined as: 1) development or worsening of regional wall motion abnormality; 2) left ventricular ejection fraction reduction ≥ 8%; and/or 3) horizontal or downsloping ST-segment depression ≥ 1 mm in 2 or more leads lasting for ≥ 3 consecutive beats during at least 1 mental test or during the exercise test. Mental stress-induced ischemia occurred in 43.45%, whereas exercise-induced ischemia occurred in 33.79% (p = 0.002) of the study population (N = 310). Women (odds ratio [OR]: 1.88), patients who were not married (OR: 1.99), and patients who lived alone (OR: 2.24) were more likely to have mental stress-induced ischemia (all p mental stress-induced ischemia (all p Mental stress-induced ischemia is more common than exercise-induced ischemia in patients with clinically stable coronary heart disease. Women, unmarried men, and individuals living alone are at higher risk for mental stress-induced ischemia. (Responses of Myocardial Ischemia to Escitalopram Treatment [REMIT]; NCT00574847). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Confluence of depression and acute psychological stress among patients with stable coronary heart disease: effects on myocardial perfusion.

    Science.gov (United States)

    Burg, Matthew M; Meadows, Judith; Shimbo, Daichi; Davidson, Karina W; Schwartz, Joseph E; Soufer, Robert

    2014-10-30

    Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD. Patients (N=146) completed the Beck Depression Inventory-I (BDI-I), a measure of depression linked to recurrent ACS and post-ACS mortality, and underwent single-photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI-I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI-I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications. Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression-associated risk for ACS recurrence and mortality. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  19. Myocardial Hemorrhage After Acute Reperfused ST-Segment–Elevation Myocardial Infarction

    Science.gov (United States)

    Carrick, David; Haig, Caroline; Ahmed, Nadeem; McEntegart, Margaret; Petrie, Mark C.; Eteiba, Hany; Hood, Stuart; Watkins, Stuart; Lindsay, M. Mitchell; Davie, Andrew; Mahrous, Ahmed; Mordi, Ify; Rauhalammi, Samuli; Sattar, Naveed; Welsh, Paul; Radjenovic, Aleksandra; Ford, Ian; Oldroyd, Keith G.

    2016-01-01

    Background— The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. Methods and Results— We performed a prospective cohort study in patients with reperfused ST-segment–elevation MI who underwent cardiac magnetic resonance 2 days (n=286) and 6 months (n=228) post MI. A serial imaging time-course study was also performed (n=30 participants; 4 cardiac magnetic resonance scans): 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value of hemorrhage 2 days post MI was associated with clinical characteristics indicative of MI severity and inflammation. Myocardial hemorrhage was a multivariable associate of adverse remodeling (odds ratio [95% confidence interval]: 2.64 [1.07–6.49]; P=0.035). Ten (4%) patients had a cardiovascular cause of death or experienced a heart failure event post discharge, and myocardial hemorrhage, but not microvascular obstruction, was associated with this composite adverse outcome (hazard ratio, 5.89; 95% confidence interval, 1.25–27.74; P=0.025), including after adjustment for baseline left ventricular end-diastolic volume. In the serial imaging time-course study, myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients 4 to 12 hours, 2 days, 10 days, and 7 months post reperfusion. The amount of hemorrhage (median [interquartile range], 7.0 [4.9–7.5]; % left ventricular mass) peaked on day 2 (Phemorrhage and microvascular obstruction follow distinct time courses post ST-segment–elevation MI. Myocardial hemorrhage was more closely associated with adverse outcomes than microvascular obstruction. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02072850. PMID:26763281

  20. Diagnostic value of stress-rest myocardial perfusion imaging in detection of coronary disease in elderly patients

    International Nuclear Information System (INIS)

    Han Pingping; Tian Yueqin; Fang Wei; Shen Rui; Yang Minfu; Wei Hongxing; Guo Xinhua; He Zuoxiang

    2009-01-01

    Objective: Coronary artery disease is one of the most common causes of death in elderly people. Yet, definite diagnosis is a dilemma due to the variety of symptoms and signs. The aim of this study was to evaluate the diagnostic value of nuclear stress-rest myocardial perfusion imaging(MPI) in detection of coronary disease in the elderly. Methods: Two hundred and five elderly subjects (≥60 years old, average of 67 ± 5) who were suspected to have coronary disease, underwent both stress-rest myocardial perfusion imaging (185 with exercise stress and 20 with adenosine stress) and coronary angiography (CAG). All had no pereutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Coronary angiography was used as a 'golden standard' to evaluate the sensitivity, specificity and accuracy of the stress-rest myocardial perfusion imaging. χ 2 -test was used in data analysis with SPSS 15.0. Results: Among 205 patients. there were 57 patients with an abnormal CAG result and 148 patients with a normal result. Of the 57 patients, there were 30 one-, 19 two-, and 8 three-vessel stenosis. Fifteen were mild-, 17 were moderate-, 17 were severe stenosis, and 8 were totally occluded.About 63% (36/57) had positive stress-rest MPI. Of the 148 subjects who had a normal CAG, 135 had negative MPL. The sensitivity.specificity and accuracy of stress MPI were 63% (36/57), 91% (135/148) and 83% (171/205) in patient level.respectively. The di-agnostic sensitivities of stress-rest MPI for detection of one-, two-, and three-vessel stenosis were 57%(17/30), 58% (11/19) and 8/8, respectively. All 185 patients who underwent exemise stress MPI were divided into 2 groups according to whether the patients reached the target heart rate or not at the peak of the test. And 53 patients (29%) were group 1 (reached the target heart rate)and 132 patients (71%) were group 2 (did not reach the target heart rate). The sensitivity of group 1 wag higher than that of group 2, but with no

  1. Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease

    International Nuclear Information System (INIS)

    Cho, Sang-Geon; Park, Ki Seong; Kim, Jahae; Kim, Jong Sang; Song, Ho-Chun; Jabin, Zeenat; Kang, Sae-Ryung; Kwon, Seong Young; Jeong, Geum-Cheol; Song, Minchul; Min, Jung-Joon; Bom, Hee-Seung; Cho, Jae Yeong; Kim, Hyun Kuk

    2017-01-01

    The aim of this study was to evaluate the prognostic value of additional evaluation of left ventricular mechanical dyssynchrony (LVMD) by gated myocardial perfusion single-photon emission computed tomography (GMPS) in patients with acute myocardial infarction (MI) and multivessel disease. One hundred and nine acute MI patients with >50 % stenosis in at least one non-culprit artery who underwent GMPS within 2 weeks were enrolled. All patients underwent successful revascularization of the culprit arteries. Those with previous MI, atrial fibrillation, or frequent ventricular premature complexes, cardiac devices, significant patient motion, or procedure-related events were excluded. Phase standard deviation (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. Patients were followed up for a median of 26 months after index MI, for composite major adverse cardiac events (MACE), which consisted with all-cause death, unplanned hospitalization due to heart failure and severe ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation). Independent predictors of MACE were evaluated. MACE occurred in 22 patients (20 %). Stress PSD (53.3 ± 17.3 vs. 35.3 ± 18.9 ; p <0.001), stress PBW (147.6 ± 54.6 vs. 96.8 ± 59.2 ; p = 0.001) and resting PBW (126.8 ± 37.5 vs. 96.6 ± 48.9 ; p = 0.001) were significantly higher in patients with MACE compared to those without. Multivariate analysis revealed that stress PSD ≥45.5 and stress PBW ≥126.0 were predictive of MACE, as well as suboptimal non-culprit artery revascularization (SNR) and renin-angiotensin system (RAS) blockade medication. Higher stress PSD and stress PBW were associated with poorer prognosis both in patients with and without SNR, and those with RAS blockade medication, but not in those without RAS blockade medication. LVMD measured by GMPS showed added prognostic value in acute MI with multivessel disease. GMPS could serve as a comprehensive evaluation imaging

  2. Clinical values of left ventricular mechanical dyssynchrony assessment by gated myocardial perfusion SPECT in patients with acute myocardial infarction and multivessel disease

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sang-Geon; Park, Ki Seong; Kim, Jahae; Kim, Jong Sang; Song, Ho-Chun [Chonnam National University Hospital, Department of Nuclear Medicine, Gwang-ju (Korea, Republic of); Jabin, Zeenat; Kang, Sae-Ryung; Kwon, Seong Young; Jeong, Geum-Cheol; Song, Minchul; Min, Jung-Joon; Bom, Hee-Seung [Chonnam National University Hwasun Hospital, Department of Nuclear Medicine, Hwasun-gun, Jeonnam (Korea, Republic of); Cho, Jae Yeong; Kim, Hyun Kuk [Chonnam National University Hospital, Department of Cardiology, Gwang-ju (Korea, Republic of)

    2017-02-15

    The aim of this study was to evaluate the prognostic value of additional evaluation of left ventricular mechanical dyssynchrony (LVMD) by gated myocardial perfusion single-photon emission computed tomography (GMPS) in patients with acute myocardial infarction (MI) and multivessel disease. One hundred and nine acute MI patients with >50 % stenosis in at least one non-culprit artery who underwent GMPS within 2 weeks were enrolled. All patients underwent successful revascularization of the culprit arteries. Those with previous MI, atrial fibrillation, or frequent ventricular premature complexes, cardiac devices, significant patient motion, or procedure-related events were excluded. Phase standard deviation (PSD) and phase histogram bandwidth (PBW) were measured for assessment of LVMD. Patients were followed up for a median of 26 months after index MI, for composite major adverse cardiac events (MACE), which consisted with all-cause death, unplanned hospitalization due to heart failure and severe ventricular arrhythmias (sustained ventricular tachycardia or ventricular fibrillation). Independent predictors of MACE were evaluated. MACE occurred in 22 patients (20 %). Stress PSD (53.3 ± 17.3 vs. 35.3 ± 18.9 ; p <0.001), stress PBW (147.6 ± 54.6 vs. 96.8 ± 59.2 ; p = 0.001) and resting PBW (126.8 ± 37.5 vs. 96.6 ± 48.9 ; p = 0.001) were significantly higher in patients with MACE compared to those without. Multivariate analysis revealed that stress PSD ≥45.5 and stress PBW ≥126.0 were predictive of MACE, as well as suboptimal non-culprit artery revascularization (SNR) and renin-angiotensin system (RAS) blockade medication. Higher stress PSD and stress PBW were associated with poorer prognosis both in patients with and without SNR, and those with RAS blockade medication, but not in those without RAS blockade medication. LVMD measured by GMPS showed added prognostic value in acute MI with multivessel disease. GMPS could serve as a comprehensive evaluation imaging

  3. Correlation between Left Ventricular Global and Regional Longitudinal Systolic Strain and Impaired Microcirculation in Patients with Acute Myocardial Infarction

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Høfsten, Dan Eik; Christophersen, Thomas Brøcher

    2012-01-01

    investigated if LRS and GLS imaging is superior to conventional measures of left ventricle (LV) function. Methods: In a consecutive population of first time AMI patients, who underwent successful revascularization, we performed comprehensive TTE. GLS and LRS were obtained from the three standard apical views...... elevation myocardial infarction. The GLS was -15.2 [-19.3;-10.1]% in the total population of 183 patients. Total wall motion score index (WMSI) in the population was 1.19 [1;1.5]. Eighty-five patients suffered from culprit lesion in left anterior descending artery (LAD). The CFR in these patients was 1......Objectives: We investigated the correlation between left ventricular global and regional longitudinal systolic strain (GLS and LRS) and coronary flow reserve (CFR) assessed by transthoracic echocardiography (TTE) in patients with a recent acute myocardial infarction (AMI). Furthermore, we...

  4. Long-term safety and feasibility of three-vessel multimodality intravascular imaging in patients with ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Taniwaki, Masanori; Radu, Maria D; Garcia-Garcia, Hector M

    2015-01-01

    We assessed the feasibility and the procedural and long-term safety of intracoronary (i.c) imaging for documentary purposes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary PCI in the s......We assessed the feasibility and the procedural and long-term safety of intracoronary (i.c) imaging for documentary purposes with optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary PCI...... in the setting of IBIS-4 study. IBIS4 (NCT00962416) is a prospective cohort study conducted at five European centers including 103 STEMI patients who underwent serial three-vessel coronary imaging during primary PCI and at 13 months. The feasibility parameter was successful imaging, defined as the number...... of pullbacks suitable for analysis. Safety parameters included the frequency of peri-procedural complications, and major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI) and any clinically-indicated revascularization at 2 years. Clinical outcomes were compared...

  5. Asymptomatic myocardial ischemia following cold provocation

    International Nuclear Information System (INIS)

    Shea, M.J.; Deanfield, J.E.; deLandsheere, C.M.; Wilson, R.A.; Kensett, M.; Selwyn, A.P.

    1987-01-01

    Cold is thought to provoke angina in patients with coronary disease either by an increase in myocardial demand or an increase in coronary vascular resistance. We investigated and compared the effects of cold pressor stimulation and symptom-limited supine bicycle exercise on regional myocardial perfusion in 35 patients with stable angina and coronary disease and in 10 normal subjects. Regional myocardial perfusion was assessed with positron emission tomography and rubidium-82. Following cold pressor stimulation 24 of 35 patients demonstrated significant abnormalities of regional myocardial perfusion with reduced cation uptake in affected regions of myocardium: 52 +/- 9 to 43 +/- 9 (p less than 0.001 vs normal subjects). Among these 24 patients only nine developed ST depression and only seven had angina. In contrast, 29 of 35 patients underwent supine exercise, and abnormal regional myocardial perfusion occurred in all 29, with a reduction in cation intake from 48 +/- 10 to 43 +/- 14 (p less than 0.001 vs normal subjects). Angina was present in 27 of 29 and ST depression in 25 of 29. Although the absolute decrease in cation uptake was somewhat greater following cold as opposed to exercise, the peak heart rate after cold was significantly lower than that after exercise (82 +/- 12 vs 108 +/- 16 bpm, p less than 0.05). Peak systolic blood pressures after cold and exercise were similar (159 +/- 24 vs 158 +/- 28). Thus, cold produces much more frequent asymptomatic disturbances of regional myocardial perfusion in patients with stable angina and coronary disease than is suggested by pain or ECG changes

  6. Clinical Significance of Reverse Redistribution Phenomenon on Delayed Tc-99m Tetrofosmin Myocardial Perfusion Imaging in Patients with Acute Myocardial Infarction

    International Nuclear Information System (INIS)

    Park, Soon Ah; Kim, Dae Weung; Kim, Chang Guhn; Jeong, Jin Won; Kim, Nam Ho; Yun, Kyeong Ho

    2009-01-01

    This study was performed to investigate the clinical significance of reverse redistribution (RR) phenomenon detected on delayed Tc-99m tetrofosmin myocardial single photon emission computed tomography (SPECT) in patients with acute myocardial infarction after revascularization. A Tc-99m tetrofrosmin myocardial SPECT was performed in 67 consecutive patients after revascularization for acute myocardial infarction. Myocardial SPECT imaging was performed for early imaging at 40 min and for delayed imaging at 180 min after reinjection at myocardial stress. Regional myocardial uptakes were scored by 4-point scoring in the left ventricular wall divided into 17 segments. Reverse redistribution was defined as an increase of more than 2 point in the activity score on the delayed image. Follow-up myocardial SPECT and coronary angiography (CAG) were performed 9 months later. On myocardial SPECT performed following revascularization, RR was observed in 100 of all 319 segments (31%) and in 43 patients (64%). The abnormalities of perfusion and regional wall motion were more severe in the patients with RR compared to those without RR (p<0.05). On follow-up myocardial SPECT, the myocardial perfusion, regional wall motion, and myocardial thickness were significantly improved in the patients with RR (p<0.05) however, these changes were not significant in those without RR. There was no significant difference between the patients with RR and those without RR in the occurrence of restenosis on CAG. In patients with acute myocardial infarction, the regions showing the RR phenomenon on delayed Tc-99m tetrofosmin SPECT may reflect viable myocardium and indicate recovery of salvaged myocardium

  7. Effect of nicorandil on the myocardial tissue perfusion and myocardial cell injury in patients with diabetes after PCI

    Directory of Open Access Journals (Sweden)

    Xue-Li Ren1

    2017-04-01

    Full Text Available Objective: To study the effect of nicorandil on the myocardial tissue perfusion and myocardial cell damage in patients with diabetes after percutaneous coronary intervention (PCI. Methods: 68 patients with coronary heart disease and type 2 diabetes mellitus who received PCI in our hospital between May 2011 and September 2015 were collected and then divided into observation group and control group (n=34 according to the single-blind randomized control method. Control group of patients received PCI alone, and the observation group of patients received nicorandil therapy after PCI. After treatment, real-time myocardial ultrasound contrast was used to evaluate the myocardial perfusion of two groups of patients; blood biochemical analyzer was used to detect the contents of peripheral blood myocardial enzyme spectrum indexes; the ELISA method was used to detect the contents of serum oxidative stress indicators; RIA method was used to detect the contents of serum apoptosis molecules. Results: After treatment, the myocardial tissue perfusion parameters plateau peak intensity (A, slope rate of curve (β and myocardial blood flow (A×β levels of observation group were significantly higher than those of control group (P<0.05; peripheral blood myocardial enzyme spectrum indexes creatine kinase (CK, lactate dehydrogenase (LDH, troponin I (cTnI and glutamic oxalacetic transaminase (GOT contents of observation group were significantly lower than those of control group (P<0.05; serum vitamin E (VitE and vitamin C (VitC contents of observation group were significantly higher than those of control group while malondialdehyde (MDA, advanced oxidation protein products (AOPPs, soluble apoptosis-associated factor (sFas and soluble apoptosis-associated factor ligand (sFasL contents were lower than those of control group (P<0.05. Conclusion: Adjuvant nicorandil therapy can improve the myocardial perfusion and reduce the myocardial cell injury in patients with coronary

  8. An Unusual Complication Following Transarterial Chemoembolization: Acute Myocardial Infarction

    International Nuclear Information System (INIS)

    Lai Yiliang; Chang Weichou; Kuo Wuhsien; Huang Tienyu; Chu Hengcheng; Hsieh Tsaiyuan; Chang Weikuo

    2010-01-01

    Transarterial chemoembolization has been widely used to treat unresectable hepatocellular carcinoma. Various complications have been reported, but they have not included acute myocardial infarction. Acute myocardial infarction results mainly from coronary artery occlusion by plaques that are vulnerable to rupture or from coronary spasm, embolization, or dissection of the coronary artery. It is associated with significant morbidity and mortality. We present a case report that describes a patient with hepatocellular carcinoma who underwent transarterial chemoembolization and died subsequently of acute myocardial infarction. To our knowledge, there has been no previous report of this complication induced by transarterial chemoembolization for hepatocellular carcinoma. This case illustrates the need to be aware of acute myocardial infarction when transarterial chemoembolization is planned for the treatment of hepatocellular carcinoma, especially in patients with underlying coronary artery disease.

  9. Increase in mean platelet volume in patients with myocardial bridge.

    Science.gov (United States)

    Bilen, Emine; Tanboga, Ibrahim Halil; Kurt, Mustafa; Kocak, Umran; Ayhan, Huseyin; Keles, Telat; Bozkurt, Engin

    2013-01-01

    Myocardial bridge is associated with atherosclerosis altered in shear stress and endothelial dysfunction. Mean platelet volume (MPV), a determinant of platelet activation, is shown to be related with atherosclerosis and endothelial dysfunction. In this study, we aimed to evaluate platelet function assessed by MPV in patients with myocardial bridge. Forty-two patients with myocardial bridge in the left anterior descending artery (LAD) and 43 age- and gender-matched healthy participants were included in the study. Myocardial bridging was defined as an intramyocardial systolic compression or milking of a segment of an epicardial coronary artery on angiography. For the entire study population, MPV was measured using an automatic blood counter. The study population consisted of 42 patients with myocardial bridge (52.7 ± 10.2, 76.2% male) and 43 age- and sex-matched healthy control participants (52.1 ± 10.4, 74.4% male). Compared to the control group, MPV value was significantly higher in patients with myocardial bridge (8.9 ± 1.24 vs 8.3 ± 0.78; P = .01). Further, there were no significant differences between groups regarding hemoglobin level, platelet count, fasting blood glucose, and creatinine levels. Our study findings indicated that myocardial bridge is associated with elevated MPV values. Our results might partly explain the increased cardiovascular events in patients with myocardial bridge.

  10. Dobutamine cardiovascular magnetic resonance for the detection of myocardial ischemia with the use of myocardial tagging.

    Science.gov (United States)

    Kuijpers, Dirkjan; Ho, Kai Yiu J A M; van Dijkman, Paul R M; Vliegenthart, Rozemarijn; Oudkerk, Matthijs

    2003-04-01

    The purpose of this study was to assess the value of high-dose dobutamine cardiovascular magnetic resonance (CMR) with myocardial tagging for the detection of wall motion abnormalities as a measure of myocardial ischemia in patients with known or suspected coronary artery disease. Two hundred eleven consecutive patients with chest pain underwent dobutamine-CMR 4 days after antianginal medication was stopped. Dobutamine-CMR was performed at rest and during increasing doses of dobutamine. Cine-images were acquired during breath-hold with and without myocardial tagging at 3 short-axis levels. Regional wall motion was assessed in a 16-segment short-axis model. Patients with new wall motion abnormalities (NWMA) were examined by coronary angiography. Dobutamine-CMR was successfully performed in 194 patients. Dobutamine-CMR without tagging detected NWMA in 58 patients, whereas NWMA were detected in 68 patients with tagging (P=0.002, McNemar). Coronary angiography showed coronary artery disease in 65 (96%) of these 68 patients. All but 3 of the 65 patients needed revascularization. In the 112 patients with a negative dobutamine-CMR study, without baseline wall motion abnormalities, the cardiovascular occurrence-free survival rate was 98.2% during the mean follow-up period of 17.3 months (range, 7 to 31). Dobutamine-CMR with myocardial tagging detected more NWMA compared with dobutamine-CMR without tagging and reliably separated patients with a normal life expectancy from those at increased risk of major adverse cardiac events.

  11. Radiation-induced myocardial perfusion abnormalities in breast cancer patients following external beam radiation therapy

    Directory of Open Access Journals (Sweden)

    Mohammad Eftekhari

    2015-01-01

    Full Text Available Objective(s: Radiation therapy for breast cancer can induce myocardial capillary injury and increase cardiovascular morbidity and mortality. A prospective cohort was conducted to study the prevalence of myocardial perfusion abnormalities following radiation therapy of left-sided breast cancer patients as compared to those with right–sided cancer. Methods: To minimize potential confounding factors, only those patients with low 10-year risk of coronary artery disease (based on Framingham risk scoring were included. All patients were initially treated by modified radical mastectomy and then were managed by postoperative 3D Conformal Radiation Therapy (CRT to the surgical bed with an additional 1-cm margin, delivered by 46-50 Gy (in 2 Gy daily fractions over a 5-week course. The same dose-adjusted chemotherapy regimen (including anthracyclines, cyclophosphamide and taxol was given to all patients. Six months after radiation therapy, all patients underwent cardiac SPECT for the evaluation of myocardial perfusion. Results: A total of 71 patients with a mean age of 45.3±7.2 years [35 patients with leftsided breast cancer (exposed and 36 patients with right-sided cancer (controls] were enrolled. Dose-volume histogram (DVH [showing the percentage of the heart exposed to >50% of radiation] was significantly higher in patients with left-sided breast cancer. Visual interpretation detected perfusion abnormalities in 42.9% of cases and 16.7% of controls (P=0.02, Odds ratio=1.46. In semiquantitative segmental analysis, only apical (28.6% versus 8.3%, P=0.03 and anterolateral (17.1% versus 2.8%, P=0.049 walls showed significantly reduced myocardial perfusion in the exposed group. Summed Stress Score (SSS of>3 was observed in twelve cases (34.3%, while in five of the controls (13.9%,(Odds ratio=1.3. There was no significant difference between the groups regarding left ventricular ejection fraction. Conclusion: The risk of radiation induced myocardial

  12. Acute myocardial infarct imaging with indium-111-labeled monoclonal antimyosin Fab

    International Nuclear Information System (INIS)

    Khaw, B.A.; Yasuda, T.; Gold, H.K.; Leinbach, R.C.; Johns, J.A.; Kanke, M.; Barlai-Kovach, M.; Strauss, H.W.; Haber, E.

    1987-01-01

    Indium-111 monoclonal antimyosin Fab scintigraphy was used to detect myocardial necrosis in 52 of 54 patients (96.3%) with acute myocardial infarction. Infarcts were visualized when coronary arteries were persistently occluded (n = 10), became patent after thrombolysis (n = 33), or became patent after spontaneous reperfusion (n = 7). Posteroinferolateral visualizations were obtained in two patients with clinical and enzymatic evidence of infarction but normal electrocardiograms. Of the two patients in whom no infarcts were visualized, one had an anterior myocardial infarct. This patient underwent successful thrombolytic therapy, with attendant minimization of creatine kinase release. The other patient had a small, nonreperfused inferior myocardial infarct. Five patients with a history of remote infarction and acute necrosis showed antimyosin uptake only in regions concordant with the acute episodes of infarction, and radiolabeled antimyosin Fab localized in neither old infarcts nor normal, noninfarcted myocardium. Antimyosin Fab scintigraphy, thus, appears to be a highly specific means of delineating necrotic myocardium, at least in this limited and selected group of patients

  13. Correlation of Admission Heart Rate With Angiographic and Clinical Outcomes in Patients With Right Coronary Artery ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: HORIZONS-AMI (The Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) Trial.

    Science.gov (United States)

    Kosmidou, Ioanna; McAndrew, Thomas; Redfors, Björn; Embacher, Monica; Dizon, José M; Mehran, Roxana; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

    2017-07-19

    Bradycardia on presentation is frequently observed in patients with right coronary artery ST-segment elevation myocardial infarction, but it is largely unknown whether it predicts poor angiographic or clinical outcomes in that patient population. We sought to determine the prognostic implications of admission heart rate (AHR) in patients with ST-segment elevation myocardial infarction and a right coronary artery culprit lesion. We analyzed 1460 patients with ST-segment elevation myocardial infarction and a right coronary artery culprit lesion enrolled in the randomized HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial who underwent primary percutaneous coronary intervention. Patients presenting with high-grade atrioventricular block were excluded. Outcomes were examined according to AHR range (AHR 100 beats per minute). Angiographic analysis showed no significant association between AHR and lesion location or complexity. On multivariate analysis, admission bradycardia (AHR ST-segment elevation myocardial infarction and a right coronary artery culprit lesion undergoing primary percutaneous coronary intervention, admission bradycardia was not associated with increased mortality or major adverse cardiac events at 1 year. URL: https://www.clinicaltrials.gov. Unique identifier: NCT00433966. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  14. 201Tl myocardial imaging in patients with pulmonary hypertension

    International Nuclear Information System (INIS)

    Cohen, H.A.; Baird, M.G.; Rouleau, J.R.; Fuhrmann, C.F.; Bailey, I.K.; Summer, W.R.; Strauss, H.W.; Pitt, B.

    1976-01-01

    The appearance of the right ventricular myocardium on thallium 201 myocardial perfusion images was evaluated in patients with chronic pulmonary hypertension and compared to patients without pulmonary hypertension. Four groups of patients were studied: (1) eight normals, (2) five patients with angiographically documented coronary artery disease and normal pulmonary artery pressures, (3) ten patients with moderate to severe pulmonary parenchymal or vascular disease and documented pulmonary hypertension and (4) eight patients with chronic left ventricular dysfunction and pulmonary hypertension discovered during cardiac catheterization. The right ventricular free wall was visualized on the thallium 201 myocardial perfusion image in only one of eight normals (group 1) and in only one of the five patients with coronary artery disease (group 2) and measured 0.5 cm and 0.9 cm in thickness, respectively. In patients with documented pulmonary hypertension the right ventricle was visualized on low contrast thallium 201 myocardial perfusion image in all patients. The apparent right ventricular free wall thickness measured from the ungated thallium 201 myocardial perfusion images was 1.7 +- 0.3 cm in group 3 and 1.5 +- 0.2 cm in group 4. Right ventricular hypertrophy was detected by electrocardiography in only five of ten patients in group 3 and only one of eight patients in group 4. Thallium 201 myocardial perfusion imaging appears to be a useful technique for assessing the effects of chronic pulmonary hypertension on the right ventricular myocardium

  15. Demographic And Technical Risk Factors Of 30-Day Stroke, Myocardial Infarction, And/Or Death In Standard And High Risk Patients Who Underwent Carotid Angioplasty And Stenting

    Directory of Open Access Journals (Sweden)

    Samaneh Yousefi

    2017-02-01

    Full Text Available Background: Carotid angioplasty and stenting (CAS is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after carotid angioplasty and stenting. Methods and Material: This is a prospective study conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing carotid angioplasty and stenting were enrolled. Both standard risk and high risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. 30-day stroke, myocardial infarction, and/or death were considered as the composite primary outcome of the study. Results:  two hundred and fifty one patients were recruited (mean age: 71.1+ 9.6 years, male: 65.3%.  One hundred and seventy eight (70.9% patients were symptomatic; 73 (29.1%, 129 (51.4%, 165 (65.7% and 62 (24.7% patients were diabetic, hyperlipidemic, hypertensive and smoker respectively. CAS performed for left ICA in 113 (45.4% patients. 14 (5.6% patients had Sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 +13.8 %. Embolic protection device was used in 203 (96.2% patients. Predilation and post-dilation were performed in 39 (18.5% and 182 (86.3% patients respectively. Composite outcome was observed in 3.6% (3.2% stroke, 0% myocardial infarction and 1.2% death. Left sided lesions and presence of DM was significantly associated with poor short term outcome. (P value: 0.025 and 0.020, respectively Conclusion: There was a higher risk of short term major complications in diabetic patients and left carotid artery intervention.

  16. Myocardial perfusion scintigraphy fi ndings in patients with mild coronary atherosclerotic lesions on coronary angiography

    Directory of Open Access Journals (Sweden)

    Zeki Dostbil

    2010-09-01

    Full Text Available Objectives: Myocardial perfusion scintigraphy (MPS iswidely used in functional assessment of myocardial per-fusion. But, some study results are in contradiction withseverity of coronary artery disease detected by coronaryangiography (CA. It is frequently encountered case thatCA is completely normal whereas MPS describes isch-emia. In this study, we aimed to investigate whether mildatherosclerotic lesions cause ischemia.Materials and methods: MPS with 99mTc-MIBI was per-formed in 52 patients who applied to cardiology clinics forhistory of chest pain and underwent diagnostic CA within3 months.Results: In 22 of 52 patients with mild atherosclerotic le-sions, ischemia in various degrees was detected on MPS.In statistical analysis, any signifi cant relationship was notfound between ischemia and gender, hypertension, DM,dyslipidemia, smoking, mitral valve insuffi ciency, left ven-tricular hypertrophy, exercise testing result and affectedcoronary artery.Conclusion: Our study fi ndings have shown that mild ath-erosclerotic lesions even at very early stage may causemyocardial ischemia

  17. Glyburide increases risk in patients with diabetes mellitus after emergent percutaneous intervention for myocardial infarction - A nationwide study

    DEFF Research Database (Denmark)

    Jørgensen, C H; Gislason, G H; Bretler, D

    2011-01-01

    Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular.......9%) received metformin. Cox proportional hazard regression analyses adjusted for age, sex, calendar year, comorbidity and concomitant pharmacotherapy showed an increased risk of cardiovascular mortality (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.26-6.72 ; p=0.012), cardiovascular mortality...... and nonfatal myocardial infarction (HR 2.69 , 95% CI 1.21-6.00; p=0.016), and all-cause mortality (HR 2.46, 95% CI 1.11-5.47; p=0.027), respectively, with glyburide compared to metformin. CONCLUSIONS: Glyburide is associated with increased cardiovascular mortality and morbidity in patients with diabetes...

  18. Prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia: study by 99mTc-sestamibi radionuclide scintigraphy.

    Science.gov (United States)

    Ismail, Ahmed M; Rayan, Mona; Adel, Amr; Demerdash, Salah; Atef, Mohamed; Abdallah, Mohamed; Nammas, Wail

    2014-02-01

    We explored the prevalence and pattern of abnormal myocardial perfusion in patients with isolated coronary artery ectasia (CAE), as demonstrated by (99m)Tc-sestamibi scintigraphy. Prospectively, we enrolled 35 patients with angiographically documented CAE and no significant coronary obstruction, who underwent elective coronary angiography. Patients underwent Stress-rest (99m)Tc-sestamibi scintigraphy within 4 days of coronary angiography. They were divided into 2 groups: group I: with normal perfusion scan; and group II: with reversible perfusion defects. The mean age was 49.6 ± 6.9 years; 34 (97.1 %) were males. Seventy-nine (75.2 %) arteries were affected by CAE. Among 79 arteries affected by CAE, affection was diffuse in 37 (46.8 %). Thirteen (37.1 %) patients had normal perfusion scan (group I), whereas 22 (62.9 %) had reversible perfusion defects (group II). Among 22 patients with reversible perfusion defects, 20 (90.9 %) had mild and 2 (9.1 %) had moderate ischemia. Among 49 myocardial segments with reversible perfusion defects, 22 (44.9 %) were basal, 18 (36.7 %) mid-, and 9 (18.4 %) apical segments. Diffuse CAE was significantly more prevalent in group II versus group I, in all 3 major coronary arteries (p < 0.05 for all). In patients with isolated CAE who underwent elective coronary angiography, reversible perfusion defects demonstrated by (99m)Tc-sestamibi scintigraphy were rather prevalent, mostly mild, more likely to affect the basal and mid-segments of the myocardium, and more frequently associated with diffuse ectasia.

  19. Prognostic value of normal exercise myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Lin Jinghui; Zhu Mei; Wu Shuyan

    1996-01-01

    To assess the prognostic implications, patients with a normal exercise myocardial imaging were followed up. 54 patients underwent exercise myocardial perfusion imaging and exercise ECG test. The images of all of them were normal. Coronary arteriography was performed in 50 patients. Among them 4 patients had single vessel lesion. Follow-up period of all the patients was >1 year (12∼90 Mo.). Likelihood of coronary artery disease (CAD, CAD LK) was estimated before and after test by Bayesian analysis. Mean of the pretest CAD LK was 19% and after test decreased to 13%. The difference between the CAD LK pre- and after test was significant (U = 6.0198, P<0.01). During the follow-up period cardiac event (CE) occurred in only one patient. The CE rate was 0.2% per year. No CE occurred in the 4 patients with CAD and in the 55 patients with positive exercise ECG. The data confirm that a normal stress myocardial imaging predicts an excellent prognosis even in patients with CAD or a high pretest CAD LK or a positive exercise ECG

  20. Neuroprotective strategies for patients with acute myocardial infarction combined with hypoxic ischemic encephalopathy in the ICU

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    Weiwei Hu

    2017-11-01

    Full Text Available Background: We investigated neuroprotective treatment strategies for patients with acute myocardial infarction (AMI complicated with hypoxic ischemic encephalopathy (HIE in the ICU. Methods: The 83 cases diagnosed with secondary AMI were, for the first time, divided into an observation group (n = 43 and control group (n = 40. All of the patients underwent emergency or elective PCI. Patients in the control group were treated with mannitol to reduce intracranial pressure and cinepazide maleate to improve microcirculation in the brain as well as given a comprehensive treatment with oxygen inhalation, fluid infusion, acid-base imbalance correction and electrolyte disturbance. Patients in the observation group underwent conventional treatment combined with neuroprotective therapeutic strategies. The effects of the different treatment strategies were compared. Results: Consciousness recovery time, reflex recovery time, muscle tension recovery time and duration of ICU stay were significantly shorter in the observation group compared with the control group (P < 0.05. After treatment, the jugular vein oxygen saturation (SjvO2 and blood lactate (JB-LA levels of both groups were lower than before treatment and the cerebral oxygen utilization rate (O2UC increased, with a significantly higher increase in the observation group (P < 0.05. After treatment, the activities of daily living (ADL score was higher for both groups and the neural function defect (NIHS score was lower. Conclusion: The neuroprotective strategies of hypothermia and ganglioside administration assisted with hyperbaric oxygen was effective for treating AMI patients with HIE and may be worth clinical promotion. Keywords: ICU, Acute myocardial infarction, Hypoxic ischemic encephalopathy, Neural protection

  1. Exercise-induced ST-segment depression and myocardial ischemia in patients with hypertrophic cardiomyopathy. Myocardial scintigraphic study

    International Nuclear Information System (INIS)

    Miyai, Nobuyuki; Kawasaki, Tatsuya; Taniguchi, Takuya; Kamitani, Tadaaki; Kawasaki, Shingo; Sugihara, Hiroki

    2005-01-01

    Patients with hypertrophic cardiomyopathy (HCM) sometimes develop myocardial ischemia during exercise in the absence of coronary lesions. The relationship between myocardial ischemia and ST-segment depression was investigated during exercise testing in patients with HCM. Regional hypoperfusion and/or transient left ventricular cavity dilation, a parameter of subendocardial hypoperfusion, were assessed on exercise 99 m Tc-tetrofosmin myocardial scintigraphy in 42 patients with non-obstructive HCM. The scintigraphic results were further correlated with the ST-segment responses to exercise. Regional hypoperfusion or transient left ventricular cavity dilation were observed in 19 (45%) or 16 (38%) patients with HCM, respectively. The incidence of ST-segment depression ≥0.1 mV during exercise testing was similar in HCM patients with regional hypoperfusion, with transient left ventricular cavity dilation, and without hypoperfusion (42%, 38%, 38%, p=0.95). Furthermore, exercise-induced ST-segment depression ≥0.1 mV occurred similarly irrespective of symptoms, exercise tolerance, the degree or the site of hypertrophy, or the presence or absence of resting ST-segment depression. ST-segment depression during exercise testing was common in patients with HCM, but seems to be an unreliable marker of myocardial ischemia as assessed by exercise scintigraphy. (author)

  2. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction.

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    Tor Biering-Sørensen

    Full Text Available Global longitudinal systolic strain (GLS has recently been demonstrated to be a superior prognosticator to conventional echocardiographic measures in patients after myocardial infarction (MI. The aim of this study was to evaluate the prognostic value of regional longitudinal myocardial deformation in comparison to GLS, conventional echocardiography and clinical information.In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI, treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were examined by tissue Doppler imaging (TDI and two-dimensional strain echocardiography (2DSE.During a median-follow-up of 5.3 (IQR 2.5-6.1 years the primary endpoint (death, heart failure or a new MI was reached by 145 (38.9% patients. After adjustment for significant confounders (including conventional echocardiographic parameters and culprit lesion, reduced longitudinal performance in the anterior septal and inferior myocardial regions (but not GLS remained independent predictors of the combined outcome. Furthermore, inferior myocardial longitudinal deformation provided incremental prognostic information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032. In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p<0.05 for all deformation parameters.Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional echocardiographic risk factors. Furthermore, impaired longitudinal deformation outside the culprit lesion perfusion region seems to be a paramount marker of adverse outcome.

  3. Clinical value and severity of myocardial perfusion defects in asymptomatic diabetic patients with negative or weakly positive exercise treadmill test

    International Nuclear Information System (INIS)

    Zakavi, Seyed Rasoul; Taherpour, Mehdi; Moossavi, Zohreh; Sadeghi, Ramin; Kakhki, Vahidreza Dabbagh; Rokni, Haleh

    2013-01-01

    Although coronary artery disease (CAD) is the leading cause of death in type 2 diabetic patients, it is frequently asymptomatic. Myocardial perfusion imaging (MPI) is reported to show ischemia in a significant number of asymptomatic diabetic patients. We studied the prevalence and severity of myocardial perfusion defects in asymptomatic diabetic patients and its clinical impact. One hundred thirty consecutive asymptomatic patients, aged 35-65 years with type 2 diabetes mellitus and with no history of CAD and no cardiac symptoms were recruited in the study. Echocardiography, electrocardiography (ECG), routine laboratory tests and exercise treadmill test (ETT) were performed and patients with weakly positive or negative ETT underwent Dipyridamole MPI. Patients with positive ETT were referred to coronary angiography. Patients were followed for at least 17 months (mean 21.7 months) and any cardiac event was recorded. We studied 81 female and 49 male patients with mean age of 51.8 years. Negative, weakly positive and positive ETT result was noted in 74.3%, 15% and 10.7% respectively. 75% of patients with positive ETT had coronary artery disease in angiography. Gated myocardial perfusion SPECT was done in 106 patients. MPI showed reversible defect in 26.9% of the patients with a mean summed stress score of 3.3±1.8. Follow up completed in 112 patients and only one patient with abnormal MPI underwent coronary angiography followed by PTCA. No cardiac death, MI, UA or hospital admission occurred among our patients during follow up (17-26 months). Mean stress end diastolic volume (EDV) was significantly higher in patients with reversible defect compared to patients without reversible defect based on MPI findings (62.0±31.6 Vs 48.5±18.4 ml, P=0.04). Blood glucose and HbA1c were significantly higher in patients with ischemia compared to patients without ischemia (P<0.05). Meanwhile the ratio of TG to HDL was 6.06±3.2 in ischemic patients compared to 4.8±2.3 in normal

  4. Quantitative myocardial perfusion by O-15-water PET

    DEFF Research Database (Denmark)

    Thomassen, Anders; Petersen, Henrik; Johansen, Allan

    2015-01-01

    AIMS: Reporting of quantitative myocardial blood flow (MBF) is typically performed in standard coronary territories. However, coronary anatomy and myocardial vascular territories vary among individuals, and a coronary artery may erroneously be deemed stenosed or not if territorial demarcation...... disease (CAD). METHODS AND RESULTS: Forty-four patients with suspected CAD were included prospectively and underwent coronary CT-angiography and quantitative MBF assessment with O-15-water PET followed by invasive, quantitative coronary angiography, which served as reference. MBF was calculated...

  5. Feature-tracking myocardial strain analysis in acute myocarditis. Diagnostic value and association with myocardial oedema

    Energy Technology Data Exchange (ETDEWEB)

    Luetkens, Julian A.; Schlesinger-Irsch, Ulrike; Kuetting, Daniel L.; Dabir, Darius; Homsi, Rami; Schmeel, Frederic C.; Sprinkart, Alois M.; Naehle, Claas P.; Schild, Hans H.; Thomas, Daniel [University of Bonn, Department of Radiology, Bonn (Germany); Doerner, Jonas [University Hospital Cologne, Department of Radiology, Cologne (Germany); Fimmers, Rolf [University of Bonn, Department of Medical Biometry, Informatics, and Epidemiology, Bonn (Germany)

    2017-11-15

    To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. When compared with healthy controls, myocarditis patients demonstrated reduced LS, CS and RS values (LS: -19.5 ± 4.4% vs. -23.6 ± 3.1%, CS: -23.0 ± 5.8% vs. -27.4 ± 3.4%, RS: 28.9 ± 8.5% vs. 32.4 ± 7.4%; P < 0.05, respectively). LS (T1: r = 0.462, P < 0.001; T2: r = 0.436, P < 0.001) and CS (T1: r = 0.429, P < 0.001; T2: r = 0.467, P < 0.001) showed the strongest correlations with T1 and T2 relaxations times. Area under the curve of LS (0.79) was higher compared with those of CS (0.75; P = 0.478) and RS (0.62; P = 0.008). FT CMR myocardial strain analysis might serve as a new tool for assessment of myocardial dysfunction in the diagnostic work-up of patients suspected of having acute myocarditis. Especially, LS and CS show a sufficient diagnostic performance and were most closely correlated with CMR parameters of myocardial oedema. (orig.)

  6. Feature-tracking myocardial strain analysis in acute myocarditis. Diagnostic value and association with myocardial oedema

    International Nuclear Information System (INIS)

    Luetkens, Julian A.; Schlesinger-Irsch, Ulrike; Kuetting, Daniel L.; Dabir, Darius; Homsi, Rami; Schmeel, Frederic C.; Sprinkart, Alois M.; Naehle, Claas P.; Schild, Hans H.; Thomas, Daniel; Doerner, Jonas; Fimmers, Rolf

    2017-01-01

    To investigate the diagnostic value of cardiac magnetic resonance (CMR) feature-tracking (FT) myocardial strain analysis in patients with suspected acute myocarditis and its association with myocardial oedema. Forty-eight patients with suspected acute myocarditis and 35 control subjects underwent CMR. FT CMR analysis of systolic longitudinal (LS), circumferential (CS) and radial strain (RS) was performed. Additionally, the protocol allowed for the assessment of T1 and T2 relaxation times. When compared with healthy controls, myocarditis patients demonstrated reduced LS, CS and RS values (LS: -19.5 ± 4.4% vs. -23.6 ± 3.1%, CS: -23.0 ± 5.8% vs. -27.4 ± 3.4%, RS: 28.9 ± 8.5% vs. 32.4 ± 7.4%; P < 0.05, respectively). LS (T1: r = 0.462, P < 0.001; T2: r = 0.436, P < 0.001) and CS (T1: r = 0.429, P < 0.001; T2: r = 0.467, P < 0.001) showed the strongest correlations with T1 and T2 relaxations times. Area under the curve of LS (0.79) was higher compared with those of CS (0.75; P = 0.478) and RS (0.62; P = 0.008). FT CMR myocardial strain analysis might serve as a new tool for assessment of myocardial dysfunction in the diagnostic work-up of patients suspected of having acute myocarditis. Especially, LS and CS show a sufficient diagnostic performance and were most closely correlated with CMR parameters of myocardial oedema. (orig.)

  7. Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

    International Nuclear Information System (INIS)

    Pedroso, Enio Roberto Pietra; Rezende, Nilton Alves de

    2010-01-01

    Background: non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. Objective: to verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. Methods: eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. Results: the results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. Conclusion: the results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease (author)

  8. Scintigraphy for the detection of myocardial damage in the indeterminate form of Chagas disease

    Energy Technology Data Exchange (ETDEWEB)

    Pedroso, Enio Roberto Pietra; Rezende, Nilton Alves de, E-mail: narezende@terra.com.b [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Abuhid, Ivana Moura [Instituto de Medicina Nuclear e Diagnostico Molecular, Belo Horizonte, MG (Brazil)

    2010-07-15

    Background: non-invasive cardiological methods have been used for the identification of myocardial damage in Chagas disease. Objective: to verify whether the rest/stress myocardial perfusion scintigraphy is able to identify early myocardial damage in the indeterminate form of Chagas disease. Methods: eighteen patients with the indeterminate form of Chagas Disease and the same number of normal controls, paired by sex and age, underwent rest/stress myocardial scintigraphy using sestamibi-99mTc, aiming at detecting early cardiac damage. Results: the results did not show perfusion or ventricular function defects in patients at the indeterminate phase of Chagas disease and in the normal controls, except for a patient who presented signs of ventricular dysfunction in the myocardial perfusion scintigraphy with electrocardiographic gating. Conclusion: the results of this study, considering the small sample size, showed that the rest/stress myocardial scintigraphy using sestamibi-99mTc is not an effective method to detect early myocardial alterations in the indeterminate form of Chagas disease (author)

  9. Comparison between fragmented QRS and Q waves in myocardial scar detection using myocardial perfusion single photon emission computed tomography.

    Science.gov (United States)

    Dabbagh Kakhki, Vahid Reza; Ayati, Narjess; Zakavi, Seyed Rasoul; Sadeghi, Ramin; Tayyebi, Mohammad; Shariati, Farzaneh

    2015-01-01

    Accurate diagnosis of myocardial infarction (MI) is of paramount importance in patient management, which necessitates the development of efficient and accurate diagnostic methods. Q wave is not present in all patients with MI, and its prevalence is declining. Recently, fragmented QRS (fQRS) complex has been introduced as a marker of prior MI. To investigate diagnostic value of fQRS compared to Q wave. We included 500 consecutive patients with known or suspected coronary artery disease who underwent two days of gated myocardial perfusion imaging using dipyridamole pharmacologic stress. Electrocardiogram (ECG) was evaluated to detect fQRS as well as Q-wave. Finally, subjects were compared in terms of ventricular perfusion and function indices. A total of 207 men and 269 women with mean age of 57.06 ± 12 years were studied. ECG analysis showed that 14.3% of the patients had both fQRS and Q waves, 30.7% had fQRS, and 3.8% had Q waves. Fixed myocardial perfusion defect was noted in 22.3% of patients according to MPIs. Sensitivity, specificity, and positive and negative predictive values for myocardial scar detection were 78%, 65%, 39%, and 91%, respectively, for fQRS and 61%, 94%, 76%, and 89%, respectively, for Q wave. Although fQRS had lower specificity compared to Q wave in the detection of myocardial scar, due to higher sensitivity and negative predictive value can be an invaluable diagnostic index. There is also an incremental value for fQRS in association with Q-wave in myocardial scar assessment.

  10. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  11. Rivaroxaban as an Antithrombotic Agent in a Patient With ST-Segment Elevation Myocardial Infarction and Left Ventricular Thrombus

    Directory of Open Access Journals (Sweden)

    Rajeev Seecheran

    2017-03-01

    Full Text Available The incidence of left ventricular (LV thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS. Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

  12. Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).

    Science.gov (United States)

    Bolognese, Leonardo; Falsini, Giovanni; Schwenke, Carsten; Grotti, Simone; Limbruno, Ugo; Liistro, Francesco; Carrera, Arcangelo; Angioli, Paolo; Picchi, Andrea; Ducci, Kenneth; Pierli, Carlo

    2012-01-01

    Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ≥25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ≥50%, increase in sCr ≥0.5 or ≥1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction

  13. Myocardial revascularization with coronary endarterectomy. Stratification of risk factors for early mortality

    Directory of Open Access Journals (Sweden)

    Atik Fernando Antibas

    2000-01-01

    Full Text Available OBJECTIVE: To determine the risk factors for mortality related to myocardial revascularization when performed in association with coronary endarterectomy. METHODS: We assessed retrospectively 353 patients who underwent 373 coronary endarterectomies between January '89 and November '98, representing 3.73% of the myocardial revascularizations in this period of time. The arteries involved were as follows: right coronary artery in 218 patients (58.45%; left anterior descending in 102 patients (27.35%; circumflex artery in 39 patients (10.46%; and diagonal artery in 14 patients (3.74%. We used 320 (85.79% venous grafts and 53 (14.21% arterial grafts. RESULTS: In-hospital mortality among our patients was 9.3% as compared with 5.7% in patients with myocardial revascularizations without endarterectomy (p=0.003. Cause of death was related to acute myocardial infarction in 18 (54.55% patients. The most significant risk factors for mortality identified were as follows: diabetes mellitus (p=0.001; odds ratio =7.168, left main disease (<0.001; 9.283, female sex (0.01; 3.111, acute myocardial infarction (0.02; 3.546, ejection fraction <35% (<0.001; 5.89, and previous myocardial revascularization (<0.001; 4.295. CONCLUSION: Coronary endarterectomy is related to higher mortality, and the risk factors involved are important elements of a poor outcome.

  14. Low-fat diet and regular, supervised physical exercise in patients with symptomatic coronary artery disease: reduction of stress-induced myocardial ischemia

    International Nuclear Information System (INIS)

    Schuler, G.; Schlierf, G.; Wirth, A.

    1988-01-01

    The effects of physical exercise and normalization of serum lipoproteins on stress-induced myocardial ischemia were studied in 18 patients with coronary artery disease, stable angina pectoris, and mild hypercholesterolemia (total serum cholesterol 242 +/- 32 mg/dl). These patients underwent a combined regimen of low-fat/low-cholesterol diet and regular, supervised physical exercise at high intensity for 12 months. At 1 year serum lipoproteins has been lowered to ideal levels (serum cholesterol 202 +/- 31 mg/dl, low-density lipoproteins 130 +/- 30 mg/dl, very low-density lipoproteins 22 +/- 15 mg/dl, serum triglycerides 105 [69 to 304] mg/dl) and physical work capacity was improved by 21% (p less than .01). No significant effect was noted on high-density lipoproteins, probably as a result of the low-fat/high-carbohydrate diet. Stress-induced myocardial ischemia, as assessed by thallium-201 scintigraphy, was decreased by 54% (p less than .05) despite higher myocardial oxygen consumption. Eighteen patients matched for age and severity of coronary artery disease served as a control group and ''usual medical care'' was rendered by their private physicians. No significant changes with respect to serum lipoproteins, physical work capacity, maximal rate-pressure product, or stress-induced myocardial ischemia were observed in this group. These data indicate that regular physical exercise at high intensity, lowered body weight, and normalization of serum lipoproteins may alleviate compromised myocardial perfusion during stress

  15. Prognostic value of myocardial perfusion abnormalities for long-term prognosis in patients after coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Milvidaite, Irena; Kulakiene, Ilona; Vencloviene, Jone; Kinduris, Sarunas; Jurkiene, Nemira; Grizas, Vytautas; Navickas, Ramunas; Slapikas, Rimvydas

    2014-01-01

    The objective was to evaluate the prognostic value of exercise myocardial perfusion scintigraphy (MPS) in patients who underwent coronary artery bypass grafting (CABG). A retrospective, one-center study of 361 patients with multivessel coronary artery disease was carried out. All the patients underwent MPS after CABG due to worsened health status. MPS was performed at 4.5 years standard deviation (SD: 0.2), based on symptoms. MPS was carried out using Tc-99m methoxy isobutyl isonitrile and following a 1-day protocol (stress-rest). The end points were analyzed at 6.5 years (SD: 3.3) after MPS, on the average. SPSS software for Windows, version 13.0. The t-test or the χ 2 -test was used. Survival times were calculated. A multivariate Cox proportional hazards model was developed. During the follow-up, death occurred in 54 patients, and 37 patients experienced major adverse cardiovascular events (MACE). In the multivariate analysis, advanced age hazard ratio (HR: 1.45; 95% confidence interval [CI]: 1.4–2.02; P = 0.027), previous myocardial infarction (HR: 3.17; 95% CI: 1.22–8.2; P = 0.018), left ventricular ejection fraction of <40% (HR: 2.16; 95% CI: 1.2–3.89; P = 0.01), and the summed stress score (SSS) of ≥4 (HR: 1.87; 95% CI: 1.02–3.41; P = 0.04) were independent predictors of all-cause death. The summed difference score (SDS) was the only independent predictor of MACE (HR: 1.26; 95% CI: 1.06–1.48; P = 0.034). The parameters of MPS were found to have prognostic value in the long-term period after CABG. Advanced age, previous myocardial infarction, decreased left ventricular ejection fraction, and the abnormal SSS were associated with an increased risk of all-cause death. The SDS was found to be the only significant risk factor for MACE

  16. Prevalence of first-pass myocardial perfusion defects detected by contrast-enhanced dual-source CT in patients with non-ST segment elevation acute coronary syndromes

    Energy Technology Data Exchange (ETDEWEB)

    Schepis, Tiziano; Achenbach, Stephan; Marwan, Mohamed; Muschiol, Gerd; Ropers, Dieter; Daniel, Werner G.; Pflederer, Tobias [University of Erlangen, Department of Internal Medicine 2 (Cardiology), Erlangen (Germany)

    2010-07-15

    To investigate the prevalence and diagnostic value of first-pass myocardial perfusion defects (PD) visualised by contrast-enhanced multidetector computed tomography (MDCT) in patients admitted for a first acute coronary syndrome (ACS). Thirty-eight patients with non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA) and scheduled for percutaneous coronary intervention underwent dual-source CT immediately before catheterisation. CT images were analysed for the presence of any PD by using a 17-segment model. Results were compared with peak cardiac troponin-I (cTnI) and angiography findings. PD were seen in 21 of the 24 patients with NSTEMI (median peak cTnI level 7.07 ng/mL; range 0.72-37.07 ng/mL) and in 2 of 14 patients with UA. PD corresponded with the territory of the infarct-related artery in 20 out of 22 patients. In a patient-based analysis, sensitivity, specificity, negative and positive predictive values of any PD for predicting NSTEMI were 88%, 86%, 80% and 91%. Per culprit artery, the respective values were 86%, 75%, 80% and 83%. In patients with non-ST segment elevation ACS, first-pass myocardial PD in contrast-enhanced MDCT correlate closely with the presence of myocardial necrosis, as determined by increases in cTnI levels. (orig.)

  17. Markers of Myocardial Ischemia in Patients with Obstructive Sleep Apnea and Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Misa Valo

    2015-01-01

    Full Text Available Obstructive sleep apnea (OSA is characterized by intermittent hypoxia during sleep. We tested the hypothesis that nocturnal myocardial ischemia is detectable by ST segment depression and elevation of high sensitive troponin T (hsTrop T and B-type natriuretic peptide (NT-proBNP in patients with OSA and coexisting coronary artery disease (CAD. Twenty-one patients with OSA and CAD and 20 patients with OSA alone underwent in-hospital polysomnography. Blood samples for hsTrop T and NT-proBNP measurements were drawn before and after sleep. ST segment depression was measured at the time of maximum oxygen desaturation during sleep. The apnea-hypopnea-index (AHI, oxygen saturation nadir, and time in bed with oxygen saturation of ≤80% were similar in both groups. Levels of hsTrop T and NT-proBNP did not differ significantly before and after sleep but NT-proBNP levels were significantly higher in patients suffering from OSA and CAD compared to patients with OSA alone. No significant ST depression was found at the time of oxygen saturation nadir in either group. Despite the fact that patients with untreated OSA and coexisting CAD experienced severe nocturnal hypoxemia, we were unable to detect myocardial ischemia or myocyte necrosis based on significant ST segment depression or elevation of hsTrop T and NT-proBNP, respectively.

  18. Tl-201 myocardial perfusion scanning in patients with right bundle branch block coronary artery disease

    International Nuclear Information System (INIS)

    Shirani, J.; Malpani, A.R.; Blend, M.J.; Bekerman, C.

    1990-01-01

    This paper evaluates the specificity of stress T1-201 myocardial perfusion studies (T1-201 MPS) for coronary artery disease (CAD) in patients with right bundle branch block (RBBB). Twenty-four patients with RBBB and atypical chest pain with ECG findings limited to RBBB, adequate stress test (ie, >85% of maximal heart rate for age), and no clinical, hemodynamic, or ECG evidence of ischemia during exercise underwent T1-201 MPS. These perfusion patterns were compared with an equal number of age- and gender-matched controls with a normal ECG who met all other criteria mentioned above. Patients with RBBB showed a significantly higher frequency of reversible inferoposterior T1-201 defects (62.5% vs 20.8%)

  19. Normal stress-only myocardial single photon emission computed tomography predicts good outcome in patients with coronary artery stenoses between 40 and 70.

    Science.gov (United States)

    Jiang, Zhixin; Liu, Yangqing; Xin, Chaofan; Zhou, Yanli; Wang, Cheng; Zhao, Zhongqiang; Li, Chunxiang; Li, Dianfu

    2016-09-01

    Normal stress myocardial single photon emission computed tomography (SPECT) usually indicates good physiologic function of all coronary lesions, and also indicates a good outcome. We hypothesize that it can still predict good outcome in patients with coronary stenoses between 40 and 70%. A group of patients who underwent stress myocardial SPECT after coronary angiography were consecutively recruited in our center. Patients were eligible if they had one or more coronary stenoses between 40 and 70%. Patients with coronary stenoses greater than 50% diameter of left main or greater than 70% diameter of nonleft main epicardial vessels, and left ventricular ejection fraction less than 50% were excluded. The outcome was defined as major adverse events, including cardiac death, nonfatal myocardial infarction, and revascularization. Patients' survival curves were constructed accorded to the method of Kaplan and Meier and compared using the log-rank test. A study cohort of 77 patients was enrolled. According to the summed stress score, 43 patients were assigned to the perfusion defect group and 34 patients were assigned to the perfusion normal group. The follow-up duration was 6.4±0.3 years. In the perfusion normal group, only one of 34 (2.9%) patients developed major adverse events. In the perfusion defect group, six of 43 (14%) developed major adverse events, P-value of 0.041. It is safe to defer a percutaneous coronary intervention in patients with coronary stenoses between 40 and 70% and normal stress myocardial SPECT.

  20. Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Momose, Mitsuru; Kondo, Chisato; Kobayashi, Hideki; Kusakabe, Kiyoko [Tokyo Women' s Medical University, School of Medicine, Department of Radiology, Shinjuku-ku, Tokyo (Japan); Babazono, Tetsuya [Tokyo Women' s Medical University, School of Medicine, Diabetes Centre, Shinjuku-ku, Tokyo (Japan); Nakajima, Takatomo [Tokyo Women' s Medical University, School of Medicine, Department of Cardiology, Shinjuku-ku, Tokyo (Japan)

    2009-08-15

    Diabetic patients with chronic kidney disease (CKD) frequently develop cardiac events within several years of the initiation of haemodialysis. The present study assesses the prognostic significance of stress myocardial ECG-gated perfusion imaging (MPI) in patients with diabetic CKD requiring haemodialysis. Fifty-five asymptomatic patients with diabetic stage V CKD and no history of heart disease scheduled to start haemodialysis were enrolled in this study (56{+-}11 years old; 49 with type 2 diabetes mellitus). All patients underwent {sup 201}Tl stress ECG-gated MPI 1 month before or after the initiation of haemodialysis to assess myocardial involvement. We evaluated SPECT images using 17-segment defect scores graded on a 5-point scale, summed stress score (SSS) and summed difference scores (SDS). The patients were followed up for at least 2 years (42{+-}15 months) to determine coronary intervention (CI) and heart failure (HF) as soft events and acute myocardial infarction (AMI) and all causes of deaths as hard events. The frequencies of myocardial ischaemia, resting perfusion defects, low ejection fraction and left ventricular (LV) dilatation were 24,20,29 and 49%, respectively. Ten events (18%) developed during the follow-up period including four CI, one HF, one AMI and four sudden deaths. Multivariate Cox analysis selected SDS (p=0.0011) and haemoglobin A{sub 1c} (HbA{sub 1c}) (p=0.0076) as independent prognostic indicators for all events. Myocardial ischaemia, in addition to glycaemic control, is a strong prognostic marker for asymptomatic patients with diabetic CKD who are scheduled to start haemodialysis. Stress MPI is highly recommended for the management and therapeutic stratification of such patients. (orig.)

  1. Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced Ecg-gated multidetector-row computed tomography

    International Nuclear Information System (INIS)

    Ko, S.M.; Seo, J.B.; Hong, M.K.; Do, K.H.; Lee, S.H.; Lee, J.S.; Song, J.W.; Park, S.J.; Park, S.W.; Lim, T.H.

    2006-01-01

    Aim: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n=9) or transmural (n=6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n=6); (2) transmural late enhancement (n=1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n=2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction

  2. Usefulness of multimodality imaging for detection of myocardial infarction in patients with advanced kidney failure: case report

    Energy Technology Data Exchange (ETDEWEB)

    Veras, Mariana Ferreira; Azevedo, Jader Cunha de; Gamarski, Moisés; Mesquita, Evandro Tinoco; Mesquita, Cláudio Tinoco, E-mail: fvmari@gmail.com [Hospital Procardíaco, Rio de Janeiro, RJ (Brazil); Alves, José Galvão [Centro Universitário de Volta Redonda, RJ (Brazil)

    2016-01-15

    {sup 99m}Tc-PYP is able to locate hydroxyapatite crystal structures found within the mitochondria of irreversibly damaged myocardial cells. A study conducted in 52 patients undergoing {sup 99m}Tc-PYP imaging, which underwent necropsy after death, showed sensitivity of 89% and specificity of 100% for {sup 99m}Tc-PYP. The positive predictive value of the technique was 100%, and the negative predictive value was 72%. (author)

  3. Myocardial perfusion in silent myocardial ischemia

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

    1989-01-01

    To investigate myocardial perfusion in silent myocardial ischemia, we performed exercise stress myocardial tomography with thallium-201 (Tl) in 85 patients with coronary artery disease (CAD). Exercise stress myocardial tomography was obtained both immediately after exercise and three hours later. Patients were classified into two groups according to the presence (Symptomatic Group, n=36) or absence (Silent Group, n=49) of chest pain during exercise stress. Clinical features (age, gender and history of myocardial infarction) and arteriographically determined severity of CAD were the same in both groups. The extent of myocardial ischemia (% Ischemia) estimated by exercise stress myocardial tomography was the same in each group (30±10 % in Silent Group, 28±12 % in Symptomatic Group, NS). The severity of exercise-induced myocardial ischemia was expressed as a minimal value of myocardial Tl washout rate (minimal WOR) of each patient. Although exercise heart rate was identical in both groups, minimal WOR in Silent Group was significantly higher than that of Symptomatic Group (4±10% vs -16±14%, p<0.001). The study in patients who exhibited both silent and symptomatic ischemia showed the same results. These findings suggest that the severity of ischemia is a fundamental factor in determining the presence or absence of pain during exercise induced ischemia. (author)

  4. Myocardial perfusion abnormality and chest pain in patients with hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

    1991-01-01

    To investigate the role of myocardial ischemia in the development of chest pain in patients with hypertrophic cardiomyopathy (HCM), exercise stress (Ex) redistribution myocardial single photon emission CT's (SPECT's) with thallium-201 (Tl) were obtained in 27 patients with HCM. In all patients, coronary arteries were normal arteriographically. Patients were classified into NYHA Class I, II and III according to the frequency and severity of the chest pain during daily life. In these 3 groups, age, sex and intraventricular septal thickness measured by echocardiography were not different. Types of myocardial perfusion obtained by myocardial SPECT's were divided into 5: (1) normal perfusion, (2) no perfusion defect with abnormal myocardial Tl washout rate (WOR) during 3 hours (<30%) [Def(-)/WORabn], (3) reversible perfusion defect (RD), (4) fixed defect with abnormal WOR (FD/WORabn), and (5) fixed defect with normal WOR (FD/WORnl). In 14 patients of Class I, 9 patients (64%) showed normal perfusion but the rest showed perfusion abnormality (def(-)/WORabn in 3 and RD in 2). In Class II and III, all patients showed perfusion abnormalities of RD, FD/WORabn or FD/WORnl. As the functional class progressed from Class II to III, the ratio of fixed defect (both WORnl and WORabn) to RD increased, but it was not statistically significant. In 2 patients in whom Ex SPECT's were repeated because of the progression of the chest pain, the severity of the perfusion abnormality also progressed. Perfusion abnormalities were observed most frequently in anterior (35%), then inferior/posterior (20%) and septal wall (18%). The frequency of Ex induced ECG abnormalities (ST-depression or T wave changes) increased as the NYHA Class progressed (Class III vs I p<0.05). These findings suggested the following: chest pain in patients with HCM relates to the myocardial ischemia which may originate in the myocardial small arteries, and when the lesions progress myocardial necrosis may ensue. (author)

  5. Is dipyridamole test equivalent to exercise testing for the performing of myocardial tomo-scintigraphy? preliminary results of a systematic comparative analysis in patients having documented episodes of myocardial ischemia

    International Nuclear Information System (INIS)

    David, N.; Quiri, N.; Hassan, N.; Arsena, T.; Py, M.; Olivier, P.; Karcher, G.; Bertrand, A.; Houriez, P.; Grentzinger, A.; Angioi, M.; Danchin, N.; Juilliere, Y.

    1997-01-01

    Dipyridamole test is generally used rather than exercise testing when myocardial tomo-scintigraphy (MTS) is performed with patients unable to perform a maximal exercise test. However, this choice has never been validated by a systematic comparative analysis of the results provided by these two stress techniques with patients having a documented myocardial ischemia. We have included 20 patients who had a known coronary artery disease, for whom exercise test was positive at the time of an exercise MTS-TI201 performed in our department and who underwent an additional MTS-TI201 after intravenous administration of 0,56 mg/kg of dipyridamole and low-level exercise testing (40 W). The extent of perfusion abnormalities, observed after dipyvirdamole, was not significantly different from that evidenced at exercise, even in the analysis restricted to the eight patients who had a sub-maximal test (<80 % of predicted maximal heart rate) at the time of exercise-MTS (% of left ventricle: 17 ± 13 vs 15 ± 8). By contrast, there were important individual variations: a difference in defect-extent (≥ 10 % of left ventricle) was observed between the two tests for 11 patients (55 %), the largest defect being that observed at exercise in six cases, and after dipyridamole in five cases. With patients having exercise myocardial ischemia, the MTS obtained after dipyridamole are frequently very different from those performed after exercise, and the criterion of a low maximal heart rate doses not imply an underestimation of the perfusion abnormalities observed at exercise. (authors)

  6. Gadolinium-enhanced magnetic resonance imaging in acute myocardial infarction

    International Nuclear Information System (INIS)

    Dijkman, P.R.M. van; Wall, E.E. van der; Roos, A. de; Doornbos, J.; Laarse, A. van der; Voorthuisen, A.E. van; Bruschke, A.V.G.; Rossum, A.C. van

    1990-01-01

    To evaluate he usefulness of the paramagnetic contrast agent Gadolinium-DTPA (diethylenetriaminepentaacetic acid) in Magnetic Resonance. Imaging of acute myocardial infarction, we studied a total of 45 patients with a first acute myocardial infarction by ECG-gated magnetic resonance imaging before and after intravenous administration of 0.1 mmol/kg Gadolinium-DTPA. All patients received thrombolytic treatment by intravenous streptokinase. The magnetic resonance imaging studies were preformed after a meam of 88 h (range 15-241) after the acute onset of acute myocardial infarction. Five patients without evidence of cardiac disease served as controls. Spin-echo measurements (TE 30 ms) were made using a Philips Gyroscan (0.5 Tesla) or a Teslacon II (0.6 Tesla). The 45 patients were divided into four groups of patients. In Group I( patients) Gadolinium-DTPA improved the detection of myocardial infarction by Gadolinium-DTPA. In Group II (20 patients) the magnetic resonance imaging procedure was repeated every 10 min for up to 40 min following administration of Gadolinium-DTPA. Optimal contrast enhancement was obtained 20-25 min after Gadolinium-DTPA. In Group III (27 patients) signal intensities were significantly higher in the patients who underwent the magnetic resonance imaging study more than 72 h (mean 120) after the acute event, suggesting increased acculumation of Gadolinium-DTPA in a more advanced stage of the infarction process. In Group IV (45 patients) Gadolinium-DTPA was administered in an attempt to distinguish between reperfused and nonreperfused myocardial areas after thrombolytic treatment for acute myocardial infarction. The signal intensities did not differ, but reperfused areas showed a more homogeneous aspect whereas nonreperfused areas were visualized as a more heterogeneous contrast enhancement. It is concluded that magnetic resonance imaging using the contrast agent Gadolinium-DTPA significantly improves the detection of infarcted myocardial areas

  7. Clinical application of stress/rest myocardial perfusion imaging in the patients with 50%-75% coronary stenosis

    International Nuclear Information System (INIS)

    Han Pingping; Tian Yueqin; Fang Wei; Yang Minfu; Shen Rui; Wei Hongxing; Guo Xinhua; He Zuoxiang

    2011-01-01

    Objective: To evaluate the clinical application of stress/rest Mpi in the patients with 50%-75% coronary artery stenosis. Methods: The criteria for patient selection were that the patients should have at least one main coronary artery with stenosis more than 50%, and the maximal stenosis should be less than 75% according to Cage. The stress/rest Mpi was performed in 2 weeks before or after CAG. A total of 244 patients (178 males, 66 females) with mean age (57 ± 10) years were included in this study. Symptom restriction stress test was used and stress MPI was performed 1-1.5 h after 99 Tc m -MIBI (925 MBq) injection at the exercise peak. Rest MPI was performed within 48-72 h after stress MPI.Myocardial ischemia was diagnosed when there was a reduced uptake or even a defect in 2 different tomographic sections or in the same part of a myocardium in the continuous 2 slices. When there was an irreversible reduced uptake or defect, myocardial infarction was given as the final diagnosis. No reduced uptake or defect in all slices was shown as normal. The impact of MPI images on the selection for optimal clinical therapy plans was also discussed. χ 2 test was used for statistical analysis. Results: A total of 340 coronary arteries with stenosis 50%-75% were found by CAG. According to stress/rest MPI results, 207 patients (84.8%)presented normal, 33 had myocardial ischemia, 3 had myocardial infarction, and 1 had both myocardial infarction and ischemia. In abnormal MPI images, there were 61 ischemic segments and 9 infarct segments,which were associated with 43 stenotic arteries (23 LAD, 10 LCX, and 10 RCA). Patients were divided into 2 groups according to the results of MPI: Group 1 with normal MPI (207/244, 84.8%) and Group 2 with abnormal MPI (37/244, 15.2%). In Group 1, 9 patients underwent coronary artery revascularization (PTCA or CABG), and the others had medical treatment. Eight patients had PTCA and 29 patients had medical treatment in Group 2. There was a

  8. Carbohydrate and lipid metabolism indices dynamic in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity in 6 months and 1 year after myocardial revascularization

    Directory of Open Access Journals (Sweden)

    P. P. Kravchun

    2016-11-01

    Full Text Available Nowadays conservative therapy and reperfusion techniques, which include thrombolytic therapy and percutaneous coronary intervention considered as the main strategies for the acute coronary syndrome treatment. Aim. To assess carbohydrate and lipid metabolism in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity in 6 months and 1 year after myocardial revascularization. Methods and results. 58 patients who underwent thrombolytic therapy and 32 patients who underwent percutaneous coronary intervention were examined. Glucose level was determined by glucose oxidation method, insulin – by ELISA and lipid profile – according to the standard biochemical methods. It was established that in patients with postinfarction cardiosclerosis, type 2 diabetes and obesity positive effect was defined in carbohydrate and lipid metabolism by reducing of serum glucose level, insulin, total cholesterol, low and very low-density lipoproteins, triglycerides and increasing of high density lipoproteins, cholesterol in 6 months and 1 year after reperfusion therapy. Significant differences in carbohydrate and lipid metabolism in the examined patients, depending on the type of reperfusion therapy, have not been detected in 6 months and 1 year after revascularization. Conclusion. Comparative analysis of different methods of myocardial revascularization did not show any advantages of them.

  9. Myocardial Expression of Macrophage Migration Inhibitory Factor in Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Julia Pohl

    2017-10-01

    Full Text Available Macrophage migration inhibitory factor (MIF is a pleiotropic inflammatory protein and contributes to several different inflammatory and ischemic/hypoxic diseases. MIF was shown to be cardioprotective in experimental myocardial ischemia/reperfusion injury and its expression is regulated by the transcription factor hypoxia-inducible factor (HIF-1α. We here report on MIF expression in the failing human heart and assess myocardial MIF in different types of cardiomyopathy. Myocardial tissue samples from n = 30 patients were analyzed by quantitative Real-Time PCR. MIF and HIF-1α mRNA expression was analyzed in myocardial samples from patients with ischemic (ICM and non-ischemic cardiomyopathy (NICM and from patients after heart transplantation (HTX. MIF expression was elevated in myocardial samples from patients with ICM compared to NICM. Transplanted hearts showed lower MIF levels compared to hearts from patients with ICM. Expression of HIF-1α was analyzed and was shown to be significantly increased in ICM patients compared to patients with NICM. MIF and HIF-1α mRNA is expressed in the human heart. MIF and HIF-1α expression depends on the underlying type of cardiomyopathy. Patients with ICM show increased myocardial MIF and HIF-1α expression.

  10. Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Biering-Sorensen, Tor; Jensen, Jan Skov; Pedersen, Sune H

    2016-01-01

    deformation in comparison to GLS, conventional echocardiography and clinical information. Method In total 391 patients were admitted with ST-Segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention and subsequently examined by echocardiography. All patients were...... information to clinical and conventional echocardiographic information (Harrell's c-statistics: 0.63 vs. 0.67, p = 0.032). In addition, impaired longitudinal deformation outside the culprit lesion perfusion region was significantly associated with an adverse outcome (p...). Conclusion Regional longitudinal myocardial deformation measures, regardless if determined by TDI or 2DSE, are superior prognosticators to GLS. In addition, impaired longitudinal deformation in the inferior myocardial segment provides prognostic information over and above clinical and conventional...

  11. Evaluation of myocardial sympathetic nerve function in patients with mitral valve prolapse using iodine-123-metaiodobenzylguanidine myocardial scintigraphy

    International Nuclear Information System (INIS)

    Kishi, Fumiko; Nomura, Masahiro; Yukinaka, Michiko

    1996-01-01

    Mitral valve prolapse (MVP) is closely related to myocardial sympathetic nerve function. This study evaluated the presence of impaired myocardial sympathetic nerve function by Iodine-123-metaiodobenzylguanidine (MIBG) scintigraphy in nine patients with MVP. For comparison, 15 healthy subjects without heart disease were investigated (control group). Single photon emission computed tomography (SPECT) and anterior planar myocardial scintigraphy were performed 15 min (initial images) and 3 hours (delayed images) after injection of MIBG (111 MBq). The location and degrees of reduced tracer uptake were evaluated. Myocardial MIBG uptake was quantified by uptake ratio of the heart (H) to upper mediastinum (M) on the anterior planar images (H/M). Percentage washout of MIBG in nine sectors of all oblique slices along the short-axis was calculated. The washout rates were higher at the inferoposterior and septal segments in patients with anterior leaflet prolapse, and at inferoposterior and lateral segments in patients with posterior leaflet prolapse. The bull's eye map showed increased washout rate in the apical and posteroseptal basal segments. There was no significant difference in the H/M ratio between MVP patients and the control group. These results indicate that MIBG can be used to evaluate localized myocardial sympathetic nerve function in MVP. (author)

  12. Risk profile in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Safdar, M.H.K.; Fazal, I.; Ejaz, A.; Awan, Z.I.

    2010-01-01

    The objective of this study was to determine the frequency of risk factors in young patients with acute myocardial infarction and thus with ischemic heart disease (IHD), aged 20 to 40 years, in our population. All patients who fulfilled the inclusion criteria who presented to emergency reception of the hospital with a diagnosis of Acute MI were included. The patients were admitted to coronary care unit (CCU) and were managed for Acute myocardial infarction (MI). Their detailed history was then taken including symptoms at presentation and their risk factors were assessed with the help of history and laboratory investigations. A total of 137 patients were included during the study period. Mean age was 36 years (SD=3.67). Majority of patients were males. Smoking was the major risk factor (64.2%) followed by family history of IHD (30.7%). Most frequent risk factor for Acute myocardial infarction (MI) at young age is smoking followed by family history. (author)

  13. Noninvasive detection of regional myocardial perfusion abnormality with /sup 201/Tl and /sup 81/Rb

    Energy Technology Data Exchange (ETDEWEB)

    Narita, M; Usami, M; Kurihara, T; Kawararadani, H; Kanao, K

    1977-05-01

    Myocardial scintigrams were performed at rest and during exercise using /sup 201/Tl and /sup 81/Rb. Patients underwent graded ergometer exercise stress tests. In normals, myocardial images were horse-shoe or O-shaped and concentration of radionuclide was relatively uniform throughout the myocardium. In 13 patients with old myocardial infarctions, and abnormal Q waves, regional myocardial perfusion defects (cold area) were detected. Their locations correlated with sites of the abnormal Q waves. Two patients had no abnormal Q waves at the examination, but their scintigrams showed cold areas, the locations of which coincided with coronary angiographic findings. Exercise stress ECG and stress scintigrams were performed. Myocardial perfusion defects, which developed from exercise stress, were detected in 9 of 10 positive exercise ECG patients, 2 of 4 equivocal exercise ECG patients, and 2 of 10 negative exercise ECG patients. These 2 patients (exercise ECG (-), stress scintigram (+)) had typical angina. Findings of exercise stress scintigrams coincided better with clinical findings than did those of exercise ECG. These scintigraphic methods appear to be excellent for detection of noninvasive coronary heart disease noninvasively.

  14. Effects of the repeated administration of adenosine and heparin on myocardial perfusion in patients with chronic stable angina pectoris.

    Science.gov (United States)

    Barron, H V; Sciammarella, M G; Lenihan, K; Michaels, A D; Botvinick, E H

    2000-01-01

    The mechanism by which ischemia stimulates angiogenesis is unknown. Adenosine is released during myocardial ischemia and may be a mediator of this process. Experimental data suggest that heparin may enhance this effect. The purpose of this open-labeled, placebo-controlled trial was to determine whether repeated intravenous administration of adenosine and heparin could mimic physiologic angiogenesis and reduce the amount of exercise-induced myocardial ischemia in patients with coronary artery disease. Subjects with chronic stable angina refractory to conventional medical therapy and not suitable for revascularization received either adenosine (140 microg/kg/min for 6 minutes) and heparin (10,000 U bolus), (n = 14), or placebo, (n = 7) daily for 10 days. All patients underwent baseline and follow-up exercise testing with thallium-201 single-photon emission computed tomography myocardial perfusion imaging. A semiquantitative assessment of the extent and severity of the perfusion abnormalities was calculated by 2 blinded investigators. There was no significant change in exercise duration or in the peak heart rate systolic blood pressure product associated with adenosine and heparin compared with placebo treatment. There was, however, a 9% reduction in the extent (60.6 +/- 4.0 vs 54.9 +/- 4.1, p = 0.03) and a 14% improvement in severity (41.5 +/- 3.2 vs 35.7 +/- 2.9, p = 0.01) of the myocardial perfusion abnormalities seen in patients who received adenosine and heparin compared with placebo. Thus, in this pilot study, repeated administration of adenosine and heparin reduced the amount of exercise-induced ischemia in patients with chronic stable angina refractory to conventional treatment.

  15. Quantification of myocardial perfusion using free-breathing MRI and prospective slice tracking

    DEFF Research Database (Denmark)

    Pedersen, Henrik; Kelle, Sebastian; Ringgaard, Steffen

    2009-01-01

    . This study demonstrates the feasibility of patient-adapted 3D PST on a 3.0 Tesla MR system. Eight patients underwent free-breathing studies of myocardial perfusion, simultaneously collecting data with and without PST. On average, PST reduced residual in-plane motion by a factor of 2, compared...

  16. Predictive value of cardiac magnetic resonance imaging-derived myocardial strain for poor outcomes in patients with acute myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Won; Jeong, Yeon Joo; Lee, Gee Won; Lee, Nam Kyung; Lee, Hye Won; Kim, Jin You [Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan (Korea, Republic of); Choi, Bum Sung; Choo, Ki Seok [Pusan National University Yangsan Hospital, Yangsan (Korea, Republic of)

    2017-08-01

    To evaluate the utility of cardiovascular magnetic resonance (CMR)-derived myocardial strain measurement for the prediction of poor outcomes in patients with acute myocarditis We retrospectively analyzed data from 37 patients with acute myocarditis who underwent CMR. Left ventricular (LV) size, LV mass index, ejection fraction and presence of myocardial late gadolinium enhancement (LGE) were analyzed. LV circumferential strain (EccSAX), radial strain (ErrSAX) from mid-ventricular level short-axis cine views and LV longitudinal strain (EllLV), radial strain (ErrLax) measurements from 2-chamber long-axis views were obtained. In total, 31 of 37 patients (83.8%) underwent follow-up echocardiography. The primary outcome was major adverse cardiovascular event (MACE). Incomplete LV functional recovery was a secondary outcome. During an average follow-up of 41 months, 11 of 37 patients (29.7%) experienced MACE. Multivariable Cox proportional hazard regression analysis, which included LV mass index, LV ejection fraction, the presence of LGE, EccSAX, ErrSAX, EllLV, and ErrLax values, indicated that the presence of LGE (hazard ratio, 42.88; p = 0.014), together with ErrLax (hazard ratio, 0.77 per 1%, p = 0.004), was a significant predictor of MACE. Kaplan-Meier analysis demonstrated worse outcomes in patient with LGE and an ErrLax value ≤ 9.48%. Multivariable backward regression analysis revealed that ErrLax values were the only significant predictors of LV functional recovery (hazard ratio, 0.54 per 1%; p = 0.042). CMR-derived ErrLax values can predict poor outcomes, both MACE and incomplete LV functional recovery, in patients with acute myocarditis, while LGE is only a predictor of MACE.

  17. Phase analysis of gated blood pool scintigraphy in traumatic myocardial contusion

    International Nuclear Information System (INIS)

    Nishimaki, Hiroshi; Kobayashi, Akiyoshi

    1994-01-01

    It is not easy to make a diagnosis of myocardial contusion following blunt chest trauma, because most patients have many other concurrent injuries with diverse symptoms. The usefulness of phase analysis of gated blood pool scintigraphy (GBPS) for myocardial contusion following blunt chest trauma was evaluated. Thirty-eight patients who had been strongly suspected of having myocardial contusion from clinical symptoms and electrocardiograms underwent phase analysis of GBPS. The results of phase analysis were compared with those of two-dimensional echocardiography (2-D Echo) and CPK-MB fraction measurement in all patients, with those of 201 TlCl myocardial scintigraphy in 35 patients and with those of 99m Tc-pyrophosphate scintigraphy in 10 patients. In 29 patients (76.3%), the results of phase analysis matched those of 2-D Echo. Two patients (5.3%) who were judged as positive by 2-D Echo and as negative by phase analysis had only rupture of the chordae. Only one of two other patients who were judged as negative by 2-D Echo and as positive by phase analysis was judged as positive by 201 TlCl myocardial scintigraphy. The results of both 2-D Echo and phase analysis were not well correlated with those of CPK-MB fraction measurement and 99m Tc pyrophosphate scintigraphy. It is concluded that phase analysis of GBPS, as well as 2-D Echo, is useful for diagnosing myocardial contusion, and that phase analysis is most useful for diagnosing myocardial contusion in patients who cannot be examined by 2-D Echo because of the presence of pneumothorax and/or subcutaneous emphysema in the anterior chest wall. (author)

  18. Phase analysis of gated blood pool scintigraphy in traumatic myocardial contusion

    Energy Technology Data Exchange (ETDEWEB)

    Nishimaki, Hiroshi; Kobayashi, Akiyoshi (Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine)

    1994-01-01

    It is not easy to make a diagnosis of myocardial contusion following blunt chest trauma, because most patients have many other concurrent injuries with diverse symptoms. The usefulness of phase analysis of gated blood pool scintigraphy (GBPS) for myocardial contusion following blunt chest trauma was evaluated. Thirty-eight patients who had been strongly suspected of having myocardial contusion from clinical symptoms and electrocardiograms underwent phase analysis of GBPS. The results of phase analysis were compared with those of two-dimensional echocardiography (2-D Echo) and CPK-MB fraction measurement in all patients, with those of [sup 201]TlCl myocardial scintigraphy in 35 patients and with those of [sup 99m]Tc-pyrophosphate scintigraphy in 10 patients. In 29 patients (76.3%), the results of phase analysis matched those of 2-D Echo. Two patients (5.3%) who were judged as positive by 2-D Echo and as negative by phase analysis had only rupture of the chordae. Only one of two other patients who were judged as negative by 2-D Echo and as positive by phase analysis was judged as positive by [sup 201]TlCl myocardial scintigraphy. The results of both 2-D Echo and phase analysis were not well correlated with those of CPK-MB fraction measurement and [sup 99m]Tc pyrophosphate scintigraphy. It is concluded that phase analysis of GBPS, as well as 2-D Echo, is useful for diagnosing myocardial contusion, and that phase analysis is most useful for diagnosing myocardial contusion in patients who cannot be examined by 2-D Echo because of the presence of pneumothorax and/or subcutaneous emphysema in the anterior chest wall. (author).

  19. Effect of collateral circulation on myocardial protection in patients with acute myocardial infarction. Comparison of technetium-99m-tetrofosmin myocardial single photon emission computed tomography and coronary angiography

    International Nuclear Information System (INIS)

    Yoshida, Michi; Kondo, Makoto; Abe, Yoshiteru; Kubota, Tomoyuki; Matsuoka, Ryota; Araki, Makoto; Tanio, Hitoshi; Doyama, Kiyoshi

    2006-01-01

    Evaluation of myocardial blood flow from collateral vessels into the infarct area has been estimated by coronary angiography. In patients with acute myocardial infarction with Thrombolysis in Myocardial Infarction (TIMI) 0 flow, myocardial tracer uptake on single photon emission computed tomography (SPECT) images can predict the collateral blood flow in the infarct area if technetium (Tc)-99m-tetrofosmin was administered before recanalization. The present study investigated whether collateral blood flow evaluated by myocardial scintigraphy is a good predictor of myocardial salvage in patients with acute myocardial infarction. The study group consisted of 30 patients (mean age 65±14 years, 23 males, 7 females) with first acute myocardial infarction and coronary angiography evidence of total occlusion (TIMI 0) within 12 hr after the onset. All patients had one vessel disease related to infarction and TIMI 3 flow after percutaneous coronary intervention (PCI). Tc-99m-tetrofosmin was injected intravenously before the PCI. The regional severity score index (RSSI) was obtained from SPECT using the 17 segment method with the four-point scoring system. Myocardial viability was evaluated by the RSSI obtained from thallium-glucose-insulin infusion SPECT after 1 week and regional wall motion score index obtained from echocardiography during the chronic phase. The patients were divided into two groups according to the angiographic collateral finding. There were no differences in RSSI on thallium-glucose-insulin SPECT and regional wall motion score between the good collateral group (n=8) and poor collateral group (n=22). Myocardial Tc-99m-tetrofosmin RSSI was similar in these groups. On the other hand, the patients were divided according to Tc-99m-tetrofosmin scintigraphic evaluation before PCI. RSSI on thallium-glucose-insulin SPECT was significantly greater (0.7±0.5 vs 1.5±0.4, p<0.01) and regional wall motion score was significantly less (1.46±0.50 vs 2.08±0.78, p<0

  20. Periodic variation and its effect on management and prognosis of Korean patients with acute myocardial infarction.

    Science.gov (United States)

    Park, Hyo Eun; Koo, Bon-Kwon; Lee, Wonjae; Cho, Youngjin; Park, Jin Sik; Choi, Ji-Yong; Jeong, Myung-Ho; Kim, Jong Hyun; Chae, Shung Chull; Kim, Young Jo; Nam, Chang-Wook; Lee, Jae-Hwan; Choi, Dong Hoon; Hong, Taek Jong; Chae, Jei Keon; Rhew, Jae Young; Kim, Kee Sik; Kim, Hyo-Soo; Oh, Byung-Hee; Park, Young Bae

    2010-05-01

    The characteristics of the periodic variation in acute myocardial infarction (AMI) and the subsequent effect on management and prognosis have not been fully investigated in a large number of Asian populations. From a prospective, observational multicenter online registry, 4,573 patients diagnosed as AMI in Korea from January to December 2006 were included. The highest incidence of AMI was between 8 a.m. and noon. The number of cases was highest in the winter and lowest in the autumn (13.6 vs 11.4 patients per day, Pworking hours had a shorter time to first medical contact (203+/-288 min) compared with out-of-hours onset (230+/-288 min, P=0.003). In patients who underwent primary angioplasty, out-of hours symptom onset was associated with a greater time delay in both the patient's and the medical facility's response (door-to-balloon time out-of hours vs working hours: 101+/-54 min vs 84+/-44 min, P<0.001). In patients with ST-segment elevation myocardial infarction, symptoms to first medical contact showed a significant relationship to in-hospital mortality (for every 10 min of symptoms to first medical contact, odds ratio 1.006, 95% confidence interval 1.001-1.012, P=0.018) Circadian and periodic variation in AMI exists in Korean patients, which resulted in different patient behavior, hospital management and outcomes.

  1. Myocardial metabolic abnormalities in hypertrophic cardiomyopathy assessed by iodine-123-labeled beta-methyl-branched fatty acid myocardial scintigraphy and its relation to exercise-induced ischemia

    International Nuclear Information System (INIS)

    Matsuo, Shinro; Nakamura, Yasuyuki; Takahashi, Masayuki; Mitsunami, Kenichi; Kinoshita, Masahiko

    1998-01-01

    Reversible thallium-201 ( 201 Tl) abnormalities during exercise stress have been used as markers of myocardial ischemia in hypertrophic cardiomyopathy (HCM) and are most likely to identify relatively underperfused myocardium. Although metabolic abnormalities in HCM were reported, the relationship between impaired energy metabolism and exercise-induced ischemia has not been fully elucidated as yet. To assess the relationship between myocardial perfusion abnormalities and fatty acid metabolic abnormalities, 28 patients with HCM underwent exercise 201 Tl and rest 123 I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy. Perfusion abnormalities were observed by exercise 201 Tl in 19/28 patients with HCM. 123 I-BMIPP uptake was decreased compared with delayed 201 Tl in 106/364 (29%) of the total myocardial segments (p 123 I-BMIPP and 201 Tl was observed more often in the 49/75 (65%) segments with reversible exercise 201 Tl defects (p 123 I-BMIPP and 201 Tl suggests that myocardial ischemia may play an important role in metabolic abnormalities in HCM. (author)

  2. Usefulness of BMIPP SPECT to evaluate myocardial viability, contractile reserve and coronary stenotic progression after reperfusion in acute myocardial infarction

    International Nuclear Information System (INIS)

    Katsunuma, Eita; Kurokawa, Shingo; Takahashi, Motoi; Fukuda, Naoto; Kurosawa, Toshiro; Izumi, Tohru

    2001-01-01

    Using combined 123 I-BMIPP (BMIPP), 201 Tl (Tl) and 99m Tc-PYP (PYP) myocardial SPECT imaging, risk areas of acute myocardial infarction were documented in the acute stage, and then these images were evaluated for how well they reflected muscle viability, contractile reserve and coronary stenotic progression subsequent to reperfusion therapy. Patients who only experienced a first attack of myocardial infarction were enrolled. In total, 36 cases who had had the occluded artery successfully reperfused were examined during the past year. They had no significant vessel disease except for the culprit single artery. The patients were comprised of 32 men and 4 women. The mean age was 59.5 years. All patients underwent coronary angiography and left ventricular (LV) angiography in the emergency room. BMIPP/Tl and PYP myocardial SPECT were conducted in the acute stage and chronic stage. In the chronic stage LV angiography was repeated to assess the improvement of LV wall motion. The response to postextrasystolic potentiation (PESP) testing was performed to estimate myocardial contractile reserve. The risk area of acute myocardial infarction (AMI) was documented by reduced BMIPP accumulation. The size of reduced BMIPP accumulation was larger than that of PYP accumulation. A BMIPP/Tl discrepancy and PYP accumulation were documented to assess myocardial viability. Both improvement in LV wall motion and augmentation of PESP response were more closely related to a BMIPP/Tl discrepancy in the presence or absence of PYP accumulation. Therefore, it would be possible to evaluate myocardial viability and contractile reserve by the BMIPP/Tl discrepancy. In patients with good viability, it is important to predict whether there is coronary stenotic progression or not. In this study, we demonstrated that most patients with improved BMIPP images had no significant progression at the site of intervention. Serial observation of BMIPP images from the acute stage to the chronic stage might

  3. Equilibrium radionuclide ventriculography in male patients after transmural myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Nestaval, A; Stanek, V; Malek, I; Kidery, J; Runczik, I [Institut pro Klinickou a Experimentalni Medicinu, Prague (Czechoslovakia); Cernoch, V; Oppelt, A [Institut pro Dalsi Vzdelavani Lekaru a Farmaceutu, Prague (Czechoslovakia)

    1982-12-17

    The ejection fraction of the left ventricle was measured using the method of equilibrium radionuclide ventriculography in 10 healthy males and 57 males after the first transmural myocardial infarction. The examination was effected 4 to 7 months after the event and the sample is representative for males after myocardial infarction who are younger than 65 years and show no signs of heart insufficiency by the time of examination. The resting value of the ejection fraction was 63+-5% in healthy males, 54+-7% in patients with uncomplicated myocardial infarction and 37+-8% in patients with clinical manifestations of heart insufficiency in acute phase. The differences between the groups are statistically significant. In patients with anteroseptal localization of myocardial infarction there was a negative correlation between the ejection fraction on the one hand and the sum of the voltages of Q waves in precordial ECG map and the maximum value of serum creatine kinase in acute phase on the other. The ejection fraction was in correlation to the degree of pulmonary hypertension measured in equal phase during exercise. The ejection fraction was measured in 31 patients under the working load of 50 W; significant changes were not found in healthy males or in patients after myocardial infarction. No changes were found when the state just before discharge from the hospital was compared with his state 6 months after myocardial infarction. The results obtained in compensated patients showed a relative stability of the value of the ejection fraction both during the first 6 months after discharge and under a mild working load. A comparison between the indicators in acute phase and hemodynamic examination after 6 months shows that the value of the ejection fraction is a sensitive indicator of the extent of necrosis and functional lesion of the left ventricle.

  4. Myocardial Damage in Patients With Deferred Stenting After STEMI

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Ahtarovski, Kiril Aleksov

    2017-01-01

    BACKGROUND: Although some studies found improved coronary flow and myocardial salvage when stent implantation was deferred, the DANAMI-3-DEFER (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) did not show any improvement in clinical outcome in pa...

  5. Decreased perfusion in myocardial region of normal donor artery secondary to collateral development

    International Nuclear Information System (INIS)

    Koga, Y.; Takahashi, M.; Kojima, A.; Takaki, Y.; Tomiguchi, S.; Hirota, Y.; Kugiyama, K.; Yasue, H.; Hayasaki, K.; Kumamoto Saiseikai Hospital

    1992-01-01

    Thirty-one patients suffering from single vessel exertional angina with collaterals (Group A) were evaluated by stress 201 Tl myocardial emission CT (Tl-SPECT) with 16 controls of severely stenotic single vessel exertional angina without collaterals (Group B). Group A included 21 patients (68%) who showed an extensive perfusion defect in double artery myocardial regions, including the normal donor artery myocardial region (DMR). However, there were no such cases in Group B, giving a significant difference between these 2 groups (p < 0.001). Four patients in Group A, having a perfusion defect both in DMR and in the collateral dependent myocardial region (CMR) underwent a successful percutaneous transluminal coronary angioplasty (PTCA) with disappearance of collaterals. Tl-SPECT findings after PTCA showed no perfusion defect either in CMR or in DMR. This has been explained on the basis that the coronary collaterals stole blood and produced perfusion defect in DMR. (orig.)

  6. Characteristic findings of exercise ECG test, perfusion SPECT and coronary angiography in patients with exercise induced myocardial stunning

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Byeong Cheol; Seo, Ji Hyoung; Bae, Jin Ho; Jeong, Shin Young; Park, Hun Sik; Lee, Jae Tae; Chae, Shung Chull; Lee, Kyu Bo [School of Medicine, Kyungpook National Univ., Daegu (Korea, Republic of)

    2004-06-01

    Transient wall motion abnormality and contractile dysfunction of the left ventricle (LV) can be observed in patients with coronary artery disease due to post-stress myocardial stunning. To understand clinical characteristics of stress induced LV dysfunction, we have compared the findings of exercise stress test, myocardial perfusion SPECT and coronary angiography between subjects with and without post-stress LV dysfunction. Among subjects who underwent exercise stress test, myocardial perfusion SPECT and coronary angiography within a month of interval, we enrolled 36 patients with post-stress LV ejection fraction (LVEF) was {>=}5% lower than rest (stunning group) and 16 patients with difference of post-stress and rest LVEF was lesser than 1% (non-stunning group) for this study. Treadmill exercise stress gated myocardial perfusion SPECT was performed with dual head SPECT camera using 740 MBq Tc-99m MIBI and coronary angiography was also performed by conventional Judkins method. Stunning group had a significantly higher incidence of hypercholesterolemia than non-stunning group(45.5 vs 7.1%, p=0.01). Stunning group also had higher incidence of diabetes mellitus and lower incidence of hypertension, but these were not statistically significant. Stunning group had larger and more severe perfusion defect in stress perfusion myocardial SPECT than non-stunning group(extent 18.2 vs 9.2%, p=0.029; severity 13.5 vs 6.9, p=0.040). Stunning group also had higher degree of reversibility of perfusion defect, higher incidence of positive exercise stress test and higher incidence of having severe stenosis(80{approx}99%) in coronary angiography than non-stunning group, but these were not statistically significant. In stunning group, all of 4 patients without perfusion defect had significant coronary artery stenosis and had received revascularization treatment. Patients with post-stress LV dysfunction had larger and more severe perfusion defect and severe coronary artery stenosis than

  7. Estimation of regional myocardial sympathetic neuronal function with I-123 metaiodobenzylguanidine (MIBG) myocardial images in patients with cardiomyopathy

    International Nuclear Information System (INIS)

    Tanaka, Takeshi; Aizawa, Tadanori; Kato, Kazuzo; Nakano, Hajime; Igarashi, Masaki; Ueno, Takashi; Hirosawa, Koshichiro; Kusakabe, Kiyoko.

    1989-01-01

    Myocardial SPECT images with I-123 metaiodobenzylguanidine (MIBG) were obtained in 10 patients with cardiomyopathy under stable state. For myocardial imaging, MIBG and Tl-201 (Tl) were simultaneously injected and collected. The ratio of MIBG to Tl (M/T ratio) in ROI was obtained with 50% cut off levels in order to eliminate background activity. The patients were divided into three major groups: (l) those who had the M/T ratio ranging from 0.8 to l.20 at rest and had marked defects in the infero-lateral region on delayed MIBG images, where pathophysiologically accelerated regional sympathetic neuronal function was suspected (n=5), (II) those who had increased M/T ratios (l.6 and l.7) in the basal septal wall (n=3), and (III) those who had decreased M/T ratios (0.7 and 0.75) in the apical septal wall, where depletion of myocardial norepinephrine was suspected (n=2). These findings indicate the potential of myocardial MIBG images to evaluate myocardial distribution of norepinephrine, i.e. myocardial sympathetic neuronal function. Certain shortcomings, such as an increased background due to dual isotopes and an increased pulmonary uptake of MIBG, require further study on quantitative methods. (Namekawa, K)

  8. Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block

    International Nuclear Information System (INIS)

    Falcao, Andrea; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares Junior, Jose; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Kalil Filho, Roberto; Meneghetti, Jose C.

    2015-01-01

    Objectives: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. Objective: we sought to investigate rubidium-82 ( 82 Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. Methods: thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress 82 Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal 82 Rb-positron emission tomography studies and without left bundle branch block (GII). Results: stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p>0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). Conclusion: the data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by 82 Rb-positron emission tomography imaging may be useful in identifying coronary artery disease in patients

  9. Relation of plasma lipoprotein(a) with myocardial viability and left ventricular performance in survivors of myocardial infarction

    International Nuclear Information System (INIS)

    Aksoy, M.; Goktekin, O.; Gursurer, M.; Emre, A.; Bilge, M.; Yesilcimen, K.; Ersek, B.; Kepekci, Y.; Akdemir, I.

    1999-01-01

    Previous studies have reported that high serum lipoprotein(a) levels may be responsible for total occlusion of the infarct-related artery via inhibition of intrinsic fibrinolysis during acute myocardial infarction. We evaluated whether this would result in a greater extent of myocardial necrosis and impaired left ventricular function in patients with high lipoprotein(a) levels. Sixty-eight patients with prior myocardial infarction, who were not receiving thrombolytic therapy underwent coronary angiography and stress-redistribution-reinjection Tl-201 scintigraphy. Antegrade TIMI flow in the infarct-related artery was lower (1.54±1.14 vs 2.15±1.05; p=0.03) and the collateral index was higher (1.3±1.0 vs 0.8±0.9; p=0.07) in patients with high lipoprotein(a) levels (>30 mg/dl) compared to those with low lipoprotein(a) levels (≤30 mg/dl). Regional wall motion score index was lower (0.8±0.8 vs 1.4±0.5; p=0.008) and global ejection fraction was higher (46±10% vs 40±11%; p=0.03) in patients with low lipoprotein(a) levels. On SPECT images, the number of nonviable defects was higher in patients with high lipoprotein(a) levels (4.0±2.5 vs 1.9±1.3; p=0.0002), whereas the number of viable defects was higher in those with low lipoprotein(a) levels (2.5±1.8 vs 1.5±1.3; p=0.02). We conclude, that high lipoprotein(a) levels may prolong the occlusion of infarct-related artery during acute myocardial infarction and lead to a greater extent of myocardial necrosis and impaired left ventricular function. (author)

  10. Comparison of bioavailability and antiplatelet action of ticagrelor in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: A prospective, observational, single-centre study.

    Directory of Open Access Journals (Sweden)

    Piotr Adamski

    Full Text Available Data from available studies suggest that the presence of ST-elevation myocardial infarction (STEMI may be associated with delayed and attenuated ticagrelor bioavailability and effect compared with non-ST-elevation myocardial infarction (NSTEMI.In a single-center, prospective, observational trial 73 patients with myocardial infarction (STEMI n = 49, NSTEMI n = 24 underwent a pharmacokinetic and pharmacodynamic assessment after a 180 mg ticagrelor loading dose (LD. Ticagrelor and its active metabolite (AR-C124910XX plasma concentrations were determined with liquid chromatography tandem mass spectrometry, and their antiplatelet effect was measured with the VASP assay and multiple electrode aggregometry.During the first six hours after ticagrelor LD, STEMI patients had 38% and 34% lower plasma concentration of ticagrelor and AR-C124910XX, respectively, than NSTEMI (ticagrelor AUC(0-6: 2491 [344-5587] vs. 3991 [1406-9284] ng*h/mL; p = 0.038; AR-C124910XX AUC(0-6: 473 [0-924] vs. 712 [346-1616] ng*h/mL; p = 0.027. STEMI patients also required more time to achieve maximal concentration of ticagrelor (tmax: 4.0 [3.0-12.0] vs. 2.5 [2.0-6.0] h; p = 0.012. Impaired bioavailability of ticagrelor and AR-C124910XX seen in STEMI subjects was associated with diminished platelet inhibition in this group, which was most pronounced during the initial hours of treatment.Plasma concentrations of ticagrelor and AR-C124910XX during the first hours after ticagrelor LD were one third lower in STEMI than in NSTEMI patients. This reduced and delayed ticagrelor bioavailability was associated with weaker antiplatelet effect in STEMI.ClinicalTrials.gov identifier: NCT02602444 (November 09, 2015.

  11. Serum Zn levels in dysphagic patients who underwent endoscopic gastrostomy for long term enteral nutrition

    OpenAIRE

    Adriana Santos, Carla; Fonseca, Jorge; Brito, José; Fernandes, Tânia; Gonçalves, Luísa; Sousa Guerreiro, António

    2014-01-01

    Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedur...

  12. Early Ventricular Tachycardia or Fibrillation in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention and Impact on Mortality and Stent Thrombosis (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial).

    Science.gov (United States)

    Kosmidou, Ioanna; Embacher, Monica; McAndrew, Thomas; Dizon, José M; Mehran, Roxana; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

    2017-11-15

    The prevalence and impact of early ventricular arrhythmias (ventricular tachycardia [VT]/ventricular fibrillation [VF]) occurring before mechanical revascularization for acute ST segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention are poorly understood. We sought to investigate the association between early VT/VF and long-term clinical outcomes using data from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial. Among 3,602 patients with STEMI, 108 patients (3.0%) had early VT/VF. Baseline clinical characteristics were similar in patients with versus without early VT/VF. Patients with early VT/VF had shorter symptom-to-balloon times and lower left ventricular ejection fraction and underwent more frequent thrombectomy compared with patients without early VT/VF. Adjusted 3-year rates of all-cause death (15.7% vs 6.5%; adjusted hazard ratio 2.62, 95% confidence interval 1.48 to 4.61, p stent thrombosis (13.7% vs 5.7%; adjusted hazard ratio 2.74, 95% confidence interval 1.52 to 4.93, p Stents in Acute Myocardial Infarction trial, VT/VF occurring before coronary angiography and revascularization in patients with STEMI was strongly associated with increased 3-year rates of death and stent thrombosis. Further investigation into the mechanisms underlying the increased risk of early stent thrombosis in patients with early VT/VF is required. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  14. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  15. Evaluation of initial uptake and redistribution on stress thallium-201 myocardial perfusion images in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Watanabe, Yoshihiko; Tonooka, Ichiroh; Kanaya, Tohru; Tsuiki, Kai; Yasui, Shouji.

    1984-01-01

    Stress thallium-201 myocardial perfusion imaging was performed on 29 patients with previous myocardial infarction and 29 patients with angina pectoris at exercise to evaluate thallium-201 kinetics in ischemic heart disease. Four views of thallium-201 images (right anterior oblique, antero-posterior, left anterior oblique and left lateral views) were obtained at 5 min after treadmill exercise with administration of 2 mCi of thallium-201 chloride (initial image) and at 3 hours later (delayed image). Myocardial images were divided into 6 segments (anterior, lateral, inferior, posterior, apical and septal segments) and initial uptake (IU) and redistribution index (RDI, the ratio of the maximal washout rate to a washout rate in each segment) were calculated in order to assess the relations of thallium-201 kinetics to wall motion abnormality and coronary artery stenosis. In myocardial infarction, IU and RDI were decreased in proportion to the severity of wall motion abnormality and coronary artery stenosis. Contrarily, in angina pectoris, IU was decreased but RDI was increased proportionally to the severity of coronary arterial stenosis. In conclusion, IU and redistribution of thallium-201 were affected essentially by both the grade of coronary arterial stenosis and the amount of residual viable heart muscle in patients with ischemic myocardial disease. (author)

  16. Influence of the prevalence of coronary artery disease in patients with normal myocardial perfusion SPECT imaging. Cooperative study in South America

    International Nuclear Information System (INIS)

    Balestrini, V.R.; Arja, V.J.; Sandrin, A.L.; Sala, J.P.; Joekes, S.; Bier, G.; Precoma, D.; Yamada, A.

    2002-01-01

    An important feature of myocardial perfusion imaging is the ability to predict prognosis and identify high- and low-risk patients for coronary events. According to Bayes' theorem, the significance of test's results, relates not only the sensitivity and specificity of a test but also the prevalence of disease in the population under study. Aim: evaluate the relationship between pretest likelihood (PTL) and coronary events (CE) in patients with normal myocardial perfusion SPECT imaging during a long period of time. Material and Methods: The population included 709 patients (411 men and 298 women, mean age 58 years old) who underwent stress/rest myocardial perfusion SPECT imaging at nuclear cardiology laboratories in Argentina and Brazil, with scintigraphic images interpreted as normal. Analyzed variables: clinical, EKG and stress test. Perfusion agents: Tc-99m-tetrofosmin: 36.5%, Tc99m-sestamibi 5.8% and Tl-201 57.7%. Mean follow up: 919 days. CE: soft (unstable angina and need for revascularization) and hard (AMI and cardiac death). Results: Stress test: exercise stress test 72.2%, dipyridamole 25%, adenosine 1.7%, dobutamine 1.1%. PTL [ 9' (M/F): 59/11% (p 78%] 31 vs. 50%. Conclusions: 1) There was a relationship between PTL, events rate and time to event. 2) We found a low hard events rate (0.85%). 3) The results in this group of patients with normal myocardial perfusion SPECT imaging may suggest a guarantee period of low risk of coronary events between 2-3 years. 4) In spite of there is a low event rate in total population with normal myocardial perfusion imaging, patients with highest prevalence of coronary artery disease have more statistical probabilities of coronary events and therefore they have to be watched closely

  17. Are patients with non-ST elevation myocardial infarction undertreated?

    Directory of Open Access Journals (Sweden)

    Gosselink AT Marcel

    2007-03-01

    Full Text Available Abstract Background The worse prognosis in patients without ST-elevation (non-STEMI as compared to ST-elevation myocardial infarction (STEMI, may be due to treatment differences. We aimed to evaluate the differences in characteristics, treatment and outcome in patients with non-STEMI versus STEMI in an unselected patient population. Methods Individual patient data from all patients in our hospital with a discharge diagnosis of MI between Jan 2001 and Jan 2002 were evaluated. Follow-up data were obtained until December 2004. Patients were categorized according to the presenting electrocardiogram into non-STEMI or STEMI. Results A total of 824 patients were discharged with a diagnosis of MI, 29% with non-STEMI and 71% with STEMI. Patients with non-STEMI were significantly older and had a higher cardiovascular risk profile. They underwent less frequently coronary angiography and revascularization and received less often clopidogrel and ACE-inhibitor on discharge. Long-term mortality was significantly higher in the non-STEMI patients as compared to STEMI patients, 20% vs. 12%, p = 0.006, respectively. However, multivariate analysis showed that age, diabetes, hypertension and no reperfusion therapy (but not non-STEMI presentation were independent and significant predictors of long-term mortality. Conclusion In an unselected cohort of patients discharged with MI, there were significant differences in baseline characteristics, and (invasive treatment between STEMI and non-STEMI. Long-term mortality was also different, but this was due to differences in baseline characteristics and treatment. More aggressive treatment may improve outcome in non-STEMI patients.

  18. Clinical evaluation of adenosine and exercise stress 99Tcm-MIBI myocardial imaging in detection of myocardial ischemia in patients with untypical chest pain

    International Nuclear Information System (INIS)

    Tian Yueqin; He Zuoxiang; Wang Qi; Hu Fenghuan; Yang Weixian; Qiao Shubing; Liu Xiujie

    2005-01-01

    Objective: To evaluate the value of adenosine and exercise stress 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial imaging for the diagnosis of myocardial ischemia in patients with untypical chest pain. Methods: Two groups included. Group 1: 67 cases of adenosine 99 Tc m -MIBI myocardial imaging. Group 2: 81 cases of exercise stress 99 Tc m -MIBI myocardial imaging. All of the patients had coronary angiography (CAG). The results of them were compared. Results: 23 out of 67 patients in group 1 had significant coronary stenosis after CAG, 16 showed reversible perfusion abnormalities in adenosine imaging. 41 of 44 patients with normal CAG showed normal adenosine imaging. The sensitivity, specificity and accuracy of adenosine imaging for coronary artery disease detection were 70%, 93% and 85%, respectively. Group 2: 22 out of 31 patients with significant coronany stenosis after CAG showed reversible perfusion abnormalities, 48 of 50 patients with normal CAG showed normal exercise imaging. The sensitivity, specificity and accuracy of exercise imaging for coronary artery disease detection were 71%, 96% and 86%, respectively. Conclusion: Reversible perfusion abnormalities found both in adenosine and exercise stress 99 Tc m -MIBI myocardial imaging were the key point for diagnosis of myocardial ischemia in patients with untypical chest pain. (authors)

  19. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Cerqueira, M.D.; Jacobson, A.F.

    1989-05-01

    Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using /sup 111/In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities.

  20. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis

    International Nuclear Information System (INIS)

    Cerqueira, M.D.; Jacobson, A.F.

    1989-01-01

    Myocardial abscess formation in patients with bacterial endocarditis in most clinical settings, especially in patients with prosthetic valves, is a primary indicator for surgical valve replacement. We report the detection of myocardial abscesses using 111 In leukocyte scintigraphy in three patients with prosthetic or native valve endocarditis and nondiagnostic echocardiograms. Leukocyte scintigraphy may allow identification of myocardial abscess formation earlier than other imaging modalities

  1. Myocardial perfusion assessed by contrast echocardiography and single photon emission computed tomography in the evaluation of patients with acute chest pain and normal electrocardiogram

    International Nuclear Information System (INIS)

    Soares, J. Jr.; Ferreira, S.M.A.; Matias, W. Jr.; Giorgi, M.C.P.; Izaki, M.; Luz, P.L.; Ramires, J.A.F.; Meneghetti, J.C.

    2002-01-01

    Aim : Evaluation of diagnostic accuracy of myocardial contrast echocardiography (MCE) in comparison with single-photon emission computed tomography (SPECT) for the detection of myocardial ischemia in patients with acute chest pain. Material and Methods : Eighteen patients (pts) with chest pain lasting ≥30 minutes, occurring within 6 hours of emergency room presentation and a normal or no diagnostic electrocardiogram were studied. Pts underwent rest MCE and SPECT. For both exams myocardial perfusion was assessed in the same 7 segments (apical, anterior, inferior, anteroseptal, inferoseptal, lateral and posterior) of left ventricle. A total of 126 segments were analyzed. Images were classified as positive for ischemia if they had a perfusion defect. Coronary angiography was performed if MCE or SPECT images were classified as positive for ischemia or by clinical indication. Otherwise the patients underwent stress SPECT. Significant coronary artery disease (CAD) was defined as ≥70% stenosis in a major coronary artery or its branches. Final diagnosis of an acute coronary event (ACE) was established in the presence of positive findings in MCE or SPECT in addition to significant CAD in the corresponding territory. Kappa statistics were calculated to evaluate the concordance between MCE and SPECT. κ values of ≤0.4, >0.4 and >0.7 indicate fair, good and excellent agreement, respectively. Results: Thirteen out of 18 pts underwent coronary angiography (seven pts had positive findings on SPECT, 2 on MCE, 2 on both exams and 1 had clinical indication). Significant CAD was detected on six. Five pts underwent stress SPECT and no perfusion defect was detected. Therefore, six pts (33.3%) had an ACE and 12 (66.6%) had not. There were no statistical differences between groups according to age, gender, duration of pain, free pain interval, presence of risk factors and antecedents. Concordance between MCE and SPECT for evaluation of perfusion defects showed a ? coefficient of 0

  2. Acute myocardial infarction after heart irradiation in young patients with Hodgkin's disease

    International Nuclear Information System (INIS)

    Joensuu, H.

    1989-01-01

    Forty-seven patients younger than 40 years at the time of the diagnosis, and irradiated to the mediastinum for Hodgkin's disease at Turku University Central Hospital from 1977 to 1982, were regularly followed for 56 to 127 months after therapy. Two patients developed an acute myocardial infarction ten and 50 months after cardiac irradiation at the age of only 28 and 24 years, respectively. None of the patients died from lymphoma within five years from the diagnosis, but one of the infarctions was eventually fatal. Since acute myocardial infarction is rare in this age group, the result suggests strongly that prior cardiac irradiation is a risk factor for acute myocardial infarction. The possibility of radiation-induced myocardial infarction should be taken into account both in treatment planning and follow-up of patients with Hodgkin's disease

  3. Follow-up of regional myocardial T2 relaxation times in patients with myocardial infarction evaluated with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Krauss, X.H.; Wall, E. van der; Laarse, A. van der; Dijkman, P.R.M. van; Bruschke, A.V.G.; Doornbos, J.; Roos, A. de; Voorthuisen, A.E. van

    1990-01-01

    Multi-echo spin-echo cardiac magnetic resonance imaging studies (echo times 30, 60, 90 and 120 ms) were performed in 19 patients with a 7-14-day (mean 10) old myocardial infarction and were repeated in 13 patients 4-7 months (mean 6) later. Also, 10 normal subjects were studied with magnetic resonance imaging. T2 relaxation times of certain left ventricular segments were calculated from the signal intensities at echo times of 30 and 90 ms. Compared to normal individuals, the mean T2 values on the early magnetic resonance images of the patients with inferior infarction showed significantly prolonged T2 times in the inferiorly localized segments, while on the follow-up magnetic resonance images the T2 times had almost returned to the normal range. Also the patients with anterior infarction showed significantly prolonged T2 times in the anteriorly localized segments on the early nuclear magnetic resonance images, but the T2 times remained prolonged at the follow-up magnetic resonance images. For every patient a myocardial damage score was determined, which was defined as the sum of the segmental T2 values in the patients minus the upper limit of normal T2 values obtained from the normal volunteers (= mean normal+2SD). The damage score on both the early and late magnetic resonance imaging study correlated well with the infarction size determined by myocardial enzyme release. Only the patients with an inferior infarction showed a significant decrease in damage score at follow-up magnetic resonance imaging. It is concluded that the regional T2 relaxation times are increased in infarcted myocardial regions and may remain prolonged for at least up to 7 months after the acute event, particularly in patients with an anterior infarction. These findings demonstrate the clinical potential of T2-weighted magnetic resonance imaging studies for detecting myocardial infarction, and estimating infarct size for an extended period after acute myocardial infarction. (author). 29 refs

  4. Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty

    International Nuclear Information System (INIS)

    Miller, H.I.; Almagor, Y.; Keren, G.

    1987-01-01

    Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 +/- 289 mU/ml in group I, and 1,614 +/- 709 mU/ml in group II (p less than 0.05). The mean initial left ventricular ejection fraction was 47 +/- 11% in group I and 37 +/- 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 +/- 9% in group I (p less than 0.05) and to 40 +/- 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect

  5. Cardiac sympathetic neuronal damage precedes myocardial fibrosis in patients with Anderson-Fabry disease

    International Nuclear Information System (INIS)

    Imbriaco, Massimo; Piscopo, Valentina; Ponsiglione, Andrea; Nappi, Carmela; Puglia, Marta; Dell'Aversana, Serena; Spinelli, Letizia; Cuocolo, Alberto; Pellegrino, Teresa; Petretta, Mario; Riccio, Eleonora; Pisani, Antonio

    2017-01-01

    Cardiac sympathetic denervation may be detectable in patients with Anderson-Fabry disease (AFD), suggesting its usefulness for early detection of the disease. However, the relationship between sympathetic neuronal damage measured by 123 I-metaiodobenzylguanidine (MIBG) imaging with myocardial fibrosis on cardiac magnetic resonance (CMR) is still unclear. Cardiac sympathetic innervation was assessed by 123 I-MIBG single-photon emission computed tomography (SPECT) in 25 patients with genetically proved AFD. Within one month from MIBG imaging, all patients underwent contrast-enhanced CMR. MIBG defect size and fibrosis size on CMR were measured for the left ventricle (LV) and expressed as %LV. Patients were divided into three groups according to MIBG and CMR findings: (1) matched normal, without MIBG defects and without fibrosis on CMR (n = 10); (2) unmatched, with MIBG defect but without fibrosis (n = 5); and (3) matched abnormal, with MIBG defect and fibrosis (n = 10). The three groups did not differ with respect to age, gender, α-galactosidase, proteinuria, glomerular filtration rate, and troponin I, while New York Heart Association class (p = 0.008), LV hypertrophy (p = 0.05), and enzyme replacement therapy (p = 0.02) were different among groups. Although in patients with matched abnormal findings, there was a significant correlation between MIBG defect size and area of fibrosis at CMR (r 2 = 0.98, p < 0.001), MIBG defect size was larger than fibrosis size (26 ± 23 vs. 18 ± 13%LV, p = 0.02). Sympathetic neuronal damage is frequent in AFD patients, and it may precede myocardial damage, such as fibrosis. Thus, 123 I-MIBG imaging can be considered a challenging technique for early detection of cardiac involvement in AFD. (orig.)

  6. Myocardial ischemia in severe aortic regurgitation despite angiographically normal coronary arteries

    International Nuclear Information System (INIS)

    Aksoy, S.; Cam, N.; Guney, M.R.; Gurkan, U.; Oz, D.; Poyraz, E.; Eksik, A.; Agirbasli, M.

    2012-01-01

    Patients with severe aortic regurgitation frequently present with angina pectoris. The exact pathophysiology for angina in aortic regurgitation is not clear. Left ventricular hypertrophy and myocardial blood supply-demand mismatch have been the suggested mechanisms to explain ischemia. However, no conclusive clinical study exists to define the incidence of ischemia in patients with severe aortic regurgitation and normal coronary arteries. We, therefore, investigated the frequency of myocardial ischemia in relation to left ventricular hypertrophy or dilatation in patients with severe aortic regurgitation and normal coronary arteries. We reviewed the medical records of all patients (n=311) with aortic valve replacement due to aortic regurgitation between 2007 and 2010. We selected subjects with normal coronary arteries (n=182) for the study purpose, and we identified 35 patients who underwent myocardial perfusion scintigraphy prior to the coronary angiography (19 female and 16 male subjects; age 45.0±8.9 years). Left ventricular hypertrophy and dilatation were detected in 9 (26%) and 5 (14%) patients, respectively. Myocardial perfusion scintigraphy showed evidence of ischemia in 10 (29%) patients with normal coronary arteries. The presence of ischemia did not relate to the presence of left ventricular hypertrophy and/or dilatation. As a potential mechanism, aortic regurgitation causes backflow of blood from the aorta into the left ventricle, hence disturbs coronary flow dynamics. In conclusion, myocardial ischemia is common (nearly one-third) among patients with severe aortic regurgitation even in the absence of coronary obstruction, left ventricular hypertrophy and/or dilatation. (author)

  7. Quantification of myocardial area at risk in the absence of collateral flow: the validation of angiographic scores by myocardial perfusion single-photon emission computed tomography.

    Science.gov (United States)

    Rodríguez-Palomares, José F; Alonso, Albert; Martí, Gerard; Aguadé-Bruix, Santiago; González-Alujas, M T; Romero-Farina, Guillermo; Candell-Riera, Jaume; García del Blanco, Bruno; Evangelista, Artur; García-Dorado, David

    2013-02-01

    Our study aimed to compare the area at risk (AAR) determined by single-photon emission computed tomography (SPECT) with the Bypass Angioplasty Revascularization Investigation (BARI) and modified Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) angiographic scores in the setting of patients undergoing coronary angioplasty for either unstable angina or an STEMI. Radionuclide myocardial perfusion imaging prior to reperfusion has classically been the most widely practised technique for assessing the AAR and has been successfully used to compare the efficacy of various reperfusion strategies in patients with an ST-segment elevation myocardial infarction (STEMI). The BARI and modified APPROACH scores are angiographic methods widely used to provide a rapid estimation of the AAR; however, they have not been directly validated with myocardial perfusion single-photon emission computed tomography (SPECT). Fifty-five patients with no previous myocardial infarction who underwent coronary angioplasty for single-vessel disease (unstable angina: n = 25 or an STEMI: n = 30) with no evidence of collaterals (Rentrop Collateral Score collateral flow, BARI and APPROACH scores constitute valid methods for AAR estimation in current clinical practice, with more accurate results when used for the LAD territory; both are useful not only in STEMI patients but also in patients with unstable angina.

  8. Extracorporeal shockwave myocardial therapy is efficacious in improving symptoms in patients with refractory angina pectoris--a multicenter study.

    Science.gov (United States)

    Prasad, Megha; Wan Ahmad, Wan Azman; Sukmawan, Renan; Magsombol, Edward-Bengie L; Cassar, Andrew; Vinshtok, Yuri; Ismail, Muhammad Dzafir; Mahmood Zuhdi, Ahmad Syadi; Locnen, Sue Ann; Jimenez, Rodney; Callleja, Homobono; Lerman, Amir

    2015-05-01

    Medically refractory angina remains a significant health concern despite major advances in revascularization techniques and emerging medical therapies. We aimed to determine the safety and efficacy of extracorporeal shockwave myocardial therapy (ESMT) in managing angina pectoris. A single-arm multicenter prospective study was designed aiming to determine the safety and efficacy of ESMT. Patients of functional Canadian Cardiovascular Society class II-IV, despite stable and optimal medical management, with documented myocardial segments with reversible ischemia and/or hibernation on the basis of echocardiography/single-photon emission computerized tomography (SPECT) were enrolled from 2010 to 2012. A total of 111 patients were enrolled, 33 from Indonesia, 21 from Malaysia, and 57 from Philippines. Patients underwent nine cycles of ESMT over 9 weeks. Patients were followed up for 3-6 months after ESMT treatment. During follow-up, patients were subjected to clinical evaluation, the Seattle Angina Questionnaire, assessment of nitrate intake, the 6-min walk test, echocardiography, and SPECT. The mean age of the population was 62.9±10.9 years. The summed difference score on pharmacologically induced stress SPECT improved from 9.53±17.87 at baseline to 7.77±11.83 at follow-up (P=0.0086). Improvement in the total Seattle Angina Questionnaire score was seen in 83% of patients (Pangina.

  9. Five-year evolution of reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction in France.

    Science.gov (United States)

    El Khoury, Carlos; Bochaton, Thomas; Flocard, Elodie; Serre, Patrice; Tomasevic, Danka; Mewton, Nathan; Bonnefoy-Cudraz, Eric

    2017-10-01

    To assess 5-year evolutions in reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction. Using data from the French RESCUe network, we studied patients with ST-segment elevation myocardial infarction treated in mobile intensive care units between 2009 and 2013. Among 2418 patients (median age 62 years; 78.5% male), 2119 (87.6%) underwent primary percutaneous coronary intervention and 299 (12.4%) pre-hospital thrombolysis (94.0% of whom went on to undergo percutaneous coronary intervention). Use of primary percutaneous coronary intervention increased from 78.4% in 2009 to 95.9% in 2013 ( P trend 90 minutes delay group (83.0% in 2009 to 97.7% in 2013; P trend <0.001 versus 34.1% in 2009 to 79.2% in 2013; P trend <0.001). In-hospital (4-6%) and 30-day (6-8%) mortalities remained stable from 2009 to 2013. In the RESCUe network, the use of primary percutaneous coronary intervention increased from 2009 to 2013, in line with guidelines, but there was no evolution in early mortality.

  10. Myocardial ischemia and angina pectoris. The clinical problem in patients

    Energy Technology Data Exchange (ETDEWEB)

    Selwyn, A.P.; Fox, K.M.; Jonathan, A.; Lavender, P.; Watson, I.

    1981-02-01

    Ambulatory monitoring of ST segment changes was performed in 60 patients presenting with angina, positive ECG stress tests and coronary artery disease, 85% of ischemic ECG events were asymptomatic, 37% occurred with no increase in heart rate and 15% of episodes either lasted 20 minutes or more or fluctuated in severity. A controlled pilot study in ten patients showed depression. Radionuclide studies in 50 patients with angina and coronary artery disease have shown that stress (i.e., atrial pacing) produced different patterns of disturbed regional myocardial perfusion related to the patient's exercise capacity and eventually leading to a decrease in regional myocardial perfusion during the ischemic episode. ST segment depression appeared only after the decrease in regional myocardial perfusion. These findings combined with past research suggest that patients with angina and coronary artery disease can suffer frequent asymptomatic disturbances of the regional myocardial perfusion. The frequency of these episodes and the time course for the recovery of the metabolic consequences mean that segments of ventricular myocardium may be constantly abnormal. The relative importance of changes in coronary tone and malfunction of platelets in the diseased coronary tree needs to be examined in clinical research. Pilot studies of antiplatelet agents have shown a significant beneficial effect on episodes of ischemia occurring at night and those occurring without any increase in heart rate. The techniques and observations in these patients with coronary artery disease all suggest that acute transient regional myocardial ischemia is caused by a variety of mechanisms. Further research using objective methods is required to discover the causes of ischemia and to rationalize treatment.

  11. Diagnosis of accessory conduction pathway using ECG-gated emission CT analysis. Studies in patients with WPW syndrome who underwent surgery

    Energy Technology Data Exchange (ETDEWEB)

    Misaki, Takuro; Mukai, Keiichi; Tsubota, Makoto; Iwa, Takashi; Nakajima, Ken-ichi; Hisada, Kin-ichi

    1987-09-01

    Pinpointing the location of accessory conduction pathway (ACP) is of great importance in the surgical treatment for Wolff-Parkinson-White (WPW) syndrome. For this purpose, this study explored the usefulness of ECG-gated emission computed tomography (Gated-ECT) in 30 patients who preoperatively underwent Gated-ECT. The site of earliest contraction at level of atrioventicular valves, obtained on tomographic phase analysis, was compared with the site of earliest activation, obtained on epicardial mapping during surgery. The concordance rate of the two methods was 94 % (28/30). Among them, one patient was found to have the association of corrected transposition of great arteries on Gated-ECT. Gated-ECT was, however, of limited value in differentiating right posterior ACP from right postseptal ACP. The discordance between the sites of earliest contraction and activation, which was observed in the two others, was likely due to decreased wall motion resulting from myocardial disturbance. Gated-ECT may have a diagnostic potential for the location of ACP, especially in view of providing images that corresponded to the surgical anatomy. (Namekawa, K.).

  12. Coronary collateral vessels in patients with previous myocardial infarction

    International Nuclear Information System (INIS)

    Nakatsuka, M.; Matsuda, Y.; Ozaki, M.

    1987-01-01

    To assess the degree of collateral vessels after myocardial infarction, coronary angiograms, left ventriculograms, and exercise thallium-201 myocardial scintigrams of 36 patients with previous myocardial infarction were reviewed. All 36 patients had total occlusion of infarct-related coronary artery and no more than 70% stenosis in other coronary arteries. In 19 of 36 patients with transient reduction of thallium-201 uptake in the infarcted area during exercise (Group A), good collaterals were observed in 10 patients, intermediate collaterals in 7 patients, and poor collaterals in 2 patients. In 17 of 36 patients without transient reduction of thallium-201 uptake in the infarcted area during exercise (Group B), good collaterals were seen in 2 patients, intermediate collaterals in 7 patients, and poor collaterals in 8 patients (p less than 0.025). Left ventricular contractions in the infarcted area were normal or hypokinetic in 10 patients and akinetic or dyskinetic in 9 patients in Group A. In Group B, 1 patient had hypokinetic contraction and 16 patients had akinetic or dyskinetic contraction (p less than 0.005). Thus, patients with transient reduction of thallium-201 uptake in the infarcted area during exercise had well developed collaterals and preserved left ventricular contraction, compared to those in patients without transient reduction of thallium-201 uptake in the infarcted area during exercise. These results suggest that the presence of viable myocardium in the infarcted area might be related to the degree of collateral vessels

  13. Two-dimensional speckle tracking echocardiography prognostic parameters in patients after acute myocardial infarction.

    Science.gov (United States)

    Haberka, Maciej; Liszka, Jerzy; Kozyra, Andrzej; Finik, Maciej; Gąsior, Zbigniew

    2015-03-01

    The aim of the study was to evaluate the left ventricle (LV) function with speckle tracking echocardiography (STE) and to assess its relation to prognosis in patients after acute myocardial infarction (AMI). Sixty-three patients (F/M = 16/47 pts; 62.33 ± 11.85 years old) with AMI (NSTEMI/STEMI 24/39 pts) and successful percutaneous coronary intervention (PCI) with stent implantation (thrombolysis in myocardial infarction; TIMI 3 flow) were enrolled in this study. All patients underwent baseline two-dimensional conventional echocardiography and STE 3 days (baseline) and 30 days after PCI. All patients were followed up for cardiovascular clinical endpoints, major adverse cardiovascular endpoint (MACE), and functional status (Canadian Cardiovascular Society and New York Heart Association). During the follow-up (31.9 ± 5.1 months), there were 3 cardiovascular deaths, 15 patients had AMI, 2 patients had cerebral infarction, 24 patients reached the MACE. Baseline LV torsion (P = 0.035), but none of the other strain parameters were associated with the time to first unplanned cardiovascular hospitalization. Univariate analysis showed that baseline longitudinal two-chamber and four-chamber strain (sLa2 0 and sLa4 0) and the same parameters obtained 30 days after the AMI together with transverse four-chamber strain (sLa2 30, sLa4 30, and sTa4 30) were significantly associated with combined endpoint (MACE). The strongest association in the univariate analysis was found for the baseline sLa2. However, in multivariable analysis only a left ventricular remodeling (LVR - 27% pts) was significantly associated with MACE and strain parameters were not associated with the combined endpoint. The assessment of LV function with STE may improve cardiovascular risk prediction in postmyocardial infarction patients. © 2014, Wiley Periodicals, Inc.

  14. Myocardial ultrasonic tissue characterization in patients with thyroid dysfunction

    Directory of Open Access Journals (Sweden)

    Schmidt André

    2010-04-01

    Full Text Available Abstract Background Structural myocardial abnormalities have been extensively documented in hypothyroidism. Experimental studies in animal models have also shown involvement of thyroid hormones in gene expression of myocardial collagen. This study was planned to investigate the ability of ultrasonic tissue characterization, as evaluated by integrated backscatter (IBS, to early identify myocardial involvement in thyroid dysfunction. Patients and Methods We studied 15 patients with hyperthyroidism (HYPER, 8 patients with hypothyroidism (HYPO, 14 patients with subclinical hypothyroidism (SCH and 19 normal (N subjects, who had normal LV systolic function. After treatment, 10 HYPER, 6 HYPO, and 8 SCH patients were reevaluated. IBS images were obtained and analyzed in parasternal short axis (papillary muscle level view, at left ventricular (LV posterior wall. The following IBS variables were analyzed: 1 the corrected coefficient (CC of IBS, obtained by dividing IBS intensity by IBS intensity measured in a rubber phantom, using the same equipment adjustments, at the same depth; 2 cardiac cyclic variation (CV of IBS - peak-to-peak difference between maximal and minimal values of IBS during cardiac cycle; 3 cardiac cyclic variation index (CVI of IBS - percentual relationship between the cyclic variation (CV and the mean value of IBS intensity. Results CC of IBS was significantly larger (p Conclusions CC of IBS was able to differentiate cardiac involvement in patients with overt HYPO and HYPER who had normal LV systolic function. These early myocardial structural abnormalities were partially reversed by drug therapy in HYPER group. On the other hand, although mean IBS intensity tended to be slightly larger in patients with SCH as compared to N, this difference was not statistical significant.

  15. Myocardial blood flow assessment with {sup 82}rubidium-PET imaging in patients with left bundle branch block

    Energy Technology Data Exchange (ETDEWEB)

    Falcao, Andrea; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares Junior, Jose; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Kalil Filho, Roberto; Meneghetti, Jose C., E-mail: andrea.falcao@incor.usp.br [Universidade de Sao Paulo (InCor/USP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Instituto do Coracao

    2015-11-15

    Objectives: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. Objective: we sought to investigate rubidium-82 ({sup 82}Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. Methods: thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress {sup 82}Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal {sup 82}Rb-positron emission tomography studies and without left bundle branch block (GII). Results: stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p>0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). Conclusion: the data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by {sup 82}Rb-positron emission tomography imaging may be useful in identifying coronary artery

  16. Increased incidence and clinical correlation of persistently abnormal technetium pyrophosphate myocardial scintigrams following acute myocardial infarction in patients with diabetes mellitus

    International Nuclear Information System (INIS)

    Nicod, P.; Lewis, S.E.; Corbett, J.C.; Buja, L.M.; Henderson, G.; Raskin, P.; Rude, R.E.; Willerson, J.T.

    1982-01-01

    Persistently abnormal /sup 99m/Tc stannous pyrophosphate myocardial scintigrams (PPi+) appear to be associated with a relatively poor prognosis after acute myocardial infarction (AMI). To assess the incidence and implications of PPi+, we performed a retrospective analysis in 29 patients with and 25 patients without diabetes mellitus who had abnormal myocardial scintigrams within 4 days of AMI and who had follow-up scintigrams at least 3 months after hospital discharge. There were no significant differences between patients with and without diabetes as regards age, incidence of transmural or nontransmural AMI, or degree of left ventricular dysfunction after AMI. Persistently abnormal PPi+ occurred more commonly in patients with diabetes than in nondiabetic patients (18 of 29, 62%, compared to 3 of 25, 12%; p less than 0.001). Patients with chronic PPi+ had more frequent cardiac complications following hospital discharge (p less than 0.005) including death, recurrent AMI, unstable angina, and intractable congestive heart failure. Postmortem analysis in two patients with diabetes and chronic PPi+ revealed marked myocytolysis. Thus, patients with diabetes mellitus have an increased incidence of post-AMI persistently abnormal technetium (PPi+) scintigrams and relatively poor prognosis following myocardial infarction

  17. Oxygen uptake kinetics during and after exercise are useful markers of coronary artery disease in patients with exercise electrocardiography suggesting myocardial ischemia

    International Nuclear Information System (INIS)

    Tajima, Akihiko; Ohkoshi, Nobuyuki; Kawara, Tokuhiro; Aizawa, Tadanori; Itoh, Haruki; Maeda, Tomoko; Osada, Naohiko; Omiya, Kazuto; Wasserman, K.

    2009-01-01

    The aim of the current study was to determine if the slowed exercise oxygen uptake (VO 2 ) kinetics, which is developed by myocardial ischemia, would be accompanied by delayed recovery VO 2 kinetics in patients with coronary artery disease (CAD). Thirty-seven patients with significant ST depression during treadmill exercise underwent cardiopulmonary exercise testing with cycle ergometer. Measurements performed are the ratios of change in increase in oxygen (O 2 ) uptake relative to increase in work rate (ΔVO 2 /ΔWR) across anaerobic threshold (AT) and 1 mm ST depression point (ST-dep), the time constants of VO 2 during recovery (T 1/2 VO 2 ), stress radio-isotope scintigraphy and coronary angiography. Patients were divided into CAD positive (CAD+) and CAD negative (CAD-) groups, based on coronary angiography. In CAD+, ΔVO 2 /ΔWR decreased above AT and ST-dep, in contrast to CAD- patients. The T 1/2 VO 2 in CAD+ (103.1±13.0 s) was greater than that of CAD- (76.5±8.7 s) and showed negative correlations to the ratios of ΔVO 2 /ΔWR across AT and ST-dep. These parameters improved in the patients who underwent coronary bypass surgery. Exercise and recovery VO 2 kinetics were slowed when myocardial ischemia was provoked by exercise. Measurement of exercise and recovery VO 2 kinetics improve the accuracy of the exercise electrocardiogram diagnosis of CAD. (author)

  18. Comparison between young males and females with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ricardo Augusto Slaibi Conti

    2002-11-01

    Full Text Available OBJECTIVE: To assess the differences between young males and females after acute myocardial infarction. METHODS: We retrospectively studied 236 patients (54 females and 182 males after acute myocardial infarction and during hospital stay assessed the following parameters: risk factors; the treatment used; the pattern of coronary artery obstruction; left ventricular ejection fraction; complications; and, using a logistic regression model, the factors related to the occurrence of reinfarction and death. RESULTS: No significant difference was observed between the sexes in risk factors, pattern of coronary artery obstruction, and left ventricular function. The time interval between symptom onset and treatment was longer in females (p=0.03, who underwent thrombolysis (p=0.01 and angioplasty (p=0.03 less frequently than males did, but not myocardial revascularization. Female sex (OR = 5.98 and diabetes (OR = 14.52 were independent factors related to the occurrence of reinfarction and death. CONCLUSION: Young males and females after acute myocardial infarction did not differ in coronary risk factors, and clinical and hemodynamic characteristics. Females had their treatment started later, and they underwent chemical thrombolysis and angioplasty less frequently than males did. Female sex and diabetes were related to the occurrence of reinfarction and death.

  19. Prognostic significance of myocardial imaging with iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid in patients with angina pectoris

    International Nuclear Information System (INIS)

    Hatano, Tsuguhisa; Chikamori, Taishiro; Kamada, Tatsuya; Morishima, Takayuki; Hida, Satoshi; Yanagisawa, Hidefumi; Iino, Hitoshi; Yamashina, Akira

    2001-01-01

    To assess the clinical significance of iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT), the predictive value of BMIPP imaging in patients with angina pectoris was evaluated. One hundred seventy-four patients who underwent BMIPP imaging in our institution were aged 61.8±11 years. One hundred thirty-five patients had stable angina and 39 had unstable angina at the time of examination. Patients with previous myocardial infarction or myocardial disorders were excluded. Early and delayed images were acquired in BMIPP SPECT, and the images were analyzed visually. Cardiac events were classified into hard and soft events: the former consisted of cardiac death and nonfatal myocardial infarction, and the latter included coronary revascularization and heart failure. The findings of BMIPP imaging were normal in 82 patients and abnormal in 92. During follow-up of 15.5±9.5 months, hard events were observed in 4 patients and soft events in 53. In patients with normal BMIPP imaging, soft events were observed in nine patients, but no hard event was encountered. Furthermore, in patients with both normal BMIPP and stress thallium imagings, no cardiac event was observed during 2 years. In contrast, 4 hard events and 44 soft events occurred in patients with abnormal BMIPP imaging. Patients with abnormal BMIPP imaging had a higher incidence of soft events than those with normal BMIPP imaging, regardless of the type of angina (16/62 vs 3/73, p<0.0005 for stable angina; 28/30 vs 6/9, p<0.0001 for unstable angina). The finding of BMIPP imaging correlates well with the mid-term prognosis of patients with angina pectoris. Since BMIPP SPECT is performed without stress to the patient, this imaging modality is important in evaluating patients with stable or unstable angina. (author)

  20. Relationship between lung-to-heart uptake ratio of technetium-99m-tetrofosmin during exercise myocardial single photon emission computed tomographic imaging and the number of diseased coronary arteries in patients with effort angina pectoris without myocardial infarction

    International Nuclear Information System (INIS)

    Okajima, Toshiya; Ueshima, Kenji; Nishiyama, Osamu; Ogawa, Muneyoshi; Ohuchi, Mami; Saitoh, Masahiko; Hiramori, Katsuhiko

    2004-01-01

    Increased lung uptake of thallium-201 in exercise myocardial perfusion imaging is a reliable marker of multivessel disease in patients with ischemic heart disease. This study investigated whether the lung-to-heart uptake ratio with technetium-99m ( 99m Tc)-tetrofosmin also provides valuable information to detect patients with multivessel disease. Fifty-three consecutive patients (35 men, 18 women, mean age 66±11 years; single-vessel disease: 29, double-vessel disease: 16, triple-vessel disease: 8) with stable effort angina pectoris without prior myocardial infarction and 17 control subjects (12 men, 5 women, mean age 62±9 years) underwent exercise myocardial perfusion imaging with 99m Tc-tetrofosmin and coronary angiography in January 2000 to December 2002. The lung-to-heart uptake ratio was calculated on an anterior projection before reconstruction of the exercise single photon emission computed tomographic images. The mean lung-to-heart uptake ratio was 0.34±0.04, 0.38±0.07, 0.41±0.05, and 0.46±0.09, in patients with normal coronary, single-vessel disease, double-vessel disease, and triple-vessel disease, respectively. Significantly higher lung-to-heart uptake ratio was associated with more diseased vessels (p 99m Tc-tetrofosmin can provide clinically useful information to detect multivessel disease in patients with ischemic heart disease. (author)

  1. Effect of perindopril on the myocardial energy consumption in patients with heart failure after myocardial infarction

    Directory of Open Access Journals (Sweden)

    Da-Peng Li

    2017-07-01

    Full Text Available Objective: To explore the clinical efficacy of perinodopril in the treatment of heart failure in patients after myocardial infarction and effect on the myocardial energy consumption. Methods: A total of 87 patients with heart failure after myocardial infarction who were admitted in our hospital from August, 2014 to October, 2015 were included in the study and divided into the routine dose group (n=43, perinodopril 4 mg/d and high dose group (n=44, perinodopril 8 mg/d according to the long-term oral dose. All the patients were given perinodopril, continuously for 6 months. The changes of blood pressure and serum biochemical indicators before and after treatment in the two groups were compared. The changes of cardiac function indicators and myocardial energy consumption indicators before and after treatment in the two groups were compared. 6MWT 6 months and 1 year after treatment in the two groups was calculated. Results: The plasma BNP and H-FABP levels, LVEDD, LVESD, MEE, and cESS after treatment in the two groups were significantly reduced when compared with before treatment, and those in the high dose group were significantly lower than those in the low dose group. LVEF and FS after treatment in the two groups were significantly increased, and those in the high dose group were significantly greater than those in the routine dose group. The seurm potassium level after treatment in the high dose group was significantly elevated when compared with before treatment, but was not significantly different from that in the routine dose group. SBP, DBP, and Scr levels after treatment in the two groups were not significantly changed. 6MWT 6 months and 1 year after treatment in the high dose group was significantly greater than that in the routine dose group. Conclusions: Perinodopril in a high dose can significantly reduce the plasma BNP and H-FABP levels in patients with heart failure after myocardial infarction, inhibit the ventricular remodeling

  2. Multidetector row computed tomography noninvasively assesses coronary reperfusion after thrombolytic therapy in patients with ST elevation myocardial infarction

    International Nuclear Information System (INIS)

    Shin, Dong-Il; Won, Yoo-Dong; Chang, Kiyuk

    2006-01-01

    The study objective was to assess the efficacy of 16-slice multidetector row computed tomography (MDCT) in estimating residual stenosis and successful reperfusion after thrombolysis in patients with ST-elevation myocardial infarction (STEMI). A total of 31 patients with STEMI underwent MDCT scanning within 6 h (mean 4.6±1.1) after thrombolysis and the results for detection of significant residual stenosis and distal flow of the infarct-related artery were compared with those from conventional coronary angiography (CCAG) performed within 24 h (mean 12.1±5.6) after the MDCT scan. Successful reperfusion was defined as Thrombolysis In Myocardial Infarction flow 2 or 3 on CCAG and full contrast enhancement of the distal artery landmarks on MDCT. A final analysis was performed using 24 patients (312 segments). MDCT had a positive predictive value of 73.3% and a negative predictive value of 95.1% for detecting significant residual stenosis. It accurately estimated 17 of 18 patients (94.4%) with successful reperfusion and 5 of 6 (83.3%) with failed reperfusion on the basis of comparison with CCAG. MDCT demonstrated high accuracy not only for the detecting residual stenosis, but also for assessing successful reperfusion after thrombolytic therapy in patients with STEMI. (author)

  3. Nuclear cardiological investigations in patients classified as physically disabled following myocardial infarction

    International Nuclear Information System (INIS)

    Mester, Janos; Zolnay, Imre; Csernay, Laszlo

    1988-01-01

    110 patients classified as physically disabled as a consequence of myocardial infarction were reinvestigated by means of nuclear cardiological methods. Resting 201 Tl perfusion scintigraphy showed a normal distribution of radioactivity, while radionuclide ventriculography revealed a normal left ventricular ejection fraction and a normokinetic left ventricle in 20 patients. The investigation of a further 19 patients demonstrated only minimal pathological changes. The results in 34 patients revealed severe myocardial damage, and in a further 19 cases the development of left ventricular aneurysm. The results clearly show the value of 201 Tl scintigraphy and radionuclide ventriculography in assessments of the degree of physical disability after myocardial infarction. (author) 15 refs.; 3 tabs

  4. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B

    2011-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred...... and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method...

  5. Myocardial area at risk after ST-elevation myocardial infarction measured with the late gadolinium enhancement after scar remodeling and T2-weighted cardiac magnetic resonance imaging

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Mathiasen, Anders B

    2012-01-01

    To evaluate the myocardial area at risk (AAR) measured by the endocardial surface area (ESA) method on late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) when applied after scar remodeling (3 months after index infarction) compared to T2-weighted CMR imaging. One hundred...... and sixty nine patients with ST-elevation myocardial infarction, treated with primary percutaneous coronary intervention, underwent one CMR within 1 week after index treatment to determine the AAR with T2-weighted imaging and a second scan 3 months after to measure AAR with the ESA method...

  6. Comparision the value of detecting myocardial viability between low dose dobutamine stress MRI and echocardiography

    International Nuclear Information System (INIS)

    He Yi; Zhang Zhaoqi; Yu Wei; Miao Cuilian; Zhao Yike; Yan Zixu

    2006-01-01

    Objective: To Compare the diagnostic value between low dose dobutamine stress transthrotic echocardiography and low dose dobutamine stress MRI in detecting myocardial viability of chronic myocardial infarction. Methods: Rest and low dose dobutamine (5, 10 μg·kg -1 ·min -1 ) stress transthrotic echocardiography and cine-MRI were performed in 30 patients with chronic myocardial infarction. 24 patients underwent successful revascularization and 10 of them underwent another rest cine-MRI study to assess segmental myocardial functional recovery. Left ventricular were divided into 16 segments, the criteria of viability in different techniques is: MRI: dobutamine induced systolic wall thickening was ≥2 mm in akinetic or diskinetic segments at rest; Echocardiography: wall motion score reduced at least 1 after dobutamine stress in akinetic or' diskinetic segments at rest. Results: One hundren and eight segments showed wall motion abnormalities of 30 patients, 65 and 56 segments shows positive reaction, 43 and 52 segments shows negativereaction in MRI and echocardiography after dobutamine stress respectively. Kappa value of the two techniques is 0.75, concordance in both techniques is 88%. Twenty-four segments showed functional recovery, 14 segments remained dysfunction 3-6 months after revascularization, the sensitivity, specificity and accuracy of detecting myocardial viability in chronic myocardial infarction in MRI and echocardiography is 95.8% vs 79.2% (P>0.05), 85.7% vs 85.7% (P>0.05), 92.1% vs 81.6% (P>0.05) respectively. The sensitivity and accuracy of MRI is a little higher. Conclusion: The ability of detecting myocardial viability by both low dose dobutamine stress transthrotic echocardiography and low dose dobutamine stress MRI is similer, the sensitivity and accuracy of MRI is a little higher. (authors)

  7. Usefulness of percutaneous transluminal coronary angioplasty in silent myocardial ischemia

    International Nuclear Information System (INIS)

    Hou, Mami

    1996-01-01

    The usefulness of percutaneous transluminal coronary angioplasty (PTCA) was assessed in patients with exercise-induced asymptomatic myocardial ischemia (silent ischemia) and compared with exercise-induced symptomatic myocardial ischemia (symptomatic ischemia). Patients with single vessel coronary artery disease (51 with angina pectoris, 40 with old myocardial infarction) and evidence of stress-induced ischemia on thallium-201 single photon emission computed tomography (SPECT) underwent successful PTCA. Thirty-seven percent of angina patients and 60% of infarction patients showed asymptomatic exercise-induced ischemia. There was no significant difference in population characteristics between silent and symptomatic patients. Patients with silent angina had significantly higher percentage thallium uptake and washout rate than symptomatic patients. After PTCA, both percentage diameter stenosis and percentage thallium uptake were improved in all patients with angina irrespective of the presence or absence of symptoms. There were no significant differences in percentage thallium uptake and washout rate between patients with silent and symptomatic infarction. After PTCA, percentage diameter stenosis, percentage thallium uptake, and washout rate improved in all infarction patients irrespective of the symptoms. Zero percent of silent angina patients, 12% of symptomatic angina patients, 12% of silent infarction patients, 19% of symptomatic infarction patients had cardiac events during about 4.5 years after PTCA. The incidence of cardiac events did not significantly differ in any patient group. PTCA improved myocardial perfusion in all patients, and the incidence of cardiac events did not differ between the silent and symptomatic groups. Revascularization with PTCA is suitable for patients with silent as well as symptomatic ischemia. (author)

  8. Elevated admission microalbuminuria predicts poor myocardial blood flow and 6-month mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Chen, Jia Wei; Wang, Yong Liang; Li, Hong Wei

    2012-04-01

    Microalbuminuria (MA) is considered a major risk factor predisposing to cardiovascular morbidity and mortality. Outcomes after percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) complicated by MA have been well described. However, data regarding admission MA and coronary and myocardial flow are scant. The aims of this study were to evaluate the effects of admission MA on coronary blood flow and prognosis in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary PCI. Did elevated admission microalbuminuria predict poor myocardial blood flow and 6-month mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention? A total of 247 patients undergoing primary PCI for STEMI within 12 hours after symptom onset were studied. Patients were divided into 2 groups according to admission urinary albumin extraction rate (UAER): (1) an MA group (UAER 20-200 µg/min), and (2) a normoalbuminuria (NA) group (UAER < 20 µg/min). Microalbuminuria was observed in 108 patients. Univariate analyses showed statistical differences between the NA and MA groups in serum creatine level, plasma glucose level, and peak creatine kinase level on presentation. Thrombolysis In Myocardial Infarction (TIMI) flow grades (TFGs) 0-2 in the MA group were more frequent (9.4% vs 21.2%, P < 0.05) than in the NA group, and corrected TIMI frame count was higher (23.9 ± 18.5 vs 29.8 ± 23.5, P < 0.05). Admission MA was an independent predictor of poor myocardial perfusion (adjusted relative risk: 3.14, 95% confidence interval: 0.99-6.78) and a higher rate of 6-month mortality in STEMI patients undergoing primary PCI (adjusted relative risk: 1.58, 95% confidence interval: 0.74-3.39). Admission MA levels are associated with impaired myocardial flow and poor prognosis in STEMI patients undergoing primary PCI. © 2012 Wiley Periodicals, Inc.

  9. Myocardial fatty acid imaging using iodine-123-BMIPP in patients with hypertensive intracranial hemorrhage

    International Nuclear Information System (INIS)

    Hashizume, Toshikazu; Sakai, Yasuhito; Hayashi, Yasushi

    2000-01-01

    An evaluation of myocardial fatty acid metabolism in hypertensive patients with major complication has not been previously established. To assess the myocardial fatty acid metabolism in hypertensive patients with intracranial hemorrhage (IH), we performed myocardial image using 123 I-15-p-iodophenyl-3-methyl pentadecanoic acid (BMIPP). Seventeen hypertensive patients with IH (HIH) and 27 hypertensive patients without IH (HT) were studied. A dose of 111 MBq of BMIPP was injected intravenously at rest, and a myocardial image was recorded 30 minutes after the injection. Myocardial perfusion image using Thallium-201 (Tl) was also performed within 2 weeks after BMIPP study. The regional myocardial uptakes of BMIPP and Tl were visually assessed in 17 segments with a four-point scoring system (0=absent to 3=normal uptake). Cardiac hypertrophy was evaluated by electrocardiogrpahy (ECG) and two-dimensional ultrasonic cardiography (UCG). Sum of uptake scores of Tl was similar in both groups (45.1±5.4 vs. 47.9±4.2), but that of BMIPP in HIH was lower than HT (35.9±7.9 vs 45.6±4.8, p<0.001). Evaluation of cardiac hypertrophy using ECG and UCG revealed no significant difference between two groups. HIH have much more eccentric hypertrophy in UCG study than HT (53% vs. 37%). These data suggest that hypertensive patients with intracranial hemorrhage have a more impaired myocardial fatty acid metabolism compared to the hypertensive patients with similar cardiac hypertrophy. BMIPP imaging might be useful to evaluate the severity of myocardial fatty acid metabolism in hypertensive patients. (author)

  10. Comparison of stress-rest and rest-stress one day myocardial perfusion scintigraphies in detecting coronary artery diseases

    International Nuclear Information System (INIS)

    Bom, Hee Seung; Min, Jung Jun; Song, Ho Cheon; Kim, Ji Yeul

    1997-01-01

    It has been shown that both rest and stress myocardial perfusion imaging with technetium agents can be performed on the same day using two different doses injected within few hours. The purpose of this study was to compare the two protocols (stress-rest and rest-stress) in detecting coronary artery diseases. One hundred and sixty patients (101 males, 59 females, mean age 57±9 years) and 120 patients (79 males, 41 females, mean age 59±10 years) underwent stress-rest myocardial perfusion SPECT and rest-stress myocardial perfusion SPECT, respectively. All of them underwent both myocardial perfusion SPECT and coronary angiography within 1 month. A coronary stenosis was considered significant when it compromised the luminal diameter by ≥50%. The chi square test was used to compare differences in sensitivity, specificity and accuracy between the two groups. The overall sensitivity, specificity and accuracy of stress-rest protocol were 99%, 35% and 68%, respectively. Those of rest-stress protocol were 96%, 47% and 78%, respectively. There was no difference between the two protocols in identifying individual diseased coronary artery branches. Therefore, one day stress-rest and rest-stress myocardial SPECT using 99m Tc agents were comparable and were very sensitive tests in detecting coronary artery diseases

  11. Rehabilitation of Patients Following Myocardial Infarction.

    Science.gov (United States)

    Blumenthal, James A.; Emery, Charles F.

    1988-01-01

    Examines three behavioral strategies in cardiac rehabilitation (CR) for formal treatment for physical and psychosocial sequelae of myocardial infarction (MI): exercise therapy, Type A modification, and nonspecific psychological therapies. Concludes CR improves the quality of life among post-MI patients, but does not prolong life or significantly…

  12. Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Kjel [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: kjel_andersen@web.de; Hennersdorf, Marcus [Department of Cardiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: hennersdorf@med.uni-duesseldorf.de; Cohnen, Mathias [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: cohnen@med.uni-duesseldorf.de; Blondin, Dirk [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de; Moedder, Ulrich [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: moedder@uni-duesseldorf.de; Poll, Ludger W. [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: poll@gmx.de

    2009-07-15

    Purpose: In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. Methods and material: Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. Results: Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. Conclusion: In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.

  13. Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

    International Nuclear Information System (INIS)

    Andersen, Kjel; Hennersdorf, Marcus; Cohnen, Mathias; Blondin, Dirk; Moedder, Ulrich; Poll, Ludger W.

    2009-01-01

    Purpose: In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. Methods and material: Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. Results: Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. Conclusion: In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.

  14. Detecting culprit vessel of coronary artery disease with SPECT 99Tcm-MIBI myocardial imaging

    International Nuclear Information System (INIS)

    Luan Zhaosheng; Zhou Wen; Peng Yong; Su Yuwen; Tian Jianhe; Gai lue; Sun Zhijun

    2002-01-01

    Objective: To assess the value of detecting culprit vessel of coronary artery disease (CAD) with SPECT 99 Tc m -MIBI myocardial imaging. Methods: Forty-six patients with CAD were studied. Every patients had multiple-vessel lesion showed by coronary arteriography and was treated by revascularization as percutaneous transluminal angioplasty (PTCA), coronary artery bypass graft (CABG) or laser holing. Exercise (EX), rest (RE) and intravenous infusion of nitroglycerine (NTG) SPECT 99 Tc m -MIBI myocardial imagings were performed before revascularization. Exercise and rest images revealed the myocardial ischemia. NTG images revealed myocardial viability. Culprit vessels were detected according to the defects showed by above mentioned images. The veracity of detected culprit vessels was tested with the outcome of the reperfusion therapy. Results: In this group, the coronary arteriography revealed 107 lesioned coronary arteries. Myocardial imaging detected 46 culprit vessels including 23 left anterior descending (LAD), 19 left circumflex coronary artery (LCX) and 4 right coronary artery (RCA). All 46 culprit vessels underwent revascularization and had nice outcome. The veracity of 99 Tc m -MIBI myocardial imaging detected culprit vessels was high according to patients' outcome. Conclusion: Exercise, rest and NTG 99 Tc m -MIBI myocardial imaging is a great method for detecting culprit vessels in multivessel coronary disease

  15. Serum uric acid level in hypertensive patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Burki, L.; Mehmood, A.

    2013-01-01

    To estimate serum uric acid level in hypertensive patients with acute myocardial infarction and hypertensive patients without myocardial infarction. Study Design Cross-sectional study. Setting Department of Medicine, Mayo Hospital, Lahore. Duration of study with dates Study was carried over a period of six months from 01-01-2007 to 30-06-2007. Subjects and methods Eighty hypertensive patients were included in the study out of which 40 patients with acute myocardial infarction were put in MI group and 40 patients without any history of myocardial infarction were labeled as non-MI group. Results Mean age of the patients in MI group and non-MI was found to be 50.0+-12.4 and 51.8+-10.1 years, respectively. Results of Serum uric acid level in MI group were 6.9+-1.0 mg/dl (0.407 +- 0.059 mmol/L ) and in non-MI group were 5.8+-1.5 mg/dl (0.342 +- 0.088 mmol/L) (p<0.001). (where 1 mmol/L = 16.78 mg/dl or 1 mg/dl = 0.059 mmol/L). Conclusion The present study proved that raised serum uric acid level can cause hypertension and further rise can lead to MI. (author)

  16. Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

    International Nuclear Information System (INIS)

    Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

    1988-01-01

    The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina

  17. [Diagnostics of acute myocardial infarction in elderly patients].

    Science.gov (United States)

    Bahrmann, P; Heppner, H J; Bahrmann, A; Christ, M; Bertsch, T; Sieber, C C

    2011-06-01

    The early diagnosis of an acute myocardial infarction (MI) is improved by the introduction of novel high-sensitivity troponin assays. These assays can measure low level myocardial injury not detectable by standard troponin assays. Especially in older patients who appear to have a higher basal troponin level, the results must always be judged in the context of the medical history, physical examination, electrocardiogram (ECG) and any further findings. Even small increases in high-sensitivity troponin indicate increased risk for death or MI during follow-up. In the case of MI an invasive strategy results in better survival rates compared with conservative therapy but at the expense of an increased risk of bleeding in elderly patients. This article provides an overview on the diagnosis of MI in elderly patients.

  18. Cardiac sympathetic neuronal damage precedes myocardial fibrosis in patients with Anderson-Fabry disease

    Energy Technology Data Exchange (ETDEWEB)

    Imbriaco, Massimo; Piscopo, Valentina; Ponsiglione, Andrea; Nappi, Carmela; Puglia, Marta; Dell' Aversana, Serena; Spinelli, Letizia; Cuocolo, Alberto [University Federico II, Department of Advanced Biomedical Sciences, Naples (Italy); Pellegrino, Teresa [National Council of Research, Institute of Biostructure and Bioimaging, Naples (Italy); Petretta, Mario [University Federico II, Department of Translational Medical Sciences, Naples (Italy); Riccio, Eleonora; Pisani, Antonio [University of Naples Federico II, Department of Public Health, Naples (Italy)

    2017-12-15

    Cardiac sympathetic denervation may be detectable in patients with Anderson-Fabry disease (AFD), suggesting its usefulness for early detection of the disease. However, the relationship between sympathetic neuronal damage measured by {sup 123}I-metaiodobenzylguanidine (MIBG) imaging with myocardial fibrosis on cardiac magnetic resonance (CMR) is still unclear. Cardiac sympathetic innervation was assessed by {sup 123}I-MIBG single-photon emission computed tomography (SPECT) in 25 patients with genetically proved AFD. Within one month from MIBG imaging, all patients underwent contrast-enhanced CMR. MIBG defect size and fibrosis size on CMR were measured for the left ventricle (LV) and expressed as %LV. Patients were divided into three groups according to MIBG and CMR findings: (1) matched normal, without MIBG defects and without fibrosis on CMR (n = 10); (2) unmatched, with MIBG defect but without fibrosis (n = 5); and (3) matched abnormal, with MIBG defect and fibrosis (n = 10). The three groups did not differ with respect to age, gender, α-galactosidase, proteinuria, glomerular filtration rate, and troponin I, while New York Heart Association class (p = 0.008), LV hypertrophy (p = 0.05), and enzyme replacement therapy (p = 0.02) were different among groups. Although in patients with matched abnormal findings, there was a significant correlation between MIBG defect size and area of fibrosis at CMR (r{sup 2} = 0.98, p < 0.001), MIBG defect size was larger than fibrosis size (26 ± 23 vs. 18 ± 13%LV, p = 0.02). Sympathetic neuronal damage is frequent in AFD patients, and it may precede myocardial damage, such as fibrosis. Thus, {sup 123}I-MIBG imaging can be considered a challenging technique for early detection of cardiac involvement in AFD. (orig.)

  19. Punjabi Sikh patients' cardiac rehabilitation experiences following myocardial infarction: a qualitative analysis.

    Science.gov (United States)

    Galdas, Paul M; Kang, H Bindy K

    2010-11-01

    To explore the cardiac rehabilitation experiences of Punjabi Sikh patients post myocardial infarction. Punjabi Sikh people are at significantly higher risk of mortality from myocardial infarction compared with those of European descent. Punjabi Sikh patients' participation in cardiac rehabilitation post myocardial infarction is therefore likely to yield considerable benefits. However, uptake of cardiac rehabilitation by South Asian people has been reported to be modest. Previous investigators have seldom provided insight into experiences of Punjabi Sikh patients post myocardial infarction and the steps that can be taken to improve the appropriateness of cardiac rehabilitation programmes for this at-risk patient group. Interpretive qualitative design. In-depth interviews, based on the McGill Illness Narrative Interview schedule, with 15 Punjabi Sikh patients post myocardial infarction attending a cardiac rehabilitation programme in British Columbia, Canada, were conducted; thematic analysis using grounded theory methods of coding and constant comparative analysis was employed. Four mutually exclusive themes emerged relating to the salient aspects of participants' cardiac rehabilitation experience: 'making sense of the diagnosis', 'practical dietary advice', 'ongoing interaction with peers and the multi-disciplinary team' and 'transport and attendance'. The themes identified point towards some of the ingredients necessary for providing culturally appropriate cardiac rehabilitation interventions for Punjabi Sikh patients following myocardial infarction. The findings highlight the importance of providing culturally relevant rehabilitation advice about diet and lifestyle changes and providing time for ongoing dialogue with support from health care professionals and peers. The findings from this study also illustrate the need to avoid generalisations about the impact religious beliefs may have on South Asian individuals' willingness to adhere to cardiac rehabilitation

  20. Acute myocardial infarction in a young patient

    International Nuclear Information System (INIS)

    Hameed, A.; Ata-ur-Rehman Quraishi

    2004-01-01

    Myocardial infarction (MI) is considered to be the disease of the fifth and sixth decade as seen in the West but an earlier age incidence is not infrequently encountered in the South Asian population. However, occurrence of MI in the teen-age still remains a rare happening. We are reporting a case of a teenager, who suffered a myocardial infarction with cardiogenic shock and pulmonary edema on two separate occasions with ECG and biochemical evidence of myocardial infarction. An exercise stress test done in between the two episodes was negative at a workload of 13.5 METs. A coronary angiogram done after the second event revealed normal coronary arteries and a preserved left ventricular systolic and segmental function. Except for low HDL (high density lipoprotein) and mildly raised homocysteine levels, the patient did not have other conventional or novel risk factors for coronary artery disease. (author)

  1. Use of myocardial imaging in the evaluation of patients with cardiovascular disease

    Energy Technology Data Exchange (ETDEWEB)

    Pitt, B.; Strauss, H.W.; Trhall, J.H.

    1980-01-01

    The role of radioisotope tracer techniques in the evaluation of patients with congenital heart disease, valvular heart disease, suspected myocardial infarction, ischemia or suspected ventricular dysfunction is reviewed. Thallium-201 myocardial imaging and exercise blood pool imaging and Technetium-88m pyrophosphate imaging of myocardial infarction are most commonly used.

  2. EFFICACY AND SAFETY OF INHALED NITRIC OXIDE USE IN PATIENTS WITH PULMONARY HYPERTENSION AND CHRONIC HEART FAILURE III-IV FUNCTIONAL CLASS, SURVIVED LEFT VENTRICULAR MYOCARDIAL INFARCTION: RESULTS OF NON-RANDOMIZED COMAPARIVE STUDY

    Directory of Open Access Journals (Sweden)

    P. N. Pavlenko

    2011-01-01

    Full Text Available Aim – assessment of the influence of inhaled nitric oxide (NO on the course of pulmonary hypertension (PH in patients with chronic heartfailure (CHF III–IV functional class (FC, myocardial infarction (MI.Materials and methods. Results of comparative non-randomized study that included 45 patients (26 men and 19 women aged 51 to 98 years with PH III–IV functional class, left ventricular myocardial infarction. In the study, patients underwent physical examination and Doppler echocardiography, and assessed FC LH (carried out with six-minute walking test, to determine the degree of dyspnea by Borg.Results. Symptoms of CHF and PH regressed in both groups of patients against the background of the therapy. Conclusion. It is established that the use of inhaled NO is a safe therapy and helps to reduce mean pulmonary arterial pressure (PAPmean in patients with PH and CHF III–IV FC, myocardial infarction. The method of inhaled NO is simple and easy to use.

  3. EFFICACY AND SAFETY OF INHALED NITRIC OXIDE USE IN PATIENTS WITH PULMONARY HYPERTENSION AND CHRONIC HEART FAILURE III-IV FUNCTIONAL CLASS, SURVIVED LEFT VENTRICULAR MYOCARDIAL INFARCTION: RESULTS OF NON-RANDOMIZED COMAPARIVE STUDY

    Directory of Open Access Journals (Sweden)

    P. N. Pavlenko

    2014-07-01

    Full Text Available Aim – assessment of the influence of inhaled nitric oxide (NO on the course of pulmonary hypertension (PH in patients with chronic heartfailure (CHF III–IV functional class (FC, myocardial infarction (MI.Materials and methods. Results of comparative non-randomized study that included 45 patients (26 men and 19 women aged 51 to 98 years with PH III–IV functional class, left ventricular myocardial infarction. In the study, patients underwent physical examination and Doppler echocardiography, and assessed FC LH (carried out with six-minute walking test, to determine the degree of dyspnea by Borg.Results. Symptoms of CHF and PH regressed in both groups of patients against the background of the therapy. Conclusion. It is established that the use of inhaled NO is a safe therapy and helps to reduce mean pulmonary arterial pressure (PAPmean in patients with PH and CHF III–IV FC, myocardial infarction. The method of inhaled NO is simple and easy to use.

  4. Clinical and angiographic characteristics of young adult patients recovered from acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Miljković Dušan

    2015-01-01

    Full Text Available Introduction. Occurrence of acute myocardial infarction in young adults is a relatively rare. In majority of the studies, age of 45 years is used as cut-off line in definition of the young patients with coronary artery disease or myocardial infarction. Studies have shown that younger population aged less than 40 years represents only 2-8% of all patients with myocardial infarction. Objective. The aim of this study was to examine the specificities of clinical and angiographic characteristics of the patients recovered from acute myocardial infarction, younger than 45 years at the moment of attack, by comparing their clinical and angiographic characteristics with those of patients older than 65 years, who recovered from acute myocardial infarction. Method. The study included 78 patients recovered from acute myocardial infarction, 33 patients were younger than 45 years (40.7 ± 3.9 years, 25 (75.7% men and eight (24.2% female, and 45 patients were older than 65 years (68.2 ± 4.2 years, 32 (71.3% men and 13 women. Detailed history taking, physical examination, permanent ECG monitoring, laboratory analyses, X-ray examination, echocardiography and selective coronarography of all patients were performed. Results. Patients younger than 45 years had a significantly higher incidence of STEMI (p 0.05 Multivessel disease existed at 54.5% under the age of 45 and 77.8% older than 65 years (p0.05. The disease of left main coronary artery had 6.1% of patients younger than 45 and 22.2% of patients older than 65 years (p0.05 Were without significant coronary artery stenosis Comparing risk factors for coronary artery disease in patients younger than 45 years and older than 65 years, we find: hypertension in 48.5% vs. 88.9% (p0.05, diabetes mellitus in 21.2% vs. 55.5% (p 0.05, and stress in 18.2% vs. 2.2% (p <0.01. Conclusion. Patients with myocardial infarction younger than 45 years are predominantly male and have a significantly higher incidence of infarction

  5. Bone marrow mononuclear cell implantation in myocardial laser channels in the ischemic heart disease surgery. Long-term results

    Science.gov (United States)

    Chernyavskiy, Alexander; Fomichev, Alexey; Minin, Stanislav; Nikitin, Nikita

    2017-10-01

    Background: The problem of incomplete myocardial revascularization for diffuse and distal lesions of the myocardium is still relevant. We assessed the clinical and instrumental long-term results of autologous bone marrow cell (BMC) implantation in laser channels in ischemic heart disease with diffuse and distal coronary disease. 35 coronary heart disease (CHD) patients with diffuse and distal coronary disease during coronary artery bypass grafting (CABG) underwent BMC implantation in laser channels. The control group consisted of 29 patients. All patients in this group underwent only CABG. Clinical and instrumental assessment of the method's effect was carried out at two weeks, six months, and six years after surgery. Indirect revascularization showed more significant decreasing of the functional class (FC) New York Heart Association (NYHA), myocardial perfusion and contractility improvement. Autologous BMC implantation in laser channels is an effective method of CHD surgical treatment if it is impossible to perform direct myocardial revascularization. The indirect revascularization effect is formed in the first six months after surgery and remains at the same level for six years.

  6. Identification of myocardial diffuse fibrosis by 11 heartbeat MOLLI T 1 mapping

    DEFF Research Database (Denmark)

    Vassiliou, Vassilios S; Wassilew, Katharina; Cameron, Donnie

    2017-01-01

    OBJECTIVES: Our objectives involved identifying whether repeated averaging in basal and mid left ventricular myocardial levels improves precision and correlation with collagen volume fraction for 11 heartbeat MOLLI T 1 mapping versus assessment at a single ventricular level. MATERIALS AND METHODS...... and ECV. To assess correlation of T 1 mapping with collagen volume fraction, a separate cohort of ten aortic stenosis patients scheduled to undergo surgery underwent one CMR scan with this 11 heartbeat MOLLI scheme, followed by intraoperative tru-cut myocardial biopsy. Six models of myocardial diffuse...... fibrosis assessment were established with incremental inclusion of imaging by averaging of the basal and mid-myocardial left ventricular levels, and each model was assessed for precision and correlation with collagen volume fraction. RESULTS: A model using 11 heart beat MOLLI imaging of two basal and two...

  7. Secondary prevention for patients following a myocardial infarction: summary of NICE guidance

    OpenAIRE

    Skinner, J S; Cooper, A; Feder, G S

    2007-01-01

    Mortality from coronary heart disease has been falling in the UK since the 1970s, but remains higher than in most other Western countries. Most patients receive some treatment for secondary prevention after myocardial infarction, but not all patients are offered the most effective secondary prevention package. The recently published NICE guideline for secondary prevention in patients after myocardial infarction, summarised in this article, makes clear recommendations for management of patient...

  8. Myocardial perfusion in patients with left bundle branch block and without coronary artery disease

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Honda, Minoru

    1992-01-01

    For the evaluation of myocardial perfusion in patients with left bundle branch block (LBBB), we performed exercise stress (Ex)-redistribution (RD) myocardial tomography with thallium-201 ( 201 Tl) in 23 patients with LBBB and without coronary artery disease (CAD). Myocardial images in patients with LBBB were compared with those of 9 patients with CAD who showed Ex induced transient septal defect. Bull'-eye maps ( 201 Tl distribution maps at Ex and RD and 201 Tl washout rate [WOR] map) were made from myocardial tomograms. In 23 patients with LBBB, 15 patients (65%) developed myocardial perfusion abnormality. In 10 (67%) of these 15 patients, transient perfusion defect appeared in the entire septum (diffuse type). On the other hand in 5 patients (33%), localized fixed perfusion defect developed at the boundary between septum and anterior wall (focal type). In focal type, every patient had other disease such as hypertension, aortic stenosis or sick sinus syndrome. While in patients with diffuse type, other diseases were observed in 30% (p 201 Tl WOR and 201 Tl uptake ratio of septum to lateral wall indicated that exercise induced septal defect was slighter in diffuse type than CAD. These points might be useful to differentiate whether CAD participates in the septal defect or not in patients with LBBB. (author)

  9. Prognostic significance of stress myocardial gated SPECT among Japanese patients referred for coronary angiography: A study of data from the J-ACCESS database

    Energy Technology Data Exchange (ETDEWEB)

    Momose, Mitsuru [Tokyo Women' s Medical University, Department of Radiology, Tokyo (Japan); Nakajima, Kenichi [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, Kyoto (Japan)

    2009-08-15

    The J-ACCESS [Japanese investigation of prognosis based on gated single photon emission computed tomography (SPECT)] study found that quantitative gated myocardial SPECT (QGS) is valuable for predicting the prognosis of Japanese patients with known or suspected ischaemic heart disease. The present study evaluates the incremental prognostic value of myocardial perfusion imaging (MPI) with QGS among patients referred for coronary angiography (CAG). Among 4,031 Japanese patients registered at 117 hospitals for the J-ACCESS study, we selected 1,011 who underwent CAG within 3 months before or after MPI with QGS. Summed stress, rest and difference scores (SSS, SRS and SDS) were generated from myocardial perfusion images using a 20-segment scoring system. Myocardial ischaemia was judged visually. End-diastolic volume (EDV), end-systolic volume (ESV) and ejection fraction (EF) were determined by QGS. Numbers of diseased (> 75% stenosis) coronary vessels (CDV) were assessed by CAG. All patients were followed up for 3 years to determine cardiac events (CE) including cardiac death, non-fatal myocardial infarction and severe heart failure. Univariate and multivariate analyses of prognostic ability included age, cardiac risk factors (hypertension, hyperlipidaemia, diabetes mellitus and prior myocardial infarction), angiographic findings and the QGS parameters as independent variables. Cardiac events occurred more frequently with increasing numbers of coronary vessel lesions (p=0.0016). Cox univariate analysis revealed that diabetes, CDV, SSS, SDS, EDV, ESV and EF were significant predictors (Wald {chi}{sup 2}=5.99, 12.9, 8.39, 9.11, 35.5, 42.1 and 31.1, respectively), whereas multivariate analysis selected only ESV and SDS as significant predictors (Wald {chi}{sup 2}=36.4, 8.4; p = 0.0038, p < 0.001). MPI with QGS, especially with gated functional data, has incremental prognostic value in addition to angiographic findings. MPI with QGS findings predominantly contribute to the

  10. Simultaneous assessment of myocardial perfusion and function during mental stress in patients with chronic coronary artery disease.

    Science.gov (United States)

    Arrighi, James A; Burg, Matthew; Cohen, Ira S; Soufer, Robert

    2003-01-01

    Mental stress (MS) is an important provocateur of myocardial ischemia in many patients with chronic coronary artery disease. The majority of laboratory assessments of ischemia in response to MS have included measurements of either myocardial perfusion or function alone. We performed this study to determine the relationship between alterations in perfusion and ventricular function during MS. Methods and results Twenty-eight patients with reversible perfusion defects on exercise or pharmacologic stress myocardial perfusion imaging (MPI) underwent simultaneous technetium 99m sestamibi single photon emission computed tomography (SPECT) MPI and transthoracic echocardiography at rest and during MS according to a mental arithmetic protocol. In all cases the MS study was performed within 4 weeks of the initial exercise or pharmacologic MPI that demonstrated ischemia. SPECT studies were analyzed visually with the use of a 13-segment model and quantitatively by semiautomated circumferential profile analysis. Echocardiograms were graded on a segmental model for regional wall motion on a 4-point scale. Of 28 patients, 18 (64%) had perfusion defects and/or left ventricular dysfunction develop during MS: 9 (32%) had myocardial perfusion defects develop, 6 (21%) had regional or global left ventricular dysfunction develop, and 3 (11%) had both perfusion defects and left ventricular dysfunction develop. The overall concordance between perfusion and function criteria for ischemia during MS was only 46%. Among 9 patients with MS-induced left ventricular dysfunction, 5 had new regional wall motion abnormalities and 4 had a global decrement in function. In patients with MS-induced ischemia by SPECT, the number of reversible perfusion defects was similar during both MS and exercise/pharmacologic stress (2.8 +/- 2.0 vs 3.5 +/- 1.8, P =.41). Hemodynamic changes during MS were similar whether patients were divided on the basis of perfusion defects or left ventricular dysfunction during MS

  11. DEPRESSIVE DISORDERS IN PATIENTS AFTER MYOCARDIAL INFARCTION

    OpenAIRE

    MUXAMADIYEVA NIGINA BAKHODIROVNA

    2016-01-01

    In article the depressions arising at patients after a myocardial infarction (MI) are shined, necessity of overcoming stigma concerning weight of the transferred MI, rational under-standing of illness especially in early period of the post infraction is defined.

  12. Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization.

    Science.gov (United States)

    Göker, Ayşe Enise; Aydoğdu, İmran; Saltürk, Ziya; Berkiten, Güler; Atar, Yavuz; Kumral, Tolgar Lütfi; Uyar, Yavuz

    2017-01-01

    The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  13. Comparative study of body surface isopotential map, left ventriculogram and thallium-201 myocardial scintigram in patients with old lateral myocardial infarction

    International Nuclear Information System (INIS)

    Matsumoto, Naoyuki

    1988-01-01

    In 16 patients with old lateral myocardial infarction, body surface isopotential maps and 12 lead electrocardiograms were compared with left ventriculographic findings. In addition 8 of these subjects were performed thallium-201 myocardial scintigraphy in order to determine the location and extent of myocardial necrosis. Common 12 lead electrocardiographic findings of the subjects were initial Q waves more than 30 msec and inverted T waves in only aVL lead. The patients were classified into 4 groups according to the location and extent of ventricular wall motion abnormalities group I (6 cases) showed hypokinesis in the anterior segment, group II (5 cases): akinesis in the anterior segment and hypokinesis in the seg. 6, group III (4 cases): hypokinesis in the anterior segment and seg. 7, group IV (1 case): hypokinesis in the anterior segment and seg. 4, 7. And each of the 4 groups demonstrated characteristic findings of surface isopotential maps. Group II with coexisting hypokinesis in the seg. 6 showed surface isopotential maps additional pattern of anterior myocardial infarction, and group III with coexisting hypokinesis in the seg. 7 showed additional patterns of posterior myocardial infarction. The classification according to the abnormality of ventricular wall motion was also conformed with the thallium-201 myocardial scintigraphic findings except one case. These results suggest that body surface isopotential map is more useful than the 12 lead electrocardiogram in detecting the location and extent of left ventricular wall motion abnormality in patients with old lateral myocardial infarction. (author) 53 refs

  14. Effect of granulocyte colony stimulating EPC on cardiac function and myocardial energy expenditure in patients with heart failure after myocardial infarction.

    Science.gov (United States)

    Zhao, Zilin; Luo, Jianchun; Ma, Lixian; Luo, Xia; Huang, Liangyan

    2015-01-01

    To study the changes of cardiac function and myocardial energy expenditure following treatment with granulocyte colony stimulating factor (G-CSF) in patients with heart failure after myocardial infarction. Thirty-eight patients with heart failure after myocardial infarction were randomized into G-CSF treatment group and control group. All the patients received conventional treatment (medication and interventional therapy), and the patients in treatment group were given additional G-CSF (600 μg/day) for 7 consecutive days. The plasma level of brain-type natriuretic peptide (BNP) and the number of endothelial progenitor cells (EPC) in the peripheral blood were detected before and at 7 days and 4 months after the treatment. The cardiac functions (LVEF, FS, LVIDs, PWTs, EDV, SV, ET) was evaluated by ultrasonic imaging before and at 2 weeks and 4 months after the treatment. The MEE and circumferential end-systolic wall stress (cESS) were calculated by correlation formula. The number of EPC was significantly higher in the treatment group than in the control group after the treatment especially at 7 days (Pexpenditure were improved in all the patients at 2 weeks and 4 months after the treatment, and the improvement was more obvious in the treatment group (Pexpenditure in patients with heart failure after myocardial infarction.

  15. Exercise and rest Tl-201 myocardial SPECT, and low dose dobutamine echocardiography to assess myocardial viability in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Toyama, Takuji; Ishida, Yoshio; Shimonagata, Tsuyoshi; Kawano, Shigeo; Beppu, Shintaro; Nishimura, Tsunehiko.

    1994-01-01

    To evaluate viability of infarcted myocardium, findings of Tl-201 myocardial SPECT were compared with those of low-dose dobutamine (DOB) echocardiography. The subjects were 19 patients with myocardial infarction (23 infarcted zones), consisting of 16 men and 3 women. Findings on myocardial SPECT were classified as evidence of myocardial viability (14 zones, Group A) and no evidence of myocardial viability (9 zones, Group B). For both groups, wall motion and regional % uptake (%UP) were obtained. DOB echocardiography revealed an improvement in 5 of 8 akinesis zones in Group A. In addition, one other zone was found improved by follow-up examination. Six hypokinesis zones were all found improved on DOB echocardiography. Out of a total of 14 akinesis or hypokinesis zones, 11 (79%) showed improvement on DOB echocardiography in Group A. In Group B, all akinesis zones remained unchanged on DOB echocardiography, although one zone was improved by follow-up examination. In 11 zones in which wall motion was improved on DOB echocardiography, %UT was increased by an average of 58% on 4 hr-delayed images and 70% on resting images. The corresponding figures for 12 zones which did not improve on DOB echocardiography were 49% and 50% on the average, respectively. In conclusion, low-dose DOB echocardiography appeared to reflect viability of severely infarcted myocardium, although it had a slightly lower sensitivity than convensional Tl-201 myocardial SPECT in its ability to detect. (N.K.)

  16. Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

    Directory of Open Access Journals (Sweden)

    Shahram Paydar

    2014-08-01

    Full Text Available Introduction: Emergency department thoracotomy (EDT may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty eight cases of EDT were enrolled (86.2% male. The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19% were alive to be transported to OR (defined as ED survived. The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived was 6.9% (4 cases. Only one case (1.7% survived to discharge from hospital (mortality rate=98.3%. There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04. The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04 and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02 were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome.

  17. An experimental study of 99Tcm-HL91 in detection of myocardial viability

    International Nuclear Information System (INIS)

    Xu Tao; Liu Baoping; Meng Yubao; Sun Bingqi; Niu Guangjun; Han Xingmin; Yuan Qiao

    2005-01-01

    Objective: To investigate whether 99 Tc m -4,9-diaza-3,3,10,10-tetramethyldodecan-2,11-dione dioxime (HL91) can be used to distinguish ischemic myocardium segments from infarction segments. Methods: Twenty-five acute myocardial infarction patients (≤6 weeks) and 5 old myocardial infarction patients (> 6 weeks) were included in the study. All the study patients underwent 99 Tc m -HL91 and 99 Tc m -methoxyisobutylisonitrile (MIBI) imaging intervented and unintervented with nitroglycerin, and the myocardium segments were divided into three groups according to 99 Tc m -MIBI imaging results: normal, ischemic, and infarction myocardium segments. The difference of the radial counts of 99 Tc m -HL91 in three groups were analyzed after the imaging with 99 Tc m -HL91. Results: 1) In acute myocardial infarction patients, the accumulation rates of 99 Tc m -HL91 was 95% in normal segment group, 157% in ischemic group, 93% in infarction group. The accumulation rates of 99 Tc m -HL91 in the ischemic group was higher than that in the normal group and infarction group. 2)In old myocardial infarction patients, the accumulation rates of 99 Tc m -HL91 were of no difference among the normal, ischemic, and infarction groups. Conclusion: 99 Tc m -HL91 is a potential marker for detecting the ischemic myocardial tissue. (authors)

  18. Assessment of myocardial enhancement during coronary CT angiography in critically ill patients

    Energy Technology Data Exchange (ETDEWEB)

    Mírka, Hynek, E-mail: mirka@fnplzen.cz [Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň (Czech Republic); Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Alej Svobody 76, 304 60 Plzeň (Czech Republic); Ferda, Jiří, E-mail: ferda@fnplzen.cz [Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň (Czech Republic); Baxa, Jan, E-mail: baxaj@fnplzen.cz [Department of Imaging Methods, Faculty of Medicine and University Teaching Hospital in Pilsen, Alej Svobody 80, 304 60 Plzeň (Czech Republic)

    2016-10-15

    Highlights: • There are still unmet needs for the imaging, such as conditions with unknown cause that are not associated with dominant symptoms indicating primarily cardiac cause. • The contribution of the myocardial enhancement evaluation improves to determining the diagnosis of acute myocardial injury and choosing appropriate treatment. • When incorporating the myocardial enhancement assessment into the imaging algorithm, emphasis is placed on a uniform evaluation approach. • The color coded images of the myocardial enhancement in emergency situations help identify the most serious pathologies and shorten the time to adequate therapy. - Abstract: There are still challenges and unmet needs for the imaging techniques, such as conditions of uncertain origin in patients with clinically serious, life-threatening conditions with unknown cause that are not associated with dominant chest pain, ECG changes or other symptoms indicating a possible primarily cardiac or coronary cause. The contribution of the myocardial enhancement evaluation of urgent cardiac CTA scans significantly improves to determining the diagnosis of acute myocardial injury and choosing appropriate treatment. When incorporating the myocardial enhancement assessment into the imaging algorithm of an emergency department, emphasis is placed on a uniform imaging procedure and a uniform evaluation approach. The color coded images of the myocardial enhancement in emergency situations helps identify the most serious pathologies and shorten the time to adequate targeted therapy in patients.

  19. Assessment of myocardial enhancement during coronary CT angiography in critically ill patients

    International Nuclear Information System (INIS)

    Mírka, Hynek; Ferda, Jiří; Baxa, Jan

    2016-01-01

    Highlights: • There are still unmet needs for the imaging, such as conditions with unknown cause that are not associated with dominant symptoms indicating primarily cardiac cause. • The contribution of the myocardial enhancement evaluation improves to determining the diagnosis of acute myocardial injury and choosing appropriate treatment. • When incorporating the myocardial enhancement assessment into the imaging algorithm, emphasis is placed on a uniform evaluation approach. • The color coded images of the myocardial enhancement in emergency situations help identify the most serious pathologies and shorten the time to adequate therapy. - Abstract: There are still challenges and unmet needs for the imaging techniques, such as conditions of uncertain origin in patients with clinically serious, life-threatening conditions with unknown cause that are not associated with dominant chest pain, ECG changes or other symptoms indicating a possible primarily cardiac or coronary cause. The contribution of the myocardial enhancement evaluation of urgent cardiac CTA scans significantly improves to determining the diagnosis of acute myocardial injury and choosing appropriate treatment. When incorporating the myocardial enhancement assessment into the imaging algorithm of an emergency department, emphasis is placed on a uniform imaging procedure and a uniform evaluation approach. The color coded images of the myocardial enhancement in emergency situations helps identify the most serious pathologies and shorten the time to adequate targeted therapy in patients.

  20. Myocardial Bridging

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2016-02-01

    Full Text Available Abstract Myocardial bridging is rare. Myocardial bridges are most commonly localized in the middle segment of the left anterior descending coronary artery. The anatomic features of the bridges vary significantly. Alterations of the endothelial morphology and the vasoactive agents impact on the progression of atherosclerosis of myocardial bridging. Patients may present with chest pain, myocardial infarction, arrhythmia and even sudden death. Patients who respond poorly to the medical treatment with β-blockers warrant a surgical intervention. Myotomy is a preferred surgical procedure for the symptomatic patients. Coronary stent deployment has been in limited use due to the unsatisfactory long-term results.

  1. Relationship between normalization of negative T waves on exercise ECG and residual myocardial viability in patients with previous myocardial infarction and no post-infarction angina

    Energy Technology Data Exchange (ETDEWEB)

    Ajisaka, Ryuichi; Watanabe, Shigeyuki; Masuoka, Takeshi; Yamanouchi, Takayoshi; Saitoh, Takumi; Toyama, Masahiro; Takeda, Tohru; Itai, Yuji; Sugishita, Yasuro [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    1998-03-01

    The usefulness of normalization of negative T waves in exercise ECG was investigated as an index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise test. A total of 39 patients, 20 with T-wave normalization (POS group) and 19 without T-wave normalization (NEG group) on exercise ECG, were studied. Myocardial viability was evaluated by thallium-201 single-photon emission computed tomography (SPECT) during exercise or at rest. We also assessed left ventricular ejection fraction (LVEF) by contrast ventriculography before (n=39) and after percutaneous transluminal coronary angioplasty (PTCA) (n=17). SPECT detected myocardial viability in 16 (80%) of the 20 patients in the POS group and in 4 (21%) of the 19 patients in the NEG group (p<0.01). LVEF increased after successful PTCA in the POS group (from 53{+-}13% to 63{+-}8%, p<0.025), but fell in the NEG group (from 57{+-}10% to 51{+-}8%). It is concluded that normalization of negative T waves on exercise ECG is a useful, simple index of myocardial viability in patients with previous myocardial infarction with no symptoms or ischemic ST-segment change during exercise testing. (author)

  2. High-Sensitivity C-Reactive Protein as a Predictor of Cardiovascular Events after ST-Elevation Myocardial Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Ribeiro, Daniel Rios Pinto; Ramos, Adriane Monserrat; Vieira, Pedro Lima; Menti, Eduardo; Bordin, Odemir Luiz Jr.; Souza, Priscilla Azambuja Lopes de; Quadros, Alexandre Schaan de; Portal, Vera Lúcia, E-mail: veraportal.pesquisa@gmail.com [Programa de Pós-Graduação em Ciências da Saúde: Cardiologia - Instituto de Cardiologia/Fundação Universitária de Cardiologia, Porto Alegre, RS (Brazil)

    2014-07-15

    The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant. The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor

  3. Frequency of adverse outcomes of acute myocardial infarction in patients with stress hyperglycem)a

    International Nuclear Information System (INIS)

    Shah, S.T.; Shah, C.F.A.; Shah, I.; Khan, S.B.; Hadi, A.; Gul, A.M.; Hafizullah, M.

    2012-01-01

    Objective: To determine the frequency of in-hospital adverse outcomes of acute myocardial infarction in patients with stress hyperglycemia. Methodology: This was a descriptive cross sectional study conducted from August 2010 to January 2011 in Cardiology department, Lady Reading Hospital, Peshawar. Patients of age 25-70 years, of either gender, non-diabetic with acute myocardial infarction with stress hyperglycemia were included. Random blood sugar >144 mg/dl was taken as stress hyperglycemia for patients at presentation of acute myocardial infarction. Patients were monitored for electrical complications such as atrial fibrillation, ventricular tachycardia, ventricular fibrillation and complete heart block and mechanical complications such as cardiac pulmonary edema and cardiogenic shock during hospital stay. The statistical analysis was performed using the statistical package for social sciences (SPSS Ver. 15.0). Results: A total of 341 patients having acute myocardial infarction with stress hyperglycemia were studied. The mean age was 56.35 +- 9.748 (95% CI 57.39 - 55.31). Male were 58.1% (n=198). The frequency of various major in-hospital electrical adverse outcomes of acute myocardial infarction with stress hyperglycemia were atrial fibrillation (AF) 15.8%, ventricular tachycardia (VT) 11.7%, ventricular fibrillation (VF) 10.9% and complete heart block (CHB) 6.7%, while mechanical adverse outcomes were cardiac pulmonary edema (CPE) 7.9% and cardiogenic shock (CS) 11.7%. Conclusion: Stress hyperglycemia has adverse impact on outcomes of patients presenting with acute myocardial infarction. Among electrical and mechanical complications of acute myocardial infarction in patients with stress hyperglycemia, the two most frequent in-hospital adverse outcomes were atrial fibrillation and cardiogenic shock, respectively. (author)

  4. Long-term effects of invasive treatment in patients with a post-thrombolytic Q-wave myocardial infarction

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Madsen, Jan Kyst; Grande, Peer

    2010-01-01

    Abstract Objectives. The aim of the present study was to assess the effect of a deferred invasive treatment strategy on long-term outcome in patients with a post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia. Design. Patients (N=751) with post-thrombolytic Q-wave myo......Abstract Objectives. The aim of the present study was to assess the effect of a deferred invasive treatment strategy on long-term outcome in patients with a post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia. Design. Patients (N=751) with post-thrombolytic Q...

  5. Respiratory muscle endurance is limited by lower ventilatory efficiency in post-myocardial infarction patients

    OpenAIRE

    Neves,Laura M. T.; Karsten,Marlus; Neves,Victor R.; Beltrame,Thomas; Borghi-Silva,Audrey; Catai,Aparecida M.

    2014-01-01

    Background: Reduced respiratory muscle endurance (RME) contributes to increased dyspnea upon exertion in patients with cardiovascular disease. Objective: The objective was to characterize ventilatory and metabolic responses during RME tests in post-myocardial infarction patients without respiratory muscle weakness. Method: Twenty-nine subjects were allocated into three groups: recent myocardial infarction group (RG, n=9), less-recent myocardial infarction group (LRG, n=10), and contr...

  6. Myocardial multilayer strain does not provide additional value for detection of myocardial viability assessed by SPECT imaging over and beyond standard strain.

    Science.gov (United States)

    Orloff, Elisabeth; Fournier, Pauline; Bouisset, Frédéric; Moine, Thomas; Cournot, Maxime; Elbaz, Meyer; Carrié, Didier; Galinier, Michel; Lairez, Olivier; Cognet, Thomas

    2018-05-14

    The aim of this study was to evaluate the value of multilayer strain analysis to the assessment of myocardial viability (MV) through the comparison of both speckle tracking echocardiography and single-photon emission computed tomography (SPECT) imaging. We also intended to determine which segmental longitudinal strain (LS) cutoff value would be optimal to discriminate viable myocardium. We included 47 patients (average age: 61 ± 11 years) referred to our cardiac imaging center for MV evaluation. All patients underwent transthoracic echocardiography with measures of LS, SPECT, and coronary angiography. In all, 799 segments were analyzed. We correlated myocardial tracer uptake by SPECT with sub-endocardial, sub-epicardial, and mid-segmental LS values with r = .514 P Multilayer strain analysis does not evaluate MV with more accuracy than standard segmental LS analysis. © 2018 Wiley Periodicals, Inc.

  7. [A Distal Bile Duct Carcinoma Patient Who Underwent Surgical Resection for Liver Metastasis].

    Science.gov (United States)

    Komiyama, Sosuke; Izumiya, Yasuhito; Kimura, Yu; Nakashima, Shingo; Kin, Syuichi; Kawakami, Sadao

    2018-03-01

    A 70-year-old man with distal bile duct carcinoma underwent a subtotal stomach-preserving pancreaticoduodenectomy without adjuvant chemotherapy. One and a half years after the surgery, elevated levels of serum SPan-1(38.1 U/mL)were observed and CT scans demonstrated a solitary metastasis, 25mm in size, in segment 8 of the liver. The patient received 2 courses of gemcitabine-cisplatin combination chemotherapy. No new lesions were detected after chemotherapy and the patient underwent a partial liver resection of segment 8. The pathological examination revealed a metachronous distant metastasis originating from the bile duct carcinoma. Subsequently, the patient received S-1 adjuvant chemotherapy for 6 months. Following completion of all therapies, the patient survived without tumor recurrence for 3 years and 10 months after the initial operation. Thus, surgical interventions might be effective in improving prognosis among selected patients with postoperative liver metastasis of bile duct carcinoma.

  8. Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP).

    Science.gov (United States)

    Pandey, Ambarish; Sood, Akshay; Sammon, Jesse D; Abdollah, Firas; Gupta, Ena; Golwala, Harsh; Bardia, Amit; Kibel, Adam S; Menon, Mani; Trinh, Quoc-Dien

    2015-04-15

    The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons-National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35% women) with previous MI who underwent major noncardiac surgery, 5.5% had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4% vs 5%, p = 0.035). In secondary outcomes, reintervention rates (22.5% vs 11%, p angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Prognostic value of myocardial perfusion SPECT versus exercise electrocardiography in patients with ST-segment depression on resting electrocardiography.

    Science.gov (United States)

    De Lorenzo, Andrea; Hachamovitch, Rory; Kang, Xingping; Gransar, Heidi; Sciammarella, Maria G; Hayes, Sean W; Friedman, John D; Cohen, Ishac; Germano, Guido; Berman, Daniel S

    2005-01-01

    The value of exercise-induced ST-segment depression for the prognostic evaluation of patients with 1 mm of ST depression or greater on the resting electrocardiogram is controversial. Patients who underwent exercise myocardial perfusion single photon emission computed tomography (MPS) and had resting ST depression of 1 mm or greater with a nondiagnostic exercise electrocardiographic response (n = 1122) were followed up for 3.4 +/- 2.3 years. Those with paced rhythm, pre-excitation, left bundle branch block, or myocardial revascularization within the first 60 days after MPS were excluded. Additional exercise-induced ST-segment depression was considered significant if > or = 2 mm MPS was scored semiquantitatively by use of a 20-segment model of the left ventricle; the percentage of myocardium involved with stress defects (% myo) was derived by normalizing to the maximal possible score of 80. Hard events were defined as nonfatal myocardial infarction or cardiac death. A Cox analysis was used to determine independent predictors of hard events among clinical, exercise, and nuclear variables. Hard event rates increased as a function of % myo for either patients with exercise-induced ST depression (1.4%/y for normal MPS vs 4.1%/y for % myo >10%, P 10%, P = .0001). Age, diabetes mellitus, shortness of breath as the presenting symptom, and % myo were independent predictors of hard events. Exercise-induced ST depression was predictive of hard events only when it was 3 mm or greater. The presence and extent of perfusion defects, reflected in the % myo, had incremental prognostic value over clinical variables and also over all degrees of exercise-induced ST depression. Although MPS effectively risk-stratifies patients with resting ST depression of 1 mm or greater, the prognostic value of exercise-induced ST depression is limited in these patients, with a small added risk when severe (> or = 3 mm).

  10. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

    Directory of Open Access Journals (Sweden)

    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  11. Value of dipyridamole stress 201Tl myocardial SPECT in detecting dysfunction of coronary microcirculation

    International Nuclear Information System (INIS)

    Lou Ying; Jiang Jinqi; Xie Wenhui; Yuan Fang; Wang Tong; Yang Yiqing

    2012-01-01

    Objective: To evaluate the value of dipyridamole stress 201 Tl myocardial SPECT in detecting dysfunction of coronary microcirculation. Methods: Forty-eight patients diagnosed with cardiac syndrome X underwent dipyridamole stress 201 Tl myocardial SPECT. Dipyridamole (0.56 mg/kg) was intravenously injected over 4 min followed by 201 Tl (111 MBq) injection at 2 min after dipyridamole administration. Image was acquired at 10 min and 240 min post-injection and co-analyzed by over two experienced doctors in nuclear medicine after three-dimensional reconstruction. The patients with 'reverse redistribution' underwent repeated dipyridamole stress 201 Tl SPECT after medical therapy for 2 weeks. The clinical symptoms and results of the treadmill exercise test pre-and post-therapy were compared. Results: Forty two patients (42/48, 87.50%) showed segmental defects: 'reverse redistribution' on delayed (240 min) 201 Tl images. After medical treatment, 36 cases of the 42 'reverse redistribution' patients had improvement in both clinical symptoms and treadmill exercise test. Post-treatment 201 Tl imaging showed improvement in 45/49 (91.84%) defect segments. Six of the 42 patients had no improvement in clinical symptoms and/or treadmill exercise test. Post-treatment 201 Tl imaging showed no improvement in all the 7 defect segments on the first scan. Conclusion: Dipyridamole stress 201 Tl myocardial SPECT may be valuable in evaluation of impaired coronary microcirculation associated with cardiac syndrome X. (authors)

  12. Improved predictive value of GRACE risk score combined with platelet reactivity for 1-year cardiovascular risk in patients with acute coronary syndrome who underwent coronary stent implantation.

    Science.gov (United States)

    Li, Shan; Liu, Hongbin; Liu, Jianfeng; Wang, Haijun

    2016-11-01

    Both high platelet reactivity (HPR) and Global Registry of Acute Coronary Events (GRACE) risk score have moderate predictive value for major adverse cardiovascular disease (CVD) events in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI), whereas the prognostic significance of GRACE risk score combined with platelet function testing remains unclear. A total of 596 patients with non-ST elevation ACS who underwent PCI were enrolled. The P2Y 12 reaction unit (PRU) value was measured by VerifyNow P2Y 12 assay and GRACE score was calculated by GRACE risk 2.0 calculator. Patients were stratified by a pre-specified cutoff value of PRU 230 and GRACE score 140 to assess 1-year risk of cardiovascular death, non-fatal myocardial infarction (MI), and stent thrombosis. Seventy-two (12.1%) patients developed CVD events during 1-year follow-up. Patients with CVD events had a higher PRU value (244.6 ± 50.9 vs. 203.7 ± 52.0, p risk independently. Compared to patients with normal platelet reactivity (NPR) and GRACE score risk (HR: 5.048; 95% CI: 2.268-11.237; p risk score yielded superior risk predictive capacity beyond GRACE score alone, which is shown by improved c-statistic value (0.871, p = 0.002) as well as net reclassification improvement (NRI 0.263, p risk of adverse CVD events. The combination of platelet function testing and GRACE score predicted 1-year CVD risk better.

  13. Detection of angina-related coronary artery in patients with unstable angina pectoris by using 123I-BMIPP myocardial scintigraphy

    International Nuclear Information System (INIS)

    Oka, Toshiaki; Inoue, Seiji; Asano, Ryuta; Handa, Atsushi; Iguchi, Nobuo; Sumiyoshi, Tetsuya; Hosoda, Saichi; Kobayashi, Hideki; Kusakabe, Kiyoko.

    1996-01-01

    To evaluate the diagnostic accuracy of detection of angina-related coronary arteries in patients with unstable angina pectoris. Twenty patients with unstable angina pectoris underwent 123 I-BMIPP scintigraphy at rest. A mean duration from last anginal attack to 123 I-BMIPP scintigraphy was 4.8±3.2 days. Seventeen of 20 angina-related coronary territories were detected by reduced 123 -BMIPP uptake. The sensitivity and specificity for detection of angina-related coronary arteries were 85% and 95%, respectively. The decrease in myocardial uptake of 123 I-BMIPP agreed with the decrease in regional wall motion by using ultrasonic echocardiography. 123 I-BMIPP scintigraphy may be useful for detection of angina-related coronary artery in a routine clinical examination in patients with unstable angina pectoris. (author)

  14. A comparative study of 99Tcm-tetrofosmin and 99Tcm-MIBI myocardial imaging

    International Nuclear Information System (INIS)

    Zhao Kui; Chen Peng; Zhang Furong; Shen Wenhua

    2001-01-01

    Objective: To evaluate the value of 99 Tc m -tetrofosmin myocardial imaging for detecting coronary artery disease. Methods: Twenty-seven patients underwent 99 Tc m -tetrofosmin SPECT, twenty-six patients underwent 99 Tc m -MIBI SPECT; coronary angiography was performed on patients included in both groups (≥50% luminal diameter stenosis was considered significant coronary stenosis). Results: 99 Tc m -tetrofosmin produced high quality myocardial images from 30 min to several hours postinjection, the outlines of myocardial perfusion images provided by 99 Tc m -tetrofosmin imaging were clearly discernible. One-day exercise/rest 99 Tc m -tetrofosmin myocardial perfusion imaging was feasible and had a high sensitivity for detection of coronary artery disease. Sensitivities of 99 Tc m -tetrofosmin SPECT and 99 Tc m -MIBI SPECT for detecting coronary artery disease were 90% and 94%, respectively. The 95% confidence limits of both sensitivities were 68.65% - 98.77% and 72.33% - 99.86%, respectively; the positive predictive values of both imaging agents were 90.0% and 89.5%, respectively, the 95% confidence limits of those were 68.38% - 98.77% and 72.33% - 99.86% respectively; the positive predictive values of both imaging agents were 90.0% and 89.5%, respectively, the 95% confidence limits of those were 68.38% - 98.77% and 66.38% - 98.70%, respectively; efficiencies of both imaging agents were 85.2% and 88.5%, respectively. The 95% confidence limits of both efficiencies were 65.81% - 95.78% and 69.44 - 98.70%, respectively. The specificity for both imaging agents was 71% and 75%. There was no significant difference among above results (P > 0.05). No ECG abnormalities were found following the injection of 99 Tc m -tetrofosmin SPECT. There were no drug-related effects on blood pressure, heart rate and body temperature. This experiment failed to provide the negative predictive value of the myocardial perfusion imaging with 99 Tc m -tetrofosmin because that few patients with

  15. Time course evaluation of myocardial perfusion after reperfusion therapy by 99mTc-tetrofosmin SPECT in patients with acute myocardial infarction.

    Science.gov (United States)

    Tanaka, R; Nakamura, T

    2001-09-01

    Myocardial perfusion imaging with 99mTc-labeled agents immediately after reperfusion therapy can underestimate myocardial salvage. It is also conceivable that delayed imaging is useful for assessing the risk area. However, to our knowledge, very few studies have sequentially evaluated these image changes. We conducted 99mTc-tetrofosmin (TF) and 123I-beta-methyl-p-iodophenylpentadecanoic acid (BMIPP) SPECT before and after reperfusion to treat acute myocardial infarction and quantified changes in TF myocardial accumulation and reverse redistribution. Seventeen patients with a first myocardial infarction underwent successful reperfusion. We examined SPECT images obtained at the onset (preimage), those acquired 30 min (early image) and 6 h (delayed image) after TF injection, and images acquired 1, 4, 7, and 20 d after reperfusion (post-1-d, post-4-d, post-7-d, and post-20-d image, respectively). We also examined BMIPP SPECT images after 7 +/- 1.8 d (BMIPP image). Polar maps were divided into 48 segments to calculate percentage uptake, and time course changes in segment numbers below 60% were observed as abnormal area. Moreover, cardiac function was analyzed by gated TF SPECT on 1 and 20 d after reperfusion. In reference to the abnormal area on the early images, the post-1-d image was significantly improved compared with the preimage (P < 0.01) as was the post-7-d image compared with the post-1-d and post-4-d images (P < 0.05, respectively). However, post-20-d and post-7-d images did not significantly differ. Therefore, the improvement in myocardial accumulation reached a plateau 7 d after reperfusion. On the other hand, the abnormal area on the delayed images was significantly greater (P < 0.01) compared with that on the early images from 4 to 20 d after reperfusion, as the value was essentially constant. The correlations of the abnormal area between the preimage and the post-7-d delayed image, the preimage and the BMIPP image, and the post-7-d delayed image and the

  16. Screening for silent myocardial ischemia caseof diabetics : interest of myocardial perfusion scintigraphy

    International Nuclear Information System (INIS)

    Bahri, Haifa

    2007-01-01

    Silent myocardial ischemia is a major cause of morbidity and mortality in diabetic patients. Its diagnosis by noninvasive means such as myocardial SPECT would improve the management of these patients. The purpose of this study is to assess the frequency of silent myocardial ischemia in asymptomatic diabetics and their evolution. As a result, the myocardial SPECT is a reliable tool for screening for silent myocardial ischemia in diabetic patients. Its prognostic value allows to stratify the cardiac risk and guide therapeutic management. Its integration into a screening strategy in Tunisia seems limited by its low availability and cost. The latter could be reduced by better patient selection.

  17. Myocardial strain assessment by cine cardiac magnetic resonance imaging using non-rigid registration.

    Science.gov (United States)

    Tsadok, Yossi; Friedman, Zvi; Haluska, Brian A; Hoffmann, Rainer; Adam, Dan

    2016-05-01

    To evaluate a novel post-processing method for assessment of longitudinal mid-myocardial strain in standard cine cardiac magnetic resonance (CMR) imaging sequences. Cine CMR imaging and tagged cardiac magnetic resonance imaging (TMRI) were performed in 15 patients with acute myocardial infarction (AMI) and 15 healthy volunteers served as control group. A second group of 37 post-AMI patients underwent both cine CMR and late gadolinium enhancement (LGE) CMR exams. Speckle tracking echocardiography (STE) was performed in 36 of these patients. Cine CMR, TMRI and STE were analyzed to obtain longitudinal strain. LGE-CMR datasets were analyzed to evaluate scar extent. Comparison of peak systolic strain (PSS) measured from CMR and TMRI yielded a strong correlation (r=0.86, pcine CMR data. The method was found to be highly correlated with strain measurements obtained by TMRI and STE. This tool allows accurate discrimination between different transmurality states of myocardial infarction. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1,493 consecutive patients: assessment of myocardial wall motion and perfusion.

    Science.gov (United States)

    Korosoglou, Grigorios; Elhmidi, Yacine; Steen, Henning; Schellberg, Dieter; Riedle, Nina; Ahrens, Johannes; Lehrke, Stephanie; Merten, Constanze; Lossnitzer, Dirk; Radeleff, Jannis; Zugck, Christian; Giannitsis, Evangelos; Katus, Hugo A

    2010-10-05

    This study sought to determine the prognostic value of wall motion and perfusion assessment during high-dose dobutamine stress (DS) cardiac magnetic resonance imaging (MRI) in a large patient cohort. DS-MRI offers the possibility to integrate myocardial perfusion and wall motion analysis in a single examination for the detection of coronary artery disease (CAD). A total of 1,493 consecutive patients with suspected or known CAD underwent DS-MRI, using a standard protocol in a 1.5-T magnetic resonance scanner. Wall motion and perfusion were assessed at baseline and during stress, and outcome data including cardiac death, nonfatal myocardial infarction ("hard events"), and "late" revascularization performed >90 days after the MR scans were collected during a 2 ± 1 year follow-up period. Fifty-three hard events, including 14 cardiac deaths and 39 nonfatal infarctions, occurred during the follow-up period, whereas 85 patients underwent "late" revascularization. Using multivariable regression analysis, an abnormal result for wall motion or perfusion during stress yielded the strongest independent prognostic value for both hard events and late revascularization, clearly surpassing that of clinical and baseline magnetic resonance parameters (for wall motion: adjusted hazard ratio [HR] of 5.9 [95% confidence interval (CI): 2.5 to 13.6] for hard events and of 3.1 [95% CI: 1.7 to 5.6] for late revascularization, and for perfusion: adjusted HR of 5.4 [95% CI: 2.3 to 12.9] for hard events and of 6.2 [95% CI: 3.3 to 11.3] for late revascularization, p < 0.001 for all). DS-MRI can accurately identify patients who are at increased risk for cardiac death and myocardial infarction, separating them from those with normal findings, who have very low risk for future cardiac events. (Prognostic Value of High Dose Dobutamine Stress Magnetic Resonance Imaging; NCT00837005). Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Re-initiating professional working activity after myocardial infarction in primary percutaneous coronary intervention networks era

    Directory of Open Access Journals (Sweden)

    Zdravko Babić

    2015-12-01

    Full Text Available Objectives: To investigate the aspects of return to work, socio-economic and quality of life aspects in 145 employed patients under 60 years of age treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Material and Methods: During hospital treatment demographic and clinical data was collected. Data about major adverse cardiovascular events, rehabilitation, sick leave, discharge from job and retirement, salary, major life events and estimation of quality of life after myocardial infarction were obtained after follow-up (mean: 836±242 days. Results: Average sick leave was 126±125 days. Following myocardial infarction, 3.4% of patients were discharged from their jobs while 31.7% retired. Lower salary was reported in 17.9% patients, major life events in 9.7%, while 40.7% estimated quality of life as worse following the event. Longer hospitalization was reported in patients transferred from surrounding counties, those with inferior myocardial wall and right coronary artery affected. Age, hyperlipoproteinemia and lower education degree were connected to permanent working cessation. Significant salary decrease was observed in male patients. Employer type was related to sick leave duration. Impaired quality of life was observed in patients who underwent in-hospital rehabilitation and those from surrounding counties. Longer sick leave was observed in patients with lower income before and after myocardial infarction. These patients reported lower quality of life after myocardial infarction. Conclusions: Inadequate health policy and delayed cardiac rehabilitation after myocardial infarction may lead to prolonged hospitalization and sick leave as well as lower quality of life after the event, regardless of optimal treatment in acute phase of disease.

  20. Re-initiating professional working activity after myocardial infarction in primary percutaneous coronary intervention networks era.

    Science.gov (United States)

    Babić, Zdravko; Pavlov, Marin; Oštrić, Mirjana; Milošević, Milan; Misigoj Duraković, Marjeta; Pintarić, Hrvoje

    2015-01-01

    To investigate the aspects of return to work, socio-economic and quality of life aspects in 145 employed patients under 60 years of age treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. During hospital treatment demographic and clinical data was collected. Data about major adverse cardiovascular events, rehabilitation, sick leave, discharge from job and retirement, salary, major life events and estimation of quality of life after myocardial infarction were obtained after follow-up (mean: 836±242 days). Average sick leave was 126±125 days. Following myocardial infarction, 3.4% of patients were discharged from their jobs while 31.7% retired. Lower salary was reported in 17.9% patients, major life events in 9.7%, while 40.7% estimated quality of life as worse following the event. Longer hospitalization was reported in patients transferred from surrounding counties, those with inferior myocardial wall and right coronary artery affected. Age, hyperlipoproteinemia and lower education degree were connected to permanent working cessation. Significant salary decrease was observed in male patients. Employer type was related to sick leave duration. Impaired quality of life was observed in patients who underwent in-hospital rehabilitation and those from surrounding counties. Longer sick leave was observed in patients with lower income before and after myocardial infarction. These patients reported lower quality of life after myocardial infarction. Inadequate health policy and delayed cardiac rehabilitation after myocardial infarction may lead to prolonged hospitalization and sick leave as well as lower quality of life after the event, regardless of optimal treatment in acute phase of disease. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  1. Myocardial revascularization in the elderly patient: with or without cardiopulmonary bypass?

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    Iglézias José Carlos Rossini

    2003-01-01

    Full Text Available OBJECTIVE: To verify if there is advantage in myocardial revascularization the elderly without cardiopulmonary bypass (CPB in relation to the use of the same, being considered the viability of complete myocardial revascularization (MR and the hospital morbidity and mortality. METHOD: We prospectively studied a hundred consecutive, no randomized patients, with age > or = 70 years, submitted to the primary and isolated myocardial revascularization between January and December of 2000. The patients were divided in two groups, G1 - 50 patients operated with CPB and G2 - 50 patients operated without CPB. Univariate testing of variables was performed with chi-squared analysis in the SPSS 10.0 Program and a p value less than 0.005 was considered significant. RESULTS: There was no renal failure or myocardial infarction (MI in both groups; the incidence of respiratory failure was identical in the two groups (4%; two patient of G1 they had Strokes, and 12 presented low output syndrome, occurrences not registered in G2. The need of ventilatory support > 24 hs was not significant between groups. Medium time of hospital stay was 21.8 and 11.7 days respectively (NS and the survival after 30 days were similar in the two groups. The patients' of G1 eighty percent had more than two approached arteries, against only 48% of G2 (p < 0.0001. CONCLUSION: Because the largest number of grafts in the patients of G1, we can affirm that the use of CPB can provide a larger probability of complete RM.

  2. Abnormal perfusion on myocardial perfusion SPECT in patients with Wolff-Parkinson-White syndrome

    International Nuclear Information System (INIS)

    Kang, Do Young; Cha, Kwang Soo; Han, Seung Ho; Park, Tae Ho; Kim, Moo Hyun; Kim, Young Dae

    2005-01-01

    Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkison-White) syndrome. Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECT with Fitzpatrick's algorithm of electrophysiologic study and radiofrequency catheter ablation. Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients(mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent (11.0 ± 8.5%, range:3 ∼ 35%) and mild to moderate severity (-71 ± 42.7%, range:-217 ∼ -39%) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patients with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but if did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome

  3. Abnormal perfusion on myocardial perfusion SPECT in patients with Wolff-Parkinson-White syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Do Young; Cha, Kwang Soo; Han, Seung Ho; Park, Tae Ho; Kim, Moo Hyun; Kim, Young Dae [Donga University College of Medicine, Busan (Korea, Republic of)

    2005-02-15

    Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkison-White) syndrome. Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECT with Fitzpatrick's algorithm of electrophysiologic study and radiofrequency catheter ablation. Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients(mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent (11.0 {+-} 8.5%, range:3 {approx} 35%) and mild to moderate severity (-71 {+-} 42.7%, range:-217 {approx} -39%) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patients with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but if did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome.

  4. Myocardial glucose utilisation in type II diabetes mellitus patients treated with sulphonylurea drugs

    International Nuclear Information System (INIS)

    Yokoyama, Ikuo; Inoue, Yusuke; Moritan, Toshiyuki; Ohtomo, Kuni; Nagai, Ryozo

    2006-01-01

    Chronic sulphonylurea treatment maintains improved glycaemic control through mechanisms other than enhancement of insulin secretion and may act on various organs. The aim of this study was to investigate whether the chronic use of sulphonylurea drugs influences PET measurement of myocardial glucose utilisation (MGU) in type II diabetes mellitus. Forty-two patients with type II diabetes mellitus and 17 control subjects underwent dynamic 18 F-FDG PET to measure MGU during hyperinsulinaemic euglycaemic clamping. Twenty-one patients had been taking sulphonylurea drugs for more than 1 year (SU group), and the other 21 patients were drug naive (non-SU group). The haemoglobin A1c levels in the two patient groups were similar. Glucose disposal rate (GDR) was also determined as a marker of whole-body insulin resistance. GDR in the SU group (9.01±2.53 mg min -1 kg -1 ) was significantly higher than that in the non-SU group (4.10±2.47, p -1 100 g -1 ) was significantly higher than that in the non-SU group (5.53±2.05, p<0.01) and was similar to that in the controls (7.49±2.74). (orig.)

  5. [Reduction of in-hospital mortality and improved secondary prevention after acute myocardial infarction. First results from the registry of secondary prevention after acute myocardial infarction (SAMI)].

    Science.gov (United States)

    Tebbe, U; Messer, C; Stammwitz, E; The, G S; Dietl, J; Bischoff, K-O; Schulten-Baumer, U; Tebbenjohanns, J; Gohlke, H; Bramlage, P

    2007-07-30

    In hospital mortality of acute myocardial infarction (AMI) has been reduced due to the availability of better therapeutic strategies. But there is still a gap between mortality rates in randomised trials and daily clinical practice. Thus, it was aim of the present registry to document the course and outcome of patients with AMI and to improve patient care by implementing recent guidelines. In a nationwide registry study in hospitals in Germany with a cardiology unit or an internal medicine department data on consecutive patients were recorded for six to twelve months at admission, discharge and during a follow-up of one year. From 02/2003 until 10/2004 a total of 5,353 patients with acute myocardial infarction (65.7 % male, mean age of 67.6 +/- 17.7 years; 55.1 % of them with ST elevation myocardial infarction (STEMI) were included in the registry. Of the patients with STEMI, 76.6 % underwent acute intervention, 37.1 % had thrombolysis, 69.7 % percutaneous transluminal coronary angioplasty (PTCA). 40.0 % of those with non-Stemi (NSTEMI) had an acute intervention, 6.6 % thrombolysis, 73.5 % PTCA. Recommended secondary prevention consisted of ASS (93.2 %), beta-blockers (93.0 %), CSE-inhibitors (83.5 %), ACE-inhibitors (80.9 %) and clopidogrel (74.0 %). In-hospital mortality was 10.5 % (STEMI) and 7.4 % (NSTEMI). The 9 % mortality among patients with acute myocardial infarction treated in the hospitals participating in the SAMI registry is low compared to that in similar collectives. The high number of patients who had thrombofibrinolysis and coronary interventions as well as the early initiation of drug therapy contributed to these results. Medical treatment in the prehospital phase of these patients remains still insufficient and to a substantial extent contributes to the mortality of acute myocardial infarction.

  6. Myocardial perfusion and left ventricular function during exercise evaluated by 201Tl myocardial scintigraphy and 99mTc radionuclide ventriculography in patients treated with PTCA

    International Nuclear Information System (INIS)

    Honda, Toshio; Jo, Tadafumi; Doiuchi, Junji

    1992-01-01

    To evaluate the effects of percutaneous transluminal coronary angioplasty (PTCA), we investigated myocardial ischemia and left ventricular function during exercise before and after successful PTCA in 30 patients. We used extent and severity scores of 201 thallium ( 201 Tl) exercise myocardial scintigraphy to assess myocardial ischemia and determined global and regional left ventricular ejection fraction (EF and REF) of 99m Tc-RBC exercise radionuclide ventriculography to assess left ventricular function. The extent and severity scores of stress images were significantly less after PTCA than before PTCA. The scores of the redistribution images were unchanged before and after PTCA. Global EF during exercise was significantly higher after PTCA than before PTCA. There was no difference in resting global EF between before and after PTCA. Myocardial ischemia induced by exercise was semi-quantitatively analyzed as transient perfusion defect with severity score. Severity score was significantly less after PTCA than before PTCA. ΔEF, which was obtained by subtraction of resting global EF from exercise one, was significantly higher after PTCA than before PTCA. However, the degree of improvement in myocardial ischemia and left ventricular function varied from patient to patient. In 17 patients with one-vessel left anterior descending artery disease, ΔREF, which was determined by subtracting resting regional EF from exercise one, was significantly higher in septal and apical segments after PTCA than before PTCA. Myocardial ischemia and left ventricular function under exercise were alleviated by PTCA. However, the degree of improvement varied from patient to patient and it might have been affected by various factors including coronary dissection, edema, thrombus, restenosis, spasm, side branch stenosis or occlusion, distal thrombus, and myocardial hibernation. (author)

  7. BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia.

    Science.gov (United States)

    Manka, Robert; Paetsch, Ingo; Schnackenburg, Bernhard; Gebker, Rolf; Fleck, Eckart; Jahnke, Cosima

    2010-09-22

    The purpose of this study was to determine the ability of blood oxygen level dependent (BOLD) cardiovascular magnetic resonance (CMR) to detect stress-inducible myocardial ischemic reactions in the presence of angiographically significant coronary artery disease (CAD). Forty-six patients (34 men; age 65 ± 9 years,) with suspected or known coronary artery disease underwent CMR at 3Tesla prior to clinically indicated invasive coronary angiography. BOLD CMR was performed in 3 short axis slices of the heart at rest and during adenosine stress (140 μg/kg/min) followed by late gadolinium enhancement (LGE) imaging. In all 16 standard myocardial segments, T2* values were derived at rest and under adenosine stress. Quantitative coronary angiography served as the standard of reference and defined normal myocardial segments (i.e. all 16 segments in patients without any CAD), ischemic segments (i.e. supplied by a coronary artery with ≥50% luminal narrowing) and non-ischemic segments (i.e. supplied by a non-significantly stenosed coronary artery in patients with significant CAD). Coronary angiography demonstrated significant CAD in 23 patients. BOLD CMR at rest revealed significantly lower T2* values for ischemic segments (26.7 ± 11.6 ms) compared to normal (31.9 ± 11.9 ms; p BOLD CMR at 3Tesla proved feasible and differentiated between ischemic, non-ischemic, and normal myocardial segments in a clinical patient population. BOLD CMR during vasodilator stress identified patients with significant CAD.

  8. Value of Tl-201 in evaluating myocardial damage and ischemia in transplant patients

    International Nuclear Information System (INIS)

    Jazmati, B.; Tumeh, S.S.; Holman, L.B.

    1989-01-01

    Orthotopic heart transplant recipients suffer from graft rejection and accelerated coronary artery disease. The authors have evaluated 29 recipients of orthotopic heart transplants who had multiple biopsy-proved episodes of rejection and underwent annual T1-201 exercise myocardial scintigraphy and coronary angiography. Of 43 pairs of nuclear scans and coronary angiograms, 39 showed normal radiotracer uptake and coronary arteries. In four scans, there were ischemic changes, and in only one case was there significant two-vessel coronary artery disease. The nuclear scans correlated with the coronary angiograms in 93% of the cases. The authors conclude that T1-201 myocardial scintigraphy is insensitive in the early detection of graft rejection and can reliably rule out significant coronary artery disease in transplant recipients

  9. Silent ischemia in patients after uncomplicated myocardial infarction

    International Nuclear Information System (INIS)

    Samarzija, M.; Tezak, S.

    1994-01-01

    The purpose of this study was to determine the frequency and importance of silent ischemia in patients (pts) after the acute myocardial infarction (A MI) as well as to establish diagnostic and prognostic value of exercise stress test (EST), Holter (H) monitoring and thallium-201 (Tl) scintigraphy. All the three tests were performed 2-4 months following the AMI. The criterion for diagnosing myocardial ischemia on EST and H is 1 mm or more of horizontal or down-sloping ST depression. Additional criteria for Holter imply the ischemic episode should last one minute and be separated from other episodes by at least one minute. Planar thallium images were performed 5-10 minute after the stress test; the delayed images were obtained after 3-6 hours. Visual and quantitative methods were employed in the analysis of TI-scintigraphy. Scintigraphy was considered positive if exercise- induced perfusion defects showed redistribution. The study included 74 asymptomatic patients after the AMI. The patients were divided into two groups by results of quantitative Tl-scintigraphy: Group I - 44 pts with silent ischemia, Group II - 30 pts without ischemia. In Group I, out of 44 pts, 9 had a positive exercise stress, 4 showed a painless ST depression on Holter and 7 had both tests positive, whereas 24 pts had only scintigraphy positive. In Group II one patient had positive EST and H. Sensitivity and specificity were determined by results of coronary arteriography performed on 33 pts: EST (Se=40%, Sp=80%), H (Se=219, Sp=100%) and scintigraphy (Se=93%, Sp =80%). During the follow-up period lasting at least 12 months, in Group I 3 pts died, 1 developed a new myocardial infarction and 15 pts had painful ischemic occurrences. In Group II only 3 pts developed symptoms of angina pectoris. Tl-scintigraphy was the only non-invasive test showing significant correlation with the follow-up outcomes. The diagnostic and prognostic superiority of Tl-scintigraphy justifies its value as the initial

  10. Depression in myocardial infarction patients at Ayub Teaching Hospital Abbottabad

    International Nuclear Information System (INIS)

    Maqsood, S.; Khan, M.N.; Hayat, U.

    2017-01-01

    There is a considerably high prevalence of depression in post myocardial infarction (MI) patients. This study was designed with an aim to detect depression in patients with acute MI admitted to the CCU at Ayub Teaching Hospital Abbottabad. Methods: This descriptive cross-sectional study enrolled 246 male and female patients with acute MI. The patients were interviewed on the 3rd day of admission and their answers were marked according to the HADS-D scale. Results: With a cut-off score of 11, the frequency of depression in study participants was 27.24% (n=67). No statistically significant association was found between the age and sex of patients and depression. Conclusion: Depression is fairly common following acute MI and the management plans should include a consultation with psychiatric for individualized management of depression in post myocardial infarction patients. (author)

  11. Comparative study of adenosine and exercise 201Tl myocardial perfusion tomographic imaging for detection of coronary heart disease

    International Nuclear Information System (INIS)

    Wang Xiong

    1997-01-01

    To compare diagnostic accuracy of adenosine and exercise 201 Tl myocardial perfusion tomographic imaging for detection of coronary heart disease (CHD) in patients with a normal rest ECG and no history of myocardial infarction, 81 patients with CHD and 10 normal control subjects underwent adenosine myocardial perfusion imaging, exercise nuclide myocardial perfusion imaging was performed in 117 patients with CHD and 16 normal control subjects, two groups also had coronary arteriography. Both exercise and adenosine testing parameters were analysed. It is shown: 1) The sensitivity and specificity for detection of CHD were 79% vs 80% for adenosine group and 81% vs 81% for exercise myocardial perfusion imaging group respectively. There was no significant difference in comparison with two matched groups (χ 2 = 1.13, χ 2 = 0.18, χ 2 = 0.12, P>0.05). 2) Side effects induced by adenosine accounted for 89% of patients, all symptoms were mild and disappeared quickly after the termination of the study except in 2 cases withdrawal of infusion needed because of severe angina pectoris. Adenosine myocardial perfusion imaging is a safe and sensitive method for detection of CHD. The diagnostic value of adenosine test is similar to that of exercise myocardial perfusion imaging and particularly useful in evaluating patients unable to perform exercise test or achieve adequate level of exercise

  12. Comparing Cognitive and Somatic Symptoms of Depression in Myocardial Infarction Patients and Depressed Patients in Primary and Mental Health Care

    NARCIS (Netherlands)

    Groenewold, Nynke A.; Doornbos, Bennard; Zuidersma, Marij; Vogelzangs, Nicole; Penninx, Brenda W. J. H.; Aleman, Andre; de Jonge, Peter

    2013-01-01

    Depression in myocardial infarction patients is often a first episode with a late age of onset. Two studies that compared depressed myocardial infarction patients to psychiatric patients found similar levels of somatic symptoms, and one study reported lower levels of cognitive/affective symptoms in

  13. Predictive Risk Factors for Upper Gastrointestinal Bleeding with Simultaneous Myocardial Injury

    Directory of Open Access Journals (Sweden)

    I-Chen Wu

    2007-01-01

    Full Text Available The aims of this study were to: (1 evaluate the epidemiology of simultaneous upper gastrointestinal bleeding (UGIB and myocardial injury using parameters including troponin I (TnI; and (2 investigate the predictive risk factors of this syndrome. One hundred and fifty-five patients (101 men, 54 women; mean age, 64.7 ± 10.4 years; range, 38–94 years at the emergency department (ED with the major diagnosis of UGIB were included. They underwent serial electrocardiography (ECG and cardiac enzyme follow-up. Emergent gastroendoscopy was performed within 24 hours in most patients except for those who refused or were contraindicated. Mild myocardial injury was defined as the presence of any of the following: typical ST-T change on ECG, elevated creatine kinase-MB (CK-MB > 12U/L, or TnI > 0.2ng/dL. Moderate myocardial injury was defined as the presence of any two of the previously mentioned conditions. In total, 51 (32.9% and 12 (7.74% patients developed mild and moderate myocardial injuries, respectively. Myocardial injury was more common among patients with variceal bleeding (20/25 = 80.0% than those with ulcer bleeding (23/112 = 20.5%. It could partially be attributed to a higher baseline TnI level in cirrhotic patients. After adjusting for significant risk factors revealed by the univariate analysis, UGIB patients with a history of liver cirrhosis and more than three cardiac risk factors comprised a high-risk group for simultaneously developing myocardial injury. Other factors including age, gender, the color of nasogastric tube irrigation fluid, history of nonsteroidal anti-inflammatory drug use, vasopressin or terlipressin administration, vital signs, and creatinine recorded at the ED were not significant predictors. Those who developed myocardial injury had a longer hospital stay (mean duration, 8.73 ± 6.94 vs. 6.34 ± 2.66 days; p = 0.03 and required transfusion of more units of packed erythrocytes.

  14. Myocardial fatty acid utilisation during exercise induced ischemia in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Virtanen, K.S.; Nikkinen, P.; Lindroth, L.; Kuikka, J.T.

    2002-01-01

    Aim: Reversible or irreversible myocardial damage due to ischemia correlates with altered membrane functions of the cells. To compare myocardial free fatty acid (FFA) metabolism and flow during exercise induced ischemia we studied ten patients with coronary artery disease but without previous myocardial infarction. Methods: A series of post-exercise single-photon emission computed tomography (SPECT) measurements was performed after injection of 123 I labelled heptadecanoic acid (HDA). Myocardial perfusion was estimated from the separately performed exercise-redistribution thallium study. Fatty acid metabolic rate, thallium uptake and washout were calculated for anterior, lateral, posterior and septal segments. Results: The more reduced post-exercise FFA metabolic rate (-63±18%, mean ±1 SD) compared to flow (-36±16%) was related to the severity of myocardial ischemia and wall motion abnormalities. Conclusion: In this small group of patients, the reduced post-exercise FFA metabolic rate tentatively suggests a parsimonious workload of the exercising myocardium by reducing oxygen consumption in patients with coronary artery disease. (orig.) [de

  15. Emotions delay care-seeking in patients with an acute myocardial infarction.

    Science.gov (United States)

    Nymark, Carolin; Mattiasson, Anne-Cathrine; Henriksson, Peter; Kiessling, Anna

    2014-02-01

    In acute myocardial infarction the risk of death and loss of myocardial tissue is at its highest during the first few hours. However, the process from symptom onset to the decision to seek medical care can take time. To comprehend patients' pre-hospital delay, attention must be focused on the circumstances preceding the decision to seek medical care. To add a deeper understanding of patients' thoughts, feelings and actions that preceded the decision to seek medical care when afflicted by an acute myocardial infarction. Fourteen men and women with a first or second acute myocardial infarction were interviewed individually in semi-structured interviews. Data were analysed by qualitative content analysis. Four themes were conceptualized: 'being incapacitated by fear, anguish and powerlessness', 'being ashamed of oneself', 'fear of losing a healthy identity' and 'striving to avoid fear by not interacting with others'. Patients were torn between feelings such as anguish, fear, shame and powerlessness. They made an effort to uphold their self-image as being a healthy person thus affected by an unrecognized discomfort. This combined with a struggle to protect others from involvement, strengthened the barriers to seeking care. The present study indicates that emotional reactions are important and influence patients' pre-hospital behaviour. Being ashamed of oneself stood out as a novel finding. Emotions might be an important explanation of undesired and persisting patient delays. However, our findings have to and should be evaluated quantitatively. Such a study is in progress.

  16. Effect of loading-dose ticagrelor on coronary blood flow, left ventricular remodeling and myocardial enzyme spectrum in patients with acute myocardial infarction after interventional therapy

    Directory of Open Access Journals (Sweden)

    Xiao-Rui Xie

    2016-12-01

    Full Text Available Objective: To study the effect of loading-dose ticagrelor on coronary blood flow, left ventricular remodeling and myocardial enzyme spectrum in patients with acute myocardial infarction after interventional therapy. Methods: A total of 86 patients with acute myocardial infarction who received emergency PCI in our hospital between May 2013 and May 2016 were selected and randomly divided into two groups, ticagrelor group received perioperative ticagrelor therapy and clopidogrel group received perioperative clopidogrel therapy. After PCI, coronary blood flow reperfusion was evaluated, serum myocardial remodeling indexes and myocardial enzymes were determined, and cardiac color Doppler ultrasonography was conducted to determine the cardiac function indexes. Results: TIMI grading and TMPG grading of ticagrelor group after PCI were significantly higher than those of clopidogrel group; serum MMP9, BNP, CITP, PICP, PIIINP, CK, CK-MB, cTnI and cTnT content of ticagrelor group 24h after operation were significantly lower than those of clopidogrel group; LVEDD, LVSED and LVMI of ticagrelor group 2 weeks after operation were significantly lower than those of clopidogrel group while LVEF was significantly higher than that of clopidogrel group. Conclusion: Peri-PCI loading-dose ticagrelor can improve coronary blood perfusion and reduce ventricular remodeling and myocardial injury in patients with acute myocardial infarction.

  17. Clinical significance of technetium-99m stannous pyrophosphate myocardial scintigrams in patients with acute and old myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Kanazawa, Ikuo; Eno, Shin; Takeuchi, Masaaki

    1987-08-01

    Seventy-five consecutive patients with acute (43) or old (32) myocardial infarction (AMI, OMI) have been examined by myocardial scintiscanning with technetium-99m stannous pyrophosphate (PYP). Using Parker's classification, the PYP scans were graded as positive in 56 % of the AMI patients; in restricting to the PYP scans obtained within the first 3 days after the onset, the positive rate was 86 %. Positive or negative PYP scans for the AMI patients were independent of maximum creatine phosphokinase and infarct site. For OMI patients, the PYP scans were positive in 41 %, with decreased left ventricular function being more common than those having negative PYP scans. In the group of positive scans, clinical manifestations tended to be remarkable, which were likely due to persistent cardiac ischemia during chronic stage. (Namekawa, K.).

  18. Selective cerebro-myocardial perfusion in complex congenital aortic arch pathology: a novel technique.

    Science.gov (United States)

    De Rita, Fabrizio; Lucchese, Gianluca; Barozzi, Luca; Menon, Tiziano; Faggian, Giuseppe; Mazzucco, Alessandro; Luciani, Giovanni Battista

    2011-11-01

    Simultaneous cerebro-myocardial perfusion has been described in neonatal and infant arch surgery, suggesting a reduction in cardiac morbidity. Here reported is a novel technique for selective cerebral perfusion combined with controlled and independent myocardial perfusion during surgery for complex or recurrent aortic arch lesions. From April 2008 to April 2011, 10 patients with arch pathology underwent surgery (two hypoplastic left heart syndrome [HLHS], four recurrent arch obstruction, two aortic arch hypoplasia + ventricular septal defect [VSD], one single ventricle + transposition of the great arteries + arch hypoplasia, one interrupted aortic arch type B + VSD). Median age was 63 days (6 days-36 years) and median weight 4.0 kg (1.6-52). Via midline sternotomy, an arterial cannula (6 or 8 Fr for infants) was directly inserted into the innominate artery or through a polytetrafluoroethylene (PTFE) graft (for neonates cerebro-myocardial perfusion was 39 ± 18 min (17-69). Weaning from cardiopulmonary bypass was achieved without inotropic support in three and with low dose in seven patients. One patient required veno-arterial extracorporeal membrane oxygenation. Four patients, body weight cerebro-myocardial perfusion is feasible in patients with complex or recurrent aortic arch disease, starting from premature newborn less than 2.0 kg of body weight to adults. The technique is as safe as previously reported methods of cerebro-myocardial perfusion and possibly more versatile. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  19. [Myocardial bridge as the only cause of acute coronary syndrome among the young patients].

    Science.gov (United States)

    Miakinkova, Liudmila O; Teslenko, Yurii V; Tsyhanenko, Irina V

    2018-01-01

    Introduction: Myocardial bridge is an inborn anomaly of coronary artery development, when a part of it is submerged in a myocard, which is pressing the coronary artery to a systola and restrains coronary blood circulation. Generally this feature of coronary blood circulation does not cause any clinical symptoms because the 85% of coronary blood stream of the left ventricle is provided by diastolic filling. Hemodynamic changes in atherosclerosis, tahicardie, hypertrophie of myocard are leading to the manifestation of clinical symptoms of ischemia. The aim: The purpose of the investigation was to discover the features of clinical development of acute coronary syndrome caused by myocardial bridge of young patients without the features of atherosclerotical harm of coronary arteries. Materials and methods: Eight causes of acute coronary syndrome among patients of 28±8,5 years with myocardial bridge which was revealed during coronary angiography, were investigated. Standardized examination and conservative treatment of patients was held, except for three who have got interventional therapy. Results: According to our investigation, myocardial bridge of all investigated patients was located in the middle of the third front interventricular branch of the left coronary artery. Causes of acute coronary syndrome manifestation were tahicardia, spasms of coronary artery, inducted by iatrogenic factors hypertrophie of myocard, hypertrophic cardiomyopatie. Connection between the manifestation of clinical symptoms and length of tunneled segment which did not depend on the level of systolic compres was discovered. The results of conservative and interventional treatment were analyzed. Conclusions: Myocardial bridge can be the cause of myocardial ischemia among patients without signs of coronary atherosclerosis with additional hemodynamic risk facts such as tahicardia, spasms of coronary artery, hypertrophie of myocard. Clinical symptomatology of the acute coronary syndrome is more

  20. Regional left ventricular myocardial contraction abnormalities and asynchrony in patients with hypertrophic cardiomyopathy evaluated by magnetic resonance spatial modulation of magnetization myocardial tagging

    International Nuclear Information System (INIS)

    Mishiro, Yuichiro; Oki, Takashi; Iuchi, Arata

    1999-01-01

    Global left ventricular (LV) pump function is generally preserved in patients with hypertrophic cardiomyopathy (HCM). However, it is unknown whether regional myocardial contractility is impaired, especially in nonhypertrophied regions. The purpose of this study was to evaluate regional LV myocardial contraction in patients with HCM using magnetic resonance (MR) spatial modulation of magnetization (SPAMM) myocardial tagging. The study group comprised 20 patients with asymmetric septal hypertrophy (HCM group) and 16 age-matched normal patients (control group), and data were collected using transthoracic M-mode and 2-dimensional echocardiography, and MR SPAMM myocardial tagging. The systolic strain ratio, maximum systolic strain velocity, and time from end-diastole to maximum systolic strain (ΔT) in the anterior, ventricular septal, inferior and lateral regions for 2 LV short-axis sections at the levels of the chordae tendineae and papillary muscles were measured at 50-ms intervals by MR myocardial tagging. The end-diastolic anterior and ventricular septal wall thicknesses and LV mass index were significantly different between the HCM and control groups. The systolic strain ratio for all 4 walls, particularly the anterior and ventricular septal regions, was significantly lower in the HCM group. In the HCM group, the maximum systolic strain velocity was significantly lower and ΔT was significantly shorter for all 4 walls, particularly the anterior and ventricular septal regions. The standard deviation for the ΔT, calculated from the ΔT for the 8 regions of the 2 LV short-axis sections, was significantly greater in the HCM group. In conclusion, regional LV myocardial contraction is impaired in both hypertrophied and nonhypertrophied regions, and systolic LV wall asynchrony occurs in patients with HCM. (author)

  1. Worsening atrioventricular conduction after hospital discharge in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the HORIZONS-AMI trial.

    Science.gov (United States)

    Kosmidou, Ioanna; Redfors, Björn; McAndrew, Thomas; Embacher, Monica; Mehran, Roxana; Dizon, José M; Ben-Yehuda, Ori; Mintz, Gary S; Stone, Gregg W

    2017-11-01

    The chronic effects of ST-segment elevation myocardial infarction (STEMI) on the atrioventricular conduction (AVC) system have not been elucidated. This study aimed to evaluate the incidence, predictors, and outcomes of worsened AVC post-STEMI in patients treated with a primary percutaneous coronary intervention (PCI). The current analysis included patients from the HORIZONS-AMI trial who underwent primary PCI and had available ECGs. Patients with high-grade atrioventricular block or pacemaker implant at baseline were excluded. Analysis of ECGs excluding the acute hospitalization period indicated worsened AVC in 131 patients (worsened AVC group) and stable AVC in 2833 patients (stable AVC group). Patients with worsened AVC were older, had a higher frequency of hypertension, diabetes, renal insufficiency, previous coronary artery bypass grafting, and predominant left anterior descending culprit lesions. Predictors of worsened AVC included age, hypertension, and previous history of coronary artery disease. Worsened AVC was associated with an increased rate of all-cause death and major adverse cardiac events (death, myocardial infarction, ischemic target vessel revascularization, and stroke) as well as death or reinfarction at 3 years. On multivariable analysis, worsened AVC remained an independent predictor of all-cause death (hazard ratio: 2.005, confidence interval: 1.051-3.827, P=0.0348) and major adverse cardiac events (hazard ratio 1.542, confidence interval: 1.059-2.244, P=0.0238). Progression of AVC system disease in patients with STEMI treated with primary PCI is uncommon, occurs primarily in the setting of anterior myocardial infarction, and portends a high risk for death and major adverse cardiac events.

  2. Clinical studies on the thallium-201 myocardial scintiphotography in patient with ischemic heart disease

    International Nuclear Information System (INIS)

    Owada, Kenji

    1980-01-01

    Thallium-201 myocardial scintiphotography was performed in 41 patients with myocardial infarction, 13 with angina pectoris and 12 without coronary artery disease. 1) In patients with congestive heart failure, blood clearance of 201 Tl was delayed and radioactivity on the lung area increased compared with normal cases. 2) The scintillation camera image on a globular model containing 0.5 mCi of 201 Tl was recorded in a magnetic disk as 64 * 64 matrix. Myocardial area was estimated as an area where the count showed more than 55% of maximum counts of myocardium. On the myocardial area, cold area due to infarction was defined as an area where the count showed less than 70% of the maximum. 3) The infarct size (%) was calculated as an ratio of the number of matrix in cold area against to myocardial area on the images of ANT, LAO, and LAT view. The mean infarct size (%) was larger in the patient with cardiomegaly (CTR >= 55%) than those without it, and it was larger in the patients with high values of serum CPK or LDH than in those with low values of them. 4) The correlation coefficient between the mean infarct size (%) and direction of QRS vector at the maximum, 20 msec and 40 msec were r = 0.780, 0.672 and 0.766, respectively. 5) Mean values of MBF/CO (%) ratio were showing significant low in myocardial infarction and in angina pectoris. 6) The mean value of Myocardial blood flow (MBF) was showing significant low in myocardial infarction and in angina pectoris. MBF (ml/min/m 2 ) value expressed the states of coronary blood flow better than MBF/CO (%). (J.P.N.)

  3. Clinical studies on myocardial perfusion imaging in patients with right ventricular overload

    International Nuclear Information System (INIS)

    Abo, Kenji; Yamagata, Takashi; Nakajima, Masao; Fujita, Kimiaki; Morita, Nobuo

    1979-01-01

    Patients with heart disease which had been clinically diagnosed underwent 201 Tl myocardial perfusion imaging. The thickness of right ventricular wall measured from original images was directly proportional to systolic pressure of the right ventricle measured by cardiac catheterization, and 201 Tl activity in the right ventricle was more directly proportional to systolic pressure of the right ventricle. Imaging patterns of various diseases were also described. Images of patients with hypertrophic cardiomyopathy revealed that right ventricular wall was thin and right ventricular cavity was small, but the thickness of septal wall and left ventricular wall were maximal. Images of patients with mitral insufficiency revealed that the thickness of right ventricular wall, septal wall, and left ventricular wall was medium, and the right ventricular cavity was smaller than the left ventricular cavity. Images of patients with congestive cardiomyopathy and congestive cardiac failure showed that enlargement of both ventricular cavities was disproportionate to the thickness of each wall. Images of patients with arterial septal defect revealed that the thickness of each wall was comparatively normal, the right ventricular cavity was maximal, and the left ventricular cavity was minimal. Images of patients with primary pulmonary hypertention, pulmonary stenosis and tetralogy of Fallot in whom pressure overload was recognized revealed severe thickenings of right ventricular wall, moderate enlargement of the right ventricle, small left ventricle, and thin left ventricular wall. (Tsunoda, M.)

  4. Changes in somatotropic hormone secretion in patients with acute myocardial infarct

    International Nuclear Information System (INIS)

    Milanov, S.; Milkov, V.; Atanasov, I.; Sotirov, I.; Kamenova, Ts.

    1982-01-01

    Secretion of somatotropic hormone (STH) was estimated by radioimmunoassay during intravenous glucose-tolerance test (IGTT) in 17 patients with acute myocardial infarct (AMI) and 10 patients with chronic ischemic heart disease, without evidence of recent myocardial infarct. In both groups of patients the basal STH levels were elevated, as compared to those in normal individuals, with statistical significance (p<0.001). During the IGTT, somatotropic hormone in AMI patients was slightly reduced, which was out of proportion to the blood glucose changes. During IGTT in patients with chronic ischemic heart disease, the somatotropic hormone secretion, though increased, followed the blood glucose changes. These changes in STH secretion during IGTT in AMI patients are indicative of impaired hypothalamo-pituitary interrelations mediated by central nervous route. (author)

  5. The prognostic value of 99MTc-MIBI stress-rest myocardial perfusion imaging in patients suspected with coronary artery disease

    International Nuclear Information System (INIS)

    Wu Zhifang; Li Sijin; Liu Jianzhong; Zhang Wanchun

    2004-01-01

    Objective: To evaluate the prognostic value of 99mTc-MIBI stress-rest myocardial perfusion imaging (MPI) for patients suspected with coronary artery disease (CAD). Methods: 206 consecutive patients suspected with CAD (165 males, 41 females; age range 16-90 years, mean age 55.94±12.46 years) underwent 99mTc-MIBI stress-rest myocardial perfusion imaging (two days protocol), 57 pts with hypertension, 68 pts with hyperlipemia, 39 pts with diabetes and 62 pts with the family history of CAD. According to the imaging results, the 206 patients were divided into 3 groups. G1, normal, 135 pts; G2, reversible defects, 20 pts; G3, fixed defects, 51 pts. The mean time of follow-up was 33.25±14.95 (1-56) months. Results: The rate of cardiac events (CE) occurrence of the three groups was 1.5% (2/135), 65% ( 13/20) and 7.8% (4/51) respectively and there was significant difference between them. Kaplan-Meier survival curves analyzing the no-CE rates in the three groups, ischemic patients demonstrated a more significantly lower than normal and infarction ones in the no-CE rates(Log-rank statistic, chi-square 124.89, P <0.0001). The better predictor of future cardiac events is the reversible defect. Over all, 23.9% of the patients with abnormal stress MPI occurred cardiac events, but only 7.5% of the patients with abnormal rest ones did(chi-square 5.80, P =0.016). The prognoses of patients with normal stress MPI result were better than those with normal rest ones (1.5% versus 9.7%, chi-square 8.94, P =0.0028). Compared with rest MPI, the stress one is a better predictable method to analyze the patient' s condition and evaluate the prognosis. Conclusions: 99mTc-MIBI stress-rest myocardial perfusion imaging is a better Methods to evaluate the prognosis of patients suspected with CAD, and the rate of CE occurrence was 65% in reversible defects patients in this study. (authors)

  6. Effects of Cardiac Rehabilitation on Sexual Dysfunction of Post Myocardial Infarction Patients

    Directory of Open Access Journals (Sweden)

    Jamshid Najafian

    2001-01-01

    Full Text Available Objective: The common sexual complains in patients with coronary heart disease and post myocardial infarction are decrease in libido, impotence, and premature or delay ejaculation. Cardiac rehabilitation could decrease many of the psychological features of myocardial infarction and also increase exercise capacity of patients. Rehabilitation may also improve sexual disturbances in these patients directly or indirectly. This study is a clinical trial that evaluate the effect of rehabilitation on sexual problem of post MI patients. Materials & Methods: 60 patients took part in this study. All of them were men aged between 35 and 65. All patients had myocardial infarction one month ago. 30 patients were referred for cardiac rehabilitation (Case, and 30 people were patients who were not recommended to take part in rehabilitation because their physician did not believe on rehabilitation. Questioner for anxiety, depression, impotency, libido and premature ejaculation were evaluated by before and after study period. The cardiac rehabilitation composed of 24 sessions. Each session consisted of one hour of aerobic exercise (10 min warm up, 10 min cool down and 40 min isotonic exercise. Results: After cardiac rehabilitation the scores for anxiety, depression, premature ejaculation and impotency were decreased and the scores of libido were increased. In both case and control groups, the changes were significant by paired t test P<0.05. The differences between case and control were significant for depression, libido and impotency by independent t test. Conclusion: Cardiac rehabilitation could improve sexual problems in post myocardial infarction patients directly and indirectly by effect on psychological characteristics.

  7. Incidence of Bradycardia and Outcomes of Patients Who Underwent Orbital Atherectomy Without a Temporary Pacemaker.

    Science.gov (United States)

    Lee, Michael S; Nguyen, Heajung; Shlofmitz, Richard

    2017-02-01

    We analyzed the incidence of bradycardia and the safety of patients with severely calcified coronary lesions who underwent orbital atherectomy without the insertion of a temporary pacemaker. The presence of severely calcified coronary lesions can increase the complexity of percutaneous coronary intervention due to the difficulty in advancing and optimally expanding the stent. High-pressure inflations to predilate calcified lesions may cause angiographic complications like perforation and dissection. Suboptimal stent expansion is associated with stent thrombosis and restenosis. Orbital atherectomy safely and effectively modifies calcified plaque to facilitate optimal stent expansion. The incidence of bradycardia in orbital atherectomy is unknown. Fifty consecutive patients underwent orbital atherectomy from February 2014 to September 2016 at our institution, none of whom underwent insertion of a temporary pacemaker. The final analysis included 47 patients in this retrospective study as 3 patients were excluded because of permanent pacemaker implantation. The primary endpoint was significant bradycardia, defined as bradycardia requiring emergent pacemaker placement or a heart rate pacemaker appears to be safe.

  8. Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

    2016-01-01

    The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

  9. High fat diet-induced glucose intolerance impairs myocardial function, but not myocardial perfusion during hyperaemia: a pilot study

    Directory of Open Access Journals (Sweden)

    van den Brom Charissa E

    2012-06-01

    Full Text Available Abstract Background Glucose intolerance is a major health problem and is associated with increased risk of progression to type 2 diabetes mellitus and cardiovascular disease. However, whether glucose intolerance is related to impaired myocardial perfusion is not known. The purpose of the present study was to study the effect of diet-induced glucose intolerance on myocardial function and perfusion during baseline and pharmacological induced hyperaemia. Methods Male Wistar rats were randomly exposed to a high fat diet (HFD or control diet (CD (n = 8 per group. After 4 weeks, rats underwent an oral glucose tolerance test. Subsequently, rats underwent (contrast echocardiography to determine myocardial function and perfusion during baseline and dipyridamole-induced hyperaemia (20 mg/kg for 10 min. Results Four weeks of HFD feeding resulted in glucose intolerance compared to CD-feeding. Contractile function as represented by fractional shortening was not altered in HFD-fed rats compared to CD-fed rats under baseline conditions. However, dipyridamole increased fractional shortening in CD-fed rats, but not in HFD-fed rats. Basal myocardial perfusion, as measured by estimate of perfusion, was similar in CD- and HFD-fed rats, whereas dipyridamole increased estimate of perfusion in CD-fed rats, but not in HFD-fed rats. However, flow reserve was not different between CD- and HFD-fed rats. Conclusions Diet-induced glucose intolerance is associated with impaired myocardial function during conditions of hyperaemia, but myocardial perfusion is maintained. These findings may result in new insights into the effect of glucose intolerance on myocardial function and perfusion during hyperaemia.

  10. Effect of post-myocardial infarction streptokinase (sk) therapy, on myocardial viability - evaluation with thallium-201 single photon emission computed tomography (TL-201 SPECT)

    International Nuclear Information System (INIS)

    Shaikh, M.S.; Raza, M.; Kayani, A.M.; Fazal, I.

    2011-01-01

    To evaluate the effect of post-myocardial infarction Streptokinase therapy on myocardial viability, employing Thallium-201 single photon emission computed tomography (TL-201 SPECT). Design: Retrospective, experimental study. Place and duration of study: The Nuclear Cardiology Department, Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi, from 1 April, 2009 to 31 October, 2009. Patients and Methods: Male patients, who had suffered from acute myocardial infarction (AMI), in an area supplied by the left anterior descending (LAD) artery, had infarct-related electrocardiogram (ECG) changes and received or did not receive Streptokinase therapy, were included. Those with a normal ECG, or history of revascularisation, or non-ST elevation MI, or more than one MIs, were excluded. The patients were divided into groups 1 (who received Streptokinase) and 2 (who did not receive Streptokinase). Each group contained 42 patients and all underwent scintigraphic viability study through intravenous injection of 3.0 mCi (123 MBq) of TL-201, followed by rest-redistribution SPECT imaging on a dual head, dedicated cardiac gamma camera system (Philips Cardio MD). Emory's cardiac toolbox and AutoQUANT were used for data processing and quantitative estimation of viable myocardium. Empirical scores from 0 to 2 were assigned to each of the scans, in the order of increasing viability, and these were compared across the two groups. Result: Group 1 contained 42 patients (age range = 38 to 80 years, mean = 53.98 +- 11.26 years), in whom empirical viability scoring was done. Score 0 was seen in 2 patients, score 1 was seen in 15 patients and score 2 was seen in 25 patients form this group. Group 2 also contained 42 patients (age range = 38 to 80 years, mean = 56.71 +- 9.05 years), in whom viability score of 0 was seen in 3 patients, score 1 was seen in 11 patients and score 2 was seen in 28 patients form this group. Age difference between the two groups was

  11. Clinical Significance of Histological Features of Thrombi in Patients with Myocardial Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Sebben, Juliana Canedo; Cambruzzi, Eduardo; Avena, Luisa Martins; Gazeta, Cristina do Amaral; Gottschall, Carlos Antonio Mascia; Quadros, Alexandre Schaan de, E-mail: quadros.pesquisa@gmail.com [Instituto de Cardiologia / Fundação Universitária de Cardiologia - IC/FUC, Porto Alegre, RS (Brazil)

    2013-12-15

    Percutaneous Coronary Intervention (PCI) is the most common strategy for the treatment of Acute ST segment elevation Myocardial Infarction (STEMI), and thromboaspiration has been increasingly utilized for removal of occlusive thrombi. To analyze the influence of histopathological features of coronary thrombi in clinical outcomes of patients with STEMI, and the association of these variables with clinical, angiographic, and laboratory features and medications used in hospitalization. Prospective cohort study. All patients were monitored during hospitalization and thirty days after the event. Aspirated thrombi were preserved in formalin and subsequently stained with hematoxylin-eosin and embedded in paraffin. Thrombi were classified as recent and old. The primary outcome was the occurrence of major cardiovascular events within thirty days. During the study period, 1,149 patients were evaluated with STEMI, and 331 patients underwent thrombi aspiration, leaving 199 patients available for analysis. It was identified recent thrombi in 116 patients (58%) and old thrombi in 83 patients (42%). Recent thrombi have greater infiltration of red blood cells than old thrombi (p = 0.02), but there were no statistically significant differences between other clinical, angiographic, laboratory, and histopathological features and medications in both group of patients. The rates of clinical outcomes were similar in both groups. Recent thrombi were identified in 58% of patients with STEMI and it was observed an association with infiltration of red blood cells. There was no association between histopathological features of thrombi and clinical variables and cardiovascular outcomes.

  12. The relationship between coronary artery calcification detected by non-gated multi-detector CT in patients with suspected ischemic heart disease and myocardial ischemia detected by thallium exercise stress testing

    International Nuclear Information System (INIS)

    Nishida, Chikako; Okajima, Kaoru; Yamamoto, Takashi; Hattori, Ryuichi; Kudo, Takashi; Nishimura, Yasumasa

    2005-01-01

    The objective of this study was to examine whether we could predict myocardial ischemia when coronary artery calcification is detected by non-gated multidetector CT in patients with suspected ischemic heart disease. Eighty-three patients suspected of having ischemic heart disease (55 men, 28 women; age range 36-83 years; mean age 68 years) underwent multidetector CT and Tl-201 single photon emission computed tomography. Prediction of myocardial ischemia by coronary arterial calcification detected on CT was evaluated by comparing the coronary artery territories that showed calcification with the area of myocardial ischemia determined by SPECT. The sensitivity, specificity, positive predictive value, and negative predictive value of multidetector CT for predicting myocardial ischemia were calculated. Coronary angiography was also examined and compared with multidetector CT. Risk factors, including hypertension, smoking, hyperlipidemia, diabetes, and family history, were compared for evidence of coronary artery calcification detected by multidetector CT and myocardial ischemia detected by thallium nuclear scans. For analysis by patients, the sensitivity, specificity, positive predictive value, and negative predictive value of coronary artery calcification for myocardial ischemia detection were 65, 63, 56, and 71%, respectively. Similarly, for analysis by coronary arterial territories, those values were 56, 77, 41 and 86%, respectively. Coronary stenosis on CAG was also related to the ischemia determined by SPECT and calcification on multidetector CT. Ischemia was better influenced by risk factors than was coronary arterial calcification. For analysis by coronary arterial territories, the specificity and negative predictive value of coronary arterial calcification seen by multidetector CT are relatively high. (author)

  13. Hemodynamic pattern in myocardial infarction patients at the common stages of rehabilitation

    International Nuclear Information System (INIS)

    Perepech, N.B.

    1986-01-01

    Integrated body rheography, radiocardiography and radionuclide ventriculography were used to investigate hemodynamic changes in 101 myocardial infarction patients during the hospital stage of the disease. Changes in major hemodynamic parameters were demonstrated by the end of the 1st week and when walking was resumed. At the resumed-walking stage, the mechanism of declining stroke and cardiac indices was shown to depend on physical activation rates. Hemodynamic response is mostly conditioned by myocardial insufficiency when walking is resumed rapidly during the 2nd week, and by smaller venous return due to hypovolemia where it is resumed slowly during the 4th week. Expanding motion regimens at slow rates results in persistent hemodynamic disturbances in myocardial infarction patients

  14. Age-related in-hospital mortality among patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Abid, A.R.; Rafique, S.; Ahmed, R.Z.; Anjum, A.H.; Tarin, S.M.A.

    2004-01-01

    Objective: To evaluate the in-hospital mortality of acute myocardial infarction among different age groups. Subjects and Methods: The subjects were 460 admitted patients of acute myocardial infarction who fulfilled our inclusion criteria. Patients were divided into four age groups. Group-I included patients in 20-40 years, group-II (41-50 years), group-III (51-60 years) and group-IV (>60 years). Mortality was compared between different age groups by Chi-square and linear-regression models. Results: The total in-hospital mortality was 16.7%. It gradually increased from 5.6% in group-I (20-40 years) patients to 21% in group-IV (>60 years) patients. While mortality in groups group-II (41-50 years) and group-III (51-60 years) patients was 16.7% and 18.6% respectively. A marked increase in mortality was noted with increase in age. Group- IV (>60 years) patients presented 2 hours late to the hospital than the group-I (20-40 years) patients. There was no statistical difference in site of infarction in different age groups. Old age (group-IV i.e. >60 years old) was more associated with heart failure (higher Killip class) on presentation. Lesser number of patients in group-IV received thrombolytic therapy than group-I. Only 31.09% patients in group-IV and 62.5% patients in group-I received streptokinase therapy respectively. Conclusion: In patients with acute myocardial infarction age was a powerful independent predictor of in-hospital mortality and complications. (author)

  15. Detection of hibernating myocardium in patients with myocardial infarction by low-dose dobutamine echocardiography. Comparison with thallium-201 scintigraphy with reinjection

    International Nuclear Information System (INIS)

    Takagi, Tsutomu; Yoshikawa, Junichi; Yoshida, Kiyoshi; Akasaka, Takashi; Honda, Yasuhiro; Yonezawa, Yoshihiro; Shakudo, Masahiro

    1995-01-01

    The identification of hibernating myocardium is important for selecting patients who will benefit from coronary revascularization. The relationship between echocardiographic and radioisotopic markers of hibernating myocardium and postrevascularization recovery of myocardial function was investigated in 21 patients who underwent successful revascularization. Each patient underwent low-dose dobutamine stress echocardiography and thallium-201 ( 201 Tl) scintigraphy with reinjection before revascularization. The presence of contractile reserve in dobutamine stress echocardiography and Tl uptake in 201 Tl scintigraphy with reinjection were defined as markers of hibernating myocardium. Follow-up echocardiograms were evaluated for improved regional wall motion in all patients at a mean of 8.6 months after revascularization. Sensitivity, specificity, and positive and negative predictive values of low-dose dobutamine stress echocardiography for indicating recovery of function after revascularization were 75.0%, 77.8%, 81.8%, and 70.0%, respectively. Sensitivity, specificity, and positive and negative predictive values of 201 Tl scintigraphy with reinjection for indicating recovery of function after revascularization were 91.7%, 55.6%, 73.3%, and 83.3%, respectively. There were no statistical differences between low-dose dobutamine echocardiography and 201 Tl scintigraphy in predicting postrevascularization recovery of function in patients with hibernating myocardium. (author)

  16. Usefulness of {sup 201}Tl myocardial perfusion SPECT in prediction of left ventricular remodeling following an acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Seok Nam; Park, C. H.; Hwang, Kyung Hoon [Ajou Univ. College of Medicine, Suwon (Korea, Republic of)

    2000-02-01

    We investigated the role of myocardial perfusion SPECT in prediction of ventricular dilatation and the role of revascularization including thrombolytic therapy and PTCA in prevention of ventricular dilatation after an acute myocardial linfarction (AMI). We performed dipyridamole stress, 4 hour redistribution, and 24 hour reinjection Tl-201 SPECT in 6 patients with AMI two to nine days after attack. Perfusion and wall motion abnormalities were quantified by perfusion index(PI) and wall motion index (WMI). Left ventricular ejection fraction (LVEF), WMI and ventricular volume were measured within 1 week of AMI and after average of 6 months. According to serial changes of left ventricular end-diastolic volume (LVEDV), patients were divided into two groups. We compared WMI, PI and LVEF between the two groups. Relationships among degree of volume, stress-rest PI, WMI, CKMB,Q wave, LVEF and revascularization were analysed using multivariate analysis. Only initial rest perfusion index was significantly different between the two groups (p<0.05). While initial LVEF, stress PI, CKMB, trial of revascularization procedure, presence of Q wave and WMI were not significantly different between the two groups. Eight of 16 patients (50%) showed LV dilatation on follow-up echocardiography. Three of 3 patients (100%) who did not undergo revascualrization procedure documented LV dilatation. And only 5 (38%) of the remaining 13 patients who underwent revascularization revealed LV dilatation. There was no difference in infarct location between the two groups. By multivariate linear regression analysis in patients only undergoing revascularization, rest perfusion index was the only significant factor. Myocardial perfusion SPECT performed prior to revascularization was useful in prediction of LV dilatation after an AMI. Rest perfusion index on myocardial perfusion plays as a significant predictor of left ventricular dilatation after AMI. And revascularization appears to be a valuable

  17. Usefulness of 123I-BMIPP myocardial imaging in patients with stable effort angina and unstable angina

    International Nuclear Information System (INIS)

    Inoue, Seiji; Kobayashi, Hideki; Oka, Toshiaki; Kawaguchi, Masao; Momose, Mitsuru; Kasanuki, Hiroshi; Kusakabe, Kiyoko; Hosoda, Saichi

    1995-01-01

    We evaluated the clinical significance of myocardial imaging using 123 I-15-(p-iodophenyl)-3-methyl pentadecanoic acid (BMIPP) scintigraphy in patients with stable effort angina pectoris (SAP) and unstable angina pectoris (UAP). Thirty-three patients with SAP were studied using rest BMIPP and stress 201 TlCl (Tl) myocardial scintigraphy, and 13 patients with worsening effort type of UAP were also examined using both rest BMIPP and Tl scintigraphy. We compared those BMIPP findings with myocardial perfusion images obtained with Tl and the regional wall motion determined by left ventriculography. In 45% of 282 segments of myocardial ischemia of SAP, the degree of myocardial uptake of BMIPP was concordant with that of stress Tl and the defect score of Tl was higher than that of BMIPP. On the other hand, in 32% of 62 segments of ischemia of UAP, the degree of myocardial BMIPP and Tl uptake was concordant and BMIPP defect score was higher than Tl score. In SAP, the decrease in regional wall motion agreed better with the decrease in myocardial uptake of BMIPP than that of Tl. These results suggest that myocardial ischemic regions decreased BMIPP uptake show the disturbance of fatty acid metabolism and lead to abnormal wall motions. Such ischemic regions may be clinically severe state in patients with angina pectoris. (author)

  18. Myocardial CT perfusion imaging and SPECT for the diagnosis of coronary artery disease

    DEFF Research Database (Denmark)

    George, Richard T; Mehra, Vishal C; Chen, Marcus Y

    2014-01-01

    %, respectively, for SPECT. CONCLUSION: The overall performance of myocardial CT perfusion imaging in the diagnosis of anatomic CAD (stenosis ≥50%), as demonstrated with the Az, was higher than that of SPECT and was driven in part by the higher sensitivity for left main and multivessel disease.......PURPOSE: To compare the diagnostic performance of myocardial computed tomographic (CT) perfusion imaging and single photon emission computed tomography (SPECT) perfusion imaging in the diagnosis of anatomically significant coronary artery disease (CAD) as depicted at invasive coronary angiography....... MATERIALS AND METHODS: This study was approved by the institutional review board. Written informed consent was obtained from all patients. Sixteen centers enrolled 381 patients from November 2009 to July 2011. Patients underwent rest and adenosine stress CT perfusion imaging and rest and either exercise...

  19. Sex Differences in Mental Stress-Induced Myocardial Ischemia in Patients With Coronary Heart Disease.

    Science.gov (United States)

    Vaccarino, Viola; Wilmot, Kobina; Al Mheid, Ibhar; Ramadan, Ronnie; Pimple, Pratik; Shah, Amit J; Garcia, Ernest V; Nye, Jonathon; Ward, Laura; Hammadah, Muhammad; Kutner, Michael; Long, Qi; Bremner, J Douglas; Esteves, Fabio; Raggi, Paolo; Quyyumi, Arshed A

    2016-08-24

    Emerging data suggest that young women with coronary heart disease (CHD) are disproportionally vulnerable to the adverse cardiovascular effects of psychological stress. We hypothesized that younger, but not older, women with stable CHD are more likely than their male peers to develop mental stress-induced myocardial ischemia (MSIMI). We studied 686 patients (191 women) with stable coronary heart disease (CHD). Patients underwent (99m)Tc-sestamibi myocardial perfusion imaging at rest and with both mental (speech task) and conventional (exercise/pharmacological) stress testing. We compared quantitative (by automated software) and visual parameters of inducible ischemia between women and men and assessed age as an effect modifier. Women had a more-adverse psychosocial profile than men whereas there were few differences in medical history and CHD risk factors. Both quantitative and visual indicators of ischemia with mental stress were disproportionally larger in younger women. For each 10 years of decreasing age, the total reversibility severity score with mental stress was 9.6 incremental points higher (interaction, P<0.001) and the incidence of MSIMI was 82.6% higher (interaction, P=0.004) in women than in men. Incidence of MSIMI in women ≤50 years was almost 4-fold higher than in men of similar age and older patients. These results persisted when adjusting for sociodemographic and medical risk factors, psychosocial factors, and medications. There were no significant sex differences in inducible ischemia with conventional stress. Young women with stable CHD are susceptible to MSIMI, which could play a role in the prognosis of this group. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. Diagnosis of acute myocardial infarction in patients undergoing open heart surgery: a comparison of serial myocardial imaging with cardiac enzymes, electrocardiography, and vectocardiography

    International Nuclear Information System (INIS)

    Lowenthal, I.S.; Parisi, A.F.; Tow, D.E.; Barsamian, E.M.; Sasahara, A.A.; McCaughan, D.; Clemson, H.C.

    1977-01-01

    In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patients imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery

  1. Myocardial stress in patients with acute cerebrovascular events

    DEFF Research Database (Denmark)

    Jespersen, C.M.; Hansen, J.F.

    2008-01-01

    Signs of myocardial involvement are common in patients with acute cerebrovascular events. ST segment deviations, abnormal left ventricular function, increased N-terminal pro-brain natriuretic peptide (NT-proBNP), prolonged QT interval, and/or raised troponins are observed in up to one third...

  2. Myocardial viability assessed with fluorodeoxyglucose and PET in patients with Q wave myocardial infarction receiving thrombolysis: relationship to coronary anatomy and ventricular function.

    Science.gov (United States)

    Fragasso, G; Chierchia, S L; Rossetti, E; Sciammarella, M G; Conversano, A; Lucignani, G; Landoni, C; Calori, G; Margonato, A; Fazio, F

    1997-03-01

    In previously thrombolysed patients, we analysed residual myocardial viability using the PET-FDG technique and correlated its presence and extent to the angiographic appearance of the infarct-related vessel and left ventricular function. Thirty-six patients who had undergone intravenous thromboloysis for acute myocardial infarction 4.8 +/- 7.2 months previously were studied. Coronary angiography, left ventriculography, and assessment of myocardial perfusion and metabolism were all performed within 1 week. All patients exhibited perfusion defects consistent with the clinically identified myocardial infarction site. Residual viability, as assessed by the PET-FDG technique, was present in 53% of cases. The infarct-related coronary artery was patent in 19 (53%) patients (TIMI grade 3, 79%); of the remaining 17 with occluded infarct-related arteries, 11 had collaterals to the infarct area. Significant FDG uptake was observed in 63% of patients with a patent infarct-related artery and in 41% of those with an occluded infarct-related artery. The same study protocol was adopted in a control group of 30 patients with myocardial infarction who did not receive thrombolysis. The number of infarct-related patent vessels was significantly lower in these patients (30 vs 53%) (TIMI grade 3, 56%), but the overall percentage of PET viability was again 53%. Qualitative analysis of the regional perfusion pattern showed that the magnitude and severity of the perfusion defect was similar in the two groups, regardless of the presence or absence of FDG uptake. Global left ventricular function was also similar in the two groups. However, regional wall motion was significantly better in the thrombolysed patients with a patent infarct-related artery than in those who had not received thrombolysis and whose culprit vessel was also patent. In conclusion, the results of our study support the notion that early recanalization of the infarct-related artery is critical for preserving left

  3. EFFECTS OF COMBINATION THERAPY ON PLATELET COUNT IN PATIENTS OF MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    Sadaf Ahmed

    2014-12-01

    Full Text Available Aspirin and clopidogrel are usually used individually to prevent adverse cardiovascular events and stroke. They are used in stabilizing the blood pressure in patients of myocardial infarction while combination therapy of aspirin and Clopidogrel (dual anti-platelet therapy is used for preventing adverse cardiovascular events in myocardial infarction patients. A cross-sectional observational study is conducted through a structured questionnaire from 110 patients of K.I.H.D (Karachi Institute of Heart Disease hospital, Karachi, Pakistan. Indoor/admitted patients with diagnosis of acute coronary syndrome (ACS, non-ST elevation myocardial infarction (NSTE-MI, ST elevation myocardial infarction (STE-MI, supra ventricular tachycardia (SVT were included along with those with previous or current onset of angina pectoris or heart attack. Information from the test reports of these patients was included in the data. Patients without proper test reports were excluded from the study. Combination therapy duration is considered as key tool for evaluation. Out of 100 patients (after exclusion criteria applied almost 18% patients were using the combination therapy for 10 to 25 years while 52% of patients were using the combination therapy for 1 to 10 years. Platelet count of 88% patients was found to be in between 1,50,000–3,50,000/µl. Remaining patients had less than 1,50,000 µl to more than 3,50,000 to 4,50,000 µl. Most frequently reported side effects were chest pain, respiratory issues, headache and depression. On the basis of our data analysis it is concluded that long duration dual anti-platelet therapy will not harm platelet count in human blood but it can create drug dependency in patients. Hypertension is not completely cured with this therapy but can help in stabilizing blood pressure.

  4. [Evaluation of myocardial uptake of beta-methyl-(123I)-iodophenylpentadecanoic acid (123I-BMIPP)].

    Science.gov (United States)

    Momose, M; Kobayashi, H; Saito, K; Matsumoto, N; Maki, M; Hosoda, S; Kusakabe, K

    1994-12-01

    To evaluate the myocardial uptake of beta-methyl-(123I)-iodophenylpentadecanoic acid (123I-BMIPP), nineteen patients with ischemic heart disease including left ventricular hypertrophy (mean age 63 +/- 7.8, 14 males and 5 females) underwent BMIPP myocardial scintigraphy. Myocardial uptake (MU) of BMIPP to the total injected dose was calculated from anterior view of the planar image in all subjects, and was compared with plasma glucose (BS), triglyceride (TG), and free fatty acid (FFA). It was also compared with left ventricular mass (LVM) calculated with echocardiography. MU was not related to BS, TG, and FFA, however had the positive correlation with LVM (r = 0.676, p < 0.01). Myocardial uptake per left ventricular mass (MU/LVM) had the negative correlation with LVM (r = -0.671, p < 0.01). Further studies for the significance of MU/LVM will be required.

  5. Evaluation of myocardial uptake of β-methyl-(123I)-iodophenylpentadecanoic acid (123II-BMIPP)

    International Nuclear Information System (INIS)

    Momose, Mitsuru; Kobayashi, Hideki; Matsumoto, Nobusuke; Maki, Masako; Kusakabe, Kiyoko; Saito, Katsumi; Hosoda, Saichi.

    1994-01-01

    To evaluate the myocardial uptake of β-methyl-( 123 I)-iodophenylpentadecanoic acid ( 123 I-BMIPP), nineteen patients with ischemic heart disease including left ventricular hypertrophy (mean age 63±7.8, 14 males and 5 females) underwent BMIPP myocardial scintigraphy. Myocardial uptake (MU) of BMIPP to the total injected dose was calculated from anterior veiw of the planar image in all subjects, and was compared with plasma glucose (BS), triglyceride (TG), and free fatty acid (FFA). It was also compared with left ventricular mass (LVM) calculated with echocardiography. MU was not related to BS, TG, and FFA, however had the positive correlation with LVM (r=0.676, p<0.01). Myocardial uptake per left ventricular mass (MU/LVM) had the negative correlation with LVM (r=-0.671, p<0.01). Further studies for the significance of MU/LVM will be required. (author)

  6. Relationship between collateral circulation and myocardial viability of 18F-FDG PET/CT subtended by chronic total occluded coronary arteries.

    Science.gov (United States)

    Dong, Wei; Li, Jianan; Mi, Hongzhi; Song, Xiantao; Jiao, Jian; Li, Quan

    2018-04-01

    To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging. A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18 F-FDG uptake. There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis-dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability. In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.

  7. Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

    International Nuclear Information System (INIS)

    Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

    1984-01-01

    Accelerated coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus is well documented; however, the prevalence of coronary involvement is unknown. Accordingly, 26 patients with systemic lupus were selected irrespective of previous cardiac history to undergo exercise thallium-201 cardiac scintigraphy. Segmental perfusion abnormalities were present in 10 of the 26 studies (38.5 percent). Five patients had reversible defects suggesting ischemia, four patients had persistent defects consistent with scar, and one patient had both reversible and persistent defects in two areas. There was no correlation between positive thallium results and duration of disease, amount of corticosteroid treatment, major organ system involvement or age. Only a history of pericarditis appeared to be associated with positive thallium-201 results (p less than 0.05). It is concluded that segmental myocardial perfusion abnormalities are common in patients with systemic lupus erythematosus. Whether this reflects large-vessel coronary disease or small-vessel abnormalities remains to be determined

  8. Arterial hypertension and associated factors in patients submitted to myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Flávia Cortez Colósimo

    2015-04-01

    Full Text Available OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p1.3: (OR=1.37;CI:1.09-1.72. CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

  9. BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia

    Directory of Open Access Journals (Sweden)

    Gebker Rolf

    2010-09-01

    Full Text Available Abstract Background The purpose of this study was to determine the ability of Blood Oxygen Level Dependent (BOLD cardiovascular magnetic resonance (CMR to detect stress-inducible myocardial ischemic reactions in the presence of angiographically significant coronary artery disease (CAD. Methods Forty-six patients (34 men; age 65 ± 9 years, with suspected or known coronary artery disease underwent CMR at 3Tesla prior to clinically indicated invasive coronary angiography. BOLD CMR was performed in 3 short axis slices of the heart at rest and during adenosine stress (140 μg/kg/min followed by late gadolinium enhancement (LGE imaging. In all 16 standard myocardial segments, T2* values were derived at rest and under adenosine stress. Quantitative coronary angiography served as the standard of reference and defined normal myocardial segments (i.e. all 16 segments in patients without any CAD, ischemic segments (i.e. supplied by a coronary artery with ≥50% luminal narrowing and non-ischemic segments (i.e. supplied by a non-significantly stenosed coronary artery in patients with significant CAD. Results Coronary angiography demonstrated significant CAD in 23 patients. BOLD CMR at rest revealed significantly lower T2* values for ischemic segments (26.7 ± 11.6 ms compared to normal (31.9 ± 11.9 ms; p Conclusions Rest and stress BOLD CMR at 3Tesla proved feasible and differentiated between ischemic, non-ischemic, and normal myocardial segments in a clinical patient population. BOLD CMR during vasodilator stress identified patients with significant CAD.

  10. Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hsieh, Y.-C.; Yap, Y.-S.; Hung, C.-H.; Chen, C.-H.; Lu, S.-N.; Wang, J.-H.

    2013-01-01

    Aim: To evaluate the incidence and associated factors of postoperative intense pain and haemodynamic changes during radiofrequency ablation of hepatocellular carcinoma. Materials and methods: A total of 123 consecutive hepatocellular carcinoma patients who underwent radiofrequency ablation were prospectively recruited. Patient factors, tumour characteristics, procedural factors, intraoperative haemodynamic changes, complications, postoperative events, laboratory values before and after ablation, and postoperative pain were evaluated. Postoperative pain was scored using a visual analogue scale after the procedure. Results: The mean age of the patients was 65.6 ± 9.6 years. In multiple logistic regression analysis, patients who underwent general anaesthesia [odds ratio (95% CI): 2.68 (1.23–5.81); p = 0.013] and had more postoperative nausea and vomiting episodes [3.10 (1.11–8.63); p = 0.036] were associated with intense pain. These findings remain robust after propensity score matching. For mean difference values between before and after RFA, higher in change in aspartate transaminase (p = 0.026), alanine transaminase (p = 0.016) and white blood cell count (p = 0.015), and lower in change in haemoglobin (p = 0.009) were also correlated with intense pain. There was no significant difference in haemodynamic changes between the general anaesthesia and local anaesthesia group during ablation. Conclusion: General anaesthesia, postoperative nausea and vomiting, and laboratory factors were associated with postoperative intense pain in patients who underwent radiofrequency ablation. Counselling and modification of analgesics should be considered in patients with related factors for intense pain

  11. Persistent chest pain following oral dipyridamole for thallium 201 myocardial imaging

    International Nuclear Information System (INIS)

    Kwai, A.H.; Jacobson, A.F.; McIntyre, K.M.; Williams, W.H.; Tow, D.E.

    1990-01-01

    A patient was admitted to the hospital with acute chest pain. After acute myocardial infarction was ruled out, he underwent a stress thallium 201 scintigraphy using oral dipyridamole and developed persistent angina with sedimentation time segement elevation. This complication has not been reported previously. It is recommended that appropriate intervention be available if severe ischemia develops following administration of dipyridamole for diagnostic imaging. (orig.)

  12. BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

    Energy Technology Data Exchange (ETDEWEB)

    Azevedo, Jader Cunha de, E-mail: jadercazevedo@gmail.com [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); Reis, Bruno Cezario Costa; Barreto, Nathalia Monerat P.B. [Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); F, Diogenes S. Junior; Prezotti, Lais S. [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Procaci, Victor Rebelo; Octaviano, Vivian Werneck [Centro Universitário de Volta Redonda, Rio de Janeiro, RJ (Brazil); Volschan, Andre [Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil); Mesquita, Evandro Tinoco; Mesquita, Claudio Tinoco [Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ (Brazil); Hospital Pró-Cardíaco, Rio de Janeiro, RJ (Brazil)

    2015-01-15

    Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events. To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS). This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%. The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia. BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.

  13. Safety of intravenous dipyridamole thallium myocardial perfusion imaging: experience in 435 patients

    International Nuclear Information System (INIS)

    Dubrey, S.W.; Noble, M.I.M.; Jewkes, R.F.; Bomanji, J.B.

    1993-01-01

    Dipyridamole stress 201 T1 scintigraphy is widely used in the investigation of myocardial ischaemia. We report our experience of adverse effects observed during this diagnostic procedure. A prospective study was undertaken of 435 consecutive patients referred to two nuclear medicine departments for assessment of myocardial perfusion. Patients were monitored prior to and following the infusion of dipyridamole. All symptomatic, haemodynamic and electrocardiographic changes were documented. No deaths occurred in this series. Adverse events were observed in 174 (40%) patients. Of these, three patients experienced 'major' adverse events (0.6%) requiring hospitalization (myocardial infarction = 1; chest pain = 1; simple partial seizure = 1). 'Moderate' adverse events occurred in 39 (8.9%) patients and required intravenous aminophylline to reverse effects (ST segment abnormalities = 26; nausea = 7; headache = 3; chest pain = 2; bronchospasm = 1; protracted vomiting = 1; diarrhoea = 1). 'Minor' adverse events were experienced by 132 (30.3%) patients and did not require aminophylline. Sixty per cent of our patients experienced no ill effects from dipyridamole given as an exercise substitute in conjunction with 201 T1 imaging. The rest had symptoms which were mostly mild, although a few patients found the experience unpleasant. Only one patient experienced a life-threatening episode. (Author)

  14. Exercise induced ST elevation and residual myocardial ischemia in previous myocardial infarction

    International Nuclear Information System (INIS)

    Shimonagata, Tsuyoshi; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Saito, Muneyasu; Sumiyoshi, Tetsuya

    1987-01-01

    The purpose of this study was to evaluate the clinical significance of stress induced ST elevation on infarcted area in 65 patients with previous myocardial infarction (single vessel disease) who had stress thallium scan. Stress induced ST changes on infarcted area were compared with quantitative assessment of myocardial ischemia (thallium ischemic score; TIS) and extent of myocardial infarction (defect score; DS) derived from circumferential profile analysis. In patients with previous myocardial infarction in less than 3 month from the onset (n = 36), left ventricular ejection fraction (LVEF) and extent of abnormal LV wall motion were not significantly different between patients with stress induced ST elevation ( ≥ 2 mm, n = 26) and those with stress induced ST elevation ( < 2 mm, n = 10), while, in patients with previous myocardial infarction in more than 3 month (n = 29), patients with stress induced ST elevation ( ≥ 2 mm, n = 15) showed left ventricular dyskinesis more frequently than those with ST elevation ( < 2 mm, n = 14). In addition, the former showed significantly higher DS and significantly lower TIS than the latter. In patients with previous myocardial infarction in less than 3 month, patients with ST elevation ( ≥ 2 mm, n = 15) with prominent upright T wave (n = 15) had transient thallium defect in infarcted area in 73 % and they had significantly higher LVEF and TIS than those with ST elevation ( < 2 mm, n = 11). These results indicated that ST elevation in infarcted area reflect different significance according to the recovery of injured myocardium and stress induced ST elevation with prominent upright T wave in infarcted area reflect residual myocardial ischemia in less than 3 month from the onset of myocardial infarction. (author)

  15. Impaired coronary flow reserve is the most important marker of viable myocardium in the myocardial segment-based analysis of dual-isotope gated myocardial perfusion single-photon emission computed tomography

    International Nuclear Information System (INIS)

    Lee, Won Woo; So, Young; Kim, Ki Bong; Lee, Dong Soo

    2014-01-01

    The aim of this study was to investigate the most robust predictor of myocardial viability among stress/rest reversibility (coronary flow reserve [CFR] impairment), 201 Tl perfusion status at rest, 201 Tl 24 hours redistribution and systolic wall thickening of 99m Tc-methoxyisobutylisonitrile using a dual isotope gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) who were re-vascularized with a coronary artery bypass graft (CABG) surgery. A total of 39 patients with CAD was enrolled (34 men and 5 women), aged between 36 and 72 years (mean 58 ± 8 standard in years) who underwent both pre- and 3 months post-CABG myocardial SPECT. We analyzed 17 myocardial segments per patient. Perfusion status and wall motion were semi-quantitatively evaluated using a 4-point grading system. Viable myocardium was defined as dysfunctional myocardium which showed wall motion improvement after CABG. The left ventricular ejection fraction (LVEF) significantly increased from 37.8 ± 9.0% to 45.5 ± 12.3% (p 201 Tl rest perfusion status (p = 0.024) were significant predictors of wall motion improvement. However, in multiple logistic regression analysis, stress/rest reversibility alone was a significant predictor for post-CABG wall motion improvement (p < 0.001). Stress/rest reversibility (impaired CFR) during dual-isotope gated myocardial perfusion SPECT was the single most important predictor of wall motion improvement after CABG.

  16. 99Tcm-MIBI single photon emission tomography (SPET) for detecting myocardial ischaemia and necrosis in patients with significant coronary artery disease

    International Nuclear Information System (INIS)

    Sciammarella, M.G.; Fragasso, G.; Gerundini, P.; Maffioli, L.; Cappelletti, A.; Margonato, A.; Savi, A.; Chierchia, S.

    1992-01-01

    The ability of 99 Tc m -methoxyisobutylisonitrile (MIBI) single photon emission tomography (SPET) to detect myocardial ischaemia and necrosis was assessed in 56 patients with clinically recognised ischaemic heart disease (IHD). All underwent coronary angiography (CA) and left ventriculography (LV). SPET images were obtained at rest and at peak exercise 90 min after injection of 99 Tc m -MIBI. The presence of persistent (P) or reversible (R) perfusion defects (PD) was then correlated to the resting and exercise ECG and to the results of CA and LV. Of the 56 patients, 34 had reversible underperfusion (RPD), 46 persistent underperfusion (PPD) and 31 had both. The occurrence of RPD correlated well with the occurrence of exercise-induced ST segment depression and/or angina (27 patients of 34 patients, 79%) and with the presence of significant coronary artery disease (CAD) (33 of 44, 73%). In 45 of 46 patients (98%) PPD corresponded to akinetic or severely hypokinetic segments (LV) usually explored by ECG leads exhibiting diagnostic Q waves (42 of 46 patients, 91%). The scan was normal both at rest and after stress in four of 11 patients with no CAD, and in two of 45 patients with CAD. Finally, an abnormal resting scan was seen in seven of 11 patients with normal coronary arteries, of whom six had regional wall motion abnormalities. In conclusion, MIBI SPET is a highly reliable technique for assessing the presence and location of myocardial ischaemia and necrosis. (Author)

  17. Noninvasive evaluation of regional myocardial perfusion in 112 patients using a mobile scintillation camera and intravenous nitrogen-13 labeled ammonia

    International Nuclear Information System (INIS)

    Walsh, W.F.; Harper, P.V.; Resnekov, L.; Fill, H.

    1976-01-01

    The short half-life positron emitter 13 N, as labeled ammonia ( 13 NH 4 + ), was evaluated as a myocardial imaging agent. Regional myocardial uptake of 13 NH 4 correlated with the distribution of labeled microspheres in experimental myocardial infarction. Using intravenous 13 NH 4 + , myocardial scintigraphy was performed in 85 cardiac patients and 27 normal subjects. Ninety-five scintigrams were suitable for analysis. Eighteen of 24 normal subjects had homogeneous myocardial images; six had inhomogeneous images attributable to early technical problems. Perfusion defects were observed in the scintigrams of 82% (57/65) of patients with coronary artery disease, being most common in patients with myocardial infarction (27/28). Six sequential studies showed changes in perfusion consistent with the clinical course of each patient. Scintigraphic abnormalities were also observed in 4/6 patients with valvular heart disease. 13 NH 4 + myocardial scintigraphy is a valid and sensitive method of assessing regional myocardial perfusion and is especially useful for sequential imaging at short intervals

  18. Effect of coronary artery recanalization on right ventricular function in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Verani, M.S.; Tortoledo, F.E.; Batty, J.W.; Raizner, A.E.

    1985-01-01

    The effects of coronary artery recanalization by intracoronary administration of streptokinase on left ventricular function during acute myocardial infarction have received increasing attention in recent years. Although myocardial dysfunction is often more pronounced in the right ventricle than in the left ventricle in patients with acute inferior wall myocardial infarction, the effect of coronary artery recanalization on right ventricular dysfunction has not been previously addressed. Accordingly, in this investigation, 54 patients who participated in a prospective, controlled, randomized trial of recanalization during acute myocardial infarction were studied. Among 30 patients with inferior wall infarction, 19 had right ventricular dysfunction on admission; 11 of these 19 had positive uptake of technetium-99m pyrophosphate in the right ventricle, indicative of right ventricular infarction. Patients with successful recanalization exhibited improved right ventricular ejection fraction from admission to day 10. However, control patients and patients who did not undergo recanalization also exhibited improvement. These data indicate that the right ventricular dysfunction commonly associated with inferior wall infarction is often transient, and improvement is the rule, irrespective of early recanalization of the infarct vessel

  19. Myocardial infarction

    International Nuclear Information System (INIS)

    Ando, Jyoji; Yasuda, Hisakazu; Miyamoto, Atsushi; Kobayashi, Tsuyoshi

    1980-01-01

    sup(99m)Tc-pyrophosphate (PYP) scintigraphy and 201 Tl myocardial scintigraphy were utilized for the diagnoses of the presence, the region, and the extent of myocardial infarction. Exercise 201 Tl myocardial scintigrams and exercise radionuclide ventriculography were utilized for diagnosis of coronary artery lesions in angina pectoris. Radionuclide ventriculography was used to investigate effects of coronary artery lesions on cardiac function and hemodynamics. In order to select adequate treatments for myocardial infarction and estimate the prognosis, it was necessary to detect the presence, the region, and the extent of acute myocardial infarction and to investigate effects of partial infarction on hemodynamics by using radionuclide imaging. Exercise myocardial scintigraphy could be carried out noninvasively and repeatedly for diagnosis of coronal artery disease. Therefore, this method could be applied widely. It was possible to use this method as a screening test of coronary artery diseases for the diagnoses of asymptomatic patients who showed ST changes in ECG, the patients with cardiac neurosis and the patency after a reconstructive surgery of coronary artery. (Tsunoda, M.)

  20. P-wave dispersion and its relationship to aortic stiffness in patients with acute myocardial infarction after cardiac rehabilitation

    Directory of Open Access Journals (Sweden)

    Rezzan Deniz Acar

    2014-07-01

    Full Text Available BACKGROUND: The aim of our study was to investigate the P-wave dispersion from standard electrocardiograms (ECGs in patients with acute myocardial infarction (AMI after cardiac rehabilitation (CR and determine its relation to arterial stiffness. METHODS: This is a prospective study included 33 patients with AMI and successfully re-vascularized by percutaneous coronary intervention (PCI underwent CR. Left ventricular ejection fraction (LVEF was measured by biplane Simpson’s method. Left atrium (LA volume was calculated. The maximum and minimum durations of P-waves (Pmax and Pmin, respectively were detected, and the difference between Pmax and Pmin was defined as P-wave dispersion (Pd = Pmax–Pmin. Aortic elasticity parameters were measured. RESULTS: LVEF was better after CR. The systolic and diastolic blood pressures decreased after CR, these differences were statistically significant. With exercise training, LA volume decreased significantly. Pmax and Pd values were significantly shorter after the CR program. The maximum and minimum P-waves and P-wave dispersion after CR were 97 ± 6 ms, 53 ± 5 ms, and 44 ± 5 ms, respectively. Aortic strain and distensibility increased and aortic stiffness index was decreased significantly. Aortic stiffness index was 0.4 ± 0.2 versus 0.3 ± 0.2, P = 0.001. Aortic stiffness and left atrial volume showed a moderate positive correlation with P-wave dispersion (r = 0.52, P = 0.005; r = 0.64, P = 0.000, respectively. CONCLUSION: This study showed decreased arterial stiffness indexes in AMI patient’s participated CR, with a significant relationship between the electromechanical properties of the LA that may raise a question of the preventive effect of CR from atrial fibrillation and stroke in patients with acute myocardial infarction.   Keywords: Cardiac Rehabilitation, P-Wave Dispersion, Aortic Stiffness, Acute Myocardial Infarction 

  1. "DETERMINANTS OF PREHOSPITAL DELAY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION"

    Directory of Open Access Journals (Sweden)

    M. Alidoosti

    2004-05-01

    Full Text Available Determination of pre-hospital delay time of patients with acute myocardial infarction and seeking ways of speeding up the time for reperfusion is an important factor to lower mortality in these patients. This is a cross-sectional study to determine pre-hospital delay time, its components, and related causes and conditions, obtained in 375 patients with prolonged chest pain referred to four hospitals of Tehran University of Medical Sciences. Means of transport to hospital, reasons of ambulance disuse, decision time by the patient and finally the entire time of pre-hospital delay were specified. Suspected factors related to delays of more than 2 and 6 h were scrutinized with chi-square test. Rate of ambulance utility (18.9% directly correlated with age of patients (P<0.05. Principal motives to disuse ambulance insuccession were unrememberance (33.7%, access to private vehicle (32.8% and supposition of sufficient speed of personal reference (18.9%. Pre-hospital delay time was 8.1 ± 9.1 h (mean ± SD in whole patients and 7.6 ± 9.1 h in those with acute myocardial infarction. Delays of more than 2 and 6 hoccurred in 67.5% and 33.6% of patients, respectively. Decision time constitute three fourth of whole pre-hospital delay and was correlated with female gender, older age, history of diabetes, lower level of literacy and nocturnal onset of symptoms. In conclusion, a significant number of patients with acute myocardial infarction have pre-hospital delay of more than 2 and even 6 h, when golden time for thrombolytic therapy has already been elapsed.

  2. The Severity of Coronary Arterial Stenosis in Patients With Acute ST-Elevated Myocardial Infarction: A Thrombolytic Therapy Study

    Science.gov (United States)

    Kilic, Salih; Kocabas, Umut; Can, Levent Hurkan; Yavuzgil, Oguz; Zoghi, Mehdi

    2018-01-01

    Background It is widely believed that ST-elevated myocardial infarction (STEMI) generally occurs at the site of mild to moderate coronary stenosis. The aim of this study was to determine the degree of stenosis of infarct-related artery (IRA) in STEMI patients who underwent coronary angiography (CAG) after successful reperfusion with thrombolytic therapy (TT). Methods A total of 463 consecutive patients between January 2008 and December 2013 with acute STEMI treated with TT were evaluated retrospectively. The patients in whom reperfusion failed (n = 120), death occurred before CAG (n = 12), IRA cannot be determined (n = 10), and CAG was not performed in index hospitalization (n = 54) were excluded from the study. To determine the severity of stenosis of IRA, two experienced cardiologists who were unaware of each other used quantitative CAG analysis. Significant stenosis was defined as a ≥ 50% stenosis in the coronary artery lumen. A total of 267 patients who were successfully reperfused with TT and in whom CAG was performed during hospitalization with median 8 (1 - 17) days after myocardial infarction were included in the study. Results The mean age of patients was 55.7 ± 10.8 years (85.5% male). Most of the patients had a significant stenosis in IRA ( ≥ 50%, n = 236, group 1) after successful TT; whereas only 11.6% had stenosis < 50% (n = 31, group 2). In addition, majority of the patients had ≥ 70.4% (n = 188, 70.4%) stenosis in IRA. Average of stenosis in IRA was 74±16%. Conclusions In contrast to the general opinion, we detected that majority of STEMI patients had a significant stenosis in IRA. PMID:29479380

  3. Silent ischemia in patients after the acute myocardial infarction

    International Nuclear Information System (INIS)

    Samarzija, M.

    1991-01-01

    The purpose of this study was to determine the frequency and importance of silent ischemia in patients (pts) after acute myocardial infarction (AMI) as well as to establish diagnostic and prognostic values of exercise stress test (EST), Holter (H) monitoring and thallium-201 (Tl) scintigraphy. All the tests were performed 2-4 months following the AMI. The criterion for diagnostic myocardial ischemia on EST and H is 1 mm or more of horizontal or down-sloping ST depression. Additional criteria for Holter imply that the ischemic episode should last one minute and be separated from other episodes by at least one minute. Planar thallium images were performed 5-10 minutes after the stress test; the delayed images were obtained after 3-6 hours. Visual and quantitative methods were employed in the analysis of Tl-scintigraphy. Scintigraphy was considered positive if exercise-induced perfusion defects showed redistribution. The study included 74 asymptomatic patients after the AMI. The patients were divided into two groups by results of quantitative Tl-scintigraphy: Group I - 44 pts with silent ischemia, Group II - 30 pts without ischemia. In Group I, out of 44 pts, 9 had a positive exercise stress test, 4 showed a painless ST depression on Holter and 7 had both tests positive, whereas 24 pts had only scintigraphy positive. In Group II one patient had positive EST and H. Sensitivity and specificity were determined by results of coronary arteriography performed on 33 pts: EST (Se=40%, Sp=80%), H (Se=21%, Sp=100%) and scintigraphy (Se=93%, Sp=80%). During the follow-up period lasting at least 12 months, in Group I 3 pts died, 1 developed a new myocardial infarction and 15 pts had painful ischemic occurrences. In Group II only 3 pts developed symptoms of angina pectoris. Tl-scintigraphy was the only non-invasive test showing significant correlation with the follow-up outcomes. The diagnostic and prognostic superiority of Tl-scintigraphy justifies its value as an initial

  4. [Diagnosis and treatment of anxiety-depressive disorders in patients with myocardial infarction].

    Science.gov (United States)

    Semiglazova, M V; Krasnov, V N; Dovzhenko, T V; Lebedev, A V

    2012-01-01

    The results of the study of psychopathological, somatic and functional characteristics of anxiety-depressive disorders in patients with acute myocardial infarction are presented. The authors confirmed the wide prevalence of these disorders in acute myocardial infarction and described the features of their diagnostics, dynamics and response to complex treatment. The impact of anxiety-depressive disorders on the clinical and functional state of the cardiovascular system and the dynamics of the patient's status due the concomitant anxiety-depressive disorder are considered.

  5. A CLINICAL CASE OF ACUTE ALLERGIC MYOCARDITIS SIMULATING MYOCARDIAL INFARCTION

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2015-01-01

    Full Text Available Objective: to describe a clinical case of evolving acute eosinophilic myocarditis simulating coronary heart disease. Subjects and methods. Patient B. aged 62 years was admitted to Intensive Care Unit Fifteen, N.I. Pirogov First Moscow City Clinical Hospital, by being transferred from Thailand with a referral diagnosis of acute myocardial infarction made on November 1, 2012, with complaints of pressing and aching heart pains. At a Phuket hospital, his electrocardiogram recorded atrial fibrillation; indirect cardiac massage, electric pulse therapy, and mechanical ventilation were performed. After being admitted to the N.I. Pirogov First Moscow City Clinical Hospital, the patient underwent examination: estimation of laboratory indicators over time, electrocardiography (ECG, echocardiography, Holter ECG monitoring, and myocardial scintigraphy. Results. The patient had a history of an allergic reaction as urticaria to the ingestion of fish products. His examination showed practically all diagnostic criteria for allergic myocarditis: hypereosinophilia (the admission level of eosinophils was 9% with their further normalization; the characteristic clinical presentation of myocarditis (pressing retrosternal pain; elevated levels of cardiac specific enzymes (creatinine phosphokinase-MB, lactate dehydrogenase, troponin T; ECG changes – myocardial hypokinesis in the acute period, followed by its pattern normalization. of the pattern. Myocardial scintigraphy (by taking into account the fact that the patient had had a new allergic reaction episode, the investigators decided not to perform coronary angiography revealed decreased radiopharmaceutical accumulation in the lower left ventricular wall in the right coronary arterial bed; perfusion remained in the other myocardial walls. Conclusion. This clinical case reflects the specific features of the course of and difficulties in the diagnosis of acute allergic myocarditis that, in most cases, has no specific

  6. B-type natriuretic peptide as predictor of heart failure in patients with acute ST elevation myocardial infarction, single-vessel disease, and complete revascularization: follow-up study.

    LENUS (Irish Health Repository)

    Manola, Sime

    2012-01-31

    AIM: To assess the concentration of B-type natriuretic peptide (BNP) as a predictor of heart failure in patients with acute ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) with successful and complete revascularization. METHODS: Out of a total of 220 patients with acute STEMI admitted to the Sisters of Mercy University Hospital in the period January 1 to December 31, 2007, only patients with acute STEMI undergoing primary PCI who had single vessel disease and were successfully revascularized were included in the study. Selected patients had no history of myocardial infarction or heart failure and a normal or near-normal left ventricular ejection fraction (> or =50%) assessed by left ventriculography at admission. Only 58 patients met the inclusion criteria for the study. Out of those, 6 patients refused to participate in the study, and another 5 could not be followed up, so a total of 47 patients were evaluated. Blood samples were taken for measurement of BNP levels at admission, 24 hours later, and 7 days later. Patients were followed up for 1 year. The primary outcome was reduction in left ventricular ejection fraction (LVEF) to <50% after 1 year. RESULTS: Patients who developed echocardiographic signs of reduced systolic function defined as LVEF<50% had significantly higher values of BNP (> or =80 pg\\/mL) at 24 hours (P=0.001) and 7 days (P=0.020) after STEMI and successful reperfusion. Patients who had BNP levels > or =80 pg\\/mL after 7 days were 21 times more likely to develop LVEF<50 (odds ratio, 20.8; 95% confidence interval, 2.2-195.2; P=0.008). CONCLUSION: BNP can be used as a predictor of reduced systolic function in patients with STEMI who underwent successful reperfusion and had normal ejection fraction at admission.

  7. Myocardial adrenergic nerve activity in valvular diseases assessed by iodine-123-metaiodobenzylguanidine myocardial scintigraphy

    International Nuclear Information System (INIS)

    Imamura, Yoshihiro; Fukuyama, Takaya

    1997-01-01

    Iodine-123-metaiodobenzylguanidine (MIBG) imaging was used to assess myocardial adrenergic nerve activity in patients with heart failure. MIBG planar images were obtained in 94 patients. The uptake of MIBG, calculated as the heart-to-mediastinum activity ratio in the immediate image (15 min), showed a significant decrease only in patients with severe heart failure due to cardiomyopathy, but was not changed in those with valvular diseases. Storage and release of MIBG, calculated as the percentage myocardial MIBG washout from 15 min to 4 hours after isotope injection, was substantially accelerated in both patients with cardiomyopathy and valvular diseases in proportion to the severity of heart failure. These data suggest that, in severe heart failure associated with cardiomyopathy, norepinephrine uptake is reduced. Also, myocardial adrenergic nerve activity is accelerated in proportion to the severity of heart failure independent of the underlying cause. MIBG images were analyzed in 20 patients with mitral stenosis with the same methods to clarify whether myocardial adrenergic nerve activity is different in patients with heart failure without left ventricular volume or pressure overload. Myocardial uptake of MIBG did not show any significant difference. The percentage myocardial MIBG washout was increased in patients with severe heart failure. The closest correlation was between myocardial washout and cardiac output. In heart failure due to mitral stenosis, myocardial adrenergic nerve activity is intensified. Decrease in cardiac output associated with mitral stenosis acts as a potent stimulus for this intensification. (author)

  8. Utility of Cardiac Magnetic Resonance to assess association between admission hyperglycemia and myocardial damage in patients with reperfused ST-Segment Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Wolf Jean-Eric

    2008-01-01

    Full Text Available Abstract Aims to investigate the association between admission hyperglycemia and myocardial damage in patients with ST-segment elevation myocardial infarction (STEMI using Cardiac Magnetic Resonance (CMR. Methods We analyzed 113 patients with STEMI treated with successful primary percutaneous coronary intervention. Admission hyperglycemia was defined as a glucose level ≥ 7.8 mmol/l. Contrast-enhanced CMR was performed between 3 and 7 days after reperfusion to evaluate left ventricular function and perfusion data after injection of gadolinium-DTPA. First-pass images (FP, providing assessment of microvascular obstruction and Late Gadolinium Enhanced images (DE, reflecting the extent of infarction, were investigated and the extent of transmural tissue damage was determined by visual scores. Results Patients with a supramedian FP and DE scores more frequently had left anterior descending culprit artery (p = 0.02 and 1c (p = 0.01 and 0.04, peak plasma Creatine Kinase (p In a multivariate model, admission hyperglycemia remains independently associated with increased FP and DE scores. Conclusion Our results show the existence of a strong relationship between glucose metabolism impairment and myocardial damage in patients with STEMI. Further studies are needed to show if aggressive glucose control improves myocardial perfusion, which could be assessed using CMR.

  9. Impact of low signal intensity assessed by cine magnetic resonance imaging on detection of poorly viable myocardium in patients with prior myocardial infarction.

    Science.gov (United States)

    Ota, Shingo; Tanimoto, Takashi; Orii, Makoto; Hirata, Kumiko; Shiono, Yasutsugu; Shimamura, Kunihiro; Matsuo, Yoshiki; Yamano, Takashi; Ino, Yasushi; Kitabata, Hironori; Yamaguchi, Tomoyuki; Kubo, Takashi; Tanaka, Atsushi; Imanishi, Toshio; Akasaka, Takashi

    2015-05-13

    Late gadolinium enhancement magnetic resonance imaging (LGE-MRI) has been established as a modality to detect myocardial infarction (MI). However, the use of gadolinium contrast is limited in patients with advanced renal dysfunction. Although the signal intensity (SI) of infarct area assessed by cine MRI is low in some patients with prior MI, the prevalence and clinical significance of low SI has not been evaluated. The aim of this study was to evaluate how low SI assessed by cine MRI may relate to the myocardial viability in patients with prior MI. Fifty patients with prior MI underwent both cine MRI and LGE-MRI. The left ventricle was divided into 17 segments. The presence of low SI and the wall motion score (WMS) of each segment were assessed by cine MRI. The transmural extent of infarction was evaluated by LGE-MRI. LGE was detected in 329 of all 850 segments (39%). The low SI assessed by cine MRI was detected in 105 of 329 segments with LGE (32%). All segments with low SI had LGE. Of all 329 segments with LGE, the segments with low SI showed greater transmural extent of infarction (78 [72 - 84] % versus 53 [38 - 72] %, P cine MRI may be effective for detecting poorly viable myocardium in patients with prior MI.

  10. The impact of adenosine pharmacologic stress combined with low-level exercise in patients undergoing myocardial perfusion imaging (BIWAKO adenosine-Ex trial)

    International Nuclear Information System (INIS)

    Monzen, Hajime; Hara, Masatake; Hirata, Makoto

    2011-01-01

    The combination of adenosine infusion with low-level exercise has become a common approach for inducing stress during stress myocardial perfusion imaging (MPI). We investigated stress MPI performed by combined low-level exercise and adenosine infusion. This combined protocol can decrease adverse reactions and reduce the effect of scattered rays from the liver. Subjects were clinically referred for a 53-min rest-stress Tc-99m Sestamibi MPI procedure using BIWAKO PROTOCOL. Ninety-eight patients (44.5%) underwent adenosine infusion with ergometer exercise testing and 122 patients (55.5%) underwent adenosine infusion without exercise testing. We evaluated the liver/heart (L/H) uptake ratio, background activity in the upper mediastinum, and adverse reactions. The L/H ratio and background activity were lower in the adenosine-exercise group than in the adenosine-non-exercise group (1.8±0.54 vs. 2.1±0.62, P<0.0056; 43.1±12.2 vs. 61.5±15.4, P<0.0001). The adenosine-exercise group had fewer adverse reactions than the adenosine-non-exercise group (11.2 vs. 19.7%). All of the adverse reactions were minor, with the exception of severe back pain in one case. The incidence of adverse reactions in our study was lower than that in previous studies for unknown reason. Adenosine infusion in combination with low-level exercise seems to result in higher-quality images and fewer adverse reactions than adenosine infusion without exercise. The combined protocol decreases adverse reactions and improves the quality of myocardial perfusion images by decreasing background activity. (author)

  11. Thallium-201 myocardial imaging in acute-myocardial infarction

    International Nuclear Information System (INIS)

    Wackers, F.J.Th.; Lie, K.I.; Sokole, E.B.; Wellens, H.J.J.; Samson, G.; Schoot, J.B. van der

    1980-01-01

    Thallium-201 scintigraphy has proven to be an early and highly sensitive technique to detect myocardial perfusion abnormalities in patients with acute myocardial infarction. During the early phase of acute myocardial infarction, patients may be hemodynamically and electrically unstable. Therefore, scintigraphy is performed preferably at the bed side in the Coronary Care Unit using a mobile gamma camera. Additionally, in order to shorten imaging time in these often critically ill patients, the authors recommend injecting no less than 2 mCi of 201 Tl. Using this dosage, the imaging time per view will be approximately five minutes. Routinely, three views are taken: the first view is a supine 45 0 left-anterior-oblique view, followed by a supine anterior view and finally a left-lateral view, the latter with the patient turned on the right side. (Auth.)

  12. Myocardial turnover of P-123I-phenylpentadecanoic acid (I-PPA) in patients with valvular heart and coronary artery disease

    International Nuclear Information System (INIS)

    Reske, S.N.; Biersack, H.J.; Knopp, R.; Winkler, C.; Aurich, D.; Simon, H.; Koischwitz, D.

    1982-01-01

    Myocardial p-I 123 -Phenylpentadecanoic acid (I-PPA) turnover has been evaluated in patients with coronary artery (CAD) and valvular heart disease (VHD) and normal coronaries. After intracoronary I-PPA application myocardial extraction fractions of 25 - 30% of applied radioactivity were observed in patients with VHD, compared to 8 - 35% in patients with CAD. 2 - 3 component myocardial radioactivity clearance with half times of 0.24 - 0.5, 6 - 10 and 40 - 60 min were observed in patients with VHD. Patients with CAD showed monoexponential myocardial radioactivity clearance with half times of 26 - 67 min. After peripheral i.v. tracer application myocardial segments supplied by coronary arteries with 80 - 100% stenosis showed clearly reduced tracer uptake and prolonged elimination half times. Combined evaluation of I-PPA uptake and turnover clearly separated normally perfused myocardial segments from those supplied by coronary arteries with 80 - 100% stenosis. (Author)

  13. Cardiac troponin T: A sensitive and specific indicator of myocardial injury in patients with cerebrovascular stroke

    Directory of Open Access Journals (Sweden)

    Mohammed Amin

    2012-09-01

    Conclusions: Myocardial injury is not uncommon in patients with CVS. Silent ST-T wave changes and new resting SWMA are possible complications. We demonstrated highly significant correlation between positive troponin T and myocardial injury in these patients.

  14. The accuracy of myocardial perfusion SPECT imaging in the evaluation of coronary artery disease in women and men

    International Nuclear Information System (INIS)

    Kaminek, M.; Myslivecek, M.; Huyak, V.; Koranda, P.; Skvarilova, M.; Ostransky, J.

    2001-01-01

    The purpose of this study is to compare sensitivity, specificity and accuracy of myocardial perfusion SPECT for the detection of coronary artery disease (CAD) in women and men. 588 patients (455 males and 133 females, 273 after a previous myocardial infarction) underwent stress myocardial perfusion SPECT. The accuracy of myocardial perfusion SPECT was proved by coronary angiography (stenosis >50% was considered as a CAD). The sensitivity of SPECT was slightly higher, but statistically not significant, in men than in women (94% versus 91%, p > 0.05). The specificity was higher in women than in men (93% versus 82%), but this difference was not statistically significant either (p > 0.05). The accuracy of SPECT was the same for both sexes (92%). In angiographically verified group of patients the selection bias was obvious - patients with CAD dominated (74%) and the fraction of patients with CAD in men's group (83%) was significantly higher than in women's group (50%), p < 0.05. No significant difference was revealed in the accuracy of myocardial perfusion SPECT in men and women. Our results are in accordance with the prevailing opinion in literature that discovered differences in sensitivity, specificity and diagnostic accuracy are usually not statistically significant or that they can be explained by the selection bias of patients in angiographically verified groups (significantly higher fraction of patients with CAD in men's group). (author)

  15. Correlation of the myocardial perfusion corrected by attenuation with the coronariography. Preliminary results

    International Nuclear Information System (INIS)

    Garcia C, S.E.; Garcia O, R.

    2005-01-01

    The attenuation that suffers the radiation in the soft tissues of the hinders the appropriate interpretation of the myocardial perfusion studies, for what have been implemented attenuation correction systems to reduce the attenuation for soft tissues and to provide myocardial perfusion images more accurate in the diagnosis of coronary illness. The objective was to evaluate the utility of an attenuation correction system (with source of Gadolinium 153) to minimize the devices that look like true defects of myocardial perfusion, caused by soft tissues (mammary tissue, thoracic wall, abdomen, left hemi diaphragm), and to compare those interpretations of the studies with the interpretations of the corresponding coronariographies. The method consists of 95 electronic files which were revised with the concept of heart catheterization, being identified 20 patients from the masculine sex to those that underwent coronariography among May 1999 and December 2002, and that they had study of myocardial perfusion in a maximum period of 3 months foresaw to the invasive procedure. (Author)

  16. Intraoperative seizures and seizures outcome in patients underwent awake craniotomy.

    Science.gov (United States)

    Yuan, Yang; Peizhi, Zhou; Xiang, Wang; Yanhui, Liu; Ruofei, Liang; Shu, Jiang; Qing, Mao

    2016-11-25

    Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in awake craniotomy. Bibliographic searches of the EMBASE, MEDLINE,were performed to identify articles and conference abstracts that investigated the intraoperative seizure frequency of patients underwent AC. Twenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general intraoperative seizure(IOS) rate for patients with AC was 8%(fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%. This systematic review and meta-analysis shows that awake craniotomy is a safe technique with relatively low intraoperative seizure occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

  17. Cancer risk of patients discharged with acute myocardial infarct

    DEFF Research Database (Denmark)

    Dreyer, L; Olsen, J H

    1998-01-01

    We studied whether common shared environmental or behavioral risk factors, other than tobacco smoking, underlie both atherosclerotic diseases and cancer. We identified a group of 96,891 one-year survivors of acute myocardial infarct through the Danish Hospital Discharge Register between 1977...... and 1989. We calculated the incidence of cancer in this group by linking it to the Danish Cancer Registry for the period 1978-1993. There was no consistent excess over the expected figures for any of the categories of cancer not related to tobacco smoking. Specifically, the rates of colorectal cancer...... in acute myocardial infarct patients were similar to those of the general population, as were the rates for hormone-related cancers, including endometrial and postmenopausal breast cancers. We found a moderate increase in the risk for tobacco-related cancers, which was strongest for patients with early...

  18. Noninvasive evaluation of regional myocardial perfusion in 112 patients using a mobile scintillation camera and intravenous nitrogen-13 labeled ammonia

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, W.F.; Harper, P.V.; Resnekov, L.; Fill, H.

    1976-08-01

    The short half-life positron emitter /sup 13/N, as labeled ammonia (/sup 13/NH/sub 4//sup +/), was evaluated as a myocardial imaging agent. Regional myocardial uptake of /sup 13/NH/sub 4/ correlated with the distribution of labeled microspheres in experimental myocardial infarction. Using intravenous /sup 13/NH/sub 4//sup +/, myocardial scintigraphy was performed in 85 cardiac patients and 27 normal subjects. Ninety-five scintigrams were suitable for analysis. Eighteen of 24 normal subjects had homogeneous myocardial images; six had inhomogeneous images attributable to early technical problems. Perfusion defects were observed in the scintigrams of 82% (57/65) of patients with coronary artery disease, being most common in patients with myocardial infarction (27/28). Six sequential studies showed changes in perfusion consistent with the clinical course of each patient. Scintigraphic abnormalities were also observed in 4/6 patients with valvular heart disease. /sup 13/NH/sub 4//sup +/ myocardial scintigraphy is a valid and sensitive method of assessing regional myocardial perfusion and is especially useful for sequential imaging at short intervals.

  19. Early Risk stratification for Arrhythmic death in Patients with ST-Elevation Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Sadr-Ameli

    2007-01-01

    Full Text Available Background: Sudden cardiac death is a leading cause of death in patients with ST-elevation myocardial infarction (MI. According to high cost of modern therapeutic modalities it is of paramount importance to define protocols for risk stratification of post-MI patients before considering expensive devices such as implantable cardioverter-defibrillator.Methods: One hundred and thirty seven patients with acute ST-elevation MI were selected and underwent echocardiographic study, holter monitoring and signal-averaged electrocardiography (SAECG. Then, the patients were followed for 12 ±3 months.Results: During follow-up, 13 deaths (9.5% occurred; nine cases happened as sudden cardiac death (6.6%. The effect of ejection fraction (EF less than 40% on occurrence of arrhythmic events was significant (P<0.001. Sensitivity and positive predictive value of EF<40% was 100% and 76.95% respectively. Although with lesser sensitivity and predictive power than EF<40%, abnormal heart rate variability (HRV and SAECG had also significant effects on occurrence of sudden death (P=0.02 and P=0.003 respectively. Nonsustained ventricular tachycardia was not significantly related to risk of sudden death in this study (P=0.20.Conclusions: This study indicated that EF less than 40% is the most powerful predictor of sudden cardiac death in post MI patients. Abnormal HRV and SAECG are also important predictors and can be added to EF for better risk stratification.

  20. Myocardial contusion following nonfatal blunt chest trauma

    International Nuclear Information System (INIS)

    Kumar, S.A.; Puri, V.K.; Mittal, V.K.; Cortez, J.

    1983-01-01

    Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. Myocardial scan was positive in seven of eight patients (87.5%). CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma

  1. Corrected thrombolysis in myocardial infarction frame counts in diabetic patients with angiographically normal coronary arteries

    International Nuclear Information System (INIS)

    Turkoglu, S.; Ozdemir, M.; Tacoy, G.; Tavil, Y.; Abaci, A.; Timurkaynak, T.; Cengel, A.

    2008-01-01

    Objective was to evaluate corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) in patients with angiographically normal coronary arteries and diabetes mellitus, a condition known to be associated with microvascular dysfunction. Patients who underwent coronary angiography in Gazi University Hospital, Ankara, Turkey between January 2000 and January 2005 were studied. Corrected TIMI frame count was left circumflex (Cx) and right coronary arteries (RCA) in 118 diabetic and 122 non-diabetic patients with normal coronary angiogram. The mean CTFC values of the LAD, Cx and the RCA were similar in diabetics and nondiabetics (21.0+-7.5 versus 21.3+-9.6, 23.3+-9.7 versus 23.5+-10.8, 17.9+-6.7 versus 18.7+-7.4 respectively, p>0.05 for all comparisons). In stepwise multivariate linear regression analysis, body surface area had a significant correlation with CTFC of all the 3 coronary arteries. We conclude that CTFC in diabetics and non-diabetics with angiographically normal coronary arteries is similar. Since microvascular disease is an inherent component of diabetes, our finding may reflect the inadequacy of CTFC in predicting microvascular disease in diabetic patients with normal coronary angiograms. (author)

  2. Perfusion Computed Tomography for the Assessment of Myocardial Viability — a Case Series

    Directory of Open Access Journals (Sweden)

    Morariu Mirabela

    2016-06-01

    Full Text Available Myocardial viability plays an important role in preventing the development of left ventricular remodeling following an acute myocardial infarction. A preserved viability in the infarcted area has been demonstrated to be associated with a lower amplitude of the remodeling process, while the extent of the non-viable myocardium is directly correlated with the amplitude of the remodeling process. A number of methods are currently in use for the quantification of the viable myocardium, and some of them are based on the estimation of myocardial perfusion during pharmacologic stress. 64-slice Multi-detector Computed Tomography (MDCT during vasodilator stress test, associated with CT Coronary Angiography (CCTA has a high diagnostic accuracy in evaluating myocardial perfusion. In this article, we present a sequence of 3 clinical cases that presented with symptoms of myocardial ischemia, who underwent 64-slice MDCT imaging at rest and during adenosine stress test, in order to assess the extent of the hypoperfused myocardial areas. Coronary artery anatomy and the Coronary Calcium Score was assessed for all 3 patients by performing CT Coronary Angiography. The combination of CT Angiography and adenosine stress CT myocardial perfusion imaging can accurately detect atherosclerosic lesions that cause perfusion abnormalities, compared with the combination of invasive angiography and single-photon emission computed tomography (SPECT.

  3. Effects of statin therapy on clinical outcomes after acute myocardial infarction in patients with advanced renal dysfunction: A propensity score-matched analysis.

    Science.gov (United States)

    Kim, Jin Sug; Kim, Weon; Park, Ji Yoon; Woo, Jong Shin; Lee, Tae Won; Ihm, Chun Gyoo; Kim, Yang Gyun; Moon, Ju-Young; Lee, Sang Ho; Jeong, Myung Ho; Jeong, Kyung Hwan

    2017-01-01

    Lipid lowering therapy is widely used for the prevention of cardiovascular complications after acute myocardial infarction (AMI). However, some studies show that this benefit is uncertain in patients with renal dysfunction, and the role of statins is based on the severity of renal dysfunction. In this study, we investigated the impact of statin therapy on major adverse cardiac events (MACEs) and all-cause mortality in patients with advanced renal dysfunction undergoing percutaneous coronary intervention (PCI) after AMI. This study was based on the Korea Acute Myocardial Infarction Registry database. We included 861 patients with advanced renal dysfunction from among 33,205 patients who underwent PCI after AMI between November 2005 and July 2012. Patients were divided into two groups: a statin group (n = 537) and a no-statin group (n = 324). We investigated the 12-month MACEs (cardiac death, myocardial infarction, repeated PCI or coronary artery bypass grafting) and all-cause mortality of each group. Subsequently, a propensity score-matched analysis was performed. In the total population studied, no significant differences were observed between the two groups with respect to the rate of recurrent MI, repeated PCI, coronary artery bypass grafting (CABG), or all-cause mortality. However, the cardiac death rate was significantly lower in the statin group (p = 0.009). Propensity score-matched analysis yielded 274 pairs demonstrating, results similar to those obtained from the total population. However, there was no significant difference in the cardiac death rate in the propensity score-matched population (p = 0.103). Cox-regression analysis revealed only left ventricular ejection fraction to be an independent predictor of 12-month MACEs (Hazard ratio [HR] of 0.979, 95% confidence interval [CI], 0962-0.996, p = 0.018). Statin therapy was not significantly associated with a reduction in the 12-month MACEs or all-cause mortality in patients with advanced renal dysfunction

  4. Myocardial Perfusion and Function Are Distinctly Altered by Sevoflurane Anesthesia in Diet-Induced Prediabetic Rats.

    Science.gov (United States)

    van den Brom, Charissa E; Boly, Chantal A; Bulte, Carolien S E; van den Akker, Rob F P; Kwekkeboom, Rick F J; Loer, Stephan A; Boer, Christa; Bouwman, R Arthur

    2016-01-01

    Preservation of myocardial perfusion during surgery is particularly important in patients with increased risk for perioperative complications, such as diabetes. Volatile anesthetics, like sevoflurane, have cardiodepressive effects and may aggravate cardiovascular complications. We investigated the effect of sevoflurane on myocardial perfusion and function in prediabetic rats. Rats were fed a western diet (WD; n = 18) or control diet (CD; n = 18) for 8 weeks and underwent (contrast) echocardiography to determine perfusion and function during baseline and sevoflurane exposure. Myocardial perfusion was estimated based on the product of microvascular filling velocity and blood volume. WD-feeding resulted in a prediabetic phenotype characterized by obesity, hyperinsulinemia, hyperlipidemia, glucose intolerance, and hyperglycemia. At baseline, WD-feeding impaired myocardial perfusion and systolic function compared to CD-feeding. Exposure of healthy rats to sevoflurane increased the microvascular filling velocity without altering myocardial perfusion but impaired systolic function. In prediabetic rats, sevoflurane did also not affect myocardial perfusion; however, it further impaired systolic function. Diet-induced prediabetes is associated with impaired myocardial perfusion and function in rats. While sevoflurane further impaired systolic function, it did not affect myocardial perfusion in prediabetic rats. Our findings suggest that sevoflurane anesthesia leads to uncoupling of myocardial perfusion and function, irrespective of the metabolic state.

  5. Myocardial ischemia in hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Lima Filho, Moyses de Oliveira; Figueiredo, Geraldo L.; Simoes, Marcus V.; Pyntia, Antonio O.; Marin Neto, Jose Antonio

    2000-01-01

    Myocardial ischemia in hypertrophic cardiomyopathy is multifactorial and explains the occurrence of angina, in about 50% of patients. The pathophysiology of myocardial ischemia may be explained by the increase of the ventricular mass and relative paucity of the coronary microcirculation; the elevated ventricular filling pressures and myocardial stiffness causing a compression of the coronary microvessels; the impaired coronary vasodilator flow reserve caused by anatomic and functional abnormalities; and the systolic compression of epicardial vessel (myocardial bridges). Myocardial ischemia must be investigated by perfusion scintigraphic methods since its presence influences the prognosis and has relevant clinical implications for management of patients. Patients with hypertrophic cardiomyopathy and documented myocardial ischemia usually need to undergo invasive coronary angiography to exclude the presence of concomitant atherosclerotic coronary disease. (author)

  6. Gated-SPECT myocardial scintigraphy in left bundle branch block: A study in patients with and without coronary artery disease

    International Nuclear Information System (INIS)

    Falcao, A.M.; Moffa, P.J.; Chalela, W.A.; Soares, J.; Oliveira, C.G.; Kreling, J.C.; Ferreira, B.A.; Uchida, A.H.; Meneghetti, J.C.

    2002-01-01

    Introduction: Myocardial perfusion scintigraphy (MPS) is a non-invasive method helpful for evaluating coronary heart disease. In left bundle branch block (LBBB), the myocardial scintigraphy frequently reveals septal abnormalities in the absence of coronary artery disease (CAD) and gives rise to 'false-positive' results in patients (pts) with suspected CAD. The purpose of this study was to assess the diagnostic role of ECG-gated SPECT in pts with complete LBBB, with and without known CAD. Methods. This study included 46 pts, 29 women (63%), with mean age 63.8 ± 11.6yr, divided into two groups: Group 1 (n=21 pts) with LBBB and CAD angiographically confirmed and Group 2 (n=25 pts) with LBBB and normal coronangiography. All pts underwent MPS at rest and two stress tests - dipyridamole (DIP) and treadmill exercise test (ET) with Bruce protocol. Myocardial perfusion, wall motility and wall thickening were analyzed qualitatively by consensus of two observers in anterior, septal, inferior, lateral and apical myocardial segments. Scores were attributed to: perfusion as normal, reversible or fixed defects; motility as normal, hypokinesia, akinesia or dyskinesia and thickening if present or absent. The left ventricle ejection fraction (LVEF) was automatically calculated from the ECG-gated SPECT. Results: The comparative analysis between groups 1 and 2 for both stresses (DIP and ET) for the parameters analyzed in the myocardial segments are presented: LVEF at rest, ET and DIP show statistically significant differences between groups 1 and 2 (p<0.0001). Conclusion: In the anterior and septal segments, only septal thickening was capable of differentiating between LBBB with and without CAD, independent of the kind of stress. In the other segments there was no influence of disturbance conduction for the perfusion analysis

  7. A serial changes of thallium-201 myocardial images in a patient with nontransmural myocardial infarction

    International Nuclear Information System (INIS)

    Tanaka, Takeshi; Itoh, Yukiyoshi; Takayama, Yasuo

    1986-01-01

    A 66 year old man had suffered from inferior myocardial infarction one year ago and then suffered from effort angina. Recently rest angina attack frequently occurred and he was admitted because of angina attack refractory to TNG. The patient was diagnosed as broad nontransmural infarction. A serial thallium-201 myocardial imagings at rest and thallium-201 lung uptake imagings were performed and some interesting findings were obtained as followings. Myocardial imagings on 3rd day after admission showed no significant deffect, however EF was 34 %. Immediately after severe ischemic attack marked defect was noted at posterolateral region and ECG showed prominent precordial ST depression without accompanying significant ST change in II, III, aVF. On 3rd day after severe attack under hemodynamically and electrocardiographically stable state posterolateral defect improved, though still persisted. EF was 28 %. On 3rd day postop no marked defects were noted in myocardial imagings, so posterolateral defect at rest after severe ischemic attack was proved to be transient defect. In this case thallium-201 lung uptake was not noted before attack. Immediately after severe attack thallium lung uptake increased and maximal uptake was noted at basal zone of lung, however in chest X-P typical butterfly shadow was noted at upper zone of lung. On 3rd day after severe attack hemodynamics improved and butterfly shadow ceased, though thallium lung uptake increased and noted at upper zone of lung. After operation thallium lung uptake improved. (J.P.N.)

  8. Clinical study on the time courses of serum myosin light chain I levels in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Nakanishi, Masako; Saiki, Yasuhiko; Ui, Kazuyo

    1992-01-01

    Changes of serum myosin light chain I (Myosin LCI) concentrations and creatine kinase (CK) activities were serially measured in 23 patients with acute myocardial infarction. Intracoronary thrombolysis was performed in 14 patients (ICT group) while the remaining 9 patients were treated in the conventional manner (non ICT group). The relationships between the maximum levels of serum Myosin LCI or CK and a myocardial infarct size index or left ventricular function were evaluated in 18 patients. The myocardial infarct size index was determined by 201 Tl myocardial scintigrams performed in the chronic phase. Multiple peaks of Myosin LCI were observed in 64% (9/14) of the ICT group and the first peak in 6 of these patients appeared much earlier in the same time as CK peak than in the non-ICT group, while multiple peaks were seen only in one case in the non-ICT group. The infarct size index by 201 Tl myocardial SPECT correlated with maximum Myosin LCI levels (r=0.88, p<0.001, n=10) and CK activities (r=0.67, p<0.05, n=10). These results indicate that the measurement of serum Myosin LCI is very useful for estimating the extent of myocardial damage and suggest that myocardial degeneration occurs at a very early phase of myocardial infarction. (author)

  9. Acute Myocardial Infarction Patients

    Directory of Open Access Journals (Sweden)

    Bruce Ovbiagele

    2011-01-01

    Full Text Available Background. Diabetes mellitus (DM confers high vascular risk and is a growing national epidemic. We assessed clinical characteristics and prevalence of diagnosed DM among patients hospitalized with acute myocardial infarction (AMI in the US over the last decade. Methods. Data were obtained from all states within the US that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 2006 with a primary discharge diagnosis of AMI were included. Time trends in the proportion of these patients with DM diagnosis were computed. Results. The portion of patients with comorbid diabetes among AMI hospitalizations increased substantially from 18% in 1997 to 30% in 2006 (<.0001. Absolute numbers of AMI hospitalizations in the US decreased 8% (from 729, 412 to 672, 243, while absolute numbers of AMI hospitalizations with coexisting DM rose 51% ((131, 189 to 198, 044, both (<.0001. Women with AMI were significantly more likely to have DM than similarly aged men, but these differences diminished with increasing age. Conclusion. Although overall hospitalizations for AMI in the US diminished over the last decade, prevalence of diabetes rose substantially. This may have important consequences for the future societal vascular disease burden.

  10. Relationship between segmental thallium-201 uptake and regional myocardial blood flow in patients with coronary artery disease

    International Nuclear Information System (INIS)

    Nichols, A.B.; Weiss, M.B.; Sciacca, R.R.; Cannon, P.J.; Blood, D.K.

    1983-01-01

    The relationship between the spatial distribution of thallium-201 in myocardial perfusion scintigrams and the distribution of left ventricular regional myocardial blood flow was examined in 25 patients undergoing coronary arteriography. Thallium-201 myocardial scintigrams were obtained after symptom-limited exercise and after a 4 hr delay. Regional myocardial blood flow was measured by the xenon-133 clearance method in patients at rest and during rapid atrial pacing to a double product comparable with that achieved during exercise stress testing. Patterns of regional thallium-201 activity and regional myocardial blood flow, recorded in similar left anterior oblique projections, were compared for left ventricular segments supplied by the left anterior descending (LAD) and left circumflex (CIRC) arteries. In 11 patients without significant lesions of the left coronary artery (group 1), thallium-201 was homogeneously distributed in the LAD and CIRC distributions in scintigrams taken during peak exercise; these scintigrams correspond to homogeneous regional myocardial blood flow in the LAD and CIRC regions during pacing-induced stress. In 14 patients with significant lesions of the left coronary artery (group 2), ratios of regional thallium-201 activity in the LAD and CIRC distributions of exercise scintigrams correlated well (r . .84) with ratios of regional myocardial blood flow measured during rapid pacing. Background subtraction altered the relationship between relative thallium-201 uptake and regional myocardial blood flow, causing overestimation of the magnitude of flow reduction on exercise scintigrams

  11. Normal myocardial perfusion imaging in the presence of significant coronary artery stenosis

    International Nuclear Information System (INIS)

    Tian Yueqin; He Zuoxiang; Fang Wei; Yang Minfu; Shen Rui

    2007-01-01

    Objective: The aim of this study was to investigate the factors which might result in normal myocardial perfusion imaging in the presence of significant coronary artery stenosis. Methods: One hundred and thirty-three patients [mean age of (59±10) years, 98 men, 35 women] who underwent coronary angiography and myocardial perfusion SPECT were retrospectively analyzed. Results: Forty-six (35%) patients performed adequate bicycle exercise testing and achieved more than 85% of their predicted maximal heart rates; while 87 (65%) patients did not. Eighty-four (63%) patients had single coronary stenosis, 31(23%) two-vessel and 17(13%) three-vessel diseases. The difference in stenosis severity among the vessels in 13 (76%) cases with three-vessel diseases was not more than 20%. There were totally 202 coronary artery stenosis: 93 (46%) in left anterior descending coronary artery (LAD), 52 (26%) left circumflex coronary artery (LCX), 52(26% ) right coronary artery (RCA) and 5 (2%) left main coronary artery (LM) disease. Eighty-six(43%) vessels had 50%-70% stenosis, 100 (49%) >70%-90% and 16(8% )more than 90%. Conclusion: Normal myocardial perfusion imaging with significant coronary artery stenosis can probably due to inadequate exercise, single vessel disease and mild to moderate stenotic lesion. (authors)

  12. Evaluation of myocardial uptake of {beta}-methyl-({sup 123}I)-iodophenylpentadecanoic acid ({sup 123}II-BMIPP)

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    Momose, Mitsuru; Kobayashi, Hideki; Matsumoto, Nobusuke; Maki, Masako; Kusakabe, Kiyoko [Tokyo Women`s Medical Coll. (Japan); Saito, Katsumi; Hosoda, Saichi

    1994-12-01

    To evaluate the myocardial uptake of {beta}-methyl-({sup 123}I)-iodophenylpentadecanoic acid ({sup 123}I-BMIPP), nineteen patients with ischemic heart disease including left ventricular hypertrophy (mean age 63{+-}7.8, 14 males and 5 females) underwent BMIPP myocardial scintigraphy. Myocardial uptake (MU) of BMIPP to the total injected dose was calculated from anterior veiw of the planar image in all subjects, and was compared with plasma glucose (BS), triglyceride (TG), and free fatty acid (FFA). It was also compared with left ventricular mass (LVM) calculated with echocardiography. MU was not related to BS, TG, and FFA, however had the positive correlation with LVM (r=0.676, p<0.01). Myocardial uptake per left ventricular mass (MU/LVM) had the negative correlation with LVM (r=-0.671, p<0.01). Further studies for the significance of MU/LVM will be required. (author).

  13. Effect of programmed ventricular stimulation on myocardial lactate extraction in patients with and without coronary artery disease

    International Nuclear Information System (INIS)

    Morady, F.; DiCarlo, L.A. Jr.; Krol, R.B.; de Buitleir, M.; Nicklas, J.M.; Annesley, T.M.

    1986-01-01

    The arterial-coronary sinus lactate difference was measured in 17 patients after each step of a programmed ventricular stimulation protocol consisting of single, double, and triple extrastimuli, first at a basic drive cycle length of 600 msec, then at 400 msec, with an inter-train interval of 4 seconds. Four patients had no structural heart disease, four had an idiopathic dilated cardiomyopathy, and nine had coronary artery disease with a significant stenosis in at least one branch of the left coronary artery. Net myocardial lactate production during programmed ventricular stimulation was observed in three patients with coronary artery disease, but not in any patient without coronary artery disease. Among the patients who had coronary artery disease, net myocardial lactate production generally occurred in the patients who had more severe coronary artery disease. Exercise-induced ischemia, as demonstrated by a stress thallium-201 test, did not correlate with myocardial lactate production during programmed ventricular stimulation. Programmed ventricular stimulation, with a stimulation protocol typically used in many electrophysiology laboratories, is capable of inducing myocardial ischemia in at least some patients who have coronary artery disease. This finding suggests that myocardial ischemia may potentially influence the results of programmed ventricular stimulation in some patients with coronary artery disease

  14. Impact of endothelial dysfunction on left ventricular remodeling after successful primary coronary angioplasty for acute myocardial infarction. Analysis by quantitative ECG-gated SPECT

    International Nuclear Information System (INIS)

    Matsuo, Shinro; Nakae, Ichiro; Matsumoto, Tetsuya; Horie, Minoru

    2006-01-01

    We hypothesized that endothelial cell integrity in the risk area would influence left ventricular remodeling after acute myocardial infarction. Twenty patients (61±8 y.o.) with acute myocardial infarction underwent 99m Tc-tetrofosmin imaging in the sub-acute phase and three months after successful primary angioplasty due to myocardial infarction. All patients were administered angiotensin-converting enzyme inhibitor after revascularization. Cardiac scintigraphies with quantitative gated SPECT were performed at the sub-acute stage and again 3 months after revascularization to evaluate left ventricular (LV) remodeling. The left ventricular ejection fraction (EF) and end-systolic and end-diastolic volume (ESV, EDV) were determined using a quantitative gated SPECT (QGS) program. Three months after myocardial infarction, all patients underwent cardiac catheterization examination with coronary endothelial function testing. Bradykinin (BK) (0.2, 0.6, 2.0 μg/min) was administered via the left coronary artery in a stepwise manner. Coronary blood flow was evaluated by Doppler flow velocity measurement. Patients were divided into two groups by BK-response: a preserved endothelial function group (n=10) and endothelial dysfunction group (n=10). At baseline, both global function and LV systolic and diastolic volumes were similar in both groups. However, LV ejection fraction was significantly improved in the preserved-endothelial function group, compared with that in the endothelial dysfunction group (42±10% to 48±9%, versus 41±4% to 42±13%, p<0.05). LV volumes progressively increased in the endothelial dysfunction group compared to the preserved-endothelial function group (123±45 ml to 128±43 ml, versus 111±47 ml to 109±49 ml, p<0.05). In re-perfused acute myocardial infarction, endothelial function within the risk area plays an important role with left ventricular remodeling after myocardial infarction. (author)

  15. MYOCARDIAL DEFORMATION AND COMPLETE LEFT BUNDLE BRANCH BLOCK

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    E. N. Pavlyukova

    2015-12-01

    Full Text Available Tissue Doppler imaging is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular systolic and diastolic function. Over the last 10 years, myocardial deformation imaging has become possible initially with tissue Doppler , and more recently with myocardial speckle-tracking using 2D echocardiography. Unlike simple tissue velocity measurements, deformation measurements are specific for the region of interest. Strain rate or strain measurements have been used as sensitive indicators for subclinical diseases, and it is the most widely used tool to assess mechanical dyssynchrony. Left bundle branch block is a frequent, etiologically heterogeneous, clinically hostile and diagnostically challenging entity. About 2% of patients underwent cardiac stress testing show stable or intermittent left bundle branch block. Presence of left bundle branch block is associated with a lower and slower diastolic coronary flow velocity especially during hyperemia. Stress echocardiography is the best option for the diagnosis of ischemic heart disease, albeit specificity and sensitivity reduce in patients with left bundle branch block in the territory of left anterior descending artery in presence of initial septum dyskinesia.

  16. Stress thallium-201 myocardial scintigraphy for the detection of individual coronary arterial lesions in patients with and without previous myocardial infarction

    International Nuclear Information System (INIS)

    Rigo, P.; Bailey, I.K.; Griffith, L.S.; Pitt, B.; Wagner, H.N. Jr.; Becker, L.C.

    1981-01-01

    The value of stress thallium-201 scintigraphy for detecting individual coronary arterial stenoses was analyzed in 141 patients with angiographically proved coronary artery disease, 101 with and 40 without a previous myocardial infarction. In patients without infarction, the sensitivity for detecting greater than 50 percent narrowing in the left anterior descending, the right and the left circumflex coronary artery was 66, 53 and 24 percent, respectively. In those with a previous infarction, the sensitivity for demonstrating disease in the artery corresponding to the site of infarction was 100 percent for the left anterior descending, 79 percent for the right and 63 percent for the left circumflex coronary artery. In patients with a prior anterior infarction, concomitant right or left circumflex coronary arterial lesions were detected in only 1 of 12 cases, whereas in those with previous inferior or inferolateral infarction, the sensitivity for left anterior descending coronary artery disease was 69 percent. Because of the reasonably high sensitivity for detecting left anterior descending arterial disease, irrespective of the presence and location of previous infarction, myocardial scintigraphy was useful in identifying multivessel disease in patients with a previous inferior infarction. However, because of its relative insensitivity for right or left circumflex coronary artery disease, scintigraphy proved to be a poor predictor of multivessel disease in patients with a prior anterior infarction and in patients without previous myocardial infarction

  17. Effects of Insulin Resistance on Myocardial Blood Flow and Arterial Peripheral Circulation in Patients with Polycystic Ovary Syndrome.

    Science.gov (United States)

    Aldrighi, José M; Tsutsui, Jeane M; Kowastch, Ingrid; Ribeiro, Alessandra L; Scapinelli, Alessandro; Tamanaha, Sonia; Oliveira, Ricardo M; Mathias, Wilson

    2015-08-01

    Polycystic ovary syndrome (PCOS) is associated with increased risk for cardiovascular disease. We sought to evaluate the effects of insulin resistance (IR) on myocardial microcirculation and peripheral artery function in patients with PCOS. We studied 55 women (28 with PCOS without IR, 18 with PCOS and IR and 11 normal controls) who underwent laboratorial analysis, high-resolution vascular ultrasound and real time myocardial contrast echocardiography (RTMCE). Intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD) were evaluated by vascular ultrasound. The replenishment velocity (β), plateau of acoustic intensity (A) and myocardial blood flow reserve (MBFR) were determined by quantitative dipyridamole stress RTMCE. β reserve in group PCOS + IR was lower than control (2.34 ± 0.55 vs. 3.60 ± 0.6; P PCOS without IR (2.34 ± 0.55 vs. 3.17 ± 0.65; P PCOS without IR did not differ from those of control (4.59 ± 1.59 vs. 5.30 ± 1.64; P = 0.22) or from patients with PCOS + IR (4.59 ± 1.59 vs. 3.70 ± 1.47; P = 0.07). When comparing with control group, patients with PCOS + IR had lower MBFR (5.30 ± 1.64 vs. 3.70 ± 1.47; P = 0.01). No significant differences were found between control, PCOS without IR and PCOS + IR for FMD (0.18 ± 0.05, 0.15 ± 0.04 and 0.13 ± 0.07; P =NS) or IMT (0.48 ± 0.05, 0.47 ± 0.05 and 0.49 ± 0.07; P = NS). Women with PCOS and IR had depressed β and MBFR as demonstrated by quantitative RTMCE, but no alteration in endothelial dysfunction or IMT. PCOS without IR showed isolated depression in β reserve, probably an earlier marker of myocardial flow abnormality. © 2014, Wiley Periodicals, Inc.

  18. Clinical evaluation of 123I-metaiodobenzylguanidine myocardial scintigram in patients with vascular heart disease

    International Nuclear Information System (INIS)

    Terada, Kouji; Sugihara, Hiroki; Shiga, Koji

    1995-01-01

    Myocardial sympathetic nerve function can be evaluated by 123 I-metaiodobenzylguanidine (MIBG) scintigraphy. Congestive heart failure is closely related to myocardial sympathetic nerve function. This study evaluated the severity of congestive heart failure in 30 patients with valvular heart disease [aortic regurgitation (AR): n=20, mean age=70±13 years; mitral regurgitation (MR): n=10, mean age=61±18 years], who had chronic heart failure by MIBG myocardial scintigraphy. Single photon emission computed tomography (SPECT) and anterior planar myocardial images were obtained 15 minutes (initial images) and 4 hours (delayed images) after injection of MIBG (111 MBq). Defect score was determined by the delayed SPECT images visually as a semi-quantitative index. Myocardial MIBG uptake was quantified by the heart to upper mediastinum uptake ratio on the delayed anterior planar images (H/M) and mean cardiac MIBG washout rate during 4 hours was calculated from the bull's eye display data (clearance). These indices were compared with the NYHA class and echocardiographic findings of the patients. MIBG regional defect in the delayed image was most frequently seen in the inferoposterior wall, and defect score and clearance were significantly higher and the H/M ratio was significantly lower in NYHA class III patients than in class II patients. In patients with AR, clearance significantly correlated with left ventricular end-systolic dimension. In patients with MR, both the H/M ratio and clearance significantly correlated with left atrial dimension. Defect score, H/M, and clearance were closely related to the severity of AR and MR. These results indicate that MIBG scan can be used to assess the severity of valvular heart disease. (author)

  19. Clinical study on myocardial imaging with β-methyl-p-(123I)-iodophenyl-pentadecanoic acid in patients with mitochondrial myopathy

    International Nuclear Information System (INIS)

    Kihara, Koichi; Nakajo, Masayuki; Shono, Hirohisa

    1992-01-01

    Myocardial imaging with β-methyl-p-( 123 I)-iodophenyl-pentadecanoic acid ( 123 I-BMIPP), a new radiopharmaceutical designed to evaluate myocardial fatty acid metabolism, was performed in 7 patients with mitochondrial myopathy to detect their myocardial damages in comparison with 201 Tl myocardial imaging. These patients were divided into 4 chronic progressive external ophthalmoplegia (CPEO) cases, 2 mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) cases and 1 myoclonus epilepsy with ragged-red fibers (MERRF). In visual assessment, we observed more myocardial segments with decreased uptake of 123 I-BMIPP compared to 201 Tl in MELAS cases than in CPEO cases. The mean myocardial uptake of 123 I-BMIPP was higher than that of 201 Tl in CPEO cases. On the other hand, in MELAS and MERRF cases, the mean myocardial uptake of 123 I-BMIPP was lower than that of 201 Tl. Abnormal findings suggesting myocardial damages were observed in echocardiogram and/or in electrocardiogram in MELAS and MERRF cases, while no such abnormal findings were observed in CPEO cases. Along with the previously reported experimental result that the impairment of rat myocardial mitochondria decreased myocardial uptake of 123 I-BMIPP, these results suggest that 123 I-BMIPP may be useful to detect myocardial damages in patients with mitochondrial myopathy. (author)

  20. Myocardial Ischaemia, Coronary Atherosclerosis and Pulmonary Pressure Elevation in Antiphospholipid Syndrome Patients.

    Science.gov (United States)

    Padjas, Agnieszka; Płazak, Wojciech; Celińska-Lowenhoff, Magdalena; Mazurek, Adam; Perricone, Carlo; Podolec, Piotr; Musiał, Jacek

    2016-01-01

    Thrombotic events in antiphospholipid syndrome (APS) involve venous and arterial circulation with the possible involvement of coronary or pulmonary microcirculation. To evaluate the influence of antiphospholipid antibodies (aPL) and on myocardial ischaemia assessed by single-photon emission computerized tomography (SPECT), coronary atherosclerosis assessed by multidetector computerized tomography (MDCT) and pulmonary pressure assessed by transthoracic echocardiography (TTE) in patients with primary antiphospholipid syndrome (PAPS). TTE, SPECT (Tc 99m sestamibi) and MDCT-based coronary calcium scoring were performed in 26 consecutive PAPS patients (20 females, 6 males, aged 20-61, mean 39.7) without any signs of other autoimmunological disease and without clinical symptoms of heart disease. Out of 26 patients, TEE showed normal left and right ventricle function in 25 (96.2%) and elevated (≥ 30 mm Hg) right ventricle systolic pressure in 7 (26.9%) patients. SPECT revealed myocardial perfusion defects in 15 (57.7%) patients: exercise-induced in 6 (23.1%) and persistent in 11 (42.3%). MDCT revealed coronary calcifications in 4 (15.4%) patients. The number of plaques ranged from 1 to 11 (median 2), volume 3-201.7 mm³ (median 7), calcium scores 1.3-202.6 (median 5.7). In the group with perfusion defects or coronary calcifications (n = 15), all the patients showed elevated aCL IgG. In most of the relatively young APS patients, without any symptoms of ischemic heart disease, SPECT showed myocardial perfusion defects, and coronary calcifications in 1/6 of them. Right ventricle systolic pressure was elevated in 1/4 of APS patients. These pathologies, well known as cardiovascular risk markers, were associated with elevated levels of the IgG class of both anti-cardiolipin and antiB2 GPI antibodies. Thus, in a high percentage of APS patients, clinically silent myocardial ischaemia, pulmonary pressure elevation and coronary atherosclerosis are present and related to the

  1. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

    OpenAIRE

    Cabeda, Est?van Vieira; Falc?o, Andr?a Maria Gomes; Soares Jr., Jos?; Rochitte, Carlos Eduardo; Nomura, C?sar Higa; ?vila, Luiz Francisco Rodrigues; Parga, Jos? Rodrigues

    2015-01-01

    Abstract Background: Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective: To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and comp...

  2. Interpretation of elevated plasma visfatin concentrations in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Lu, Li-Fen; Wang, Chao-Ping; Yu, Teng-Hung; Hung, Wei-Chin; Chiu, Cheng-An; Chung, Fu-Mei; Tsai, I-Ting; Yang, Chih-Ying; Cheng, Ya-Ai; Lee, Yau-Jiunn; Yeh, Lee-Ren

    2012-01-01

    Visfatin is a cytokine that is expressed in many tissues, including the heart, and has been proposed to play a role in plaque destabilization leading to acute myocardial injury. The present study evaluates plasma levels of visfatin in acute ST-elevation myocardial infarction (STEMI) patients and examines the temporal changes in visfatin levels from the acute period to the subacute period to determine a correlation with the degree of myocardial ischemia. We evaluated 54 patients with STEMI. Circulating levels of visfatin and brain natriuretic peptide (BNP) were measured by ELISA. In addition, local expression of visfatin and BNP were detected by quantitative real-time polymerase chain reaction and immunohistochemical (IHC) analysis of left ventricular myocytes in a mouse model of myocardial infarction (MI). Plasma levels of visfatin were significantly increased in patients with STEMI on admission, relative to controls (effort angina patients and individuals without coronary artery disease). The visfatin levels reached a peak 24h after percutaneous coronary intervention (PCI) and then decreased toward the control range during the first week after PCI. The basal plasma visfatin levels were found to correlate with peak troponin-I, peak creatine kinase-MB, total white blood cell count, and BNP levels. Trend analyses confirmed that visfatin levels correlated with the number of diseased coronary arteries. Further, in MI mice, mRNA levels of visfatin and BNP were found to be higher than in sham-treated mice. IHC analysis showed that visfatin and BNP immunoreactivity was diffusely observable in left ventricular myocytes of the MI mice. This study indicates that plasma visfatin levels are significantly higher in STEMI patients and that these higher visfatin levels correlate with elevated levels of cardiac enzymes, suggesting that increased plasma visfatin may be closely related to the degree of myocardial damage. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. Do thallium myocardial perfusion scan abnormalities predict survival in sarcoid patients without cardiac symptoms

    International Nuclear Information System (INIS)

    Kinney, E.L.; Caldwell, J.W.

    1990-01-01

    Whereas the total mortality rate for sarcoidosis is 0.2 per 100,000, the prognosis, when the heart is involved, is very much worse. The authors used the difference in mortality rate to infer whether thallium 201 myocardial perfusion scan abnormalities correspond to myocardial sarcoid by making the simplifying assumption that if they do, then patients with abnormal scans will be found to have a death rate similar to patients with sarcoid heart disease. The authors therefore analyzed complete survival data on 52 sarcoid patients without cardiac symptoms an average of eighty-nine months after they had been scanned as part of a protocol. By use of survival analysis (the Cox proportional hazards model), the only variable that was significantly associated with survival was age. The patients' scan pattern, treatment status, gender, and race were not significantly related to survival. The authors conclude that thallium myocardial perfusion scans cannot reliably be used to diagnose sarcoid heart disease in sarcoid patients without cardiac symptoms

  4. Early myocardial damage assessment in dystrophinopathies using 99Tcm-MIBI gated myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Zhang L

    2015-12-01

    Full Text Available Li Zhang,1,* Zhe Liu,2,* Ke-You Hu,3 Qing-Bao Tian,3 Ling-Ge Wei,4 Zhe Zhao,5 Hong-Rui Shen,5 Jing Hu5 1Department of Cardiovascular Disorders, 2Department of Geriatrics, The Third Hospital of Hebei Medical University, 3The Public Health Department, Hebei Medical University, 4Department of Nuclear Medicine, 5Department of Neuromuscular Disorders, The Third Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China *Li Zhang and Zhe Liu are first coauthors of this paper Background: Early detection of muscular dystrophy (MD-associated cardiomyopathy is important because early medical treatment may slow cardiac remodeling and attenuate symptoms of cardiac dysfunction; however, no sensitive and standard diagnostic method for MD at an earlier stage has been well-recognized. Thus, the aim of this study was to test the early diagnostic value of technetium 99m-methoxyisobutylisonitrile (99Tcm-MIBI gated myocardial perfusion imaging (G-MPI for MD.Methods and results: Ninety-one patients underwent 99Tcm-MIBI G-MPI examinations when they were diagnosed with Duchenne muscular dystrophy (DMD (n=77 or Becker muscular dystrophy (BMD; n=14. 99Tcm-MIBI G-MPI examinations were repeated in 43 DMD patients who received steroid treatments for 2 years as a follow-up examination. Myocardial defects were observed in nearly every segment of the left ventricular wall in both DMD and BMD patients compared with controls, especially in the inferior walls and the apices by using 99Tcm-MIBI G-MPI. Cardiac wall movement impairment significantly correlated with age in the DMD and BMD groups (rs=0.534 [P<0.05] and rs=0.784 [P<0.05], respectively. Intermittent intravenous doses of glucocorticoids and continuation with oral steroid treatments significantly improved myocardial function in DMD patients (P<0.05, but not in BMD patients.Conclusion: 99Tcm-MIBI G-MPI is a sensitive and safe approach for early evaluation of cardiomyopathy in patients with DMD or BMD

  5. Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Ängerud, Karin H; Sederholm Lawesson, Sofia; Isaksson, Rose-Marie; Thylén, Ingela; Swahn, Eva

    2017-11-01

    In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001). Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and

  6. Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation

    Directory of Open Access Journals (Sweden)

    Koulousakis Athanassios

    2005-05-01

    Full Text Available Abstract Background Spinal cord electrical stimulation (SCS has shown to be a treatment option for patients suffering from angina pectoris CCS III-IV although being on optimal medication and not suitable for conventional treatment strategies, e.g. CABG or PTCA. Although many studies demonstrated a clear symptomatic relief under SCS therapy, there are only a few short-term studies that investigated alterations in cardiac ischemia. Therefore doubts remain whether SCS has a direct effect on myocardial perfusion. Methods A prospective study to investigate the short- and long-term effect of spinal cord stimulation (SCS on myocardial ischemia in patients with refractory angina pectoris and coronary multivessel disease was designed. Myocardial ischemia was measured by MIBI-SPECT scintigraphy 3 months and 12 months after the beginning of neurostimulation. To further examine the relation between cardiac perfusion and functional status of the patients we measured exercise capacity (bicycle ergometry and 6-minute walk test, symptoms and quality of life (Seattle Angina Questionnaire [SAQ], as well. Results 31 patients (65 ± 11 SEM years; 25 male, 6 female were included into the study. The average consumption of short acting nitrates (SAN decreased rapidly from 12 ± 1.6 times to 3 ± 1 times per week. The walking distance and the maximum workload increased from 143 ± 22 to 225 ± 24 meters and 68 ± 7 to 96 ± 12 watt after 3 months. Quality of life increased (SAQ significantly after 3 month compared to baseline, as well. No further improvement was observed after one year of treament. Despite the symptomatic relief and the improvement in maximal workload computer based analysis (Emory Cardiac Toolbox of the MIBI-SPECT studies after 3 months of treatment did not show significant alterations of myocardial ischemia compared to baseline (16 patients idem, 7 with increase and 6 with decrease of ischemia, 2 patients dropped out during initial test phase

  7. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock

    NARCIS (Netherlands)

    Thiele, Holger; Akin, Ibrahim; Sandri, Marcus; Fuernau, Georg; de Waha, Suzanne; Meyer-Saraei, Roza; Nordbeck, Peter; Geisler, Tobias; Landmesser, Ulf; Skurk, Carsten; Fach, Andreas; Lapp, Harald; Piek, Jan J.; Noc, Marko; Goslar, Tomaž; Felix, Stephan B.; Maier, Lars S.; Stepinska, Janina; Oldroyd, Keith; Serpytis, Pranas; Montalescot, Gilles; Barthelemy, Olivier; Huber, Kurt; Windecker, Stephan; Savonitto, Stefano; Torremante, Patrizia; Vrints, Christiaan; Schneider, Steffen; Desch, Steffen; Zeymer, Uwe; Tebbe, Ulrich; Wöhrle, Jochen; Pachinger, Otmar; Busch, Clemens; Pfeiffer, Nathalie; Neumer, Alexander; Ouarrak, Taoufik; Reimer, Thomas; Lober, Christiane; Clemmensen, Peter; Follath, Ferenc; Wegscheider, Karl; Zeitouni, M.; Overtchouk, P.; Guedeney, P.; Hage, G.; Hauguel-Moreau, N. N.; Eitel, Ingo; Weinschenk, Sabrina; Borggrefe, Martin; Neumann, Franz-Josef; Ferenc, Miroslaw; Olbrich, Hans-Gerd; Hopf, Hans-Bernd; Kastrati, Adnan; de Waha, Antoinette; Schunkert, Heribert; Richardt, Gert; Schwarz, Bettina; Abdel-Wahab, Mohamed; Toelg, Ralph; Geist, Volker; Bahnsen-Maaß, Monika; Hennersdorf, Marcus; Graf, Jochen; Riemann, Urs; Scharpf, Dominik; Empen, Klaus; Busch, Mathias C.; Werdan, Karl; Nuding, Sebastian; Hambrecht, Rainer; Fiehn, Eduard; Gitt, Anselm K.; Mark, Bernd; Winkler, Ralph; Lauer, Bernward; Möbius-Winkler, Sven; Schulze, Christian; Minden, Hans-Heinrich; Braun-Dullaeus, Rüdiger C.; Schmeißer, Alexander; Strasser, Ruth H.; Ebner, Bernd; Ertl, Georg; Mudra, Harald; Hug, Martin; Endemann, Dierk; Hamm, Christian; Walther, Claudia; Liebetrau, Christoph; Menck, Niels; Mehilli, Julinda; Orban, Martin; Hausleiter, Jörg; Massberg, Steffen; Prondzinsky, Roland; Gielen, Stephan; Gawaz, Meinrad; Pauschinger, Matthias; Ademaj, Fadil; Bode, Christoph; Nickenig, Georg; Fichtlscherer, Stephan; Zeiher, Andreas; Viertel, Achim; Kelm, Malte; Jung, Christian; Sydow, Carsten; Karakas, Mahir; Rudolph, Volker; Baldus, Stephan; Jacobshagen, Claudius; Hasenfuß, Gerd; Pfeiffer, Dietrich; Buchter, Björn; Hügl, Burkhard; Nef, Holger; Dörr, Oliver; Reinig, Karsten; Kuck, Karl Heinz; Ghanem, Alexander; Katus, Hugo; Gori, Tommaso; Münzel, Thomas; Schnupp, Steffen; Brachmann, Johannes; Ferrari, Markus; Achenbach, Stephan; Carrié, Didier; Henry, Patrick; Manzo-Silberman, Stephane; Ledermann, Bertrand; Cayla, Guillaume; Bonnet, Jean-Louis; Windecker, Stefan; Frenk, André; Jeger, Raban; Eeckhout, Eric; Henriques, Jose P.; van Geuns, Robert-Jan; Voskuil, Michiel; Bax, M.; van der Harst, Pim; Serpytis, Rokas; Jarasuniene, Dalia; Lang, Irene Marthe; Pichler, Philipp; Weidinger, Franz; Zaruba, Marc-Michael; Dudek, Darius; Depukat, Rafal; Witkowski, Adam; Milewski, Krzysztof; Prokopczuk, Janusz; Gąsior, Mariusz; Gorycki, Bogdan; Ochała, Andrzej; Piatti, Luigi; Galvani, Marcello; Bossi, Irene; Emilia, Reggio; Pignatelli, Gianluca; Greenwood, John; Lockie, Tim; Mamas, Mamas

    2017-01-01

    In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be

  8. BOLD cardiovascular magnetic resonance at 3.0 tesla in myocardial ischemia.

    OpenAIRE

    Manka, R; Paetsch, I; Schnackenburg, B; Gebker, R; Fleck, E; Jahnke, C

    2010-01-01

    Abstract Background The purpose of this study was to determine the ability of Blood Oxygen Level Dependent (BOLD) cardiovascular magnetic resonance (CMR) to detect stress-inducible myocardial ischemic reactions in the presence of angiographically significant coronary artery disease (CAD). Methods Forty-six patients (34 men; age 65 ± 9 years,) with suspected or known coronary artery disease underwent CMR at 3Tesla prior to clinically indicated invasive coronary angiography. BOLD CMR was perfor...

  9. Surgical myocardial revascularization in patients with reduced systolic left ventricular function.

    Science.gov (United States)

    Bruno, Piergiorgio; Iafrancesco, Mauro; Massetti, Massimo

    2018-04-20

    Surgical myocardial revascularization in patients with reduced left ventricular function has been a matter of debate for decades. Recently published 10-years extension follow-up of the STICH trial have conclusively demonstrated benefit of surgical myocardial revascularization in patients with significant coronary artery disease and low left ventricular ejection fraction. However, selection of patients for surgery remains challenging as well as decision to perform percutaneous rather than surgical revascularization in this class of patients. New evidence helped to clarify the role of preoperative patients' characteristics as risk factors for surgery and to identify those patients who may benefit the most from surgery. Focus of this review is to review epidemiology, aetiology and pathophysiology of coronary artery disease in patients with reduced left ventricular function, role of viability and results of observational and investigational studies on revascularization in patients with reduced left ventricular function with a particular emphasis on relative indication of coronary artery bypass grafting and percutaneous coronary intervention and the surgical implications of development of ischemic mitral regurgitation or ischemic left ventricular aneurysm.

  10. Significance of exercise-induced ST segment depression in patients with myocardial infarction involving the left circumflex artery. Evaluation by exercise thallium-201 myocardial single photon emission computed tomography

    International Nuclear Information System (INIS)

    Koitabashi, Norimichi; Toyama, Takuji; Hoshizaki, Hiroshi

    2000-01-01

    The significance of exercise-induced ST segment depression in patients with left circumflex artery involvement was investigated by comparing exercise electrocardiography with exercise thallium-201 single photon emission computed tomography (Tl-SPECT) and the wall motion estimated by left ventriculography. Tl-SPECT and exercise electrocardiography were simultaneously performed in 51 patients with left circumflex artery involvement (angina pectoris 30, myocardial infarction 21). In patients with myocardial infarction, exercise-induced ST depression was frequently found in the V 2 , V 3 and V 4 leads. In patients with angina pectoris, ST depression was frequently found in the II, III, aV F , V 5 and V 6 leads. There was no obvious difference in the leads of ST depression in patients with myocardial infarction with ischemia and without ischemia on Tl-SPECT images. In patients with myocardial infarction, the lateral wall motion of the infarcted area evaluated by left ventriculography was more significantly impaired in the patients with ST depression than without ST depression (p<0.01). Exercise-induced ST depression in the precordial leads possibly reflects wall motion abnormality rather than ischemia in the lateral infarcted myocardium. (author)

  11. Regular dog-walking improves physical capacity in elderly patients after myocardial infarction.

    Science.gov (United States)

    Ruzić, Alen; Miletić, Bojan; Ruzić, Tatjana; Persić, Viktor; Laskarin, Gordana

    2011-09-01

    Various positive effects of pet ownership on cardiovascular health are well known. The aim of this prospective and controlled longitudinal study was to determine the effects of everyday dog-walking on physical capacity in elderly patients during the first year after myocardial infarction. Regularly dog-walking for at least 15 minutes three times a day is related to significantly higher work load on the bicycle exercise test (72.5 +/- 10.75 versus 67.6 +/- 11.6 W p physical activity in elderly cardiovascular patients promoting their physical capacity. Further researches are needed to confirm this association as well to identify other possible influences of dog ownership on the cardiovascular health and on the outcome in patients after myocardial infarction.

  12. Features of Heart Rate Variability and Early Postinfarction Remodeling Process in Patients with Recurrent Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Corina Şerban

    2013-12-01

    Full Text Available The purpose of this study was to evaluate the heart rate variability (HRV level and the features of early post-infarction left ventricular remodeling (PIR in patients with recurrent myocardial infarction (MI, which developed within six months post the initial Q-wave MI (Q-MI. Material and Methods: The study surveyed 105 male patients between 29 and 69 years of age (mean age 52.08±8.5, who underwent a Q-MI and who, for various reasons, have not undergone coronary angiography. All patients underwent echocardiography and the LVM, EDV, ESV and their indexed values, as well as the ejection fraction were determined, including Holter ECG monitoring. In the interim, analysis included the indicators recommended by the standards of measurement, physiological interpretation and clinical use of heart rate variability, such as SDNN, SDANN and RMSSD. The reduction of the total reduction of HRV was taken as SDNN≤100ms, and the marked reduction in HRV - SDNN≤50ms. Results: All the patients were divided into two groups: Group I consisted of patients who, within six months after the initial Q-wave MI, developed fatal or nonfatal reinfarction; Group II included those patients with a favorable course of the disease. The patients in both groups belonged to a somewhat similar age category. By localization of MI, occurrence of AH, as well as the incidence of LV aneurysm, both groups were comparable. However, the Group I patients in acute Q-MI showed significantly more preserved signs of residual myocardial ischemia, which was manifested as early post-infarction angina. The average values of SDNN in patients in Group I were noted to be significantly lower than that in the Group II patients. The same ratio was observed in both groups and also the indicator of SDANN, whereas the mean RMSSD values of the patients of both groups were not significantly different. The percentage of patients with reduced HRV in Group I was 1.8 times higher than that in Group II

  13. Hemoglobin levels and 30-day mortality in patients after myocardial infarction

    NARCIS (Netherlands)

    Lipsic, E; van der Horst, ICC; Voors, AA; van der Meer, P; Nijsten, MWN; van Gilst, WH; van Veldhuisen, DJ; Zijlstra, F

    2005-01-01

    Background: Anemia is an independent risk factor for cardiovascular (CV) outcomes in patients with coronary artery disease and heart failure. However, the effect of hemoglobin levels on short-term CV mortality in patients with acute myocardial infarction (MI) remains unclear. Methods: In a

  14. Clinical evaluation of 123I-BMIPP myocardial scintigraphy in patients with hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Ohtsuki, Katsuichi; Sugihara, Hiroki; Umamoto, Ikuo

    1992-01-01

    123 I-β-methyl-p-iodophenylpentadecanoic acid ( 123 I-BMIPP) myocardial scintigraphy was performed in 13 patients with hypertrophic cardiomyopathy and compared with 201 Tl myocardial scintigraphy performed within 3 months for evaluating the clinical significance of 123 I-BMIPP myocardial scintigraphy. SPECT images were divided into 13 segments and segmental images were visually scored on a 4 (increased tracer uptake) to 0 (severely decreased tracer uptake) scale according to the tracer uptake. In comparison of 123 I-BMIPP early images and 201 Tl perfusion images, mismatches were seen in about 70% of all segments. The number of segments demonstrating lower myocardial uptake of 123 I-BMIPP was larger than that of 201 Tl. In hypertrophic regions, the tracer uptake of 123 I-BMIPP early images was significantly lower than that of 201 Tl images and the lower uptake of 123 I-BMIPP delayed images was more marked. In non-hypertrophic regions, no significant difference was seen between the tracer uptakes of 123 I-BMIPP early images and 201 Tl images but the tracer uptake of 123 I-BMIPP delayed images was significantly lower than that of 201 Tl images. The mismatch between the tracer uptakes of 123 I-BMIPP images and 201 Tl images was thought to be a reflection of disordered myocardial fatty acid metabolism. 'Washout', the difference between the tracer uptakes of 123 I-BMIPP early images and delayed images was also thought to be a reflection of disordered myocardial fatty acid metabolism. These results suggest that 123 I-BMIPP is a promising radiopharmaceutical for evaluating disordered myocardial fatty acid metabolism in patients with HCM. (author)

  15. Severe acute myocardial infarction and peripheral thrombosis in patient with bladder cancer

    Directory of Open Access Journals (Sweden)

    Ahmet Seyfeddin Gürbüz

    2017-12-01

    Full Text Available Cancer-associated thrombosis worsens the lives of patients substantially. Venous manifestations of cancer-associated thrombosis include deep vein thrombosis and pulmonary embolism. Arterial events include stroke and myocardial infarction. In this patient, myocardial infarction and cardiogenic shock are associated with diffuse coronary thrombosis together with peripheral thrombosis. He had surgery because of bladder carcinoma. Severe hypercoagulable condition probably facilitated by cancer itself and surgery caused multivessel coronary and peripheral intense thrombus burden. Intracoronary 10 mcg/kg tirofiban bolus and 15 mg tissue plasminogen activator (tPA were administered respectively before revascularization and thrombectomy operation was performed. Complete revascularization was achieved.

  16. The stability of myocardial area at risk estimated electrocardiographically in patients with ST elevation myocardial infarction

    DEFF Research Database (Denmark)

    Carlsen, Esben A; Hassell, Mariëlla E C J; van Hellemond, Irene E G

    2014-01-01

    In patients with ST-elevation myocardial infarction (STEMI) the amount of myocardial area at risk (MaR) indicates the maximal potential loss of myocardium if the coronary artery remains occluded. During the time course of infarct evolution ischemic MaR is replaced by necrosis, which results...... in a decrease in ST segment elevation and QRS complex distortion. Recently it has been shown that combining the electrocardiographic (ECG) Aldrich ST and Selvester QRS scores result in a more accurate estimate of MaR than using either method alone. Therefore, we hypothesized that the combined Aldrich...... reperfusion (ECG2). The combined Aldrich and Selvester score was considered stable if the difference between ECG1 and ECG2 was ST elevation in 4...

  17. Angiographically demonstrated coronary collaterals predict residual viable myocardium in patients with chronic myocardial infarction. A regional metabolic study

    International Nuclear Information System (INIS)

    Fukai, Masumi; Ii, Masaaki; Nakakoji, Takahiro

    2000-01-01

    Angiographical demonstration of coronary collateral circulation may suggest the presence of residual viable myocardium. The development of coronary collaterals was judged according to Rentrop's classification in 37 patients with old anteroseptal myocardial infarction and 13 control patients with chest pain syndrome. The subjects with myocardial infarction were divided into 2 groups: 17 patients with the main branch of the left coronary artery clearly identified by collateral blood flow from the contralateral coronary artery [Coll (+) group, male/female 10/7, mean age 56.6 years] and 20 patients with obscure coronary trunk [Coll (-) group, male/female 16/4, mean age 54.9 years]. Thallium-201 myocardial scintigraphy and examination of local myocardial metabolism were carried out by measuring the flux of lactic acid under dipyridamole infusion load. Coronary stenosis of 99% or total occlusion was found in only 5 of 20 patients (25%) in the Coll (-) group but in 16 of 17 patients (94%) in the Coll (+) group (p<0.001). Redistribution of myocardial scintigraphy was found in 11 of 15 patients (73%) in the Coll (+) group, but only 3 of 18 patients (17%) in the Coll (-) group (p<0.01). The myocardial lactic acid extraction rate was -13.2±17.0% in the Coll (+) group, but 9.1±13.2% in the Coll (-) group (p<0.001). These results suggest that coronary collateral may contribute to minimizing the infarct area and to prediction of the presence of viable myocardium. (author)

  18. Localization and quantification of acute myocardial infarction by myocardial perfusion tomographic imaging

    International Nuclear Information System (INIS)

    Lin Xiufang; Min Changgeng; Lin Zhihu; Ke Ruoyi

    1994-01-01

    The authors reported the result of the quantification and localization of 30 clinically confirmed acute myocardial infarction patients in comparison with that of ECG. A left ventricle model was used to correct the area calculated by the method of Bull's eye. The result indicated that the infarction area calculated by the corrected Bull's eye method correlated closely with that determined by the ECG QRS scoring method (r = 0.706, P<0.01). Myocardial infarctions of all 30 patients were detected by both ECG and myocardial perfusion tomographic imaging. The accuracy of localization of myocardial infarction by myocardial perfusion imaging was similar to that of ECG in the anterior wall, anterior septum, anterior lateral and inferior wall, but superior to that of ECG in the apex, posterior lateral, posterior septum, and posterior wall

  19. One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Liu, Hai-Wei; Han, Ya-Ling; Jin, Quan-Min; Wang, Xiao-Zeng; Ma, Ying-Yan; Wang, Geng; Wang, Bin; Xu, Kai; Li, Yi; Chen, Shao-Liang

    2018-06-20

    Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year. Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ 2 = 36.253, P 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients. Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.

  20. [Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

    Science.gov (United States)

    Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

    2017-11-01

    We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

  1. The usefulness of the nuclear cardiology in the cellular implant in patients with severe myocardial damage

    International Nuclear Information System (INIS)

    Omelas A, M.; Arguero S, R.; Garrido G, M.H.; Rodriguez C, A.; Careaga, G.; Castano G, R.; Nambo, M.J.; Pascual P, J.; Ortega R, A.; Gaxiola A, A.; Magana S, J.A.; Estrada A, H.; Equipo de Tecnicos en Medicina Nuclear

    2005-01-01

    The recent therapeutic advances as the cellular implant as well as those different protocols of image acquisition in the field of the Nuclear Cardiology its have allowed that the patient with severe myocardial damage and without some possibility of revascularization is benefited with these advances. Doubtless the Tl-201 par excellence has an important paper for standardize the more appropriate therapeutic behavior for the heart attack patient; reason by this investigation protocol was developed. The objective of the study was to identify the heart attack regions without viable tissue with SPECT in patient with important myocardial damage without some possibility of traditional revascularization; for the 'Stem cell' cellular implantation therapy. The methodology it was carried out by a study of myocardial perfusion in 10 patients with important myocardial damage previous cellular implants, with PICANUC/ SPECT methodology and using a software (Emory Tool Box) for the image processing validated by the University of Emory Atlanta GA; and using as tracer the Tl - 201 to identify the heart attack regions without presence of viable tissue with an analysis model of 17 segments standardized for the left ventricle; qualifying this way the myocardial perfusion in: 0 (normal), 1 (light), 2 (moderate), 3 (severe), 4 (absent) and x (bad technique). The conclusions were that the SPECT study with PICANUC methodology with Tl-201 is safe and effective for the precise localization for the cellular implantation via direct intra myocardial. (Author)

  2. ‘Mother-in-child’ thrombectomy technique: a novel and effective approach to decrease intracoronary thrombus burden in acute myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Dauvergne, Christian; Araya, Mario [Department of Cardiology, Clinica Alemana, Santiago (Chile); Uriarte, Polentzi [Department of Cardiology, Instituto Nacional del Torax, Santiago (Chile); Novoa, Oscar; Novoa, Lilian [Department of Cardiology, Clinica Alemana, Santiago (Chile); Maluenda, Gabriel, E-mail: gabrielmaluenda@gmail.com [Department of Cardiology, Clinica Alemana, Santiago (Chile)

    2013-01-15

    Background: The presence of large thrombus burden in patients presenting with acute myocardial infarction (AMI) is common and associated with poor prognosis. This study aimed to describe the feasibility and safety of the novel ‘mother-in-child’ thrombectomy (MCT) technique in patients presenting with AMI and large thrombus burden undergoing percutaneous coronary intervention (PCI). Methods: We studied 13 patients presenting with AMI who underwent PCI with persistent large intracoronary thrombus after standard thrombectomy. The procedure was performed using a 5 F ‘Heartrail II-ST01’ catheter (Terumo Medical) into a 6 F guiding system. Angiographic assessment of thrombus burden and coronary flow was obtained at baseline, immediately after thrombectomy and at the end of the procedure. Results: The mean age was 55.9 ± 13.0 years and involved mostly males (76.9%). All patients underwent PCI via radial approach. Following MCT Thrombolysis In Myocardial Infarction (TIMI) flow improved by 2 or more degrees in 11 patients (84.5%), while visible angiographic thrombus was reduced in 11 patients (84.5%). In the final angiogram, normal TIMI flow was restored in 11 patients (84.5%), with normal myocardial ‘blush’ in 7 patients (53.8%) and total clearance of a visible thrombus in 7 patients (53.8%). Overall, 6 patients received thrombectomy as ‘stand-alone’ procedure. All patients were discharged alive after a mean of 5.6 ± 2 days. Conclusion: This initial report suggests that significant reduction in thrombus burden and improvement of the coronary flow can be safely achieved in patients presenting with AMI and large thrombus burden by using the novel MCT technique.

  3. Relation between myocardial damage and disease activity in patients with systemic lupus erythematosus by exercise {sup 201}Tl scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Kuzumoto, Masayuki [Nara Medical Univ. (Japan)

    1997-08-01

    Myocardial damage in patients with systemic lupus erythematosus (SLE) was evaluated using exercise thallium-201 myocardial scintigraphy, and the relationship between myocardial damage and disease activity of SLE was examined. Twenty-seven patients (26 women and 1 man, mean age 43 years), in whom extramural coronary artery lesions were excluded by coronary angiogram or presumed to be excluded by exercise electrocardiogram, were enrolled in this study. The mean duration of disease and the mean duration of corticosteroid therapy in these patients were 94 and 77 months, respectively. Exercise thallium-201 scintigraphy was performed twice (mean interval, 30 months) to evaluate the progression of myocardial damage. Myocardial ischemia as an index of myocardial damage was evaluated by visual analysis and ischemic score (IS). The changes in myocardial ischemia were categorized into 3 groups: improved, unchanged or worsened. The disease activity of SLE was determined by the SLE Disease Activity Index (SLEDAI), and the changes in this index were classified into the same three categories, as evaluated every six months between the two scintigraphic examinations. Disease activity was significantly correlated with myocardial ischemia (p<0.05), and with myocardial ischemia as diagnosed by {Delta}IS (difference in ischemic score between the first and second thallium-201 scintigrams: p<0.005). But neither the duration of disease nor the duration of corticosteroid therapy was correlated with IS at the first scintigraphy. These results indicate that control of SLE disease activity may be critical in the treatment of myocardial damage resulting from vascular lesions, especially intramyocardial small-artery disease, in patients with SLE. (author)

  4. Comparative study of 201Tl reinjection mycoardial imaging and late imaging after reinjection for detecting myocardial viability

    International Nuclear Information System (INIS)

    Lin Jinghui; Chai Xiaofeng; Zhu Mei

    1997-01-01

    PURPOSE: To compare 201 Tl reinjection imaging with late imaging in detecting myocardial viability. METHODS: 62 patients with myocardial infarction underwent 201 Tl exercise, 3∼5 hours redistribution, 16∼35 minutes and 12∼19 hours post 201 Tl reinjection mycoardial tomography imaging. After imaging, percutaneous transluminal coronary angioplasty (PTCA) were performed in 15 patients, and then exercise-redistribution myocardial imaging were repeated. RESULTS: 62 patients had 126 segments of irreversible defects on stress-redistribution imaging, 48 segments showed radioactive filling at 16∼35 minutes post-reinjection. The detecting rate of myocardial viability was 38.1% (48/126). 51 segments presented redistribution on 12∼19 hours late imaging, the detecting rate of myocardial viability was 40.5% (51/126). There were no significant difference in the detecting rate between them (x 2 0.16, P>0.05). But in combination of both methods, there were 62 segments refilling, thereby detecting rate was enhanced to 49.2% (62/126). In 15 patients who had PTCA, out of 17 segments were discovered to be viable before PTCA. After PTCA 12 segments had an improved perfusion of 201 Tl, the positive predictive accuracy was 70.6%. Out of 11 segments were discovered to be infarcted, 9 segments had non-improved 201 Tl perfusion after PTCA, the negative predictive accuracy was 81.8%. CONCLUSION: There were no significant difference in the detecting rate of myocardial viability between 2 '0 1 Tl reinjection and late imaging. In combination of both methods the detecting rate can be enhanced

  5. Early myocardial impairment in type 1 diabetes patients without known heart disease assessed with tissue Doppler echocardiography

    DEFF Research Database (Denmark)

    Jensen, Magnus Thorsten; Søgaard, Peter; Andersen, Henrik Ullits

    2016-01-01

    PURPOSE: Cardiovascular disease is the most common cause of mortality in type 1 diabetes; patients with albuminuria are at greatest risk. We investigated myocardial function and premature myocardial impairment in type 1 diabetes patients with and without albuminuria compared to controls. METHODS:...

  6. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

    Directory of Open Access Journals (Sweden)

    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  7. Coexistent coronary artery disease or myocardial bridging in patients with hypertrophic cardiomyopathy using coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Hwan; Chun, Eun Ju; Kim, Yeo Koon; Yoo, Jin Young; Choi, Sang Il; Choi, Dong Ju [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-07-15

    To evaluate the prevalence of coexistent coronary artery disease (CAD) or myocardial bridging (MB) in patients with hypertrophic cardiomyopathy (HCM) using coronary CT angiography (CCTA) and assess the role of CCTA. The prevalence of obstructive CAD (> 50% luminal reduction) and MB (partial and full encasement) were assessed in 150 patients with HCM diagnosed by clinical findings, electrocardiography, and echocardiography of 19588 consecutive patients who underwent CCTA for suspected CAD. The overall feasibility of coronary artery visualization was 98.9% with CCTA. In patients with HCM, the prevalence of obstructive CAD and MB (14.7% partial and 28.0% full encasement) were 23.3% and 42.7%, respectively. Age, hypertension, family history of premature CAD, Framingham risk score and severe chest pain were associated with CAD, whereas male gender and septal type were associated with MB (all p < 0.05). In comparison to invasive coronary angiography (n = 37), the diagnostic accuracy of CCTA for the detection of CAD and full encasement MB was 89.2% and 86.5%, respectively. One-quarter of patients with HCM had coexistent obstructive CAD or full encasement MB. CCTA can be a feasible and accurate noninvasive imaging modality for the detection of CAD and MB in patients with HCM.

  8. Unrecognised myocardial infarction in patients with schizophrenia

    DEFF Research Database (Denmark)

    Nielsen, Jimmi; Juel, Jacob; Alzuhairi, Karam

    2015-01-01

    OBJECTIVE: Schizophrenia is associated with a reduction of the lifespan by 20 years, with type II diabetes and cardiovascular disease contributing the most to the increased mortality. Unrecognised or silent myocardial infarction (MI) occurs in ~30% of the population, but the rates of unrecognised...... MI in patients with schizophrenia have only been sparsely investigated. METHOD: Electrocardiograms (ECG) from three psychiatric hospitals in Denmark were manually interpreted for signs of previous MI. Subsequently, ECGs were linked to the National Patient Registry in order to determine whether...... with unrecognised MI in a stepwise multiple logistic regression model compared with patients with no history of MI, OR: 1.03 per year of age, 95% CI: 1.00-1.06, p=0.021. CONCLUSION: Unrecognised MI is common among patients with schizophrenia and may contribute to the increased mortality found in this patient group....

  9. Measurement of left ventricular ejection fraction from gated technetium-99m sestamibi myocardial images

    International Nuclear Information System (INIS)

    Boonyaprapa, S.; Ekmahachai, M.; Thanachaikun, N.; Jaiprasert, W.; Sukthomya, V.; Poramatikul, N.

    1995-01-01

    Sixty patients underwent SPET imaging with MIBI. Immediately after SPET acquisition ECG-gated 99m Tc-MIBI perfusion images were acquired using 24 planar images per R-R interval. A new method for measurement of LVEF from the ECG-gated 99m Tc-MIBI perfusion images was developed. To validate the method, LVEF derived from MIBI perfusion images was compared with that from conventional radionuclide ventriculography in all 60 patients. Forty patients had evidence of myocardial infarction and 20 had normal perfusion on MIBI imaging. There was no statistically significant difference between LVEF computed from 99m Tc-MIBI perfusion images and that from radionuclide ventriculography (r=0.7062, P 99m Tc-MIBI perfusion images can be obtained at the same time as assessment of myocardial perfusion and in the same orientation and metabolism of the myocardium, thereby permitting more accurate and realistic prognosis and diagnosis in patients with coronary artery disease. (orig.)

  10. Usefulness of rest-redistribution on thallium myocardial scintigraphy in patients with acute myocardial infarction by SPECT; Analysis by bull's eye and unfolded map images

    Energy Technology Data Exchange (ETDEWEB)

    Tahara, Yorio; Taya, Makoto; Sasaki, Akira; Nishimura, Tooru; Shimoyama, Katsuya; Mizuno, Haruyoshi; Ono, Akifumi; Okada, Michio; Ishikawa, Kyozo (Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine)

    1990-01-01

    The purpose of this study was to clarify the clinical significance of rest-redistribution in myocardial scintigraphy (SPECT) in acute myocardial infarction (AMI). 30 patients with AMI within one week after the onset of attack were studied. SPECT images were obtained 10 min and 3hrs after injection of {sup 201}Tl. Bull's eye images and unfolded map images were prepared. A {sup 201}Tl uptake was studied at the infarct and non-infarct sites. Exercise SPECT and radionuclide angiography were performed in all patients one month after the onset of AMI, and the findings were compared with clinical and coronary angiographic (CAG) findings. Redistribution of Tl at rest was observed at the infarct sites in 9 of the 30 patients. Redistribution at rest was observed at the non-infarct sites in 8 patients. Redistribution at rest was observed during exercise SPECT one month after the onset of AMI in patients with redistribution at rest in the acute phase. In patients with redistribution at rest at the infarct site, left ventricular ejection fraction (EF) improved one month after the onset of AMI ({Delta}EF>5%), but it decreased slightly during exercise. Wall motion at the infarct site was not much impaired in patients who showed redistribution at rest at the infarct site. Angina pectoris and recurrence of myocardial infarction were observed more frequently on SPECT, but no characteristic findings were obtained on CAG in those with redistribution at rest. In conclusion, cardiac function and wall motion at the infarct site are better preserved in patients with redistribution of Tl at rest on SPECT in the acute stage of myocardial infarction, as compared with patients having fixed defects, but the EF decrease slightly during exercise and the frequency of post-infarction angina is greater in those patients. Resting SPECT in AMI is considered to provide useful information for predicting cardiac function and the clinical course following myocardial infarction. (author).

  11. Risk and benefit of dual antiplatelet treatment among non-revascularized myocardial infarction patients in different age groups.

    Science.gov (United States)

    Juul, Nikolai; Gislason, Gunnar; Olesen, Jonas Bjerring; Lamberts, Morten; Hansen, Morten Lock; Karasoy, Deniz; Christiansen, Christine Benn; Torp-Pedersen, Christian; Sorensen, Rikke

    2017-09-01

    Dual anti-platelet treatment with clopidogrel and aspirin is indicated for most patients after myocardial infarction. We examined the risk/benefit relationship of dual anti-platelet treatment according to age in a nationwide cohort of 30,532 myocardial infarction patients without revascularization. Patients admitted with first-time myocardial infarction in 2002-2010, not undergoing revascularization, were identified from nationwide Danish registers. Dual anti-platelet treatment use was assessed by claimed prescriptions. Stratified into age groups, risk of bleeding, all-cause mortality and a combined endpoint of cardiovascular death, recurrent myocardial infarction and ischaemic stroke was analysed by Cox proportional-hazard models and tested in a propensity-score matched population. A total of 21,302 users and 9230 non-users of dual anti-platelet treatment were included (mean age 67.02 (±13.8) years and 64.7% males). Use of dual anti-platelet treatment decreased with age: 80% (79 years). We found a reduced risk of cardiovascular death, recurrent myocardial infarction and ischaemic stroke in users 79 years (HR=0.92; 95% CI 0.84-1.01, NS). Risk of bleeding increased with dual anti-platelet treatment use in patients aged 79 years (HR=1.46; 95% CI 1.22-1.74). Similar tendencies in all four age groups were found in the propensity-matched population. Dual anti-platelet treatment use was less likely among elderly patients although similar effects regarding both risk and benefit were found in all age groups. Increased focus on initiating dual anti-platelet treatment in elderly, non-invasively treated myocardial infarction patients is warranted.

  12. Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction.

    Science.gov (United States)

    Liu, Heng-Liang; Liu, Yang; Hao, Zhen-Xuan; Geng, Guo-Ying; Zhang, Zhi-Fang; Jing, Song-Bin; Ba, Ning; Guo, Wei

    2015-01-01

    This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B (P paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors.

  13. The effect of patient anxiety and depression on motion during myocardial perfusion SPECT imaging.

    Science.gov (United States)

    Lyra, Vassiliki; Kallergi, Maria; Rizos, Emmanouil; Lamprakopoulos, Georgios; Chatziioannou, Sofia N

    2016-08-22

    Patient motion during myocardial perfusion SPECT imaging (MPI) may be triggered by a patient's physical and/or psychological discomfort. The aim of this study was to investigate the impact of state anxiety (patient's reaction to exam-related stress), trait anxiety (patient's personality characteristic) and depression on patient motion during MPI. All patients that underwent MPI in our department in a six-month period were prospectively enrolled. One hundred eighty-three patients (45 females; 138 males) filled in the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), along with a short questionnaire regarding their age, height and weight, level of education in years, occupation, and marital status. Cardiovascular and other co-morbidity factors were also evaluated. Through inspection of raw data on cinematic display, the presence or absence of patient motion was registered and classified into mild, moderate and severe, for both phases involved in image acquisition. The correlation of patient motion in the stress and delay phases of MPI and each of the other variables was investigated and the corresponding Pearson's coefficients of association were calculated. The anxiety-motion (r = 0.43, P depression-motion (r = 0.32, P patients. All the other variables did not demonstrate any association with motion in MPI, except a weak correlation between age and motion in females (r = 0.23, P anxiety-motion and depression-motion identified in female patients represents the first supporting evidence of psychological discomfort as predisposing factor for patient motion during MPI.

  14. Usefulness of myocardial scintigraphy using cigarette smoking and isosorbide dinitrate in patients with angina pectoris

    International Nuclear Information System (INIS)

    Igarashi, Takeki; Horimoto, Masashi; Funayama, Naoki

    1989-01-01

    Cigarette smoking is not only one of the most important risk factors for coronary artery disease, but also anginal attacks often occur during smoking. Coronary vasoconstriction is considered to be one of the mechanisms which cause anginal episodes. Thirty patients with angina pectoris, 27 men and 3 women, were investigated. Group I comprised 22 patients with rest angina and group II consisted of 8 patients with effort angina. Five minutes after smoking one cigarette, a first study of 20l Tl myocardial SPECT was performed. Consequently, after sublingual administration of isosorbide denitrate, a second SPECT was done. Most cases improved and it was recognized as positive when changes of localized perfusion defects were observed between both SPECTs. In the group I, 19 out of 22 patients (86%) were positive, but in the group II, 2 out of 8 (25%) were positive. The differences were statistically significant (p<0.05). By the examination of coronarty angiography in 20 patients, the result of myocardial scintigraphy using cigarette smoking and isosorbide dinitrate seemed inversely proportional to the severity of narrowing of the coronary artery. In addition, background factors including risk factors were also compared for both groups. Because the result of this myocardial scintigraphy was positive in the rest angina group and in the group with minimal coronary arteriogrpahic abnormalities, it seggests that myocardial scintigraphy using cigarette smoking and isosorbide dinitrate is useful as a non-invasive auxiliary diagnostic method to detect coronary spasm or coronary vasoconstriction-prone angina pectoris including silent myocardial ischemia. (author)

  15. sup(99m)Tc-pyrophosphate and /sup 201/Tl myocardial scintigrams in a patient with myocarditis

    Energy Technology Data Exchange (ETDEWEB)

    Kondo, M.; Nishimura, T.; Shimoto, Y.; Fuzioka, S.; Kobayashi, K. (Shimada City Hospital, Shizuoka (Japan))

    1981-09-01

    Myocardial necrosis in acute myocarditis was investigated by scintigraphy. sup(99m)Tc-pyrophosphate (PYP) and /sup 201/TI myocardial scintigrams were obtained on a patient with acute myocarditis due to mycoplasma infection. sup(99m)Tc-PYP myocardial scintigrams in the acute stage demonstrated grade 2+ findings, which remained until the chronic stage. /sup 201/TI myocardial scintigrams in the acute stage revealed impaired perfusion restricted to the posterolateral wall, and this decrease continued through the chronic stage. It was concluded that both of sup(99m)Tc-PYP and /sup 201/TI myocardial scintigrams can reveal abnormality of acute myocarditis.

  16. Clinical evaluation of {sup 123}I-metaiodobenzylguanidine myocardial scintigram in patients with vascular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Terada, Kouji; Sugihara, Hiroki; Shiga, Koji [Kyoto Prefectural Univ. of Medicine (Japan)] [and others

    1995-05-01

    Myocardial sympathetic nerve function can be evaluated by {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy. Congestive heart failure is closely related to myocardial sympathetic nerve function. This study evaluated the severity of congestive heart failure in 30 patients with valvular heart disease [aortic regurgitation (AR): n=20, mean age=70{+-}13 years; mitral regurgitation (MR): n=10, mean age=61{+-}18 years], who had chronic heart failure by MIBG myocardial scintigraphy. Single photon emission computed tomography (SPECT) and anterior planar myocardial images were obtained 15 minutes (initial images) and 4 hours (delayed images) after injection of MIBG (111 MBq). Defect score was determined by the delayed SPECT images visually as a semi-quantitative index. Myocardial MIBG uptake was quantified by the heart to upper mediastinum uptake ratio on the delayed anterior planar images (H/M) and mean cardiac MIBG washout rate during 4 hours was calculated from the bull`s eye display data (clearance). These indices were compared with the NYHA class and echocardiographic findings of the patients. MIBG regional defect in the delayed image was most frequently seen in the inferoposterior wall, and defect score and clearance were significantly higher and the H/M ratio was significantly lower in NYHA class III patients than in class II patients. In patients with AR, clearance significantly correlated with left ventricular end-systolic dimension. In patients with MR, both the H/M ratio and clearance significantly correlated with left atrial dimension. Defect score, H/M, and clearance were closely related to the severity of AR and MR. These results indicate that MIBG scan can be used to assess the severity of valvular heart disease. (author).

  17. Prognostic value of serum resistin levels in patients with acute myocardial infarction.

    Science.gov (United States)

    Erer, Hatice Betul; Sayar, Nurten; Guvenc, Tolga Sinan; Aksaray, Sebahat; Yilmaz, Hale; Altay, Servet; Turer, Ayca; Oz, Tugba Kemaloglu; Karadeniz, Fatma Ozpamuk; Oz, Dilaver; Ekmekci, Ahmet; Zencirci, Aycan Esen; Eren, Mehmet

    2014-01-01

    Resistin is a novel adipokine that is suggested to be involved in inflammatory conditions and atherosclerosis. To investigate the prognostic importance of resistin in acute myocardial infarction (AMI) patients. Resistin levels were measured in a population of 132 patients with AMI, of whom 72 (54%) had a diagnosis of ST elevation myocardial infarction (STEMI), and 60 (46%) had non-ST elevation myocardial infarction (NSTEMI). Thirty-three consecutive subjects who were referred to elective coronary angiography due to chest pain evaluation with normal coronary angiograms served as controls. All patients were followed-up for the occurrence of major adverse cardiac events (MACE). There was a significant increase in serum resistin levels in patients with AMI compared to controls (3.71 ± 4.20 vs. 2.00 ± 1.05, p = 0.001, respectively). However, serum resistin levels were similar in patients with STEMI and NSTEMI. (4.26 ± 5.11 vs. 3.06 ± 2.64, p = 0.49, respectively). The patients with MACE had significantly higher levels of serum resistin levels compared to either the AMI or the control group (6.35 ± 5.47, p = 0.005, respectively). Logistic regression analysis revealed that resistin, left ventricular ejection fraction, and coronary artery bypass graft were independent predictors of MACE in AMI patients (OR = 1.11, 95% CI 1.01-1.22, p = 0.03 and OR = 3.84, 95% CI 1.26-11.71, p = 0.018, respectively). Serum resistin level was increased in patients with AMI and constituted a risk factor for MACE in this group.

  18. Detecting Myocardial Ischemia With 99mTechnetium-Tetrofosmin Myocardial Perfusion Imaging in Ischemic Stroke.

    Science.gov (United States)

    Giannopoulos, Sotirios; Markoula, Sofia; Sioka, Chrissa; Zouroudi, Sofia; Spiliotopoulou, Maria; Naka, Katerina K; Michalis, Lampros K; Fotopoulos, Andreas; Kyritsis, Athanassios P

    2017-10-01

    To assess the myocardial status in patients with stroke, employing myocardial perfusion imaging (MPI) with 99m Technetium-tetrofosmin ( 99m Tc-TF)-single-photon emission computed tomography (SPECT). Fifty-two patients with ischemic stroke were subjected to 99m Tc-TF-SPECT MPI within 1 month after stroke occurrence. None of the patients had any history or symptoms of coronary artery disease or other heart disease. Myocardial perfusion imaging was evaluated visually using a 17-segment polar map. Myocardial ischemia (MIS) was defined as present when the summed stress score (SSS) was >4; MIS was defined as mild when SSS was 4 to 8, and moderate/severe with SSS ≥9. Patients with SSS >4 were compared to patients with SSS SSS >9 were compared to patients with SSS SSS, with the oldest age exhibiting the highest SSS ( P = .01). The association of age with SSS remained statistically significant in the multivariate analysis ( P = .04). The study suggested that more than half of patients with stroke without a history of cardiac disease have MIS. Although most of them have mild MIS, we suggest a thorough cardiological evaluation in this group of patients for future prevention of severe myocardial outcome.

  19. Follow-up of acute myocardial infarction with Gd-DTPA-enhanced MR image

    International Nuclear Information System (INIS)

    Matheijssen, N.A.A.; Dijkman, P.; Rossum, A.C. van der; Laarse, A. van der; Voorthuisen, A. van; Bruschke, A.

    1990-01-01

    MR imaging with Gd-DTPA has been shown to be useful in the identification of acutely infarcted myocardium. The purpose of this paper is to assess the influence of Gd-DTPA on myocardial signal intensity (SI) at different intervals after acute myocardial infarction (SMI). The authors used Gd-DTPA-enhanced MR imaging to study 84 patients at different intervals after AMI. A total of 109 T1-weighted MR studies were performed with a Philips Gyroscan magnet (0.5T) before and 20 minutes after Gd-DTPA (0.15 mmol/kg given intravenously). Four groups were studied. Group 1 underwent MR imaging less than 1 week after AMI; group 2, 1-3 weeks; group 3, 3-6 weeks; and group 4, over 6 weeks after AMI

  20. Post-traumatic stress disorder symptoms in first-time myocardial infarction patients: roles of attachment and alexithymia.

    Science.gov (United States)

    Gao, Wen; Zhao, Jing; Li, Yang; Cao, Feng-Lin

    2015-11-01

    To explore the roles of attachment and alexithymia in the severity of post-traumatic stress disorder symptoms and to specify the relationship between sub-dimensions of attachment, alexithymia and posttraumatic stress disorder symptoms in patients with first-time myocardial infarction in mainland China. Patients experiencing myocardial infarction have a risk of developing post-traumatic stress disorder symptoms. However, there have been few studies on the roles of attachment and alexithymia. A cross-sectional survey design. Ninety-seven patients participated in the assessment of post-traumatic stress disorder symptoms, attachment and alexithymia from June-December in 2012. To assess post-traumatic stress disorder symptoms and their correlates, we administered the Post-traumatic Stress Disorder Checklist-Civilian Version, the 20-item Toronto Alexithymia Scale and the Experiences in Close Relationships Scale 5-17 days after the remission of first myocardial infarction attack. Twenty-five (25·77%) patients met the criteria of posttraumatic stress disorder symptoms. Greater attachment anxiety and avoidance were associated with more severe posttraumatic stress disorder symptoms. Except for externally oriented thinking, all dimensions of alexithymia were significantly correlated with post-traumatic stress symptoms. In the regression model, attachment anxiety and difficulties identifying feelings were found to be predictive and the total regression equation explained 24·2% variance of posttraumatic stress disorder symptoms among myocardial infarction patients. First-time myocardial infarction patients were at risk of developing posttraumatic stress disorder symptoms. Attachment anxiety and difficulties identifying feelings were positively associated with posttraumatic stress disorder symptoms in the early stage of myocardial infarction rehabilitation. It is essential to evaluate the causal relationship between attachment, alexithymia and posttraumatic stress disorder

  1. [sup 99]Tc[sup m]-MIBI single photon emission tomography (SPET) for detecting myocardial ischaemia and necrosis in patients with significant coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Sciammarella, M.G.; Fragasso, G.; Gerundini, P.; Maffioli, L.; Cappelletti, A.; Margonato, A.; Savi, A.; Chierchia, S. (Istituto Scientifico H San Raffaele, Milan (Italy). Dept. of Nuclear Medicine)

    1992-12-01

    The ability of [sup 99]Tc[sup m]-methoxyisobutylisonitrile (MIBI) single photon emission tomography (SPET) to detect myocardial ischaemia and necrosis was assessed in 56 patients with clinically recognised ischaemic heart disease (IHD). All underwent coronary angiography (CA) and left ventriculography (LV). SPET images were obtained at rest and at peak exercise 90 min after injection of [sup 99]Tc[sup m]-MIBI. The presence of persistent (P) or reversible (R) perfusion defects (PD) was then correlated to the resting and exercise ECG and to the results of CA and LV. Of the 56 patients, 34 had reversible underperfusion (RPD), 46 persistent underperfusion (PPD) and 31 had both. The occurrence of RPD correlated well with the occurrence of exercise-induced ST segment depression and/or angina (27 patients of 34 patients, 79%) and with the presence of significant coronary artery disease (CAD) (33 of 44, 73%). In 45 of 46 patients (98%) PPD corresponded to akinetic or severely hypokinetic segments (LV) usually explored by ECG leads exhibiting diagnostic Q waves (42 of 46 patients, 91%). The scan was normal both at rest and after stress in four of 11 patients with no CAD, and in two of 45 patients with CAD. Finally, an abnormal resting scan was seen in seven of 11 patients with normal coronary arteries, of whom six had regional wall motion abnormalities. In conclusion, MIBI SPET is a highly reliable technique for assessing the presence and location of myocardial ischaemia and necrosis. (Author).

  2. Fatty acid myocardial imaging using iodine-123-beta-methyl-para-iodophenyl pentadecanoic acid (BMIPP) in patients with hypertrophic cardiomyopathy (HCM)

    International Nuclear Information System (INIS)

    Wada, Toyofumi

    1993-01-01

    Myocardial ischemia has been shown to develop during exercise and to play an important role on the pathophysiology in patients with hypertrophic cardiomyopathy (HCM). However, it is known whether or not myocardial ischemia is present under basal condition. BMIPP myocardial imaging has been proven to be useful for the detection of regional abnormalities of fatty acid metabolism induced by myocardial ischemia. We therefore performed BMIPP and Tl myocardial imagings in 18 patients with HCM. Six patients with chest pain syndrome or idiopathic ventricular arrhythmia served as controls. BMIPP and Tl scintigraphies were performed at least five days apart for avoiding cross talk and after overnight fasting. Six control subjects presented BMIPP images similar to Tl images without appreciable discrepancy. Of 18 patients with HCM, 15 manifested segments of reduced BMIPP uptakes as compared with those of Tl images. These segments of reduced BMIPP in patients with HCM were mainly observed in segments of increased Tl uptake, and suggested that myocardial ischemia was present under basal condition. Since the reduction of BMIPP uptake were often localized to parts of segments of increased Tl uptake, small coronary disease seemed to be a mechanism responsible for myocardial ischemia developing during resting condition. Four patients with apical hypertrophy showed reduction of BMIPP uptake in the hypertrophied apical segments. The observation suggests that abnormal myocardial energy metabolism is in progress during resting state, although the condition is generally considered to be benign. (author)

  3. Pharmacological radionuclide ventriculography for detection of myocardial contractile reserve in patients after myocardial infarction: head-to-head comparison of low dose dobutamine and low dose dypiridamole

    International Nuclear Information System (INIS)

    Petrasinovic, Z.; Ostojic, M.; Beleslin, B.; Stojkovic, S.; Nedeljkovic, M.; Stankovic, G.; Dikic, A.; Pavlovic, S.; Sobic, D.

    2002-01-01

    Background. Low dose pharmacological stress echocardiography with either dobutamine or dipyridamole infusion has been proposed for recognition of myocardial viability. However, dependence on adequate acoustic window, observer experience, and the mild degree of wall motion changes make the viability assessment by stress echocardiography especially bothersome. The objective of the study was to evaluate the ability of low dose dobutamine and low dose dipyridamole radionuclide ventriculography to detect contractile reserve in patients after myocardial infarction and functional recovery after coronary angioplasty. Methods. The study group consisted of 20 consecutive patients (52±10 years, 17 male) with previous myocardial infarction and resting regional dyssynergy, in whom diagnostic cardiac catheterization revealed significant one-vessel coronary artery stenosis suitable for angioplasty. Each patient underwent equilibrium 99m-Tc radionuclide ventriculography which was performed at rest and during low dose dipyridamole (0.28 mg/kg over 2 minutes) and low dose dobutamine infusion (up to 10 mcg/kg/min). Left ventricular global and regional ejection fractions were determined. Increase of regional ejection fraction for >5% (inferoapical and posterolateral regions) or >10% (anteroseptal regions) during low dose dobutamine and dipyridamole in infarcted regions, as well as in the follow up period, was considered as index of contractile reserve. After 8 weeks of successful angioplasty, resting radionuclide ventriculography was repeated in all patients in order to identify functional recovery of the infarct zone. Results. Out of the 180 analyzed segments (20x9), 90 regional ejection fractions have shown depressed contractility. The mean of the regional ejection fractions showing depressed contractility increased from the resting value of 34±12% to 42±14% in the follow-up period (p=0.06). Of the 90 with baseline dyssynergy, 46 were responders during low-dose dobutamine (51

  4. Exercise-induced ST-T changes and severity of myocardial ischemia in single-vessel coronary artery disease

    International Nuclear Information System (INIS)

    Shimonagata, Tsuyoshi; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Takamiya, Makoto; Sumiyoshi, Tetsuya; Saito, Muneyasu.

    1986-01-01

    The purpose of this study was to evaluate how exercise-induced ST-T changes reflect the severity of myocardial ischemia in 66 patients with singlevessel disease (SVD) who underwent stress thallium scans. Quantitative assessment of myocardial ischemia was performed with thallium ischemic score (TIS) derived from circumferential profile analysis. Circumferential profiles of the initial and 4 hr redistribution myocardial image were generated for each of three views (ANT, LAO 45, LAO 70) and TIS was obtained as the average of the area between the initial and 4 hr redistribution profile for each view. In 66 patients with SVD, TIS were compared with coronary angiographic findings. TIS was correlated well with the severity of coronary artery stenosis. In addition, TIS was also correlated well with lung thallium uptake in 46 LAD disease. Therefore, these data proved that TIS was useful for the evaluation of the severity of myocardial ischemia. In 46 LAD disease, TIS, being as the indicator of the severity of myocardial ischemia, was compared precisely with results of stress electrocardiograms to evaluate how exercise-induced ST-T changes reflect the severity of myocardial ischemia. Patients with negative U wave had the highest mean TIS and those with horizontal or down sloping ST depression of 1.0 mm or more had higher mean TIS than those with slow upsloping ST depression of 1.5 mm or more, but there were no significant differences between these groups and those without ST-T change and the mean TIS was not different significantly between V 2-6 ST depression group and V 2-6 , II, III, a V F ST depression group. In conclusion, these results indicated that exercise-induced ST-T changes reflect the severity of myocardial ischemia in some degree but also has a limitation in evaluation of the severity of myocardial ischemia. (author)

  5. [Association between collateral circulation and myocardial viability evaluated by cardiac magnetic resonance imaging in patients with coronary artery chronic total occlusion].

    Science.gov (United States)

    Li, J N; Zhang, L J; He, Y; Chen, Y L; Huang, R C; Lyu, S Z; Song, X T

    2017-07-24

    Objective: Late gadolinium enhancement(LGE) cardiac magnetic resonance imaging(CMR) was used to evaluate the myocardial viability of chronic total occlusion(CTO) in patients with coronary heart disease and to observe the relationship between collateral circulation and myocardium viability in these patients. Methods: This retrospective study included 40 patients with CTO diagnosed by invasive coronary angiography (CAG) from September 2015 to June 2016 in our department, all patients performed CMR examination within one week after CAG.The collateral circulation of CTO was graded with Rentrop classification as follows: poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group.According to CMR images, the delayed enhancement transmural extent of myocardial segments were scored, the ventricular wall motion of the myocardial segment were graded, and the wall motion score index (WMSI) was calculated.Spearman correlation analysis was used to analyze the relationship between the delayed enhancement transmural extent of myocardial segments and WMSI. Results: In the no or poor collateral group of 6 myocardial regions, 1 myocardial region had viable myocardium and 3 myocardial regions had no viable myocardium; in the moderate collateral group of 16 myocardial regions, 11 myocardial regions had viable myocardium and 5 myocardial regions had no viable myocardium; in the good collateral group of 24 myocardial regions, 21 myocardial regions had viable myocardium and 3 myocardial regions had no viable myocardium, there was significant difference between the groups ( P =0.002). The WMSI of poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group were 1.54±0.50, 1.21±0.34 and 1.26±0.40, respectively, there was no significant difference between the groups ( P =0.063). Spearman correlation analysis showed that the extent of delayed enhancement transmural extent of

  6. Assessment of neutrophil / lymphocyte ratio in patients with myocardial bridge

    Directory of Open Access Journals (Sweden)

    Abdulkadir Yıldız

    2014-03-01

    Full Text Available Objective: Myocardial bridge (MB is a congenital anomaly characterized by systolic narrowing of the epicardial coronary arterial segment while traveling in the myocardium. It is a benign entity but previous studies showed that the proximal portion is prone to an enhanced atherosclerosis. Neutrophil/lymphocyte ratio (NLR is a sensitive marker of systemic inflammation used as a predictor for adverse cardiovascular outcomes in atherosclerotic heart disease. So in this study, we sought to evaluate the association between NLR and myocardial bridging. Methods: A total of 172 patients (mean age: 50.8 ± 11.5 years, 77.3% men with either angiographically proven MB or normal coronary arteries were included in the study. For the entire study population, hematologic parameters were measured using an automatic blood counter. Results: The study population consisted of 71 patients with MB (mean age: 51.4 ± 11.9 years, 80.3% male and 101 patients with normal coronary arteries (mean age: 50.5 ± 11.3 years, 75.2% male. There were no significant differences between groups regarding hemoglobin level, platelet count, glucose and creatinine. Compared to the control group, NLR was significantly higher in patients with MB (2.45 ± 1.19 vs. 1.72 ± 0.48; p 1.82 predicted myocardial bridge presence with 70% sensitivity and 71% specificity (ROC area under curve: 0.733, 95% CI: 0.654-0.811, p < 0.001. Conclusion: Our study findings demonstrated that MB is associated with elevated NLR, which is used to assess inflammatory status of the body. J Clin Exp Invest 2014; 5 (1: 24-28

  7. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both

    DEFF Research Database (Denmark)

    Solomon, Scott D; Zelenkofske, Steve; McMurray, John J V

    2005-01-01

    BACKGROUND: The risk of sudden death from cardiac causes is increased among survivors of acute myocardial infarction with reduced left ventricular systolic function. We assessed the risk and time course of sudden death in high-risk patients after myocardial infarction. METHODS: We studied 14......,609 patients with left ventricular dysfunction, heart failure, or both after myocardial infarction to assess the incidence and timing of sudden unexpected death or cardiac arrest with resuscitation in relation to the left ventricular ejection fraction. RESULTS: Of 14,609 patients, 1067 (7 percent) had an event...... percent confidence interval, 0.11 to 0.18 percent) after 2 years. Patients with a left ventricular ejection fraction of 30 percent or less were at highest risk in this early period (rate, 2.3 percent per month; 95 percent confidence interval, 1.8 to 2.8 percent). Nineteen percent of all sudden deaths...

  8. Dysphagia among adult patients who underwent surgery for esophageal atresia at birth.

    Science.gov (United States)

    Huynh Trudeau, Valérie; Maynard, Stéphanie; Terzic, Tatjana; Soucy, Geneviève; Bouin, Mickeal

    2015-03-01

    Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and⁄or anatomical anomalies. To determine the motor and anatomical causes of dysphagia. A total of 41 adults, followed at the Esophageal Atresia Clinic at Hôpital Saint-Luc (Montreal, Quebec), were approached to particpate in the present prospective study. Evaluation was completed using upper endoscopy, manometry and barium swallow for the participants who consented. The medical charts of respondents were systematically reviewed from the neonatal period to 18 years of age to assess medical and surgical history. All 41 patients followed at the clinic consented and were included in the study. Dysphagia was present in 73% of patients. Esophagogastroduodenoscopy was performed in 32 patients: hiatal hernia was present in 62% (n=20); esophageal diverticulum in 13% (n=4); macroscopic Barrett esophagus in 31% (n=10); and esophagitis in 19% (n=6). Histological esophagitis was present in 20% and intestinal metaplasia in 10%. There were no cases of dysplagia or adenocarcinoma. Esophageal manometry was performed on 56% of the patients (n=23). Manometry revealed hypomotility in 100% of patients and included an insufficient number of peristaltic waves in 96%, nonpropagating peristalsis in 78% and low-wave amplitude in 95%. Complete aperistalsis was present in 78%. The lower esophageal sphincter was abnormal in 12 (52%) patients, with incomplete relaxation the most common anomaly. Of the 41 patients, 29 (71%) consented to a barium swallow, which was abnormal in 13 (45%). The anomalies found were short esophageal dilation in 28%, delay in esophageal emptying in 14%, diverticula in 14% and stenosis in 7

  9. Clinical study on myocardial imaging with. beta. -methyl-p-( sup 123 I)-iodophenyl-pentadecanoic acid in patients with mitochondrial myopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kihara, Koichi; Nakajo, Masayuki; Shono, Hirohisa (Kagoshima Univ. (Japan). Faculty of Medicine) (and others)

    1992-04-01

    Myocardial imaging with {beta}-methyl-p-({sup 123}I)-iodophenyl-pentadecanoic acid ({sup 123}I-BMIPP), a new radiopharmaceutical designed to evaluate myocardial fatty acid metabolism, was performed in 7 patients with mitochondrial myopathy to detect their myocardial damages in comparison with {sup 201}Tl myocardial imaging. These patients were divided into 4 chronic progressive external ophthalmoplegia (CPEO) cases, 2 mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) cases and 1 myoclonus epilepsy with ragged-red fibers (MERRF). In visual assessment, we observed more myocardial segments with decreased uptake of {sup 123}I-BMIPP compared to {sup 201}Tl in MELAS cases than in CPEO cases. The mean myocardial uptake of {sup 123}I-BMIPP was higher than that of {sup 201}Tl in CPEO cases. On the other hand, in MELAS and MERRF cases, the mean myocardial uptake of {sup 123}I-BMIPP was lower than that of {sup 201}Tl. Abnormal findings suggesting myocardial damages were observed in echocardiogram and/or in electrocardiogram in MELAS and MERRF cases, while no such abnormal findings were observed in CPEO cases. Along with the previously reported experimental result that the impairment of rat myocardial mitochondria decreased myocardial uptake of {sup 123}I-BMIPP, these results suggest that {sup 123}I-BMIPP may be useful to detect myocardial damages in patients with mitochondrial myopathy. (author)

  10. Evaluation of myocardial damage in Duchenne's muscular dystrophy with thallium-201 myocardial SPECT

    International Nuclear Information System (INIS)

    Tamura, Takuhisa; Shibuya, Noritoshi; Hashiba, Kunitake; Oku, Yasuhiko; Mori, Hideki; Yano, Katsusuke.

    1993-01-01

    Myocardial damage and cardiopulmonary functions in patients with Duchenne's muscular dystrophy (DMD) were assessed using thallium-201 myocardial single-photon emission computed tomography (SPECT) and technetium-99m multigated radionuclide angiography. Twenty-five patients with DMD were divided into 4 groups according to percent of perfusion defect (%PD) calculated by the bull's-eye method and age. PD was detected in 24 (96.0%) of 25 patients with DMD, and it spread from the left ventricular lateral wall to the anterior wall and/or interventricular septum. PD was detected even in a 6-year-old DMD boy. Patients in Group I (%PD≥10% and age<15 years old) were shown to have a higher risk of left-sided heart failure without respiratory failure. Patients in Group II (%PD≥10 and age≥15) showed decreased pulmonary function and worsened arterial blood gas values as compared with Group IV (%PD<10 and age≥15). There was no significant difference in cardiac function among the 4 groups. It is postulated that myocardial damage in Group II patients is dependent primarily on a deficiency of dystrophin and on chronic respiratory failure, and that some of them are at risk of cardiopulmonary failure. It is concluded that myocardial SPECT is useful for the early diagnosis of myocardial damage and evaluation of cardiopulmonary function in DMD patients. (author)

  11. Myocardial scintigraphy with 201Tl in combination with pharmacological tests in the diagnosis of coronary heart diseases

    International Nuclear Information System (INIS)

    Tokareva, E.A.; Sergienko, V.B.; Sidorenko, B.A.

    1989-01-01

    The paper presents the results from examination of 67 patients with coronary heart disease verified by a bicycle ergometric tests, 48 underwent 201 Tl myocardial scintigraphy along with a dipyridamole test, 19, the scintigraphy in combination with an isoproterenol test. The feasibilities of employing the procedures in the diagnosis of coronary heart disease were compared by statistic analysis

  12. Gadolinium enhanced cardiovascular magnetic resonance in Anderson-Fabry disease. Evidence for a disease specific abnormality of the myocardial interstitium.

    Science.gov (United States)

    Moon, James C C; Sachdev, Bhavesh; Elkington, Andrew G; McKenna, William J; Mehta, Atul; Pennell, Dudley J; Leed, Philip J; Elliott, Perry M

    2003-12-01

    Anderson-Fabry Disease (AFD), an X-linked disorder of sphingolipid metabolism, is a cause of idiopathic left ventricular hypertrophy but the mechanism of hypertrophy is poorly understood. Gadolinium enhanced cardiovascular magnetic resonance can detect focal myocardial fibrosis. We hypothesised that hyperenhancement would be present in AFD. Eighteen males (mean 43+/-14 years) and eight female heterozygotes (mean 48+/-12 years) with AFD underwent cine and late gadolinium cardiovascular magnetic resonance. Nine male (50%) had myocardial hyperenhancement ranging from 3.4% to 20.6% (mean 7.7+/-5.7%) of total myocardium; in males, percentage hyperenhancement related to LV mass index (r=0.78, P=0.0002) but not to ejection fraction or left ventricular volumes. Lesser hyperenhancement was also found in four (50%) heterozygous females (mean 4.6%). In 12 (92%) patients with abnormal gadolinium uptake, hyperenhancement occurred in the basal infero-lateral wall where, unlike myocardial infarction, it was not sub-endocardial. In two male patients with severe LVH (left ventricular hypertrophy) and systolic impairment there was additional hyperenhancement in other myocardial segments. These observations suggests that myocardial fibrosis occurs in AFD and may contribute to the hypertrophy and the natural history of the disease.

  13. Assessment of myocardial washout of Tc-99m-sestamibi in patients with chronic heart failure. Comparison with normal control

    Energy Technology Data Exchange (ETDEWEB)

    Kumita, Shin-ichiro; Seino, Yoshihiko; Cho, Keiichi; Nakajo, Hidenobu; Toba, Masahiro; Fukushima, Yoshimitsu; Takano, Teruo; Kumazaki, Tatsuo [Nippon Medical School, Tokyo (Japan); Okamoto, Noriake [Bristol-Myers Squibb K.K., Tokyo (Japan)

    2002-06-01

    In contrast to {sup 201}TlCl, {sup 99m}Tc-sestamibi shows very slow myocardial clearance after its initial myocardial uptake. In the present study, myocardial washout of {sup 99m}Tc-sestamibi was calculated in patients with non-ischemic chronic heart failure (CHF) and compared with biventricular parameters obtained from first-pass and ECG-gated myocardial perfusion SPECT data. After administration of {sup 99m}Tc-sestamibi, 25 patients with CHF and 8 normal controls (NC) were examined by ECG-gated myocardial perfusion SPECT and planar data acquisition in the early and delayed (interval of 3 hours) phase. Left ventricular ejection fraction (LVEF, %), peak filling rate (PFR, sec{sup -1}), end-diastolic volume (LVEDV, ml) and end-systolic volume (LVESV, ml) were automatically calculated from the ECG-gated SPECT data. Myocardial washout rates over 3 hours were calculated from the early and delayed planar images. Myocardial washout rates in the CHF group (39.6{+-}5.2%) were significantly higher than those in the NC group (31.2{+-}5.5%, p<0.01). The myocardial washout rates for the 33 subjects showed significant correlations with LVEF (r=-0.61, p<0.001), PFR (r=-0.47, p<0.01), LVEDV (r=0.45, p<0.01) and LVESV (r=0.48, p<0.01). The myocardial washout rate of {sup 99m}Tc-sestamibi is considered to be a novel marker for the diagnosis of myocardial damage in patients with chronic heart failure. (author)

  14. Predictors of abnormal heart rate response to dipyridamole in patients undergoing myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    De Souza Leao Lima, R.; Machado, L.; Azevedo, A.B.; De Lorenzo, A.

    2011-01-01

    The objective of this study was to identify predictors of abnormal HR response to dipyridamole (DIP) in patients undergoing myocardial perfusion SPECT (MPS). Patients with a reduced heart rate (HR) response to DIP have higher cardiac mortality, but the mechanism is unknown. We studied 432 patients who underwent dual-isotope gated MPS. DIP (0.56 mg/kg) was infused over 4 min, and Tc-99m tetrofosmin was injected 3 min after the end of the infusion. MPS was semiquantitatively interpreted. Left ventricular ejection fraction (LVEF) and volumes were automatically calculated. The population was categorized into quartiles according to HR ratio, and characteristics in each quartile were compared. Logistic regression analysis was performed to identify predictors of abnormal HR response, using the lowest quartile as the independent variable. Patients with abnormal HR response were more frequently without chest pain, with a history of chronic renal failure and taking digoxin. Baseline HR was higher and had fewer symptoms during stress. The stress and rest perfusion defects were greater, but reversibility was not; in addition, LVEF was lower. Multivariable logistic regression analysis demonstrated that the independent predictors of abnormal HR response were baseline HR and low LVEF. LV dysfunction is an independent predictor of abnormal HR response to DIP, and the association between low LVEF and low HR ratio may explain the link between abnormal HR ratio and increased mortality. (author)

  15. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

    Directory of Open Access Journals (Sweden)

    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  16. Changes in myocardial perfusion due to physical exercise in patients with stable coronary artery disease

    International Nuclear Information System (INIS)

    Kendziorra, Kai; Foerster, Marcus; Sabri, Osama; Kluge, Regine; Walther, Claudia; Moebius-Winkler, Sven; Conradi, Katrin; Schuler, Gerhard; Hambrecht, Rainer

    2005-01-01

    Percutaneous transluminal coronary angioplasty (PTCA) is one of the main therapy options for patients with coronary artery disease (CAD), resulting in an improvement in myocardial perfusion and exercise capacity. Nevertheless, studies have also demonstrated a positive effect of regular exercise training on myocardial perfusion and maximum exercise capacity. The aim of this study was to evaluate changes in myocardial stress perfusion after 1 year of exercise training in comparison with the effects of PTCA in patients with CAD. In 66 male patients with angiographically confirmed significant coronary artery stenosis in one target vessel, myocardial perfusion scintigraphy was performed at baseline and 12 months after randomisation into either a physical exercise group or a PTCA group. Circumferential count rate profiles in 16 wall segments were classified according to their relative count rate and localisation within or outside the area supplied by the stenosed vessel. Ischaemic segments showed a significant improvement in myocardial count rate within the target area after 12 months in both the PTCA and the training group (PTCA group: from 76.8±4.9% to 86.6±10.9%, p=0.03; training group: from 74.0±7.3% to 83.7±10.8%, p<0.01). Outside the target area only the training group showed a significant improvement (from 77.7±4.4% to 91.7±4.8%, p<0.01). Our data indicate a significant improvement in stress myocardial perfusion in the training group after 12 months. The ischaemia is reduced not only in the target region of the leading stenosis but also in other ischaemic myocardial areas. In contrast, after PTCA stress perfusion improves only in the initially ischaemic parts of the target area. (orig.)

  17. Right ventricular volumes and function in thalassemia major patients in the absence of myocardial iron overload

    Directory of Open Access Journals (Sweden)

    Porter John B

    2010-04-01

    Full Text Available Abstract Aim We aimed to define reference ranges for right ventricular (RV volumes, ejection fraction (EF in thalassemia major patients (TM without myocardial iron overload. Methods and results RV volumes, EF and mass were measured in 80 TM patients who had no myocardial iron overload (myocardial T2* > 20 ms by cardiovascular magnetic resonance. All patients were receiving deferoxamine chelation and none had evidence of pulmonary hypertension or other cardiovascular comorbidity. Forty age and sex matched healthy non-anemic volunteers acted as controls. The mean RV EF was higher in TM patients than controls (males 66.2 ± 4.1% vs 61.6 ± 6%, p = 0.0009; females 66.3 ± 5.1% vs 62.6 ± 6.4%, p = 0.017, which yielded a raised lower threshold of normality for RV EF in TM patients (males 58.0% vs 50.0% and females 56.4% vs 50.1%. RV end-diastolic volume index was higher in male TM patients (mean 98.1 ± 17.3 mL vs 88.4 ± 11.2 mL/m2, p = 0.027, with a higher upper limit (132 vs 110 mL/m2 but this difference was of borderline significance for females (mean 86.5 ± 13.6 mL vs 80.3 ± 12.8 mL/m2, p = 0.09, with upper limit of 113 vs 105 mL/m2. The cardiac index was raised in TM patients (males 4.8 ± 1.0 L/min vs 3.4 ± 0.7 L/min, p Conclusion The normal ranges for functional RV parameters in TM patients with no evidence of myocardial iron overload differ from healthy non-anemic controls. The new reference RV ranges are important for determining the functional effects of myocardial iron overload in TM patients.

  18. Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery.

    Science.gov (United States)

    Lazzeroni, Davide; Bini, Matteo; Camaiora, Umberto; Castiglioni, Paolo; Moderato, Luca; Bosi, Davide; Geroldi, Simone; Ugolotti, Pietro T; Brambilla, Lorenzo; Brambilla, Valerio; Coruzzi, Paolo

    2018-01-01

    Background High levels of serum uric acid have been associated with adverse outcomes in cardiovascular diseases such as myocardial infarction and heart failure. The aim of the current study was to evaluate the prognostic role of serum uric acid levels in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. Design We performed an observational prospective cohort study. Methods The study included 1440 patients with available serum uric acid levels, prospectively followed for 50 ± 17 months. Mean age was 67 ± 11 years; 781 patients (54%) underwent myocardial revascularization, 474 (33%) cardiac valve surgery and 185 (13%) valve-plus-coronary artery by-pass graft surgery. The primary endpoints were overall and cardiovascular mortality while secondary end-points were combined major adverse cardiac and cerebrovascular events. Results Serum uric acid level mean values were 286 ± 95 µmol/l and elevated serum uric acid levels (≥360 µmol/l or 6 mg/dl) were found in 275 patients (19%). Overall mortality (hazard ratio = 2.1; 95% confidence interval: 1.5-3.0; p uric acid levels, even after adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate, atrial fibrillation and medical therapy. Moreover, strong positive correlations between serum uric acid level and probability of overall mortality ( p uric acid levels predict mortality and adverse cardiovascular outcome in patients undergoing myocardial revascularization and/or cardiac valve surgery even after the adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate and medical therapy.

  19. Absence of accelerated atherosclerotic disease progression after intracoronary infusion of bone marrow derived mononuclear cells in patients with acute myocardial infarction--angiographic and intravascular ultrasound--results from the TErapia Celular Aplicada al Miocardio Pilot study.

    Science.gov (United States)

    Arnold, Roman; Villa, Adolfo; Gutiérrez, Hipólito; Sánchez, Pedro L; Gimeno, Federico; Fernández, Maria E; Gutiérrez, Oliver; Mota, Pedro; Sánchez, Ana; García-Frade, Javier; Fernández-Avilés, Francisco; San Román, Jose A

    2010-06-01

    We tried to evaluate a putative negative effect on coronary atherosclerosis in patients receiving intracoronary infusion of unfractionated bone marrow mononuclear cells (BMMC) following an acute ST-elevation myocardial infarction. Peripheral blood mononuclear cells or enriched CD133(+) BMMC have been associated with accelerated atherosclerosis of the distal segment of the infarct related artery (IRA). Thirty-seven patients with ST-elevation myocardial infarction from the TECAM pilot study underwent intracoronary infusion of autologous BMMC 9 +/- 3.1 days after onset of symptoms. We compared angiographic changes from baseline to 9 months of follow-up in the distal non-stented segment of the IRA, as well as in the contralateral coronary artery, with a matched control group. A subgroup of 15 treated patients underwent additional IVUS within the distal segment of the IRA. No difference between stem cell and control group were found regarding changes in minimum lumen diameter (0.006 +/- 0.42 vs 0.06 +/- 0.41 mm, P = ns) and the percentage of stenosis (-2.68 +/- 12.33% vs -1.78 +/- 8.75%, P = ns) at follow-up. Likewise, no differences were seen regarding changes in the contralateral artery (minimum lumen diameter -0.004 +/- 0.54 mm vs -0.06 +/- 0.35 mm, P = ns). In the intravascular ultrasound substudy, no changes were demonstrated comparing baseline versus follow-up in maximum area stenosis and plaque volume. In this pilot study, analysis of a subgroup of patients found that intracoronary injection of unfractionated BMMC in patients with acute ST-elevation myocardial infarction was not associated with accelerated atherosclerosis progression at mid term. Prospective, randomised studies in large cohorts with long-term angiographic and intravascular ultrasound follow-up are necessary to determine the safety of this therapy. Copyright 2010 Mosby, Inc. All rights reserved.

  20. Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results

    Directory of Open Access Journals (Sweden)

    Umut Elboga

    2017-05-01

    Full Text Available Aim: Coronary artery disease (CAD is one of the most frequent causes of mortality and morbidity worldwide. Coronary angiography is the gold standard for the anatomical diagnosis of coronary artery stenosis. Myocardial Perfusion Scintigraphy (MPS is a non-invasive imaging modality used for the diagnosis of CAD. In this study, we aimed to compare the findings of MPS and coronary angiogram. Material and Method: Eighty-one patients (37 males, 44 females; mean age 55 ± 10.95 years with angina and detected perfusion defects on MPS were included in this study. All of the patients underwent coronary angiogram. A narrowing %u2265 50% was considered pathological on the coronary angiography. Results: Findings of the coronary angiogram and MPS were compared and found consistent in 51 (63% patients. A coronary narrowing < 50% was detected by coronary angiogram in 4 (5% of the remaining patients. Coronary angiogram was found to be normal in the remaining 26 patients (32% and these patients were evaluated as cardiac syndrome X (CSX known as microvascular angina (MA. Discussion: The findings showed that MPS is superior to coronary angiogram in the early diagnosis of myocardial perfusion disorders at the microvascular level. Therefore, we concluded that MPS should be the primary diagnostic tool to begin treatment before an anatomically large narrowing occurs in the coronaries.

  1. Practical guidelines for treatment with beta-blockers and nitrates in patients with acute myocardial infarction

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); P.W.J.C. Serruys (Patrick); P.M. Fioretti (Paolo); M.J.B.M. van den Brand (Marcel); P.G. Hugenholtz (Paul)

    1983-01-01

    textabstractTreatment of a patient with myocardial infarction might include opiates and sedatives to reduce pain and anxiety, heparin, antiarrhythmic drugs, diuretics which aim at improvement of myocardial function and drugs which might reduce the ischemic area at risk and thus mortality such as

  2. Silent left ventricular dysfunction during routine activity after thrombolytic therapy for acute myocardial infarction

    International Nuclear Information System (INIS)

    Kayden, D.S.; Wackers, F.J.; Zaret, B.L.

    1990-01-01

    To investigate prospectively the occurrence and significance of postinfarction transient left ventricular dysfunction, 33 ambulatory patients who underwent thrombolytic therapy after myocardial infarction were monitored continuously for 187 +/- 56 min during normal activity with a radionuclide left ventricular function detector at the time of hospital discharge. Twelve patients demonstrated 19 episodes of transient left ventricular dysfunction (greater than 0.05 decrease in ejection fraction, lasting greater than or equal to 1 min), with no change in heart rate. Only two episodes in one patient were associated with chest pain and electrocardiographic changes. The baseline ejection fraction was 0.52 +/- 0.12 in patients with transient left ventricular dysfunction and 0.51 +/- 0.13 in patients without dysfunction (p = NS). At follow-up study (19.2 +/- 5.4 months), cardiac events (unstable angina, myocardial infarction or death) occurred in 8 of 12 patients with but in only 3 of 21 patients without transient left ventricular dysfunction (p less than 0.01). During submaximal supine bicycle exercise, only two patients demonstrated a decrease in ejection fraction greater than or equal to 0.05 at peak exercise; neither had a subsequent cardiac event. These data suggest that transient episodes of silent left ventricular dysfunction at hospital discharge in patients treated with thrombolysis after myocardial infarction are common and associated with a poor outcome. Continuous left ventricular function monitoring during normal activity may provide prognostic information not available from submaximal exercise test results

  3. Remote ischaemic conditioning before hospital admission, as a complement to angioplasty, and effect on myocardial salvage in patients with acute myocardial infarction: a randomised trial.

    Science.gov (United States)

    Bøtker, Hans Erik; Kharbanda, Rajesh; Schmidt, Michael R; Bøttcher, Morten; Kaltoft, Anne K; Terkelsen, Christian J; Munk, Kim; Andersen, Niels H; Hansen, Troels M; Trautner, Sven; Lassen, Jens Flensted; Christiansen, Evald Høj; Krusell, Lars R; Kristensen, Steen D; Thuesen, Leif; Nielsen, Søren S; Rehling, Michael; Sørensen, Henrik Toft; Redington, Andrew N; Nielsen, Torsten T

    2010-02-27

    Remote ischaemic preconditioning attenuates cardiac injury at elective surgery and angioplasty. We tested the hypothesis that remote ischaemic conditioning during evolving ST-elevation myocardial infarction, and done before primary percutaneous coronary intervention, increases myocardial salvage. 333 consecutive adult patients with a suspected first acute myocardial infarction were randomly assigned in a 1:1 ratio by computerised block randomisation to receive primary percutaneous coronary intervention with (n=166 patients) versus without (n=167) remote conditioning (intermittent arm ischaemia through four cycles of 5-min inflation and 5-min deflation of a blood-pressure cuff). Allocation was concealed with opaque sealed envelopes. Patients received remote conditioning during transport to hospital, and primary percutaneous coronary intervention in hospital. The primary endpoint was myocardial salvage index at 30 days after primary percutaneous coronary intervention, measured by myocardial perfusion imaging as the proportion of the area at risk salvaged by treatment; analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00435266. 82 patients were excluded on arrival at hospital because they did not meet inclusion criteria, 32 were lost to follow-up, and 77 did not complete the follow-up with data for salvage index. Median salvage index was 0.75 (IQR 0.50-0.93, n=73) in the remote conditioning group versus 0.55 (0.35-0.88, n=69) in the control group, with median difference of 0.10 (95% CI 0.01-0.22; p=0.0333); mean salvage index was 0.69 (SD 0.27) versus 0.57 (0.26), with mean difference of 0.12 (95% CI 0.01-0.21; p=0.0333). Major adverse coronary events were death (n=3 per group), reinfarction (n=1 per group), and heart failure (n=3 per group). Remote ischaemic conditioning before hospital admission increases myocardial salvage, and has a favourable safety profile. Our findings merit a larger trial to establish the effect of remote

  4. Evaluation of myocardial fatty acid metabolism in the area of fill-in after thallium reinjection in patients with prior myocardial infarction

    International Nuclear Information System (INIS)

    Matsunari, Ichiro; Fujino, Susumu; Nishikawa, Takahiro; Ichiyanagi, Kenji; Taki, Junichi; Nakajima, Kenichi; Tonami, Norihisa; Hisada, Kinichi.

    1995-01-01

    Myocardial fatty acid utilization in the area with thallium fill-in after reinjection was assessed using 123 I-labeled 15-(p-iodophenyl) 3R, S-methylpentadecanoic acid (BMIPP). We studied 22 patients with prior myocardial infarction that revealed persistent defects on standard exercise-redistribution thallium imaging. In each patient, exercise-redistribution-reinjection thallium imaging was performed. Within two weeks of the thallium study, resting BMIPP imaging was performed 20 min after injection of BMIPP (148 MBq). Following qualitative analysis of the obtained thallium and BMIPP images, quantitative analysis was performed on the basis of relative regional uptake. Of 199 myocardial segments that showed persistent defects on exercise-redistribution images, 73 segments showed apparent fill-in on the reinjection images (fill-in positive), and the remaining 126 segments did not (fill-in negative). When BMIPP images were compared with the corresponding thallium reinjection images, reduced BMIPP uptake compared with thallium was frequently observed in the area of fill-in positive segments (65 of 73 segments, 89%). Quantitative analysis also showed decrease in BMIPP activity compared to thallium activity in the area of fill-in (49.7±16.1 vs. 65.8±16.0%, p<0.001). In contrast, only 24 of the 126 fill-in negative segments (19%) showed lower BMIPP uptake than thallium. These results suggest that impaired fatty acid utilization in the area of thallium new fill-in after reinjection already exists at resting condition. Thus, BMIPP imaging combined with exercise-redistribution-reinjection thallium imaging provides insights to understanding fatty acid utilization in ischemic but viable myocardium identified by thallium reinjection in patients with prior myocardial infarction. (author)

  5. Differential loss of natural killer cell activity in patients with acute myocardial infarction and stable angina pectoris.

    Science.gov (United States)

    Yan, Wenwen; Zhou, Lin; Wen, Siwan; Duan, Qianglin; Huang, Feifei; Tang, Yu; Liu, Xiaohong; Chai, Yongyan; Wang, Lemin

    2015-01-01

    To evaluate the activity of natural killer cells through their inhibitory and activating receptors and quantity in peripheral blood mononuclear cells extracted from patients with acute myocardial infarction, stable angina pectoris and the controls. 100 patients with myocardial infarction, 100 with stable angina, and 20 healthy volunteers were recruited into the study. 20 randomly chosen people per group were examined for the whole human genome microarray analysis to detect the gene expressions of all 40 inhibitory and activating natural killer cell receptors. Flow cytometry analysis was applied to all 200 patients to measure the quantity of natural killer cells. In myocardial infarction group, the mRNA expressions of six inhibitory receptors KIR2DL2, KIR3DL3, CD94, NKG2A, KLRB1, KLRG1, and eight activating receptors KIR2DS3, KIR2DS5, NKp30, NTB-A, CRACC, CD2, CD7 and CD96 were significantly down-regulated (Pangina patients and the controls. There was no statistical difference in receptor expressions between angina patients and control group. The quantity of natural killer cells was significantly decreased in both infarction and angina patients compared with normal range (Pangina patients showed a quantitative loss and dysfunction of natural killer cells in myocardial infarction patients.

  6. Effects of isosorbide dinitrate on exertion-induced anomalous myocardial perfusion in coronary diseases studied with the aid of 201Th scintiscanning

    International Nuclear Information System (INIS)

    Wolf, R.; Pretschner, P.; Engel, H.J.; Hundeshagen, H.; Lichtlen, P.R.; Medizinische Hochschule Hannover

    1979-01-01

    The effect of isosorbide dinitrate (ISDN) (10 mg sublingually) on myocardial perfusion under ischemic conditions was analyzed in 14 patients with angiographically severe coronary artery disease and typical angina pectoris, using 201-thallium-myocardial scintiscanning. All patients underwent two identical scintiscans with the same work load during bicycle ergometry; a control scintiscan leading to angina and ST-depressions of > 0.1 mV was followed 4-6 weeks later by a scintiscan after ISDN; all drugs - except sublingual nitroglycerin - were withheld for an entire week. - Results: 25 of 39 new or enlarged, exercise-induced defects (64%) were normalized after ISDN; 14 new or enlarged defects remained unchanged (p [de

  7. LOW ADHERENCE TO TREATMENT AFTER MYOCARDIAL INFARCTION: CAUSES AND WAYS OF ADJUSTMENT CONSIDERING PSYCHO-EMOTIONAL STATE OF PATIENTS

    Directory of Open Access Journals (Sweden)

    E. A. Kuzheleva

    2016-01-01

    Full Text Available Aim. To study the reasons of low adherence to treatment in patients after myocardial infarction as well as methods of its correction considering the mental and emotional state of patients. Material and methods. Patients (n=115 after myocardial infarction registered in "Acute Myocardial Infarction Register» were enrolled into the study. The Moriscos-Green scale was used to determine the degree of adherence to treatment, and psycho-emotional state of patients was assessed by the Hospital Anxiety and Depression Scale (HADS. The special questionnaire was used to study the causes of poor adherence. Results. Only 45% of patients after myocardial infarction have a high commitment to the doctor's recommendations. The main reason for low adherence was forgetfulness (42%. Among other reasons were: fear of side effects (16%; lack of therapeutic effect according to patients' opinion (12%; doubts about the doctor's prescriptions (14%; a large number of prescribed drugs (12%; high cost of drugs (4%. The structure of the causes of poor adherence to treatment varied greatly depending on the psycho-emotional status. Adherence to treatment can be improved by specific physician’s actions (48.5% of patients. At the same time 14% of patients did not want to take drugs for a long time under any circumstances. Conclusion. Adherence to treatment of patients after myocardial infarction deserves attention from doctors. The personalized approach considering patient’s opinion, as well as their specific features, is essential for the development of ways to improve adherence.

  8. Evaluation of coronary hemodynamics and exercise 201Tl-myocardial scintigraphy in patients with vasospastic angina

    International Nuclear Information System (INIS)

    Matsumura, Kentaro; Nakase, Emiko; Haiyama, Tohru; Hasegawa, Akira; Saito, Takayuki

    1992-01-01

    To clarify the coronary hemodynamics and myocardial perfusion in patients with vasospastic angina, we performed exercise 201 Tl-myocardial scintigraphy (planar and SPECT) in 72 patients and left coronary digital subtraction angiography (DSA) in 37 patients without significant organic coronary artery stenosis. Coronary artery spasm was documented by coronary angiography in all patients. Fifty-four patients (75%) developed exercise-induced 201 Tl-myocardial perfusion defect on SPECT. 201 Tl pulmonary uptake (L/H) was significantly increased in patients with vasospastic angina. Especially, L/H was higher in patients with multiple small perfusion defect on 201 Tl-SPECT, so that exercise-induced left ventricular dysfunction existed in patients with vasospastic angina and especially in cases of multiple small perfusion defect on 201 Tl-SPECT. The left coronary circulation time (CCT) was prolonged in patients with vasospastic angina. The mechanism of prolonged CCT is still unknown, but we suspected that prolonged CCT was induced by increased peripheral coronary vascular resistance in patients with vasospastic angina. It was concluded that the peripheral coronary circulation was disturbed in patients with vasospastic angina, but its abnormal coronary circulation had no relation to location of spasm-induced vessels. We concluded that impaired coronary microcirculation was taken a part of pathophysiology in vasospastic angina. (author)

  9. Automated quantitative coronary computed tomography correlates of myocardial ischaemia on gated myocardial perfusion SPECT

    International Nuclear Information System (INIS)

    Graaf, Michiel A. de; Boogers, Mark J.; Veltman, Caroline E.; El-Naggar, Heba M.; Bax, Jeroen J.; Delgado, Victoria; Broersen, Alexander; Kitslaar, Pieter H.; Dijkstra, Jouke; Kroft, Lucia J.; Younis, Imad Al; Reiber, Johan H.; Scholte, Arthur J.

    2013-01-01

    Automated software tools have permitted more comprehensive, robust and reproducible quantification of coronary stenosis, plaque burden and plaque location of coronary computed tomography angiography (CTA) data. The association between these quantitative CTA (QCT) parameters and the presence of myocardial ischaemia has not been explored. The aim of the present investigation was to evaluate the association between QCT parameters of coronary artery lesions and the presence of myocardial ischaemia on gated myocardial perfusion single-photon emission CT (SPECT). Included in the study were 40 patients (mean age 58.2 ± 10.9 years, 27 men) with known or suspected coronary artery disease (CAD) who had undergone multidetector row CTA and gated myocardial perfusion SPECT within 6 months. From the CTA datasets, vessel-based and lesion-based visual analyses were performed. Consecutively, lesion-based QCT was performed to assess plaque length, plaque burden, percentage lumen area stenosis and remodelling index. Subsequently, the presence of myocardial ischaemia was assessed using the summed difference score (SDS ≥2) on gated myocardial perfusion SPECT. Myocardial ischaemia was seen in 25 patients (62.5 %) in 37 vascular territories. Quantitatively assessed significant stenosis and quantitatively assessed lesion length were independently associated with myocardial ischaemia (OR 7.72, 95 % CI 2.41-24.7, p 2 = 20.7) and lesion length (χ 2 = 26.0) to the clinical variables and the visual assessment (χ 2 = 5.9) had incremental value in the association with myocardial ischaemia. Coronary lesion length and quantitatively assessed significant stenosis were independently associated with myocardial ischaemia. Both quantitative parameters have incremental value over baseline variables and visually assessed significant stenosis. Potentially, QCT can refine assessment of CAD, which may be of potential use for identification of patients with myocardial ischaemia. (orig.)

  10. Reduction of st segment elevation in diabetic patients with myocardial infarction after thrombolytic therapy

    International Nuclear Information System (INIS)

    Syed, U.

    2017-01-01

    Acute coronary artery disease (CAD) is one of the main cause of death in today's world. Myocardial infarction (MI) tends to be more common among diabetic patients. One of the most effective and used (in our settings) methods of resolution of MI is administration of streptokinase (SK). This study was conducted with the aim to determine the efficacy of thrombolytic therapy in reduction of ST segment elevation in acute MI patients presenting with diabetes. Methods: A descriptive case series with selection of 130 patients through non-probability purposive sampling was conducted at the Medical Departments of Services Hospital Lahore. The study was completed in 6 Months. Patients 18-80 years of age having either gender diagnosed with confirmed acute myocardial infarction were included in this study. All patients were then injected with streptokinase 1.5 mu. Pre and Post SK ECGs were done and ST segment elevation measured also measuring reduction of ST segment. Results: The mean age of the patients was noted as 54.42+-8.80 years. There were 62.31% males. Mean reduction in ST-segment elevation of the patients was noted as 58.53+-26.01. The efficacy was achieved in 47.7% patients. Conclusion: It is concluded that SK can be effective in almost half of diabetic patients with myocardial infarction. (author)

  11. Diagnosis of silent myocardial ischemia in type 2 diabetic patients by electrocardiogram, ergometry and Gated-SPECT

    International Nuclear Information System (INIS)

    Penna Quian, Yamile; Fernandez-Britto Rodriguez, Jose; Bacallao Gallestey, Jorge; Batista Cuellar, Juan Felipe; Coca Perez, Marco Antonio; Toirac Garcia, Noresma; Penna Coego, Andria

    2008-01-01

    31 asymptomatic type 2 diabetic patients were studied by lab tests, electrocardiogram, ergometry, Gated-SPECT and coronariography to determine the relation between the atherosclerotic risk factors and the silent myocardial ischemia. Patients were classified into two groups: positive SPECT and negative SPECT. Association tests were made for each variable and ROC curves were constructed to identify risk markers. In 35.5% of the patients silent myocardial ischemia was detected with a good angiographic correlation. A significant association was evidenced between positive SPECT and the atherosclerotic risk factors, namely, low values of HDLc, family pathological history of ischemic heart disease and peripheral vascular disease. The logistic regression models showed that low values of HDLc together with family pathological history of ischemic heart disease may be strong predictors of silent myocardial ischemia in asymptomatic type 2 diabetic patients

  12. Increased Regional Epicardial Fat Volume Associated with Reversible Myocardial Ischemia in Patients with Suspected Coronary Artery Disease

    Science.gov (United States)

    Khawaja, Tuba; Greer, Christine; Thadani, Samir R.; Kato, Tomoko S.; Bhatia, Ketan; Shimbo, Daichi; Konkak, Andrew; Bokhari, Sabahat; Einstein, Andrew J.; Schulze, P. Christian

    2015-01-01

    Epicardial adipose tissue is a source of pro-inflammatory cytokines and has been linked to the development of coronary artery disease. No study has systematically assessed the relationship between local epicardial fat volume (EFV) and myocardial perfusion defects. We analyzed EFV in patients undergoing SPECT myocardial perfusion imaging combined with computed tomography (CT) for attenuation correction. Low-dose CT without contrast was performed in 396 consecutive patients undergoing SPECT imaging for evaluation of coronary artery disease. Regional thickness, cross-sectional areas, and total EFV were assessed. 295 patients had normal myocardial perfusion scans and 101 had abnormal perfusion scans. Mean EFVs in normal, ischemic, and infarcted hearts were 99.8 ± 82.3 cm3, 156.4 ± 121.9 cm3, and 96.3 ± 102.1 cm3, respectively (P < 0.001). Reversible perfusion defects were associated with increased local EFV compared to normal perfusion in the distribution of the right (69.2 ± 51.5 vs 46.6 ± 32.0 cm3; P = 0.03) and left anterior descending coronary artery (87.1 ± 76.4 vs 46.7 ± 40.6 cm3; P = 0.005). Our results demonstrate increased regional epicardial fat in patients with active myocardial ischemia compared to patients with myocardial scar or normal perfusion on nuclear perfusion scans. Our results suggest a potential role for cardiac CT to improve risk stratification in patients with suspected coronary artery disease. PMID:25339129

  13. Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease

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    Serro-Azul João Batista

    2001-01-01

    Full Text Available OBJETIVE: Antihypertensive therapy with thiazides decreases coronary events in elderly patients. However, the influence of diuretics on myocardial ischemia has not been fully investigated. The aim of this study was to compare the effect of chlorthalidone and diltiazem on myocardial ischemia. METHODS: Following a randomized, double-blind, crossover protocol, we studied 15 elderly hypertensive patients aged 73.6±4.6 years with myocardial ischemia. All patients had angiographically documented coronary artery disease. We measured patients using 48- hour ambulatory electrocardiogram monitoring and exercise testing. After a 2-week period using placebo, patients received chlorthalidone or diltiazem for 4 weeks. RESULTS: Both treatments lowered systolic and diastolic blood pressures. The number of ischemic episodes on ambulatory electrocardiogram recordings was reduced with the use of chlorthalidone (2.5±3.8 and diltiazem (3.2±4.2 when compared with placebo (7.9±8.8; p<0.05. The total duration of ischemic episodes was reduced in both treatments when compared with placebo (chlorthalidone: 19.2±31.9min; diltiazem: 19.3±29.6min; placebo: 46.1±55.3min; p<0.05. CONCLUSION: In elderly hypertensive patients with coronary artery disease, chlorthalidone reduced myocardial ischemia similarly to diltiazem. This result is consistent with epidemiological studies and suggests that reduction of arterial blood pressure with thiazide therapy plays an important role in decreasing myocardial ischemia.

  14. Factors Affecting Myocardial Infarction in Cervical Cancer Patients: A Population-Based Study

    Science.gov (United States)

    Hsieh, Chen-Hsi; Chiou, Wen-Yen; Lee, Ching-Chih; Lee, Moon-Sing; Lin, Hon-Yi; Su, Yu-Chieh; Hung, Shih-Kai

    2013-01-01

    Background Radiotherapy (RT) or concurrent chemoradiation therapy has been suggested to increase the risk of coronary heart disease for cervical cancer patients, but the results of studies have been inconsistent. Therefore, we aimed to investigate the factors which influence the risk of developing myocardial infarction (MI) in cervical cancer patients with a large, nationwide cohort. Methods The study analyzed data from the 1996 to 2010 National Health Insurance Research Database provided by the National Health Research Institutes in Taiwan. The assessed number of patients with cervical cancer with radiotherapy only, surgery with bilateral oophorectomy only, and with appendectomy were 308, 323 and 229, respectively. The Kaplan-Meier method and the Cox proportional hazards model were used to assess the risk of myocardial infarction. Results The adjusted hazard ratio for cervical cancer in patients with MI was 1.97 (95% CI, 0.97 - 3.91; P = 0.05) for the group that received RT alone, and 2.13 (95% CI, 1.11 - 3.75; P = 0.01) for the surgery group when compared with controls. The more risk comorbidities they have, the higher the risk of myocardial infarction would be for the patients. Conclusion The incidence of MI was significantly higher among cervical cancer patients with RT alone or surgery with bilateral oophorectomy alone than among general populations. RT might be as a factor to increase risk as bilateral oophorectomy. Whether RT itself triggers menopause or impairs the ovarian hormone production that increases the risk of MI needs to be further investigated. PMID:24171059

  15. The Effect and Side Effect of Dipyridamole in Myocardial SPECT

    International Nuclear Information System (INIS)

    Yang, Hyung In; Lee, Dong Soo; Yeo, Jeong Suk; Bae, Sang Kyun; Choi, Chang Woon; Chung, June Key; Lee, Myung Chul; Koh, Chang Soon

    1993-01-01

    Dipyridamole is an agent that may be used to noninvasively evaluate coronary artery disease. The effect of dipyridamole infusion its generally related to its induced peripheral vasodilatory effect. In normal person, heart rate is generally increased slightly while blood pressure decrease, but the achieved double product and related myocardial oxygen consumption have no significant change. The purpose of this study is to examine the effect and side effect of dipyridamole, and to compare different response to dipyridamole among the patients. We evaluated 847 patients who underwent dipyridamole stress myocardial SPECT. 93.6% of them had induced hypotension 0.9% showed no change of blood pressure, 5.5% had increased blood pressure 8.3% had no change of pulse rate more than 10% of basal pulse rate. Among diabetes, 16.9% was not change of pulse rate, 6.7% in non-diabetes. There was no significant correlation between age and rate pressure product rest(RPPr), in patients without perfusion defects on SPECT(y=7.1x+48.4r=0.13 p>0.01). As increasing age, RPPs/RPPr was declined(y=-11.6x+68.9 r=0.17 p<0.01), similar results were obtained in patients with perfusion defect. The size of perfusion defect on myocardial SPECT have no correlation between RPPr and RPPs/RPPr. The side effects of dipyridamole included chest pain and chest tightness, headache, abdominal pain, dizziness, nausea, and dyspnea. As increasing age, dipyridamole-induced cardiac work at rest was increased, cardiac response to dipyridamole was decreased.

  16. Assessment of right ventricular function by myocardial performance index in diabetic patients

    Directory of Open Access Journals (Sweden)

    Ayman Ahmed Abdelaziz

    2011-09-01

    Conclusion: Myocardial performance index is a useful noninvasive tool for the detection of early right ventricular systolic and diastolic dysfunction in diabetic patients, regardless of coexisting hypertension.

  17. Assessment of left ventricular myocardial scar with three-dimensional MRI

    International Nuclear Information System (INIS)

    Yin Gang; Zhao Shihua; Lu Minjie

    2011-01-01

    Objective: To assess the value of free-breathing 3D phase sensitive inversion recovery (PSIR) turbo FLASH for demonstrating the left ventricular myocardial scar in patients with myocardial infarction. Methods: Twenty-three patients with myocardial infarction underwent 2D and 3D phase sensitive inversion recovery (PSIR) Turbo FLASH sequences 10-15 minutes after injection of dimeglumine gadopentetate. The image quality, the area, location and volume of hyperenhanced scar were independently assessed by two experienced radiologists. Student's t test or rank sum test and Pearson linear correlation were used for the statistics. Results: There were no significant differences in the overall image quality (2.57± 0.59 vs 2.39±0.66, Z=-0.93, P=0.35), the area (24.48±10.83 vs 29.00±11.56, Z=-1.41, P=0.16) and location (16.78±6.51 vs 18.87±6.76, Z=-1.17, P=0.24) of hyperenhanced scar between 2D and 3D PSIR sequences. The mean volume of hyperenhanced scar was significantly greater in 3D PSIR sequence than that in 2D PSIR sequence [(23.46±10.61) vs (31.65±13.86) cm 3 , t=-2.25, P= 0.03]. There was a good correlation in the volume of hyperenhanced scar between 2D PSIR and 3D PSIR sequences (r=0.940, P 2 =0.883). Conclusion: Free-breathing 3D PSIR Turbo FLASH is a promising new imaging technique for accurate assessment of myocardial scar. (authors)

  18. "Spice" (Synthetic Marijuana) Induced Acute Myocardial Infarction: A Case Series.

    Science.gov (United States)

    Ul Haq, E; Shafiq, A; Khan, A A; Awan, A A; Ezad, S; Minteer, W J; Omar, B

    2017-01-01

    Marijuana is the most widely abused "recreational" substance in the United States, with highest prevalence in young adults. It is reported to cause ischemic strokes, hepatitis, anxiety, and psychosis. Although it is associated with dose dependent tachycardia and can lead to coronary vasospasm, it has not been directly related to acute myocardial infarction (AMI). Marijuana induced coronary vasospasm can result in endothelial denudation at the site of a vulnerable atherosclerotic plaque in response to hemodynamic stressors, potentially causing an AMI. Spice refers to herbal mixture with composition and effects similar to that of marijuana and therefore is referred to as "synthetic marijuana." Herein, we report 3 cases of spice induced ST-segment elevation myocardial infarction. All patients were relatively young and had few or absolutely no risk factors for cardiovascular disease. All patients underwent emergent coronary angiography, with two needing stent placement and the third requiring only aspiration thrombectomy. Our case series emphasizes the importance of suspecting and investigating synthetic marijuana use in low risk young adults presenting with AMI.

  19. The Olson method for detection of acute myocardial ischemia in patients with coronary occlusion.

    Science.gov (United States)

    Lindow, Thomas; Olson, Charles W; Swenne, Cees A; Man, Sumche; Pahlm, Olle

    An automated ECG-based method may provide diagnostic support in the management of patients with acute coronary syndrome. The Olson method has previously proved to accurately identify the culprit artery in patients with acute coronary occlusion. The Olson method was applied to 360 patients without acute myocardial ischemia and 52 patients with acute coronary occlusion. This study establishes the normal variation of the Olson wall scores in patients without acute myocardial ischemia, which provides the basis for implementation of the Olson method for triage of patients with acute coronary syndrome. All patients with acute occlusion had Olson wall scores above the upper limit of normal. The Olson method can be used for ischemia detection with very high sensitivity. Future studies are needed to explore specificity in patients with non-ischemic ST elevation. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Imaging of Myocardial Fibrosis in Patients with End-Stage Renal Disease: Current Limitations and Future Possibilities

    Directory of Open Access Journals (Sweden)

    M. P. M. Graham-Brown

    2017-01-01

    Full Text Available Cardiovascular disease in patients with end-stage renal disease (ESRD is driven by a different set of processes than in the general population. These processes lead to pathological changes in cardiac structure and function that include the development of left ventricular hypertrophy and left ventricular dilatation and the development of myocardial fibrosis. Reduction in left ventricular hypertrophy has been the established goal of many interventional trials in patients with chronic kidney disease, but a recent systematic review has questioned whether reduction of left ventricular hypertrophy improves cardiovascular mortality as previously thought. The development of novel imaging biomarkers that link to cardiovascular outcomes and that are specific to the disease processes in ESRD is therefore required. Postmortem studies of patients with ESRD on hemodialysis have shown that the extent of myocardial fibrosis is strongly linked to cardiovascular death and accurate imaging of myocardial fibrosis would be an attractive target as an imaging biomarker. In this article we will discuss the current imaging methods available to measure myocardial fibrosis in patients with ESRD, the reliability of the techniques, specific challenges and important limitations in patients with ESRD, and how to further develop the techniques we have so they are sufficiently robust for use in future clinical trials.

  1. Microdose flare-up vs. flexible-multidose GnRH antagonist protocols for poor responder patients who underwent ICSI.

    Science.gov (United States)

    Esinler, I

    2014-01-01

    To compare the performance of microdose flare-up (MF) and flexible-multidose gonadotropin-releasing hormone (GnRH) antagonist protocols in poor responder patients who underwent intracytoplasmic sperm injection (ICSI). One hundred and 12 consecutive patients (217 cycles) suspected to have poor ovarian response were enrolled. Group 1 (MF GnRH agonist group) constituted 64 patients (135 cycles) who underwent MF GnRH agonist protocol. Group 2 (flexible-multidose GnRH antagonist group) constituted 48 patients (82 cycles) who underwent flexible-multidose GnRH antagonist protocol. The duration of stimulation (d) (11.5 +/- 2.1 vs. 10.4 +/- 2.7, p or = seven blastomeres and < 10% fragmentation at day 3 (35.9% vs. 65.1%, p < 0.05) were significantly lower in Group 1 when compared to Group 2. The number of embryos transferred (2.2 +/- 1.3 vs. 2.4 +/- 0.9), the clinical pregnancy per embryo transfer (16.3% vs. 25.8%), and the implantation rate (8.6% vs. 12.2%) were comparable between groups. Although the flexible-multidose GnRH antagonist protocol produced better oocyte and embryo parameters, the clinical pregnancy rate and the implantation rates were comparable between the flexible-multidose GnRH antagonist and MF protocols in poor responder patients.

  2. Safety and Tolerability of Transitioning from Cangrelor to Ticagrelor in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Badreldin, Hisham A; Carter, Danielle; Cook, Bryan M; Qamar, Arman; Vaduganathan, Muthiah; Bhatt, Deepak L

    2017-08-01

    The 3 phase 3 CHAMPION (Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials collectively demonstrated the safety of transitioning from cangrelor, a potent, parenteral rapidly-acting P2Y 12 inhibitor, to clopidogrel in patients who underwent percutaneous coronary intervention (PCI). However, variation in timing of therapy, site-specific binding, and drug half-lives may theoretically complicate switching to other oral P2Y 12 inhibitors. Since regulatory approval, limited data are available regarding the "real-world" safety and tolerability of transitioning to these more potent oral P2Y 12 antagonists. From November 2015 to January 2017, we evaluated the clinical profiles and efficacy and safety outcomes in cangrelor-treated patients who underwent PCI transitioned to clopidogrel (n = 42) or ticagrelor (n = 82) at a large, tertiary care center. Most patients receiving cangrelor underwent PCI with a drug-eluting stent for acute coronary syndrome via a radial approach in the background of unfractionated heparin. Stent thrombosis within 48 hours was rare and occurred in 1 patient treated with ticagrelor. Global Use of Strategies to Open Occluded Coronary Arteries-defined bleeding occurred in 20% of patients switched to ticagrelor and 29% of patients switched to clopidogrel, but none were severe or life-threatening. In conclusion, rates of stent thrombosis and severe/life-threatening bleeding were low and comparable with those identified in the CHAMPION program, despite use of more potent oral P2Y 12 inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Effects of a novel multimodal group intervention on myocardial perfusion in patients with coronary heart disease (CHD)

    International Nuclear Information System (INIS)

    Theissen, P.; Schicha, H.; Albus, C.; Koehle, K.; Griebenow, R.; Son, P.

    2002-01-01

    Full text: Recently, it could be shown that a multimodal intervention can promote health behavior in patients with CHD. Purpose of the actual study was to evaluate the effects on somatic endpoints, e.g. myocardial perfusion. We randomly assigned 77 patients (age 54 ± 6.9 y, male 87 %) with angiographically documented CHD to a multimodal group intervention plus standardized cardiological care (INT n=39) or standardized cardiological care only (CO n = 38). The intervention, for out-patients only, consisted of 77.5 hours of group-psychotherapy, relaxation and exercise training, and teaching lessons for one year. A Thallium myocardial perfusion scintigraphy (MyoSc) (after bicycle exercise test and at rest; 70 - 110 MBq Thallium-201, SPECT-technique, quantitative wash-out (w.-o.) analysis derived from polar maps) was performed at baseline, after 2 years, and 3 years, respectively: A w.-o. increase res. decrease by 5 % or more indicated an improved / a diminished myocardial perfusion within the affected coronary artery territory. Results were analyzed on an intention to treat basis. 70/77 patients (91 %) completed the study (drop-outs CO n=4, INT n=3). After 2 years (1st interval), there was no significant difference between groups. After 3 years (2nd interval) 36/39 patients (92.3 %) of INT showed a stable or improved myocardial perfusion, compared to 18/38 patients (47.4 %) of CO (p= 0.008). The recent data analysis demonstrates the extra benefit of a multimodal intervention, compared to standardized cardiological care alone, on myocardial perfusion in CHD patients. (author)

  4. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Prognostic value of biological markers in myocardial infarction patients.

    Science.gov (United States)

    Berezin, Alexander E; Samura, Tatiana A

    2013-04-01

    The aim of this study was to compare the prognostic value of matrix metalloproteinase-3 and -9, and NT-pro-natriuretic peptide for fatal and nonfatal complications in Q-wave myocardial infarction patients in the acute and postinfarction periods. 85 men and women with documented Q-wave myocardial infarction were observed for 1 year after hospitalization. Clinical endpoints were identified through the hospital patient-tracking system, with a review of medical records for each recorded endpoint. Left ventricular ejection fraction and wall motion index were calculated. Measurements of matrix metalloproteinases and NT-pro-natriuretic peptide were performed by an enzyme-linked immunosorbent assay. A cutoff value of 9.7 ng·mL(-1) for matrix metalloproteinase-3 showed the best discriminatory power (sensitivity = 77.8%, specificity = 90.8%). The optimal cutoff value of matrix metalloproteinase-9 was 18.1 ng·mL(-1) (sensitivity, 70.5%; specificity, 75%), and the cutoff for NT-pro-natriuretic peptide was 885 pmol·L(-1) (sensitivity, 58%; specificity, 68.6%). Matrix metalloproteinase-3 and -9 were strongly related with a positive prognostic value of 70% (sensitivity and specificity, 84% and 82%, respectively). These data may be helpful for further stratification of patients into cardiovascular mortality risk groups.

  6. Prediction of left ventricular functional recovery in patients with acute myocardial infarction using single photon emission computed tomography with thallium-201 and iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid

    International Nuclear Information System (INIS)

    Hashimoto, Akiyoshi; Nakata, Tomoaki; Nagao, Kazuhiko

    1995-01-01

    The relationships between myocardial perfusion, fatty acid metabolism, and cardiac function were investigated using dual single photon emission computed tomography (SPECT) with thallium and iodine-123-β-methyl-p-iodophenyl-pentadecanoic acid ( 123 I-BMIPP) during the acute ( 10±1 days) and recovery (60±14 days) phases in 29 patients with acute myocardial infarction. There were 18 patients who underwent successful primary coronary angioplasty (PTCA group) and 11 patients who received conservative therapy (non PTCA group). Thallium and BMIPP uptakes were scored visually by a 4-point system and left ventricular ejection fraction (LVEF) was calculated by radionuclide ventriculography. Although significant positive correlations between thallium and 123 I-BMIPP scores were observed during both phases, BMIPP scores were significantly lower than thallium scores in both acute and recovery phases in the PTCA group. No significant difference in thallium and 123 I-BMIPP scores was observed at the recovery phase in the non PTCA group. LVEF significantly correlated with thallium and 123 I-BMIPP scores in both phases in the PTCA group. Furthermore, the difference between thallium and 123 I-BMIPP scores during the acute phase significantly correlated with the improvement of LVEF during the follow-up period in the PTCA group (y=0.92x-0.77, r=0.65, p 123 I-BMIPP SPECT is increased by reperfusion therapy and persists at least until the recovery phase of myocardial infarction. The recovery of left ventricular function depends on the extent of the mismatched uptake, indicating a predictor for functional recovery following acute myocardial infarction. (author)

  7. Radiation dose to radiosensitive organs in PET/CT myocardial perfusion examination using versatile optical fibre

    Science.gov (United States)

    Salasiah, M.; Nordin, A. J.; Fathinul Fikri, A. S.; Hishar, H.; Tamchek, N.; Taiman, K.; Ahmad Bazli, A. K.; Abdul-Rashid, H. A.; Mahdiraji, G. A.; Mizanur, R.; Noor, Noramaliza M.

    2013-05-01

    Cardiac positron emission tomography (PET) provides a precise method in order to diagnose obstructive coronary artery disease (CAD), compared to single photon emission tomography (SPECT). PET is suitable for obese and patients who underwent pharmacologic stress procedures. It has the ability to evaluate multivessel coronary artery disease by recording changes in left ventricular function from rest to peak stress and quantifying myocardial perfusion (in mL/min/g of tissue). However, the radiation dose to the radiosensitive organs has become crucial issues in the Positron Emission Tomography/Computed Tomography(PET/CT) scanning procedure. The objective of this study was to estimate radiation dose to radiosensitive organs of patients who underwent PET/CT myocardial perfusion examination at Centre for Diagnostic Nuclear Imaging, Universiti Putra Malaysia in one month period using versatile optical fibres (Ge-B-doped Flat Fibre) and LiF (TLD-100 chips). All stress and rest paired myocardial perfusion PET/CT scans will be performed with the use of Rubidium-82 (82Rb). The optic fibres were loaded into plastic capsules and attached to patient's eyes, thyroid and breasts prior to the infusion of 82Rb, to accommodate the ten cases for the rest and stress PET scans. The results were compared with established thermoluminescence material, TLD-100 chips. The result shows that radiation dose given by TLD-100 and Germanium-Boron-doped Flat Fiber (Ge-B-doped Flat Fiber) for these five organs were comparable to each other where the p>0.05. For CT scans,thyroid received the highest dose compared to other organs. Meanwhile, for PET scans, breasts received the highest dose.

  8. Mild troponin I elevation does not predict ischemia on myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Le Dung Ha

    2017-08-01

    Full Text Available IntroductionData are limited on the degree of mild troponin I elevation and clinical risk factors in predicting myocardial ischemia.MethodsHospitalized adult patients who underwent myocardial perfusion imaging (MPI from 2015 to 2016 at Rochester General Hospital and had mild troponin I elevation (>0.1 and <1.5 ng/mL were included. Predictors of outcomes were determined using logistic regression model.ResultsOne hundred and sixty-six patients with mild troponin I elevation who underwent MPI were followed. Mean age was 69.6 ± 12.5 years and 53.0% of the patients were female. Fourteen patients (8.4% presented with typical chest pain (CP, 60 patients (36.1% had atypical CP and 92 patients (55.4% had no CP on presentation. MPI was positive for ischemia in 45 patients (27.1%. There was no difference in peak troponin I level with ischemia versus no ischemia on MPI (0.34 ng/dL [0.13-0.69] vs. 0.23 ng/dL [0.14-0.50], p value 0.254. Atypical CP did not predict the presence of ischemia on MPI (odds ratio [OR] 1.97, 95% confidence interval [CI] 0.91-4.26. Coronary artery disease (CAD history (age and sex adjusted p value 0.013, diabetes (adjusted p value 0.036, creatinine ≥2 mg/dL (adjusted p value 0.019 and dialysis (adjusted p value 0.006 were statistically significant predictors of ischemia on MPI.ConclusionsIn patients presenting with mild troponin I elevation, peak troponin I level did not predict ischemia on MPI. The presence of CAD history, diabetes, elevated creatinine and dialysis were predictors of ischemia on MPI.

  9. Precatheterization Use of P2Y12 Inhibitors in Non-ST-Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In-Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry®.

    Science.gov (United States)

    Badri, Marwan; Abdelbaky, Amr; Li, Shuang; Chiswell, Karen; Wang, Tracy Y

    2017-09-22

    Current guidelines recommend early P2Y 12 inhibitor administration in non-ST-elevation myocardial infarction, but it is unclear if precatheterization use is associated with longer delays to coronary artery bypass grafting (CABG) or higher risk of post-CABG bleeding and transfusion. This study examines the patterns and outcomes of precatheterization P2Y 12 inhibitor use in non-ST-elevation myocardial infarction patients who undergo CABG. Retrospective analysis was done of 20 304 non-ST-elevation myocardial infarction patients in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry (2009-2014) who underwent catheterization within 24 hours of admission and CABG during the index hospitalization. Using inverse probability-weighted propensity adjustment, we compared time from catheterization to CABG, post-CABG bleeding, and transfusion rates between patients who did and did not receive precatheterization P2Y 12 inhibitors. Among study patients, 32.9% received a precatheterization P2Y 12 inhibitor (of these, 2.2% were given ticagrelor and 3.7% prasugrel). Time from catheterization to CABG was longer among patients who received precatheterization P2Y 12 inhibitor (median 69.9 hours [25th, 75th percentiles 28.2, 115.8] versus 43.5 hours [21.0, 71.8], P ST-elevation myocardial infarction patients who undergo early catheterization and in-hospital CABG. Despite longer delays to surgery, the majority of pretreated patients proceed to CABG <3 days postcatheterization. Precatheterization P2Y 12 inhibitor use is associated with higher risks of postoperative bleeding and transfusion. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  10. A Meta-Analysis of Circulating Microvesicles in Patients with Myocardial Infarction.

    Science.gov (United States)

    Wang, Zhida; Cai, Wang; Hu, Shaolan; Xia, Yufei; Wang, Yao; Zhang, Qi; Chen, Liming

    2017-07-10

    Cell-derived microvesicles (MVs) are vesicles released from activated or apoptotic cells. However, the levels of MVs in myocardial infarction have been found inconsistent in researches. To assess the association between MVs and myocardial infarction by conducting a meta-analysis. A systematic literature search on PubMed, Embase, Cochran, Google Scholar electronic database was conducted. Comparison of the MVs levels between myocardial infarction patients and healthy persons were included in our study. Standard Mean Difference (SMD) and 95% confidence interval (CI) in groups were calculated and meta-analyzed. 11 studies with a total of 436 participants were included. Compared with the health persons, AMVs [SMD = 3.65, 95% CI (1.03, 6.27)], PMVs [SMD = 2.88, 95% CI (1.82, 3.93),] and EMVs [SMD = 2.73, 95% CI (1.13, 4.34)], levels were higher in patients with myocardial infarction. However, LMVs levels [SMD = 0.73, 95% CI (-0.57, 2.03)] were not changed significantly in patients with myocardial infarction. AMVs, PMVs and EMVs might be potential biomarkers for myocardial infarction. As microvesículas derivadas de células (MVs) são vesículas liberadas de células ativadas ou apoptóticas. No entanto, os níveis de MVs no infarto do miocárdio foram encontrados inconsistentes nas pesquisas. Avaliar a associação entre MV e infarto do miocárdio por meio de uma meta-análise. Foi realizada uma pesquisa sistemática na literatura em PubMed, Embase, Cochran e no banco de dados eletrônico do Google Scholar. Uma comparação dos níveis de MV entre pacientes com infarto do miocárdio e pessoas saudáveis foi incluída no nosso estudo. A Diferença Média Padrão (DMP) e o intervalo de confiança (IC) de 95% nos grupos foram calculadas e meta-analisadas. Foram incluídos 11 estudos com um total de 436 participantes. Em comparação com as pessoas saudáveis, as MVA [DMP = 3,65, IC 95% (1,03, 6,27)], MVPs [DMP = 2,88, IC 95% (1,82, 3,93)] e MVEs [DMP = 2,73, IC 95% (1

  11. Electro-mechanical characteristics of myocardial infarction border zones and ventricular arrhythmic risk: novel insights from grid-tagged cardiac magnetic resonance imaging

    International Nuclear Information System (INIS)

    Wong, Dennis T.L.; Weightman, Michael J.; Baumert, Mathias; Tayeb, Hussam; Richardson, James D.; Puri, Rishi; Bertaso, Angela G.; Roberts-Thomson, Kurt C.; Sanders, Prashanthan; Worthley, Matthew I.; Worthley, Stephen G.

    2012-01-01

    To investigate whether grid-tag myocardial strain evaluation can characterise 'border-zone' peri-infarct region and identify patients at risk of ventricular arrhythmia as the peri-infarct myocardial zone may represent an important contributor to ventricular arrhythmia following ST-segment elevation myocardial infarction (STEMI). Forty-five patients with STEMI underwent cardiac magnetic resonance (CMR) imaging on days 3 and 90 following primary percutaneous coronary intervention (PCI). Circumferential peak circumferential systolic strain (CS) and strain rate (CSR) were calculated from grid-tagged images. Myocardial segments were classified into 'infarct', 'border-zone', 'adjacent' and 'remote' regions by late-gadolinium enhancement distribution. The relationship between CS and CSR and these distinct myocardial regions was assessed. Ambulatory Holter monitoring was performed 14 days post myocardial infarction (MI) to estimate ventricular arrhythmia risk via evaluation of heart-rate variability (HRV). We analysed 1,222 myocardial segments. Remote and adjacent regions had near-normal parameters of CS and CSR. Border-zone regions had intermediate CS (-9.0 ± 4.6 vs -5.9 ± 7.4, P < 0.001) and CSR (-86.4 ± 33.3 vs -73.5 ± 51.4, P < 0.001) severity compared with infarct regions. Patients with 'border-zone' peri-infarct regions had reduced very-low-frequency power on HRV analysis, which is a surrogate for ventricular arrhythmia risk (P = 0.03). Grid-tagged CMR-derived myocardial strain accurately characterises the mechanical characteristics of 'border-zone' peri-infarct region. Presence of 'border-zone' peri-infarct region correlated with a surrogate marker of heightened arrhythmia risk following STEMI. (orig.)

  12. Clinical evaluation of sup 123 I-BMIPP myocardial scintigraphy in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Ohtsuki, Katsuichi; Sugihara, Hiroki; Umamoto, Ikuo (Kyoto Prefectural Univ. of Medicine (Japan)) (and others)

    1992-02-01

    {sup 123}I-{beta}-methyl-p-iodophenylpentadecanoic acid ({sup 123}I-BMIPP) myocardial scintigraphy was performed in 13 patients with hypertrophic cardiomyopathy and compared with {sup 201}Tl myocardial scintigraphy performed within 3 months for evaluating the clinical significance of {sup 123}I-BMIPP myocardial scintigraphy. SPECT images were divided into 13 segments and segmental images were visually scored on a 4 (increased tracer uptake) to 0 (severely decreased tracer uptake) scale according to the tracer uptake. In comparison of {sup 123}I-BMIPP early images and {sup 201}Tl perfusion images, mismatches were seen in about 70% of all segments. The number of segments demonstrating lower myocardial uptake of {sup 123}I-BMIPP was larger than that of {sup 201}Tl. In hypertrophic regions, the tracer uptake of {sup 123}I-BMIPP early images was significantly lower than that of {sup 201}Tl images and the lower uptake of {sup 123}I-BMIPP delayed images was more marked. In non-hypertrophic regions, no significant difference was seen between the tracer uptakes of {sup 123}I-BMIPP early images and {sup 201}Tl images but the tracer uptake of {sup 123}I-BMIPP delayed images was significantly lower than that of {sup 201}Tl images. The mismatch between the tracer uptakes of {sup 123}I-BMIPP images and {sup 201}Tl images was thought to be a reflection of disordered myocardial fatty acid metabolism. 'Washout', the difference between the tracer uptakes of {sup 123}I-BMIPP early images and delayed images was also thought to be a reflection of disordered myocardial fatty acid metabolism. These results suggest that {sup 123}I-BMIPP is a promising radiopharmaceutical for evaluating disordered myocardial fatty acid metabolism in patients with HCM. (author).

  13. Prognostic value of stress 99Tcm-MIBI myocardial perfusion SPECT after acute myocardial infarction

    International Nuclear Information System (INIS)

    Sui Xutao; Chen Zhi; Gao Shenghai; Shen Li; Li Shang'ai

    2003-01-01

    Objective: To investigate relativity of acute myocardial infarction (AMI) with clinical, stress test and perfusion imaging parameters and to assess predictive value on hard events of cardiac death or recurrent nonfatal AMI. Methods: One hundred and one patients of AMI underwent stress 99 Tc m -MIBI SPECT before discharge. Hard and soft events were followed-up, relative factors with cardiac events were analyzed by statistical methods and predictive value on hard events were assessed. Results: Independent predictors by multivariate analysis for cardiac hard events or all cardiac events consisted of a history of prior AMI (RR=5.30, CI 2.17-12.98), a low exercise capacity (RR=6.28, CI 1.92-21.46) and left ventricular ejection fraction 99 Tc m -MIBI SPECT is a single test that can provide exercise parameter, cardiac perfusion imaging information and left ventricular function assessment to identify high-risk and estimate hard prognosis at discharge of AMI patients. These high-risk patients can be referred for early invasive evaluation and intervention

  14. Prediction of Pathological Complete Response Using Endoscopic Findings and Outcomes of Patients Who Underwent Watchful Waiting After Chemoradiotherapy for Rectal Cancer.

    Science.gov (United States)

    Kawai, Kazushige; Ishihara, Soichiro; Nozawa, Hiroaki; Hata, Keisuke; Kiyomatsu, Tomomichi; Morikawa, Teppei; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. This was a retrospective comparative study. This study was conducted at a single referral hospital. A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. Although endoscopic assessment after chemoradiotherapy correlated with pathological response

  15. Proton chemical shift imaging after myocardial infarction

    International Nuclear Information System (INIS)

    Bouchard, A.; Doyle, M.; Pohost, G.M.

    1989-01-01

    The present study was undertaken to test whether chemical shift imaging could detect spatially the lipids known to accumulate in myocardium after an ischemic insult. Seven dogs underwent a 24-hour coronary artery occlusion. Hearts were removed and imaged ex vivo by the Dixon method (1.5 T), and myocardial samples were obtained for high-resolution H-1 spectroscopy. Lipid images revealed regions of increased signal intensity in the periphery f the myocardial infarction. The zones of high lipid signal corresponded to zones with elevated mobile lipids as detected by H-1 spectroscopy

  16. Selective Cerebro-Myocardial Perfusion in Complex Neonatal Aortic Arch Pathology: Midterm Results.

    Science.gov (United States)

    Hoxha, Stiljan; Abbasciano, Riccardo Giuseppe; Sandrini, Camilla; Rossetti, Lucia; Menon, Tiziano; Barozzi, Luca; Linardi, Daniele; Rungatscher, Alessio; Faggian, Giuseppe; Luciani, Giovanni Battista

    2018-04-01

    Aortic arch repair in newborns and infants has traditionally been accomplished using a period of deep hypothermic circulatory arrest. To reduce neurologic and cardiac dysfunction related to circulatory arrest and myocardial ischemia during complex aortic arch surgery, an alternative and novel strategy for cerebro-myocardial protection was recently developed, where regional low-flow perfusion is combined with controlled and independent coronary perfusion. The aim of the present retrospective study was to assess short-term and mid-term results of selective and independent cerebro-myocardial perfusion in neonatal aortic arch surgery. From April 2008 to August 2015, 28 consecutive neonates underwent aortic arch surgery under cerebro-myocardial perfusion. There were 17 male and 11 female, with median age of 15 days (3-30 days) and median body weight of 3 kg (1.6-4.2 kg), 9 (32%) of whom with low body weight (cerebro-myocardial perfusion was 30 ± 11 min (15-69 min). Renal dysfunction, requiring a period of peritoneal dialysis was observed in 10 (36%) patients, while liver dysfunction was noted only in 3 (11%). There were three (11%) early and two late deaths during a median follow-up of 2.9 years (range 6 months-7.7 years), with an actuarial survival of 82% at 7 years. At latest follow-up, no patient showed signs of cardiac or neurologic dysfunction. The present experience shows that a strategy of selective and independent cerebro-myocardial perfusion is safe, versatile, and feasible in high-risk neonates with complex congenital arch pathology. Encouraging outcomes were noted in terms of cardiac and neurological function, with limited end-organ morbidity. © 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  17. Influence of pre-infarction angina, collateral flow, and pre-procedural TIMI flow on myocardial salvage index by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Kelbæk, Henning Skov; Vejlstrup, Niels Grove

    2012-01-01

    BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial...

  18. Myocardial imaging in the noninvasive evaluation of patients with suspected ischemic heart disease

    International Nuclear Information System (INIS)

    Pitt, B.; Strauss, H.W.

    1976-01-01

    Three noninvasive radioactive tracer techniques for evaluating patients with ischemic heart disease are described: (1) myocardial perfusion imaging, (2) acute infarct imaging, and (3) the gated blood pool scan. Myocardial perfusion imaging with tracers that distribute in the myocardium in relation to regional blood flow allows detection of patients with transmural and nontransmural infarction by the finding of decreased tracer concentration in the affected region of the myocardium. If these tracers are injected at the time of maximal stress to patients with significant coronary arterial stenosis but without infarction, areas of transient ischemia can be identified as zones of decreased tracer concentration not found when an examination is performed at rest. Acute infarct imaging with tracers that localize in acutely damaged tissue permits separation of patients with acute myocardial necrosis from those without infarction and those with more chronic damage. The gated blood pool scan permits assessment of left ventricular function and regional wall motion. The measurement of ventricular volumes, ejection fraction and regional wall motion adds significantly to the determination of hemodynamic variables in assessing patients with acute infarction. The technique also permits detection of right ventricular dysfunction. Performance of a combination of these radioactive tracer techniques is often advantageous, particularly in patients with suspected infarction. The techniques can establish whether infarction is present, whether it is acute, where the damage is located and how extensive it is; they can also provide a measure of the effect of this damage on left ventricular function

  19. Impact of gender on infarct size, ST-segment resolution, myocardial blush and clinical outcomes after primary stenting for acute myocardial infarction: Substudy from the EMERALD trial.

    Science.gov (United States)

    Ng, Vivian G; Mori, Ken; Costa, Ricardo A; Kish, Mitra; Mehran, Roxana; Urata, Hidenori; Saku, Keijiro; Stone, Gregg W; Lansky, Alexandra J

    2016-03-15

    Women with AMI may have worse outcomes than men. However, it is unclear if this is related to differences in treatment, treatment effect or gender specific factors. We sought to determine whether primary percutaneous intervention (PCI) has a differential impact on infarct size, myocardial perfusion and ST segment resolution in men and women with acute myocardial infarction (AMI). A total of 501 AMI patients were prospectively enrolled in the EMERALD study and underwent PCI with or without distal protection. Post hoc gender subset analysis was performed. 501 patients (108 women, 393 men) with ST-segment elevation AMI presenting within 6h underwent primary (or rescue) PCI with stenting and a distal protection device. Women were older, had more hypertension, less prior AMI, smaller BSA, and smaller vessel size, but had similar rates of diabetes (30% versus 20.2%, p=0.87), LAD infarct, and time-to-reperfusion compared to men. Women more frequently had complete ST-resolution (>70%) at 30days (72.8% versus 59.8%, p=0.02), and smaller infarct size compared to males (12.2±19.6% versus 18.4±18.5%, p=0.006). At 6months, TLR (6.9% versus 5.2%) and MACE (11.4% versus 10.3%) were similar for women and men. Despite worse comorbidities, women with AMI treated with primary PCI with stenting showed similar early and midterm outcomes compared to men. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. Contrast-enhanced magnetic resonance imaging for the detection of ruptured coronary plaques in patients with acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Christian H P Jansen

    Full Text Available X-ray coronary angiography (XCA is the current gold standard for the assessment of lumen encroaching coronary stenosis but XCA does not allow for early detection of rupture-prone vulnerable plaques, which are thought to be the precursor lesions of most acute myocardial infarctions (AMI and sudden death. The aim of this study was to investigate the potential of delayed contrast-enhanced magnetic resonance coronary vessel wall imaging (CE-MRCVI for the detection of culprit lesions in the coronary arteries.16 patients (13 male, age 61.9±8.6 years presenting with sub-acute MI underwent CE-MRCVI within 24-72h prior to invasive XCA. CE-MRCVI was performed using a T1-weighted 3D gradient echo inversion recovery sequence (3D IR TFE 40±4 minutes following the administration of 0.2 mmol/kg gadolinium-diethylenetriamine-pentaacetic acid (DTPA on a 3T MRI scanner equipped with a 32-channel cardiac coil.14 patients were found to have culprit lesions (7x LAD, 1xLCX, 6xRCA as identified by XCA. Quantitative CE-MRCVI correctly identified the culprit lesion location with a sensitivity of 79% and excluded culprit lesion formation with a specificity of 99%. The contrast to noise ratio (CNR of culprit lesions (9.7±4.1 significantly exceeded CNR values of segments without culprit lesions (2.9±1.9, p<0.001.CE-MRCVI allows the selective visualization of culprit lesions in patients immediately after myocardial infarction (MI. The pronounced contrast uptake in ruptured plaques may represent a surrogate biomarker of plaque activity and/or vulnerability.

  1. Detection of myocardial ischemia of hypertrophic cardiomyopathy with gated 99Tcm-MIBI myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Jia Peng; Guo Wanhua; Du Minghua; Gao Ling

    2010-01-01

    Objective: To evaluate the value of gated 99 Tc m -methoxyisobutylisonitrile (MIBI) myocardial perfusion imaging in detection of myocardial ischemia in hypertrophic cardiomyopathy. Methods: Sixty-nine patients with clinically proven hypertrophic cardiomyopathy were divided into 2 groups using coronary angiogram as 'gold standard': positive group (n=19, narrowing ≥ 50%) and negative group (n=50, narrowing 99 Tc m -MIBI myocardial perfusion imaging was performed and positive in all 69 patients (41 males, 28 females, aged 35-75 years). Comparative analysis between the two groups was carried out using t-test. Results: In the positive group, reversible and irreversible perfusion defects were detected in 9 and 10 patients, respectively. Left ventricular ejection fraction (LVEF) increased to (69.1 ± 2.8)% in 8 patients and decreased to (42.8 ± 2.1)% in 11 patients. In the negative group, reversible and irreversible perfusion defects were found in 37 and 13 patients, respectively. LVEF increased to (70.8 ± 4.0)% in 38 patients and decreased to (48.9 ± 2.7)% in 12 patients. The values of ischemic area, severity and extent of perfusion defect, and LVEF were significantly different between the two groups (t=9.28, 16.51, 2.65; P 99 Tc m -MIBI myocardial perfusion imaging is valuable in assessing patients with hypertrophic cardiomyopathy. Detection for the presence or absence of coexisting coronary artery disease and myocardial ischemia has an important prognostic indication and management indication for these patients. (authors)

  2. The effect of levosimendan on myocardial ischemia–reperfusion injury in streptozotocin-induced diabetic rats

    Science.gov (United States)

    Kiraz, Hasan Ali; Poyraz, Fatih; Kip, Gülay; Erdem, Özlem; Alkan, Metin; Arslan, Mustafa; Özer, Abdullah; Şivgin, Volkan; Çomu, Faruk Metin

    2015-01-01

    Objective Ischemia/reperfusion (I/R) injury is an important cause of myocardial damage by means of oxidative, inflammatory, and apoptotic mechanisms. The aim of the present study was to examine the potential cardio protective effects of levosimendan in a diabetic rat model of myocardial I/R injury. Methods A total of 18 streptozotocin-induced diabetic Wistar Albino rats (55 mg/kg) were randomly divided into three equal groups as follows: the diabetic I/R group (DIR) in which myocardial I/R was induced following left thoracotomy, by ligating the left anterior descending coronary artery for 60 min, followed by 2 h of reperfusion; the diabetic I/R levosimendan group (DIRL), which underwent I/R by the same method while taking levosimendan intraperitoneal 12 µg kg−1; and the diabetic control group (DC) which underwent sham operations without tightening of the coronary sutures. As a control group (C), six healthy age-matched Wistar Albino rats underwent sham operations similar to the DC group. Two hours after the operation, the rats were sacrificed and the myocardial tissue samples were examined by light microscopy for evidence of myonecrosis and inflammatory cell infiltration. Results Myonecrosis findings were significantly different among groups (p=0.008). Myonecrosis was more pronounced in the DIR group compared with the C, DC, and DIRL groups (p=0.001, p=0.007 and p=0.037, respectively). Similarly, the degree of inflammatory cell infiltration showed significant difference among groups (p<0.0001). Compared with C, DC, and DIRL groups, the inflammatory cell infiltration was significantly higher among the DIR group (p<0.0001, p<0.0001, and p=0.020, respectively). Also, myocardial tissue edema was significantly different among groups (p=0.006). The light microscopic myocardial tissue edema levels were significantly higher in the DIR group than the C, DC, and DIRL groups (p=0.001, p=0.037, and p=0.014, respectively). Conclusion Taken together, our data indicate that

  3. Cardiovascular risk evaluation and prevalence of silent myocardial ischemia in subjects with asymptomatic carotid artery disease

    Directory of Open Access Journals (Sweden)

    Ciccone M

    2011-03-01

    Full Text Available Marco Matteo Ciccone1, Artor Niccoli-Asabella2, Pietro Scicchitano1, Michele Gesualdo1, Antonio Notaristefano2, Domenico Chieppa1, Santa Carbonara1, Gabriella Ricci1, Marco Sassara1, Corinna Altini2, Giovanni Quistelli1, Mario Erminio Lepera1, Stefano Favale1, Giuseppe Rubini21Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO, 2Nuclear Medicine Unit, Department of Internal Medicine and of Public Medicine, University of Bari, Bari, ItalyIntroduction: Silent ischemia is an asymptomatic form of myocardial ischemia, not associated with angina or anginal equivalent symptoms, which can be demonstrated by changes in ECG, left ventricular function, myocardial perfusion, and metabolism. The aim of this study was to evaluate the prevalence of silent myocardial ischemia in a group of patients with asymptomatic carotid stenosis.Methods: A total of 37 patients with asymptomatic carotid plaques, without chest pain or dyspnea, was investigated. These patients were studied for age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of cardiac disease, and underwent technetium-99 m sestamibi myocardial stress-rest scintigraphy and echo-color Doppler examination of carotid arteries.Results: A statistically significant relationship (P = 0.023 was shown between positive responders and negative responders to scintigraphy test when both were tested for degree of stenosis. This relationship is surprising in view of the small number of patients in our sample. Individuals who had a positive scintigraphy test had a mean stenosis degree of 35% ± 7% compared with a mean of 44% ± 13% for those with a negative test. Specificity of our detection was 81%, with positive and negative predictive values of 60% and 63%, respectively.Conclusion: The present study confirms that carotid atherosclerosis is associated with coronary atherosclerosis and highlights the importance of screening for ischemic heart disease in

  4. Quantification of the myocardial area at risk using coronary CT angiography and Voronoi algorithm-based myocardial segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, Akira; Kono, Atsushi; Coenen, Adriaan; Saru-Chelu, Raluca G.; Krestin, Gabriel P. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Sakamoto, Tsuyoshi [AZE inc, Development Division, Chiyoda, Tokyo (Japan); Kido, Teruhito; Mochizuki, Teruhito [Ehime University Graduate School of Medicine, Department of Radiology, Toon, Ehime (Japan); Higashino, Hiroshi [Yotsuba Circulation Clinic, Department of Radiology, Matsuyama, Ehime (Japan); Abe, Mitsunori [Yotsuba Circulation Clinic, Department of Cardiology, Matsuyama, Ehime (Japan); Feyter, Pim J. de; Nieman, Koen [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Cardiology, Rotterdam (Netherlands)

    2015-01-15

    The purpose of this study was to estimate the myocardial area at risk (MAAR) using coronary computed tomography angiography (CTA) and Voronoi algorithm-based myocardial segmentation in comparison with single-photon emission computed tomography (SPECT). Thirty-four patients with coronary artery disease underwent 128-slice coronary CTA, stress/rest thallium-201 SPECT, and coronary angiography (CAG). CTA-based MAAR was defined as the sum of all CAG stenosis (>50 %) related territories (the ratio of the left ventricular volume). Using automated quantification software (17-segment model, 5-point scale), SPECT-based MAAR was defined as the number of segments with a score above zero as compared to the total 17 segments by summed stress score (SSS), difference (SDS) score map, and comprehensive SPECT interpretation with either SSS or SDS best correlating CAG findings (SSS/SDS). Results were compared using Pearson's correlation coefficient. Forty-nine stenoses were observed in 102 major coronary territories. Mean value of CTA-based MAAR was 28.3 ± 14.0 %. SSS-based, SDS-based, and SSS/SDS-based MAAR was 30.1 ± 6.1 %, 20.1 ± 15.8 %, and 26.8 ± 15.7 %, respectively. CTA-based MAAR was significantly related to SPECT-based MAAR (r = 0.531 for SSS; r = 0.494 for SDS; r = 0.814 for SSS/SDS; P < 0.05 in each). CTA-based Voronoi algorithm myocardial segmentation reliably quantifies SPECT-based MAAR. (orig.)

  5. Quantification of the myocardial area at risk using coronary CT angiography and Voronoi algorithm-based myocardial segmentation

    International Nuclear Information System (INIS)

    Kurata, Akira; Kono, Atsushi; Coenen, Adriaan; Saru-Chelu, Raluca G.; Krestin, Gabriel P.; Sakamoto, Tsuyoshi; Kido, Teruhito; Mochizuki, Teruhito; Higashino, Hiroshi; Abe, Mitsunori; Feyter, Pim J. de; Nieman, Koen

    2015-01-01

    The purpose of this study was to estimate the myocardial area at risk (MAAR) using coronary computed tomography angiography (CTA) and Voronoi algorithm-based myocardial segmentation in comparison with single-photon emission computed tomography (SPECT). Thirty-four patients with coronary artery disease underwent 128-slice coronary CTA, stress/rest thallium-201 SPECT, and coronary angiography (CAG). CTA-based MAAR was defined as the sum of all CAG stenosis (>50 %) related territories (the ratio of the left ventricular volume). Using automated quantification software (17-segment model, 5-point scale), SPECT-based MAAR was defined as the number of segments with a score above zero as compared to the total 17 segments by summed stress score (SSS), difference (SDS) score map, and comprehensive SPECT interpretation with either SSS or SDS best correlating CAG findings (SSS/SDS). Results were compared using Pearson's correlation coefficient. Forty-nine stenoses were observed in 102 major coronary territories. Mean value of CTA-based MAAR was 28.3 ± 14.0 %. SSS-based, SDS-based, and SSS/SDS-based MAAR was 30.1 ± 6.1 %, 20.1 ± 15.8 %, and 26.8 ± 15.7 %, respectively. CTA-based MAAR was significantly related to SPECT-based MAAR (r = 0.531 for SSS; r = 0.494 for SDS; r = 0.814 for SSS/SDS; P < 0.05 in each). CTA-based Voronoi algorithm myocardial segmentation reliably quantifies SPECT-based MAAR. (orig.)

  6. Quantitative characterization of myocardial infarction by cardiovascular magnetic resonance predicts future cardiovascular events in patients with ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Pauly John M

    2008-04-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR can provide quantitative data of the myocardial tissue utilizing high spatial and temporal resolution along with exquisite tissue contrast. Previous studies have correlated myocardial scar tissue with the occurrence of ventricular arrhythmia. This study was conducted to evaluate whether characterization of myocardial infarction by CMR can predict cardiovascular events in patients with ischemic cardiomyopathy (ICM. Results We consecutively studied 86 patients with ICM (LVEF Conclusion Quantification of the scar volume and scar percentage by CMR is superior to LVEDV, LVESV, and LVEF in prognosticating the future likelihood of the development of cardiovascular events in patients with ICM.

  7. Predictors of myocardial injury in patients with acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    El-Sayed M Farag

    2014-03-01

    The most significant predictors for myocardial injury in patients with UGIB in descending order were hypertension, cigarette smoking, liver cirrhosis, body mass index > 25 kg/m2, and C-reactive protein level  > 5 mg/dl.

  8. Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification

    Directory of Open Access Journals (Sweden)

    Marly Uellendahl

    Full Text Available Abstract Background: Chagas disease (CD is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF in patients with CD by cardiac magnetic resonance (CMR. The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE was compared with that via Rassi score. Methods: This study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND; and symptomatic patients as Chagas Heart Disease (CHD group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score. Results: Regarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001. Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76. Conclusions: CMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD.

  9. Mental Stress-Induced-Myocardial Ischemia in Young Patients With Recent Myocardial Infarction: Sex Differences and Mechanisms.

    Science.gov (United States)

    Vaccarino, Viola; Sullivan, Samaah; Hammadah, Muhammad; Wilmot, Kobina; Al Mheid, Ibhar; Ramadan, Ronnie; Elon, Lisa; Pimple, Pratik M; Garcia, Ernest V; Nye, Jonathon; Shah, Amit J; Alkhoder, Ayman; Levantsevych, Oleksiy; Gay, Hawkins; Obideen, Malik; Huang, Minxuan; Lewis, Tené T; Bremner, J Douglas; Quyyumi, Arshed A; Raggi, Paolo

    2018-02-20

    Mental stress-induced myocardial ischemia (MSIMI) is frequent in patients with coronary artery disease and is associated with worse prognosis. Young women with a previous myocardial infarction (MI), a group with unexplained higher mortality than men of comparable age, have shown elevated rates of MSIMI, but the mechanisms are unknown. We studied 306 patients (150 women and 156 men) ≤61 years of age who were hospitalized for MI in the previous 8 months and 112 community controls (58 women and 54 men) frequency matched for sex and age to the patients with MI. Endothelium-dependent flow-mediated dilation and microvascular reactivity (reactive hyperemia index) were measured at rest and 30 minutes after mental stress. The digital vasomotor response to mental stress was assessed using peripheral arterial tonometry. Patients received 99m Tc-sestamibi myocardial perfusion imaging at rest, with mental (speech task) and conventional (exercise/pharmacological) stress. The mean age of the sample was 50 years (range, 22-61). In the MI group but not among controls, women had a more adverse socioeconomic and psychosocial profile than men. There were no sex differences in cardiovascular risk factors, and among patients with MI, clinical severity tended to be lower in women. Women in both groups showed a higher peripheral arterial tonometry ratio during mental stress but a lower reactive hyperemia index after mental stress, indicating enhanced microvascular dysfunction after stress. There were no sex differences in flow-mediated dilation changes with mental stress. The rate of MSIMI was twice as high in women as in men (22% versus 11%, P =0.009), and ischemia with conventional stress was similarly elevated (31% versus 16%, P =0.002). Psychosocial and clinical risk factors did not explain sex differences in inducible ischemia. Although vascular responses to mental stress (peripheral arterial tonometry ratio and reactive hyperemia index) also did not explain sex differences in

  10. Dipyridamole induced directory disfunction of infarcted vessel, and estimation of patients with acute myocardial infarction and successful PTCA

    International Nuclear Information System (INIS)

    Hashimoto, Yasunori; Yamabe, Hiroshi; Kim, Sushik; Yano, Takashi; Fujita, Hideki; Kakimoto, Tetsuya; Namura, Hiroyuki; Maeda, Kazumi; Yokoyama, Mitsuhiro

    1993-01-01

    The purpose of this study was to determine whether transient disturbance of vascular dilation in the peripheral coronary vessels in patients with myocardial infarction in whom coronary recanalization was successfully attained in the acute stage. The subjects were 6 patients with acute myocardial infarction in whom recanalization was successfully attained without a significant coronary stenosis by emergency percutaneous transluminal coronary angioplasty (PTCA). Dipyridamole-loaded thallium-201 myocardial scintigraphy was undertaken during the acute stage (an average of 5 days after PTCA) and during convalescent stage (an average 24 days after PTCA). Defect was seen in the infarcted areas on early images during the acute stage in all 6 patients, and Tl uptake in the infarcted areas was improved during the convalescent stage in 2 of the 6 patients. In these two patients, fill-in phenomenon was seen in the infarcted area during acute stage when images were acquired after re-injection of Tl-201. These findings suggested that transient disturbance of vascular dilation may occur in the peripheral coronary artery vessels in the infarcted area where recanalization was successfully attained in patients with acute myocardial infarction. (N.K.)

  11. Myocardial perfusion imaging for detection of silent myocardial ischemia

    International Nuclear Information System (INIS)

    Beller, G.A.

    1988-01-01

    Despite the widespread use of the exercise stress test in diagnosing asymptomatic myocardial ischemia, exercise radionuclide imaging remains useful for detecting silent ischemia in numerous patient populations, including those who are totally asymptomatic, those who have chronic stable angina, those who have recovered from an episode of unstable angina or an uncomplicated myocardial infarction, and those who have undergone angioplasty or received thrombolytic therapy. Studies show that thallium scintigraphy is more sensitive than exercise electrocardiography in detecting ischemia, i.e., in part, because perfusion defects occur more frequently than ST depression and before angina in the ischemic cascade. Thallium-201 scintigraphy can be performed to differentiate a true- from a false-positive exercise electrocardiographic test in patients with exercise-induced ST depression and no angina. The development of technetium-labeled isonitriles may improve the accuracy of myocardial perfusion imaging. 11 references

  12. Radioimmunoassay of creatine kinase-B isoenzyme in human sera: results in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Willerson, J.T.; Stone, M.J.; Ting, R.; Mukherjee, A.; Gomez-Sanchez, C.E.; Lewis, P.; Hersh, L.B.

    1977-01-01

    A radiommunoassay was developed to measure serum levels of the B isoenzyme of creatine kinase (ATP: creatine N-phosphotransferase, EC 2.7.3.2) (CPK) in order to evaluate the time course and frequency of MB isoenzyme elevation in patients with acute myocardial infarction. The method can identify as little as 0.2 ng of the B portion of the CPK-MB isoenzyme, does not significantly crossreact with CPK-MM isoenzyme, and is not affected by storage of serum at -20 0 . CPK isoenzyme containing B subunits was detected in 48 out of 51 sera from normal adults; serum levels in these individuals ranged between 1.2 and 12.5 ng/ml[mean +- SEM was 2.7 +- 0.30 ng/ml]. The mean serum level of CPK-B isoenzyme in a pool of sera obtained from 100 normal subjects was 2.9 +- 0.35 ng/ml; two patients with rhabdomyolysis that were studied had serum CPK-B isoenzyme levels of 2.5 and 3.5 ng/ml, respectively. In contrast, serum levels of the CPK-B isoenzyme were markedly elevated in sera from 18 patients with acute myocardial infarcts when obtained within 12 hr after hospital admission; the mean +- SEM concentration was 56 +- 7.8 ng/ml. We performed serial determinations on 14 patients with acute myocardial infarcts and demonstrated that maximal serum CPK-B levels occurred within the first 12 hr after admission and were lower thereafter. The serum concentration of B-containing CPK isoenzyme in 19 additional patients admitted with chest pain but without acute myocardial infarction was 3.4 +- 0.50 ng/ml. Thus, radioimmunoassay measurement of CPK-B isoenzyme appears to be a useful and sensitive test for the detection of acute myocardial infarcts in patients

  13. Automated quantitative coronary computed tomography correlates of myocardial ischaemia on gated myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Graaf, Michiel A. de; Boogers, Mark J.; Veltman, Caroline E. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); The Interuniversity Cardiology Institute of The Netherlands, Utrecht (Netherlands); El-Naggar, Heba M.; Bax, Jeroen J.; Delgado, Victoria [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Broersen, Alexander; Kitslaar, Pieter H.; Dijkstra, Jouke [Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden (Netherlands); Kroft, Lucia J. [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Younis, Imad Al [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands); Reiber, Johan H. [Leiden University Medical Center, Department of Radiology, Division of Image Processing, Leiden (Netherlands); Medis medical imaging systems B.V., Leiden (Netherlands); Scholte, Arthur J. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands)

    2013-08-15

    Automated software tools have permitted more comprehensive, robust and reproducible quantification of coronary stenosis, plaque burden and plaque location of coronary computed tomography angiography (CTA) data. The association between these quantitative CTA (QCT) parameters and the presence of myocardial ischaemia has not been explored. The aim of the present investigation was to evaluate the association between QCT parameters of coronary artery lesions and the presence of myocardial ischaemia on gated myocardial perfusion single-photon emission CT (SPECT). Included in the study were 40 patients (mean age 58.2 {+-} 10.9 years, 27 men) with known or suspected coronary artery disease (CAD) who had undergone multidetector row CTA and gated myocardial perfusion SPECT within 6 months. From the CTA datasets, vessel-based and lesion-based visual analyses were performed. Consecutively, lesion-based QCT was performed to assess plaque length, plaque burden, percentage lumen area stenosis and remodelling index. Subsequently, the presence of myocardial ischaemia was assessed using the summed difference score (SDS {>=}2) on gated myocardial perfusion SPECT. Myocardial ischaemia was seen in 25 patients (62.5 %) in 37 vascular territories. Quantitatively assessed significant stenosis and quantitatively assessed lesion length were independently associated with myocardial ischaemia (OR 7.72, 95 % CI 2.41-24.7, p < 0.001, and OR 1.07, 95 % CI 1.00-1.45, p = 0.032, respectively) after correcting for clinical variables and visually assessed significant stenosis. The addition of quantitatively assessed significant stenosis ({chi} {sup 2} = 20.7) and lesion length ({chi} {sup 2} = 26.0) to the clinical variables and the visual assessment ({chi} {sup 2} = 5.9) had incremental value in the association with myocardial ischaemia. Coronary lesion length and quantitatively assessed significant stenosis were independently associated with myocardial ischaemia. Both quantitative parameters have

  14. Early versus late percutaneous revascularization in patients hospitalized with non ST-segment elevation myocardial infarction: The atherosclerosis risk in communities surveillance study.

    Science.gov (United States)

    Arora, Sameer; Matsushita, Kunihiro; Qamar, Arman; Stacey, R Brandon; Caughey, Melissa C

    2018-02-01

    Current guidelines recommend early invasive intervention (<24 hr) for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). A delayed invasive strategy (24-72 hr) is considered reasonable for low risk patients. The real-world effectiveness of this strategy is unknown. The ARIC Study has conducted hospital surveillance of acute myocardial infarction (MI) since 1987. NSTEMI was classified using a validated algorithm. We limited our study to patients undergoing early (<24 hr of the event onset), or late (≥24 hr) percutaneous coronary intervention (PCI). Patients were stratified into low (TIMI score 2-4), and high risk (TIMI score 5-7, or presence of cardiogenic shock, ventricular fibrillation, or cardiac arrest). Associations between early versus late PCI and mortality were analyzed using multivariable logistic regression adjusted for demographics, hospitalization year, TIMI score, and comorbidities. From 1987 to 2012, 6,746 patients were hospitalized with NSTEMI and underwent PCI. Most were white (79%), male (68%), with mean age 61 years. The 28-day and 1-year mortality were 2% and 5%, respectively. Most revascularizations (65%) were late. After accounting for potential confounders, early PCI was associated with a 58% reduced 28-day mortality (OR = 0.42; 95% CI: 0.21-0.84) for the entire population, and 57% reduced mortality (OR = 0.43; 95% CI: 0.21-0.88) for high risk patients. By 1-year of follow up, there was no significant difference in mortality with respect to early vs. late PCI. In hospitalized NSTEMI patients with high risk of clinical events, early PCI is associated with improved 28-day survival. © 2017 Wiley Periodicals, Inc.

  15. Regional myocardial metabolism in patients with acute myocardial infarction assessed by positron emission tomography

    International Nuclear Information System (INIS)

    Schwaiger, M.; Brunken, R.; Grover-McKay, M.; Krivokapich, J.; Child, J.; Tillisch, J.H.; Phelps, M.E.; Schelbert, H.R.

    1986-01-01

    Positron emission tomography has been shown to distinguish between reversible and irreversible ischemic tissue injury. Using this technique, 13 patients with acute myocardial infarction were studied within 72 hours of onset of symptoms to evaluate regional blood flow and glucose metabolism with nitrogen (N)-13 ammonia and fluorine (F)-18 deoxyglucose, respectively. Serial noninvasive assessment of wall motion was performed to determine the prognostic value of metabolic indexes for functional tissue recovery. Segmental blood flow and glucose utilization were evaluated using a circumferential profile technique and compared with previously established semiquantitative criteria. Relative N-13 ammonia uptake was depressed in 32 left ventricular segments. Sixteen segments demonstrated a concordant decrease in flow and glucose metabolism. Regional function did not change over time in these segments. In contrast, 16 other segments with reduced blood flow revealed maintained F-18 deoxyglucose uptake consistent with remaining viable tissue. The average wall motion score improved significantly in these segments (p less than 0.01), yet the degree of recovery varied considerably among patients. Coronary anatomy was defined in 9 of 13 patients: patent infarct vessels supplied 8 of 10 segments with F-18 deoxyglucose uptake, while 10 of 13 segments in the territory of an occluded vessel showed concordant decreases in flow and metabolism (p less than 0.01). Thus, positron emission tomography reveals a high incidence of residual tissue viability in ventricular segments with reduced flow and impaired function during the subacute phase of myocardial infarction. Absence of residual tissue metabolism is associated with irreversible injury, while preservation of metabolic activity identifies segments with a variable outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Early detection of myocardial ischaemia in the emergency department by rest or exercise 99mTc tracer myocardial SPET in patients with chest pain and non-diagnostic ECG

    International Nuclear Information System (INIS)

    Conti, A.; Paladini, B.; Francois, C.; Grifoni, S.; Berni, G.; Gallini, C.; Costanzo, E.; Ferri, P.; Matteini, M.; Pieroni, C.; Migliorini, A.; Antoniucci, D.

    2001-01-01

    Chest pain (CP) represents a frequent reason for presentation at the emergency department (ED). A large proportion of patients have non-diagnostic ECG on presentation, and in many cases several hours have elapsed since onset of symptoms. Acute rest myocardial scintigraphy (rest SPET) has been shown to have a relevant role in the detection of patients at risk for coronary events, but its sensitivity and negative predictive value are optimal only within the first 3 h following onset of symptoms. In those with delayed presentation, exercise SPET alone, as a screening approach, appears more promising, but its feasibility and diagnostic role in the ED are still unresolved. A total of 231 consecutive patients with a recent-onset (<24 h) first episode of CP had a negative first-line work-up including ECG, troponins, creatine kinase-MB and echocardiography. These patients were considered at low risk for short-term coronary events. Patients were studied with rest SPET if they presented <3 h after onset of CP and exercise SPET if they presented after ≥3 h. The end-points of the study were detection of significant coronary artery disease (CAD) by angiography and major coronary events or cardiac death at 6 months. Eighty patients (35%) underwent rest SPET, while 151 (65%) underwent exercise SPET. Two of the 159 patients with negative SPET had evidence of critical CAD at 6-month follow-up (one patient in the rest SPET group and one in the exercise SPET group; P=NS). Of the 72 patients (31%) with a positive scan, 34 (15%) had documented CAD (16 patients in the rest SPET group and 18 in the exercise SPET group; P=NS). Sensitivity, specificity, accuracy and predictive value were not statistically different between the two groups. In conclusion, the accuracy of exercise SPET in patients with CP and delayed presentation to the ED is comparable to that of validated rest SPET in patients with early presentation. Owing to the high negative predictive value (99%), exercise SPET is

  17. Evaluation of myocardial damage in Duchenne's muscular dystrophy with thallium-201 myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Takuhisa; Shibuya, Noritoshi (Kawatana National Hospital, Nagasaki (Japan)); Hashiba, Kunitake; Oku, Yasuhiko; Mori, Hideki; Yano, Katsusuke

    1993-01-01

    Myocardial damage and cardiopulmonary functions in patients with Duchenne's muscular dystrophy (DMD) were assessed using thallium-201 myocardial single-photon emission computed tomography (SPECT) and technetium-99m multigated radionuclide angiography. Twenty-five patients with DMD were divided into 4 groups according to percent of perfusion defect (%PD) calculated by the bull's-eye method and age. PD was detected in 24 (96.0%) of 25 patients with DMD, and it spread from the left ventricular lateral wall to the anterior wall and/or interventricular septum. PD was detected even in a 6-year-old DMD boy. Patients in Group I (%PD[>=]10% and age<15 years old) were shown to have a higher risk of left-sided heart failure without respiratory failure. Patients in Group II (%PD[>=]10 and age[>=]15) showed decreased pulmonary function and worsened arterial blood gas values as compared with Group IV (%PD<10 and age[>=]15). There was no significant difference in cardiac function among the 4 groups. It is postulated that myocardial damage in Group II patients is dependent primarily on a deficiency of dystrophin and on chronic respiratory failure, and that some of them are at risk of cardiopulmonary failure. It is concluded that myocardial SPECT is useful for the early diagnosis of myocardial damage and evaluation of cardiopulmonary function in DMD patients. (author).

  18. Correlation between Stress Hyperglycemia and Short-Term Prognosis in non Diabetic Patients with Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Rafighdoust Amirhossein

    2009-03-01

    Full Text Available Background: Abnormal hyperglycemia is a common finding in early phase of acute myocardial infarction that is named as stress hyperglycemia. In this study we have evaluated primary blood sugar of non-diabetic patients with acute myocardial infarction at the time of admission to compare the early complications between patients with high or normal blood sugar. We aimed to find any relation between primary blood sugar and post MI complication rate. Materials and Methods: One hundred non-diabetic patients with acute myocardial infarction who were referred to heart emergency ward of Imam Reza Hospital (Mashhad, Iran were included in this study. According to primary blood glucose level, 50 patients with blood glucose > 126 mg/dl were compared with 50 patients with normal blood glucose level. All patients were evaluated during hospitalization and daily clinical examinations laboratory tests, and routine non-invasive assessments were done. The results were analyzed by SPSS software and the level of signification difference was described as p<0.05.Results: Sinus tachycardia, atrial fibrillation, bundle branch block, ventricular extrasystole, prolonged PR-interval and heart failure according to Klip classification and also according to echocardiographic index (EF<50 were statistically significant and more common in hyperglycemic patients (P<0.05. Thromboembolic and mechanical complications (papillary muscle dysfunction, pericarditis, phlebitis and angina were also more common in hyperglycemic group although the differences were not significant statistically. Conclusion: It seems that high rate of early complications in non-diabetic patients with acute myocardial infarction is directly related to primary hyperglycemia (stress hyperglycemia.

  19. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy

    International Nuclear Information System (INIS)

    Nesto, R.W.; Phillips, R.T.; Kett, K.G.; Hill, T.; Perper, E.; Young, E.; Leland, O.S. Jr.

    1988-01-01

    Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliability of angina as a marker for exertional ischemia. The two groups had similar clinical characteristics, treadmill test results, and extent of infarction and ischemia, but only 7 patients with diabetes compared with 17 patients without diabetes had angina during exertional ischemia. In diabetic patients the extent of retinopathy, nephropathy, or peripheral neuropathy was similar in patients with and without angina. Angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease. Given the increased cardiac morbidity and mortality in such patients, periodic objective assessments of the extent of ischemia are warranted

  20. Single photon emission computed tomography of technetium-99m tetrofosmin myocardial perfusion imaging in patients with systemic lupus erythematosus-A preliminary report

    International Nuclear Information System (INIS)

    Lin, Jen-Jhy; Hsu, Hsiu-Bao; Sun, Shung-Shung; Kao, Chia-Hung; Ho, Shung-Tai

    2003-01-01

    The purpose of this study was to evaluate the utility of single-photon emission computed tomography (SPECT) of technetium-99m tetrofosmin (Tc-99m TF) myocardial perfusion imaging to detect myocardial involvement in patients with systemic lupus erythematosus (SLE). Three groups of subjects-group 1: 25 SLE female patients with non-specific cardiac symptoms and signs, group 2: 25 female SLE patients without any cardiac symptoms and signs, and group 3: 25 female healthy controls-were evaluated by comparing rest and dipyridamole-stress Tc-99m TF myocardial perfusion SPECT. Tc-99m TF myocardial perfusion SPECT revealed perfusion defects in 88% and 40% of the cases in groups 1 and 2, respectively. However, no cases in group 3 demonstrated myocardial perfusion defects. Tc-99m TF myocardial perfusion SPECT is a useful noninvasive imaging modality to detect cardiac involvement in SLE patients with or without cardiac symptoms and signs. (author)

  1. Is the time between onset of pain and restoration of patency of infarct-related artery shortened in patients with myocardial infarction? The effects of the Kielce Region System for Optimal Management of Acute Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Marcin Sadowski

    2014-09-01

    Full Text Available Introduction : The importance of delay in the restoration of infarct-related artery patency in patients with myocardial infarction was discussed, and actions were undertaken in the Kielce Region aimed at shortening this time within the System for Optimal Management of Acute Myocardial Infarction. Aim of the research: To evaluate the effectiveness of shortening time delays during transport of patients and diagnostics of myocardial infarction in the Kielce Region. Material and methods: Time delays were analysed in 5,934 patients with ST-segment elevation myocardial infarction (STEMI, hospitalised in cardiology wards with interventional cardiology on 24-hour duty, during the period 2008–2012. Time delays were analysed between the onset of myocardial infarction pain and undertaking treatment – T1 and T2 time – within which a patient with myocardial infarction, after admission to hospital, has intervention performed on infarct-related coronary artery. Results : During the period 2008–2012, the median T1 time was successfully shortened from 355 to 203 min, and the T2 time from 101 to 48 min. Conclusions: The effectiveness of the system was confirmed, and the necessity for further improvement of the system indicated.

  2. The effect of patient anxiety and depression on motion during myocardial perfusion SPECT imaging

    International Nuclear Information System (INIS)

    Lyra, Vassiliki; Kallergi, Maria; Rizos, Emmanouil; Lamprakopoulos, Georgios; Chatziioannou, Sofia N.

    2016-01-01

    Patient motion during myocardial perfusion SPECT imaging (MPI) may be triggered by a patient’s physical and/or psychological discomfort. The aim of this study was to investigate the impact of state anxiety (patient’s reaction to exam-related stress), trait anxiety (patient’s personality characteristic) and depression on patient motion during MPI. All patients that underwent MPI in our department in a six-month period were prospectively enrolled. One hundred eighty-three patients (45 females; 138 males) filled in the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), along with a short questionnaire regarding their age, height and weight, level of education in years, occupation, and marital status. Cardiovascular and other co-morbidity factors were also evaluated. Through inspection of raw data on cinematic display, the presence or absence of patient motion was registered and classified into mild, moderate and severe, for both phases involved in image acquisition. The correlation of patient motion in the stress and delay phases of MPI and each of the other variables was investigated and the corresponding Pearson’s coefficients of association were calculated. The anxiety-motion (r = 0.43, P < 0.0001) and depression-motion (r = 0.32, P < 0.0001) correlation results were moderately strong and statistically significant for the female but not the male patients. All the other variables did not demonstrate any association with motion in MPI, except a weak correlation between age and motion in females (r = 0.23, P < 0.001). The relationship between anxiety-motion and depression-motion identified in female patients represents the first supporting evidence of psychological discomfort as predisposing factor for patient motion during MPI

  3. Radioimmunoassay determination of factor 4 platelets (PF4) in acute myocardial infarction patients

    International Nuclear Information System (INIS)

    Leon Herrejon, Ma. de L.; Graef S, A.; Altamirano B, P.; Ramos C, M.A.

    1985-01-01

    From a pathological standpoint an increase in the Factor 4 platelet has been observed in various abnormal states including myocardial infarction, diabetes mellitus, diffuse intravascular coagulation and renal insufficiency among others. Eighty subjects were studied at rest: 40 normal and under no medication, and 40 myocardial infarction patients in the acute phase and with added pathology. All were under the same therapeutic regimen. Results obtained between both groups were statistically significant with a P > 0.01. (author)

  4. Mortality after myocardial infarction in HIV-infected patients who have initiated HAART

    DEFF Research Database (Denmark)

    Rasmussen, Line D; Gerstoft, Jan; Kronborg, Gitte

    2007-01-01

    We identified all Danish HIV patients registered with myocardial infarction (MI) when on HAART (44 patients) and compared their mortality with that of matched patients with MI and no HIV and patients with HIV and no MI. Mortality in HIV-infected MI patients was not significantly different...... to that of MI only patients in the first 90 days post-MI and thereafter was not significantly different to that of HIV patients without MI. Udgivelsesdato: 2007-Apr-23...

  5. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Abildstrøm, Steen Z; Ottesen, Michael M

    2005-01-01

    AIMS: Atrial fibrillation (AF) is a common complication in patients with acute myocardial infarction and is associated with an increase in the risk of death. The excess mortality associated with AF complicating acute myocardial infarction has not been studied in detail. Observations indicate...... that AF facilitates induction of ventricular arrhythmias, which may increase the risk of sudden cardiovascular death (SCD). A close examination of the mode of death could potentially provide useful knowledge to guide further investigations and treatments. METHODS AND RESULTS: We analysed the relation...... between AF/atrial flutter (AFL) and modes of death in 5983 consecutive patients discharged alive after an acute myocardial infarction screened in the TRAndolapril Cardiac Evaluation registry. This cohort of patients with an enzyme-verified acute myocardial infarction was admitted to 27 centres in 1990...

  6. The expression of myocardial injury in cold induced myocardial imaging and echocardiography of systematic scleroderma

    International Nuclear Information System (INIS)

    Liang Jiugen; Zhu Xiaojun; Jiang Ningyi; Chen Shaoxiong

    1999-01-01

    The study was performed with cold-induced 99m Tc(MIBI) myocardial imaging (MI) in 23 patients with systematic scleroderma. The left ventricular function and wall motion were also observed by dimensional echocardiography (UCG). 14 patients had myocardial perfusion abnormalities visualized by MI, including 5 cases with fixed defects of 9 segments, 3 cases with reversible defects of 6 segments and 6 cases with both fixed and reversible one of 14 segments. The positive rate in myocardial imaging had no significant differences between patients with and without Raynaud's phenomenon (0.5>P>0.25). Compared with baseline, the ejection fraction, stroke volume, cardiac output were significantly decreased during cold-induced in patients with abnormal myocardial scintigraphy (P<0.05), and had significant difference compared with normal group (P<0.05). 4 cases with cold-induced reversible perfusion defects had anatomically correlated regional ventricular hypokinesia in UCG

  7. “Spice” (Synthetic Marijuana Induced Acute Myocardial Infarction: A Case Series

    Directory of Open Access Journals (Sweden)

    E. Ul Haq

    2017-01-01

    Full Text Available Marijuana is the most widely abused “recreational” substance in the United States, with highest prevalence in young adults. It is reported to cause ischemic strokes, hepatitis, anxiety, and psychosis. Although it is associated with dose dependent tachycardia and can lead to coronary vasospasm, it has not been directly related to acute myocardial infarction (AMI. Marijuana induced coronary vasospasm can result in endothelial denudation at the site of a vulnerable atherosclerotic plaque in response to hemodynamic stressors, potentially causing an AMI. Spice refers to herbal mixture with composition and effects similar to that of marijuana and therefore is referred to as “synthetic marijuana.” Herein, we report 3 cases of spice induced ST-segment elevation myocardial infarction. All patients were relatively young and had few or absolutely no risk factors for cardiovascular disease. All patients underwent emergent coronary angiography, with two needing stent placement and the third requiring only aspiration thrombectomy. Our case series emphasizes the importance of suspecting and investigating synthetic marijuana use in low risk young adults presenting with AMI.

  8. Prognostic Value of the Thrombolysis in Myocardial Infarction Risk Score in ST-Elevation Myocardial Infarction Patients With Left Ventricular Dysfunction (from the EPHESUS Trial).

    Science.gov (United States)

    Popovic, Batric; Girerd, Nicolas; Rossignol, Patrick; Agrinier, Nelly; Camenzind, Edoardo; Fay, Renaud; Pitt, Bertram; Zannad, Faiez

    2016-11-15

    The Thrombolysis in Myocardial Infarction (TIMI) risk score remains a robust prediction tool for short-term and midterm outcome in the patients with ST-elevation myocardial infarction (STEMI). However, the validity of this risk score in patients with STEMI with reduced left ventricular ejection fraction (LVEF) remains unclear. A total of 2,854 patients with STEMI with early coronary revascularization participating in the randomized EPHESUS (Epleronone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) trial were analyzed. TIMI risk score was calculated at baseline, and its predictive value was evaluated using C-indexes from Cox models. The increase in reclassification of other variables in addition to TIMI score was assessed using the net reclassification index. TIMI risk score had a poor predictive accuracy for all-cause mortality (C-index values at 30 days and 1 year ≤0.67) and recurrent myocardial infarction (MI; C-index values ≤0.60). Among TIMI score items, diabetes/hypertension/angina, heart rate >100 beats/min, and systolic blood pressure model, lower LVEF, lower estimated glomerular filtration rate (eGFR), and previous MI were significantly associated with all-cause mortality. The predictive accuracy of this model, which included LVEF and eGFR, was fair for both 30-day and 1-year all-cause mortality (C-index values ranging from 0.71 to 0.75). In conclusion, TIMI risk score demonstrates poor discrimination in predicting mortality or recurrent MI in patients with STEMI with reduced LVEF. LVEF and eGFR are major factors that should not be ignored by predictive risk scores in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Role of myocardial ischemia in a infarcted area as a possible mechanism for postinfarction angina pectoris

    International Nuclear Information System (INIS)

    Saito, Muneyasu; Sumiyoshi, Tetsuya; Ishikawa, Kenji; Haze, Kazuo; Fukami, Ken-ichi; Hiramori, Katsuhiko; Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kouhei

    1984-01-01

    Perfusion defects and 201 Tl redistribution on scintigraphic images were compared with clinical findings in 140 patients with myocardial infarction (consisting of 84 with single vessel disease and 56 with double vessel disease), 28 patients with one vessel disease not accompanied by infarction, and 18 healthy persons who underwent left coronary arteriography and 201 Tl stress myocardial scintigraphy. In 30 patients with single vessel disease accompanied by postinfarction angina pectoris, perfusion defects was smaller and Tl redistribution was larger than those in 54 patients with single vessel desease not accompanied by it. The 30 patients with postinfarction angina pectoris had a slight abnormality of left ventricular contraction and marked stenosis of 90% or more of the vessels. These findings were similar to those in the 28 angina patients who had one vessel disease but not accompanied by infarction. In 56 cases of double vessel disease, Tl redistribution was significantly larger in the group with angina than in the group without it. These results suggested that ischemia in an infarct area plays an important role as a mechanism for postinfarction angina pectoris. (Namekawa, K.)

  10. Effect of liraglutide on myocardial glucose uptake and blood flow in stable chronic heart failure patients

    DEFF Research Database (Denmark)

    Nielsen, Roni; Jorsal, Anders; Iversen, Peter

    2017-01-01

    BACKGROUND: The glucagon-like peptide-1 analog liraglutide increases heart rate and may be associated with more cardiac events in chronic heart failure (CHF) patients. We studied whether this could be ascribed to effects on myocardial glucose uptake (MGU), myocardial blood flow (MBF) and MBF rese...

  11. MR study of acute myocardial infarction with injection of Gd-DOTA (Fifteen patients)

    International Nuclear Information System (INIS)

    Richoz, B.; Delcour, C.; Depelchin, P.; Lenaers, A.; Jacquemin, C.; Gusella, P.; Struyven, J.; Richoz, B.

    1990-01-01

    We studied 15 patients 4 to 8 days after myocardial infarction by using ECG gated MR before and after administration of 0.2 mmol/kg Gd-DOTA. The diagnosis in each patient was confirmed by electrocardiographic criteria, elevated levels of fractionated creatine kinase (CK) isoenzyme, thallium scintigraphy, ventriculography and coronarography. T1-weighted, spin-echo images, were obtained before and immediately after injection of Gd-DOTA and were repeated 15 min later. The site of infarction was visualized in 10 patients as an area of high signal intensity after the injection of Gd-DOTA. Contrast between normal and infarcted myocardium was greatest 15 min after injection. Three patients were excluded because of failure to acquire adequate MR studies. In 2 other patients, the infarct were not detected. Before injection of Gd-DOTA, only 2 infarcts were detected. These results suggest that Gd-DOTA can improve MR visualization and detection of acute myocardial infarction [fr

  12. Frequency of dyslipidaemia in young patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Zaman, Q.U.; Fazal, I.F.; Ali, A.; Satti, L.

    2012-01-01

    Objective: To study the frequency of dyslipidaemia in young patients aged between 20-40 years, with Acute Myocardial Infarction in our population. Study design: Descriptive study Place and duration of Study: Coronary Care Unit (CCU) of Armed Forces Institute of Cardiology (AFIC) National Institute of Heart Diseases (NIHD), Rawalpindi from December 2008 to May 2009. Subjects and Methods: One hundred patients of acute myocardial infarction (AMI) fulfilling the World Health Organization (WHO) diagnostic criteria of AMI, having ages between 20-40 years, were included in the study after full informed consent using non-probability consecutive sampling. Blood samples for serum lipid profile were taken after 12 hours fasting (within 24 hours of presentation), and analyzed in laboratory of AFIC. Individual patients' results were compiled with respect to age, gender, serum total cholesterol, serum triglycerides, serum low density lipoprotein (LDL) cholesterol, serum very low density lipoprotein (VLDL) cholesterol and serum high density lipoprotein (HDL) cholesterol. The data was entered in SPSS (version 11.0) and analyzed. Results: Of the 100 patients with AMI, 47 were found to have dyslipidaernia. Hypertriglyceridaernia was the most common lipid abnormality as it was found in 32 (68.1 %) patients; followed by raised serum VLDL, hypercholesterolemia, raised serum LDL and low serum HDL found in 25 (53.2%), 16 (34.0%), 4 (8.5%) and 2 (4.3%) patients respectively. Out of 47 patients with dyslipidaemia, 28 (59.6%) had more than one lipid abnormality. Conclusion: Frequency of dyslipidaemia in young patients with AMI in our population is high. (author)

  13. Quantification of myocardial perfusion using cardiac magnetic resonance imaging correlates significantly to rubidium-82 positron emission tomography in patients with severe coronary artery disease: A preliminary study

    International Nuclear Information System (INIS)

    Qayyum, Abbas A.; Hasbak, Philip; Larsson, Henrik B.W.; Christensen, Thomas E.; Ghotbi, Adam A.; Mathiasen, Anders B.

    2014-01-01

    Introduction: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). Materials and methods: Fourteen patients with coronary artery stenosis underwent rest and adenosine stress imaging by 1.5-Tesla MR Scanner and a mCT/PET 64-slice Scanner. CMRI were analyzed based on Tikhonov's procedure of deconvolution without specifying an explicit compartment model using our own software. PET images were analyzed using standard clinical software. CMRI and PET data was compared with Spearman's rho and Bland–Altman analysis. Results: CMRI results were strongly and significantly correlated with PET results for the absolute global myocardial perfusion differences (r = 0.805, p = 0.001) and for global myocardial perfusion reserve (MPR) (r = 0.886, p < 0.001). At vessel territorial level, CMRI results were also significantly correlated with absolute PET myocardial perfusion differences (r = 0.737, p < 0.001) and MPR (r = 0.818, p < 0.001). Each vessel territory had similar strong correlation for absolute myocardial perfusion differences (right coronary artery (RCA): r = 0.787, p = 0.001; left anterior descending artery (LAD): r = 0.796, p = 0.001; left circumflex artery (LCX): r = 0.880, p < 0.001) and for MPR (RCA: r = 0.895, p < 0.001; LAD: r = 0.886, p < 0.001; LCX: r = 0.886, p < 0.001). Conclusion: On a global and vessel territorial basis, CMRI-measured absolute myocardial perfusion differences and MPR were strongly and significantly correlated with the Rb-82 PET findings

  14. Quantification of myocardial perfusion using cardiac magnetic resonance imaging correlates significantly to rubidium-82 positron emission tomography in patients with severe coronary artery disease: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Qayyum, Abbas A., E-mail: abbas.ali.qayyum@regionh.dk [Department of Cardiology and Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Hasbak, Philip, E-mail: philip.hasbak@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Larsson, Henrik B.W., E-mail: henrik.larsson@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Functional Imaging Unit, Diagnostic Department, Glostrup Hospital, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Ndr. Ringvej 57, 2600 Copenhagen (Denmark); Christensen, Thomas E., E-mail: thomas.emil.christensen@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Ghotbi, Adam A., E-mail: adam.ali.ghotbi@regionh.dk [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); Mathiasen, Anders B., E-mail: anders.b.mathiasen@gmail.com [Department of Cardiology and Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, University Hospital of Copenhagen and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, 2100 Copenhagen (Denmark); and others

    2014-07-15

    Introduction: Aim was to compare absolute myocardial perfusion using cardiac magnetic resonance imaging (CMRI) based on Tikhonov's procedure of deconvolution and rubidium-82 positron emission tomography (Rb-82 PET). Materials and methods: Fourteen patients with coronary artery stenosis underwent rest and adenosine stress imaging by 1.5-Tesla MR Scanner and a mCT/PET 64-slice Scanner. CMRI were analyzed based on Tikhonov's procedure of deconvolution without specifying an explicit compartment model using our own software. PET images were analyzed using standard clinical software. CMRI and PET data was compared with Spearman's rho and Bland–Altman analysis. Results: CMRI results were strongly and significantly correlated with PET results for the absolute global myocardial perfusion differences (r = 0.805, p = 0.001) and for global myocardial perfusion reserve (MPR) (r = 0.886, p < 0.001). At vessel territorial level, CMRI results were also significantly correlated with absolute PET myocardial perfusion differences (r = 0.737, p < 0.001) and MPR (r = 0.818, p < 0.001). Each vessel territory had similar strong correlation for absolute myocardial perfusion differences (right coronary artery (RCA): r = 0.787, p = 0.001; left anterior descending artery (LAD): r = 0.796, p = 0.001; left circumflex artery (LCX): r = 0.880, p < 0.001) and for MPR (RCA: r = 0.895, p < 0.001; LAD: r = 0.886, p < 0.001; LCX: r = 0.886, p < 0.001). Conclusion: On a global and vessel territorial basis, CMRI-measured absolute myocardial perfusion differences and MPR were strongly and significantly correlated with the Rb-82 PET findings.

  15. Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE)

    DEFF Research Database (Denmark)

    Devereaux, P J; Duceppe, Emmanuelle; Guyatt, Gordon

    2018-01-01

    BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications...... in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. METHODS: In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries. Eligible patients were aged...

  16. Myocardial infarction and other co-morbidities in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Dahl, Morten; Nordestgaard, Børge G

    2011-01-01

    Myocardial infarction is nominally the most important co-morbidity in patients with chronic obstructive pulmonary disease, and the one with the greatest potential for treatment and prevention to improve the overall prognosis of chronic obstructive pulmonary disease patients. We assessed the extent...

  17. Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

    International Nuclear Information System (INIS)

    Kuijpers, Dirkjan; Dijkman, Paul R.M. van; Janssen, Caroline H.C.; Vliegenthart, Rozemarijn; Zijlstra, Felix; Oudkerk, Matthijs

    2004-01-01

    The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) (P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event (P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy. (orig.)

  18. Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Kuijpers, Dirkjan [State University and Academic Hospital Groningen, Department of Radiology and Cardiology, Groningen (Netherlands); Bronovo Hospital, Department of Radiology and Cardiology, Bronovolaan 1, P.O. Box 96900, The Hague (Netherlands); Dijkman, Paul R.M. van [Bronovo Hospital, Department of Radiology and Cardiology, Bronovolaan 1, P.O. Box 96900, The Hague (Netherlands); Janssen, Caroline H.C.; Vliegenthart, Rozemarijn; Zijlstra, Felix; Oudkerk, Matthijs [State University and Academic Hospital Groningen, Department of Radiology and Cardiology, Groningen (Netherlands)

    2004-11-01

    The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) (P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event (P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy. (orig.)

  19. Dobutamine stress MRI. Part II. Risk stratification with dobutamine cardiovascular magnetic resonance in patients suspected of myocardial ischemia.

    Science.gov (United States)

    Kuijpers, Dirkjan; van Dijkman, Paul R M; Janssen, Caroline H C; Vliegenthart, Rozemarijn; Zijlstra, Felix; Oudkerk, Matthijs

    2004-11-01

    The aim of this study was to determine the prognostic value of dobutamine cardiovascular magnetic resonance (CMR) in patients suspected of myocardial ischemia. Clinical data and dobutamine-CMR results were analyzed in 299 consecutive patients. Follow-up data were analyzed in categories of risk levels defined by the history of coronary artery disease and presence of rest wall motion abnormalities (RWMA). Major adverse cardiac events (MACE) as evaluated end points included cardiac death, nonfatal myocardial infarction and clinically indicated coronary revascularization. Follow-up was completed in 214 (99%) patients with a negative dobutamine-CMR study (no signs of inducible myocardial ischemia) with an average of 24 months. The patients with a negative dobutamine-CMR study and RWMA showed a significantly higher annual MACE rate (18%) than the patients without RWMA (0.56%) ( P<0.001). Patients without RWMA showed an annual MACE rate of 2% when they had a history of coronary artery disease and <0.1% without a previous coronary event ( P<0.001). Dobutamine-CMR showed a positive and negative predictive value of 95 and 93%, respectively. The cardiovascular occurrence-free survival rate was 96.2%. In patients suspected of myocardial ischemia, dobutamine-CMR is able to assess risk levels for coronary events with high accuracy.

  20. Creatine Depletion and Altered Fatty Acid Metabolism in Diseased Human Hearts: Clinical Investigation Using 1H Magnetic Resonance Spectroscopy and 123I BMIPP Myocardial Scintigraphy

    International Nuclear Information System (INIS)

    Nakae, I.; Mitsunami, K.; Matsuo, S.; Horie, M.

    2007-01-01

    Background: In the heart, the creatine kinase system plays an important role in energy reserves, and myocardial energy production essentially depends upon fatty acid metabolism. Purpose: To examine myocardial creatine (CR) concentration and altered cardiac fatty acid metabolism in various forms of heart disease. Material and Methods: Myocardial CR concentration of the septum was measured by gated 1 H magnetic resonance spectroscopy (MRS), applying a point-resolved spectroscopy (PRESS) sequence in 34 patients with heart disease. Of these patients, 14 underwent 123 I BMIPP (radioactive fatty acid analogue) myocardial scintigraphy to evaluate myocardial fatty acid metabolism. Cardiac 123 I BMIPP uptake was calculated as the heart-to-mediastinum count ratio. Results: Myocardial CR concentration correlated positively with the left ventricular ejection fraction (LVEF) by echocardiography (R = 0.61, P 123 I BMIPP uptake also correlated positively with LVEF (initial image, R 0.60, P 123 I BMIPP uptake (initial image, R = 0.77, P<0.01; delayed image, R = 0.82, P<0.001; n = 14). Conclusion: Our study suggests an association between CR depletion and impaired fatty acid metabolism in various forms of heart diseases