Myocardial viability, which definition should we depend upon role of radionuclide imaging

Rest-redistribution thallium [RD T1] imaging has high negative predictive value [NPV] but low positive predictive value [PPV] for the prediction of recovery of regional myocardial dysfunction after revascularization [R]. Combining perfusion [MP] and functional data with nitrate-enhanced gazed SPECT MIBI [GSM] at rest appears to be a promising approach for viability detection. Differentiate between the role of resting TL and resting GSM for detection of viability. 66 pts with coronary artery disease [CAD] underwent T1 imaging [R-RD protocol], 2 sets of resting GSM using 2 MIBI injections, and echocardiography, both at rest and after low dose dobutamine [LDD]. One hour Before GSM2, 60 mg. of oral trimetazidine [TMZ] and nitrates had been given. All pts had their echos repeated after [R]. Perfusion and wall motion [WM] were scored from 0 to 4 [absent to normal] using 17 segment model. 385/1122 segments were found to have abnormal resting WM on echo. 165/217 of the hypokinetic segments, 48/102 of the akinetic segments and 6/66 of the dyskinetic segments showed contractile response for LDD echo. The MP images showed normal uptake, complete, partial reversibility and poor uptake in TI, GSM1 and GSM2 images as following: [54, 31, 45], [36, 22, 35], [198, 119, 190] and [32, 148, 50] of segments respectively. Following table showed degree of matching. Sensitivity and specificity of T1, GSM1 and GSM2 and LDD echo had been found respectively to be [94.9%, 75.5%], [60%, 93.6%], [94.2%, 90%] and [79.6%, 100%]. Post-revascularization Resting Echocardiography: -, -, Viable, Non-Viable, -, Viable, Non-Viable, -, Viable, Non-Viable, -, Viable, Non-Viable. Pre-revascularization: Viable- Non-Viable, Rest-Redistribution Thallium, 261- 14, 27- 83, Non-TMZ gated SPECT, 165- 110, 7- 103, TMZ gated SPECT, 259- 16, 11- 99, LDD Echocardiography, 219- 56, 0- 110. Total: -, -, 275, 110, -, 275, 110, -, 275, 110, -, 275, 110. Clinical definition of viability is better looked for in GSM2

Sex differences in the features of coronary artery disease of patients undergoing coronary angiography

This study addresses whether the sex difference affects the features of coronary artery disease of patients who have undergone coronary angiogram. 477 patients [117 women and 360 men] are included in this study. In all of them a significant lesion of 70% or more of the main coronary arteries is detected. Excluding those with previously known primary valvular, valve replacement, congenital heart disease, non-ischemic cardiomyopathy and those who have previously undergone coronary artery bypass graft or percutaneous transluminal coronary angioplasty. Main The age difference between female [mean 51 +/- 6 years] and male [48 +/- 5 years] is less than expected. There is no sex difference in either the severity or distribution of coronary artery disease. There is also no significant difference in left ventricular dysfunction between females and males. The main risk factor in females is diabetes mellitus [52%] while the main risk factor in males is smoking [61%]. Thus women can develop serious ischemic heart disease that is similar to that in men and at relatively younger age than previously described. The vulnerability to ischemic heart disease in non-elderly women needs to be emphasized