Contractility evaluation by 2 dimensional echocardiography and gated SPECT myocardial perfusion scintigraphy in hypertensive patients with clinical presentation of atypical chest pain.

BACKGROUND: Hypertension (HT) is a growing health problem in the population and associated with increased cardiovascular event risk and mortality. In hypertensive patients, progressive left ventricular (LV) contractility deterioration is detectable by gated single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy9. We planned this study to explore the agreement in ejection fraction (EF) determination between 2 dimensional echocardiography and gated SPECT analysis in selected group of patients with hypertension. PATIENTS AND METHODS: We studied 26 consecutive patients (mean age 56.5 ± 8.8 years; 6 men) with hypertension. Quantitative contractility analysis by both echocardiography and SPECT at rest was performed to investigate the agreement between two diagnostic tests. RESULTS: EF at rest was greater than 55 % in all patients. All patients had a clinical presentation of atypical chest pain. Therefore, in addition to quantitative contractility analysis at rest by echocardiography and myocardial SPECT perfusion scintigraphy, we examined ischemia by stress induction and determined that 10 patients had ischemic finding (38.4 %). The mean value of EF calculated by echocardiography was 67.5 ± 5.7 %, while EF by gated SPECT was 72.8 ± 8.5 %. We documented an acceptable agreement in EF determination between these 2 diagnostic tests by meaningful correlation (r = 0.556, p = 0.003). There was no regional contractility deterioration despite existence of ischemia in 10 patients of the study group. CONCLUSIONS: We observed that both echocardiography and gated SPECT can be used for quantification of EF in the hypertensive patients with an acceptable agreement.

Cardiac autonomic profile in rheumatoid arthritis and systemic lupus erythematosus.

Neurological involvement is a well-documented issue in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, little is known about the involvement of the autonomic nervous system. This study was conducted to investigate autonomic nervous system dysfunction in patients with RA and SLE. Twenty-six RA patients, 38 SLE patients and 40 healthy controls were recruited from our in- and out-patient departments. Heart rate variability (HRV) parameters (the power of the high- [HF] and low-frequency [LF] band of haemodynamic time series, the ratio between low- and high-frequency components [LF/HF ratio], the power spectral density), baroreflex sensitivity (BRS) and beat-to-beat blood pressures were assessed by a novel non-invasive haemodynamic monitoring tool (Task Force Monitor [TFM], CNSystems Medizintechnik GmbH, Graz, Austria). Autonomic nervous system dysfunction was determined according to classical Ewing autonomic test battery. Furthermore, we implemented a secondary autonomic test score by modifying the Ewing test battery with additional criteria. Both the classical and modified Ewing test batteries have revealed that the frequencies of autonomic neuropathy were significantly higher in patient groups compared with controls (p < 0.001). Evaluation by TFM revealed that deterioration of sophisticated autonomic parameters (such as HRV and BRS) were more pronounced in the patient groups compared with controls. There was a significant association between BRS and Ewing test scores and abnormal BRS results were more frequent in patients with autonomic dysfunction according to Ewing test batteries. No relation was found between autonomic neuropathy and disease duration, disease activity and autoantibody positivity. Consequently, we believe that further large-scale studies investigating cardiovascular autonomic neuropathy in rheumatic diseases should be carried out to verify our findings and manifest clinical consequences beyond these results.

Sidebranch occlusion in direct intracoronary stenting: predictors and results.

We assessed the angiographic predictors and results of major (> 1 mm) sidebranch occlusion (SBO) following direct intracoronary stenting (DS) in 86 patients. The occlusion of a sidebranch is a well-defined risk after balloon angioplasty and stenting. However, the impact of direct stenting without predilatation on the coronary flow of sidebranches emerging within the stented segment has not been studied solely. A total of 111 sidebranches were analyzed. Sidebranch type, take-off angle, ostial involvement and procedural characteristics were evaluated. Nine out of 111 (8%) stent-covered sidebranches were occluded. Sidebranches with > 50% stenosis that take off within or just beyond the diseased portion of the lesion (unfavorable morphology) were the most powerful morphologic predictor of SBO (odds ratio: 8.0; 95% confidence interval: 1.5--40.8; p = 0.007). Take-off angle of the sidebranch was not found to have any effect on SBO. Post-stent dilation using high-pressure inflation (15.0 +/- 2.1 atmospheres), inflation (odds ratio: 1.1; 95% CI: 1.0--1.2; p = 0.038), and 3 times inflation (odds ratio: 4.5; 95% CI: 1.1--18.3; p = 0.023) were the procedural predictor of SBO. Of those 40 unfavorable morphologies, seven (17.5%) were occluded compared to 2.8% (2/71) of the favorable morphologies. Nine out of 9 (100%) occluded after high-pressure inflation. Three patients complained of chest pain and 1 had non-Q wave myocardial infarction attributed to SBO. These findings indicate that the incidence of SBO and complications are less than expected and has a favorable outcome in direct intracoronary stenting.

Comparison of Angiographic and Clinical Outcome After Cutting Balloon and Conventional Balloon Angioplasty in Vessels Smaller than 3 mm in Diameter: A Randomized Trial.

OBJECTIVES: The purpose of the study was to evaluate and compare the immediate and six month follow-up angiographic and clinical outcome of cutting balloon angioplasty and conventional balloon angioplasty in small vessels (less than 3 mm in diameter). METHODS AND RESULTS: Between August 1995 and August 1996 a total of 71 eligible symptomatic patients with angiographically proven significant lesions in their coronary arteries smaller than 3 mm and requiring revascularization, were randomized to receive treatment by either cutting balloon angioplasty (CB) or conventional balloon angioplasty (BA). ÒStand-aloneÓ CB was performed on 51 lesions in 36 patients and BA on 47 lesions in 35 patients. Basic angiographic and clinical characteristics were similar in both groups. The overall procedural success rates for CB and BA groups were 92% and 97%, respectively. The immediate post-procedural minimal luminal diameter, residual stenosis and acute gain were similar in the CB and BA cohorts (1.93 +/- 0.36 mm, 24 +/- 12%, 1.18 +/- 0.45 mm vs. 2.01 +/- 0.34 mm, 22 +/- 9%, 1.26 +/- 0.35 mm, respectively). Total dissection rate and C-F dissections were fewer in the CB group (37%, 6% vs. 51%, 19%, respectively, p < 0.05). Six month follow-up angiographic restenosis rate was lower in the CB group (27% vs. 47%, p < 0.05). We also detected a significant difference of total number of all events at nine month clinical follow up (28% vs. 51%, p < 0.05). CONCLUSION: CB angioplasty can be performed with a comparable success rate to conventional BA in small vessels. Fewer bail-out procedures are needed as CB causes fewer and less severe dissections. There is also a significant reduction in six month restenosis rate. We suggest that CB might be a better option for revascularizing vessels smaller than 3 mm in diameter which are inherently more prone to immediate complications and late restenosis with BA.

Sublingual nitrate plus 99Tcm-tetrofosmin infusion in the detection of severely ischaemic but viable myocardium: a comparative study with stress, redistribution, reinjection and late redistribution 201Tl imaging.

To investigate the role of sublingual nitrate plus 99Tcm-tetrofosmin infusion in the detection of severely ischaemic but viable myocardium, we selected 25 patients with coronary artery disease who had at least one fixed segmental defect during conventional stress-redistribution (ST-RD) 201Tl single photon emission tomographic (SPET) imaging. Reinjection (RI) and 24 h late redistribution (LRD) imaging were also performed. Within a week of 201Tl imaging, one-day rest-stress (R-ST) 99Tcm-tetrofosmin SPET was performed with the same stress levels. The following day, 99Tcm-tetrofosmin was infused over 1 h immediately after sublingual nitrate administration and SPET images (N + Inf) were acquired. Of 100 fixed defects on R-ST 99Tcm-tetrofosmin imaging, 15 were reversible on N + Inf 99Tcm-tetrofosmin imaging. There was 91% concordance between ST-RD/RI/LRD 201Tl and R-ST/N + Inf 99Tcm-tetrofosmin imaging regarding reversibility. We conclude that N + Inf 99Tcm-tetrofosmin imaging may be clinically useful in the detection of severely ischaemic but viable myocardium.