RESUMEN
Among non-invasive methods for the detection of coronary restenosis after successful transluminal coronary angioplasty, the contribution of exercise myocardial Thallium 201 tomoscintigraphy (MTS) was assessed in a prospective study involving 168 patients with a mean age of 56 (range 32-75) who had undergone 174 successful single vessel angioplasties (86 AIV, 35 Cx, 53 RC) with residual stenosis of 50% or less. After an interval of 6 +/- 2 months, patients were reassessed without treatment by a maximum exercise test (ET) combined with Thallium 201 MTS, 24 hours before follow-up coronary arteriography. Restenosis, defined by a greater than 50% loss of the gain achieved by the initial angioplasty, was seen in 53 patients (30.4%). MTS, with the exception of any necrosed area, was read as positive in case of reversible exercise hypofixation with redistribution. Sixty seven tests were positive, 49 corresponding with restenosis. Four were normal despite restenosis. The diagnostic values of the 3 methods of angina, ET and MTS were 0.43, 0.74 and 0.92 respectively for sensitivity, 0.89, 0.85 and 0.85 for specificity, 0.64, 0.68 and 0.73 for positive predictive value and 0.78, 0.88 and 0.96 for negative predictive value. In total, MTS at 6 months had the best sensitivity for the detection of coronary restenosis after single vessel angioplasty and an excellent negative predictive value (96% alone, 100% combined with ET), eliminating the need for coronary arteriography when it is negative.
Asunto(s)
Angioplastia Coronaria con Balón , Enfermedad Coronaria/terapia , Corazón/diagnóstico por imagen , Radioisótopos de Talio , Tomografía Computarizada de Emisión , Adulto , Anciano , Angioplastia Coronaria con Balón/efectos adversos , Enfermedad Coronaria/diagnóstico por imagen , Estudios de Evaluación como Asunto , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recurrencia , Tomografía Computarizada de Emisión/métodosRESUMEN
The incidence and characteristics of carotid sinus hypersensitivity were investigated in a homogeneous population of patients undergoing radiotherapy and surgery for ear, nose and throat (E.N.T.) cancers. Among the 103 patients who were thus treated but had none of the risk factors usually correlated with the disease investigated, 30 percent showed evidence of mainly vasodepressive (87 percent) carotid hypersensitivity when subjected to carotid sinus massage accompanied by electrocardiography and intra-arterial blood pressure measurement. The large number of positive responses, as well as the good reproductibility of this provocation test and its concordance with the site of local treatment suggest that surgery contributes to the genesis of the abnormality. Owing to the considerable variations in the type of response obtained, carotid sinus hypersensitivity should systematically and repeatedly be searched for in cases of syncope in patients treated for E.N.T. cancer.
Asunto(s)
Enfermedades de las Arterias Carótidas/etiología , Neoplasias de Oído, Nariz y Garganta/complicaciones , Adulto , Anciano , Enfermedades de las Arterias Carótidas/fisiopatología , Seno Carotídeo/fisiopatología , Electrocardiografía , Estudios de Seguimiento , Masaje Cardíaco , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de Oído, Nariz y Garganta/radioterapia , Neoplasias de Oído, Nariz y Garganta/cirugía , Complicaciones Posoperatorias , Factores de TiempoRESUMEN
We report the case of a 73-year-old woman successfully treated for a subacute rupture of the ventricular free wall which occurred on the fourth day after a postero-lateral myocardial infarction. Angiography performed prior to surgical repair revealed the presence of normal coronary arteries. The pathogenetic mechanism of such a happening remains uncertain, but the role of abrupt recanalization must be considered.