Myocardial uptake of indium-111 antimyosin after coronary angioplasty. Relationship with the total burden of ischaemia.

Indium-111 antimyosin scintigraphy was performed in 24 consecutive patients after percutaneous transluminal coronary angioplasty to assess whether repeated periods of ischaemia during balloon inflation results in myocardial cell damage even after a successful procedure. Patients with unstable angina, prior myocardial infarction and whose procedure was complicated were excluded. Indium-111 monoclonal antimyosin antibodies (80 MBq) were injected 24 h after coronary angioplasty and planar images were collected 24 h later. The relative antimyosin uptake was assessed subjectively and by a heart/lung count density ratio. In addition, the intracardiac gradient of activity was assessed by a count density profile analysis of the cardiac region of interest to distinguish better the focal as opposed to the diffuse antimyosin uptake. The antimyosin uptake index was calculated by multiplying the heart/lung ratio to the intracardiac gradient of activity. After coronary angioplasty, nine patients had minor ST-T wave changes on the surface ECG, but no patient demonstrated a new Q wave. Only three patients showed a mild rise in cardiac enzyme (CK-MB) serum levels. Indium-111 antimyosin uptake (heart/lung > 1.55) was present in eight patients (33%) and was intense (heart/lung > 1.9) in five (21%). Antimyosin uptake was always seen in myocardial segments corresponding to the treated coronary artery. Patients with a positive antimyosin scan had a longer duration of balloon-induced ischaemia compared with patients with no evidence of antimyosin uptake (541 +/- 211 vs 331 +/- 137 s, P < 0.007).(ABSTRACT TRUNCATED AT 250 WORDS)

[Preclinical changes in left ventricular function in obesity. An angioscintigraphic study]. / Alterazioni precliniche della funzione ventricolare sinistra nell'obesità. Studio angioscintigrafico.

Equilibrium pool scintigraphy was performed in 11 obese subjects (BMI 34 +/- 2) and in 14 normal control subjects. Temporal and spatial smoothing of the data was then performed followed by time-activity curve generation using a semiautomatic second derivative edge-detection algorithm. The increase in counts during the first third of diastole divided by the total change in number of counts during diastole was determined as the one-third filling fraction. This index of diastolic filling was significantly decreased in obese subjects as compared to the control group. These findings indicate that diastolic abnormalities may be an early finding in obesity-linked heart disease, occurring in the presence of normal systolic function (E.F. = 65 +/- 5%).

Late arrhythmic events and patency of the infarct-related coronary artery in survivors of acute myocardial infarction.

In the present study we evaluated the influence of intravenous thrombolysis and patency of the infarct-related coronary artery on both markers of ventricular electrical instability and incidence of late arrhythmic events after acute myocardial infarction (AMI). Ninety one patients surviving a first AMI who consecutively performed coronary angiography were enrolled in the present study; 44 patients (48%) received thrombolysis, 47 patients (52%) were treated conventionally. Of 91 patients, 90 (99%) had signal-averaged electrocardiogram (SAECG), and 40 (44%) programmed ventricular stimulation. No significant difference was observed between thrombolytic-treated and control group in late potential rate, SAECG determinants and ventricular arrhythmia inducibility. Of 91 patients, 40 (44%) had occlusion of the infarct-related artery: of these, 15 (37%) had late potentials compared with 5 of 51 patients (9%) with a patent artery (p < 0.01). Mean left ventricular ejection fraction was not significantly different between the two groups (0.50 +/- 0.15 vs 0.55 +/- 0.12; p = NS). No significant difference was present between the two groups of patients with regard to inducibility of sustained ventricular tachyarrhythmias, however an odds ratio of 3.5 was observed in the group with a closed vessel.(ABSTRACT TRUNCATED AT 250 WORDS)

Accuracy and safety of technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile (Sestamibi) myocardial scintigraphy with high dose dipyridamole test in patients with effort angina pectoris: a multicenter study. Italian Group of Nuclear Cardiology.

Clinical and physiologic evidence indicates that maximal coronary vasodilation is not achieved in a large number of patients with use of the standard dose of dipyridamole (0.56 mg/kg body weight over 4 min). The feasibility, safety and accuracy of technetium-99m hexakis 2-methoxy-2-isobutyl isonitrile (Sestamibi) scintigraphy associated with intravenous high dose dipyridamole (0.56 mg/kg over 4 min followed 4 min later by an additional 0.28 mg/kg over 2 min) were evaluated in a multicenter study. Planar myocardial perfusion images were obtained at rest and after dipyridamole in 101 patients with effort chest pain and no prior myocardial infarction. High dose dipyridamole (62 patients) was used when typical chest pain or electrocardiographic (ECG) signs of ischemia, or both, did not occur during or after the standard dose (39 patients). With high dose dipyridamole, 34 patients had pain (18 patients) or ECG signs of ischemia (ST depression greater than or equal to 2 mm) (8 patients), or both (8 patients), whereas the other 28 patients had Sestamibi injection in the absence of symptoms or ECG changes. All patients underwent coronary angiography: 81 had significant coronary artery disease (greater than or equal to 50% reduction of lumen diameter) (affecting one vessel in 38, two vessels in 19 and three vessels in 24 patients) and 20 patients had normal coronary arteries. The overall sensitivity, specificity and predictive accuracy of Sestamibi scintigraphy were 81%, 90% and 83%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Reoperation for myocardial revascularization using the internal mammary artery.

From October 1984 up to February 1989, 40 patients had "redo" myocardial revascularizations using one or both internal mammary arteries (IMA) in over 1000 cases operated upon in our Department for coronary bypass grafts. Thirty-one patients had a further operation for unstable angina difficult to control with drugs. Mean interval of recurrence of angina after previous surgery was 48.5 months for all the cases, but the mean interval before the second bypass operation was 68 months. Severe disease of previous vein grafts was the reason for surgery in 25 patients and progressive atherosclerosis in native coronary arteries in 15 patients. Twenty-one patients had a single mammary artery; both mammary arteries were used in 19. Two cases had endarterectomy on left anterior descending (LAD). Four patients had peroperative acute myocardial infarction (AMI), 3 a low cardiac output syndrome, postoperative bleeding occurred in 3 cases and wound infection in one case. An intraaortic balloon pump was used preoperatively in one case and coming off bypass in two others. One patient died on the second day postoperatively from cardiac arrest following bilateral pneumothorax. There were no late deaths. At a mean follow-up of 20.5 months, 28 patients are free of symptoms but 11 are complaining of angina, 5 during exercise and 6 at rest. An exercise test was positive in 8 patients.

[Emergency myocardial revascularization in acute evolving myocardial infarct]. / Rivascolarizzazione miocardica d'emergenza nell'infarto miocardico acuto evolvente.

Immediate coronary artery bypass for acute evolving myocardial infarction could be the elective therapy if provided on useful time, because myocardial salvage can be achieved by early reperfusion. Thirty eight patients had emergency coronary artery by-pass graft for acute evolving myocardial infarction during the early phase: 35 were male, the mean age was 51 years (34 to 74). The mean interval between the onset of symptoms and surgery in this series of patients was two hours and a half. This interval seems to be also the time limit in our experience to get a partial or complete recovery of ischemic area. Four patients died in hospital, but they were in severe cardiogenic shock before emergency surgery. Twenty nine cases were free of symptoms at a mean follow-up of 18 months (6 to 36) and two suffered for residual angina. Three patients died after discharge few months later: two during redo emergency vein grafts operations, one in deep left ventricular failure, while he was waiting for heart transplant. All these patients operated on as emergency developed acute myocardial infarction during their stay in hospital waiting for catheter study, surgical operation or during percutaneous transluminal coronary angioplasty. Saphenous vein grafts, were used in twenty nine patients, left internal mammary artery in nine cases, single in four and associated to saphenous vein in five, with an average number of anastomoses of 2.6 (1 to 6) for patient. ECG was found to be normal in 76% of the patients operated on within two hours and a half from the beginning of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

[Phase and amplitude images using Fourier analysis in radioisotopic angiography. Comparison with contrast angiography for studying regional changes in ventricular contraction]. / Immagini di fase e ampiezza mediante analisi di Fourier in angiografia radioisotopica. Confronto con l'angiografia di contrasto per lo studio delle alterazioni regionali della contrazione ventricolare.

Phase-amplitude images and phase distribution histograms, derived from a temporal Fourier analysis of equilibrium ecg-gated blood pool studies, were used to assess the overall wall motion synchronism and to detect regional wall motion abnormalities in 69 consecutive patients with suspected or documented coronary artery disease, in whom biplane contrast left ventriculography and coronary angiography were performed. Four regions were considered on the 15 degrees caudal left-anterior oblique view radionuclide image, in order to identify the 7 conventional angiographic left ventricular wall segments (as the American Heart Association Council of Cardiovascular Surgery). Regional abnormalities on the phase-amplitude images from the 15 degrees caudal left anterior oblique view scans were studied in order to identify local hypokinesis, akinesis or dyskinesis (in accord to definitions used for contrast cineangiography) relative to seven conventional left ventricular wall segments. Results of phase-amplitude image analysis were compared with those of contrast cineangiography. The parametric images showed overall sensitivity of 82% and 92% respectively towards biplane and monoplane (left anterior oblique) contrast cineangiography, with a high degree of specificity (97%). Most akinetic and dyskinetic segments were correctly identified. A significant phase delay (greater than or equal to 70 degrees) from mean value, always occurred in dyskinetic segments and generally related to the severity of the wall motion abnormality. Lower accuracy was observed for hypokinetic regions; sensitivity was lower for apical and antero-lateral segments.(ABSTRACT TRUNCATED AT 250 WORDS)

[Recent developments in the medical treatment of emergency cirrhotic hemorrhage. Vasopressin and glipressin, prostaglandins, somatostatin, propranolol, cimetidine and ranitidine]. / Recenti acquisizioni in tema di trattamento medico nelle urgenze emorragiche da cirrosi. Vasopressina e glipressina, prostaglandine, somatostatina, propanololo, cimetidina e ranitidina.

Haemorrhages in the course of cirrhosis and portal hypertension are surgical emergencies. Nevertheless medical treatment may be necessary both to revive the patient and temporarily to check the haemorrhaging itself. Some views are presented on the use of drugs, both those already in clinical use and others at the experimental stage, which appear to be effective in the treatment of haemorrhaging in portal hypertension (Vasopressin, glypressin, prostaglandin, somatostatin, propranolol, cimetidine and ranitidine).

[The association of lymph nodes scintigraphy with 99Tcm-sulfur-microcolloid and ultrasounds scan in stage diagnosis of lymphomas (author's transl)]. / L'associazione di linfoscintigrafia con 99Tcm-microcolloide ed ecotomografia nella definizione di stadio dei linfomi.

Thirty seven patients with lymphomatous disease were studied to detect abdominal lymph nodes involvement by means of lymph nodes scan with 99Tcm-sulfur-microcolloid, ultrasounds scans, lymphangiographies. Lymphangiography was considered as reference standard in patients which explorative laparotomy was not performed in. Isotopic method demonstrated high sensitivity, despite low specificity. Opposite results were obtained by ultrasounds. We concluded that isotopic abdominal lymph nodes scan is a clinically valuable test, if negative, while ultrasounds are, if positive. Both methods, specially if associated, proved quite useful in restaging after therapy, where important parameters are low risk and stress for the patients, easy execution, low costs.

An analysis of the diagnostic contribution of double-radiocompound renography.

The diagnostic contribution of double-radiocompound renography was tested by applying discriminant analysis to the data obtained in one group of normal subjects and in some groups of selected pathological cases which included glomerulonephritis, pyelonephritis, and hypertension. The results obtained confirm the reliability of the test and give evidence of its usefulness in diagnostic clinical work.