99-m technetium (Dupont Cardiolite) investigations in postinfarction patients with Holter-checked silent ischaemia.

Sixteen middle-aged, normotensive, slightly overweight male patients with previous myocardial infarction were studied during Holter-checked silent myocardial ischaemia. As reference, stress and late 201-T1 scintigraphy served for comparison with Cardiolite-MIBI silent ischaemic perfusion scan, both carried out in planar mode. The circumferential profiles differed in 9 cases, on region of interest basis the segment number difference was 10, but the late distribution segment number was near to both ischaemic numbers. The quantitative scores were distinctive (ratio 133-128/103) indicating the silent ischaemia appeared in the peri-infarct area. The silent ischaemic MIBI and stress 201-T1 ischaemic score difference was reduced by means of repeated SPECT investigation. With gated radionuclide ventriculography there was -4.3% difference between the left ventricular ejection fractions, measured with first pass MIBI technique during silent ischaemia and afterwards in basal state. The impairment of the left ventricular function was reflected on the stroke pattern of our Holter-based radiocyclogram, as well. Taking the 43.7-48.0 = -4.3% "ischaemic shift" into consideration it was a close correlation (r = 0.90) between the two kinds of ejection fraction determination. The major rhythm failures (occurring during the 24 h Holter monitoring) decreased to a higher degree the left ventricular ejection fraction than silent ischaemia or silent ischaemia and minor rhythm failure together (38-42-50%).

Nonfatal myocardial infarction of women.

Five-hundred women admitted for rehabilitation to the State Hospital for Cardiology 1 to 10 months after myocardial infarction were divided into two groups, viz. group I containing patients less than 40 years of age and group II, in which the patients were older than 41 years. Forty-nine per cent of the patients were blue-collar, whereas 22% of them were white-collar workers; 16.5% had a high qualification, 28% were housewives or retired. The leading symptom at admittance, that is in the post-infarction period, was angina pectoris (32% in group I and 73% in group II). Heart failure, rhythm disturbance and hypertension occurred less frequently. The groups considerably differed from each other in the frequency of risk factors. In group I, smoking (81%), use of anticoncipients (41%) and hyperlipoproteinaemia (32%), while in group II hypertension (49%), smoking (45%), obesity (43%) and hyperlipoproteinaemia (41%) were the main risk factors.

111-indium human antimyosin monoclonal antibody-fragment study on alcoholic (and diabetic) cardiomyopathic patients (ACM-DCM) with Centocor Europe Myoscint (Msc).

The criteria of Msc-positivity were: typical accumulation of hot spots in 2 directions of planar scan in the 24-48-hr measurements, while in atypical cases the hot spots were present only in the 48 hr picture. Twenty-one male volunteers were assessed. 18 of them had ACM (2 patients were studied repeatedly). The negative and positive control cases exhibited the expected Msc pattern. Seven ACM patients were regarded typically positive, in 5 cases atypical positivity was stated, and 6 patients were classified as Msc negatives. The heart lung activity ratio was 1.75 +/- 0.45 and 1.68 +/- 0.44 for typical and atypical positive cases, respectively. The control and DCM H/L ratios were 1.15 and 1.3 +/- 0.2, respectively, in AMI the H/L was 1.91, in DCM of dilatative phase it was 1.55 +/- 0.06 with serum myosin in the normal range. Heart dilation in the DCM groups: 5 dilated out of 7 typically positive cases while in atypically positive, and negative cases the dilation occurred in 2 out of 5 and 1 out of 6 cases, respectively. Low LV-EF (less than 45%) were found in ratios of 4/7, 2/5, and 1/6 in typically positive, atypically positive and negative cases, respectively. Elevated PCP similar ratios. In the same groups pathological ECG was seen in ratios of 5/7, 1/5, and 1/6, respectively. The g-GT activity was enhanced in all cases, there was, however, no evident correlation between the actual enzyme activity and intensity of hot accumulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathophysiological significance of the global and regional left-ventricular ejection fraction (LV-EF) on ischaemic heart disease patients at rest and during ergometric exercise load (from radiocardio-cyclography (RKG-RCG) to parametric amplitude and phase scan).

As early as in the graphical RKG-RCG period a close inverse correlation could be established between the LV-EF and the serum myoglobin level during the acute course of myocardial infarction, in 10 patients in repeated follow up examinations. Corr. coeff. -0.91, p less than 0.01. In the mid seventies it could be shown by RKG-RCG, in 15 IHD patients with angina pectoris that the decrease of the basal LV-EF during ergometric load reflected the severity of IHD, compared with the increasing LV-EF tendency of 15 normal subjects. This fact could be verified on 19 middle age males (mean age, 41 years) by 99mTc RBC gamma camera ventriculography, i.e. that under modest load (100 W ergometry) a more than 10% decrease was a non-specific sign of main branch or three-vessel coronary heart disease. So in this extreme case our nuclear stethoscope-like RKG-RCG method alone may be satisfactory for staging and screening of coronary ischaemic heart disease (IHD) patients. All the 11 normal subjects belonged to the load-reaction group with more than 5% LV-EF increase, while the extensive anterior and inferior scar patients reacted without exception with more than 10% deficit (their basal LV-EF value was already under 45%). Supported by data in the literature in the comparison of load ECG and coronarography and two-step load, we could gain more refined data, but in accordance with the one-step load on the same patients. As regards the reproducibility of our global LV-EF investigations with gamma camera computer program Supersegams, it was within 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

123-Iodine heptadecanoic acid (HDA) cardiac metabolism of inactive sportsmen with nuclear cardiology, impacted into complex cardiological studies.

In 8 sportsmen and 8 healthy subjects of similar middle age the examination of the myocardial uptake of 123-I HDA and 201-T1 exhibited a correlation of r = 0.88 using our own quantitative circumferential evaluation program. The myocardial kinetics of the 123-I HDA was assessed by different methods: 1. according to Feinendegen et al. (1981), with complementary NaI-123 injection for the extra-myocardial background correction, 2. according to Dudczak (1984), with bi-exponential peeling, similar to the simplified method of the van Eenige group (1984, 1985). The utilisation-elimination kinetics resulted in comparable results with correlation coefficients of r = 0.80 and they were in accordance with the literature data; so this examination can be carried out without surplus NaI-123 injection, as well. The only significant difference was observed in some sportsmen who, after discontinuing the competitions, had a minimal delay of the HDA-kinetics in the septal region, where the echo-CG registered septal hypertrophy, as well. Otherwise the data of the HDA-kinetics, of the 201-T1 uptake and wash-out redistribution were in agreement with the results of the global and regional left ventricular ejection fractions, with the ECG at rest and during ergometric stress with the mechano-CG and with the cardio-volumetry, all exhibiting overlaps in the normal range between the sportsmen and healthy controls.