Congenital toxoplasmosis and audiological outcome: from a case series to a suggestion of patient-based schedule.

Introduction: Sensorineural hearing loss (SNHL) has been suggested to be possibly related to congenital toxoplasmosis (CT), although its prevalence varies from 0% to 26%. This variance appears to be dependent especially on early timing of treatment. However, the available data are based on outdated studies conducted on small groups of patients that lack homogeneity. Therefore, to establish evidence-based guidelines for audiologic monitoring in CT, we conducted a comprehensive evaluation of a large case series over a long period of time. Patients and methods: This is a single-center, retrospective cohort that enrolled all infants and children who were exposed in utero to Toxoplasma gondii and/or congenitally infected between September 1980 and December 2022. They underwent standard serial audiological evaluations to detect possible SNHL at an early stage. The first evaluation was performed during the initial assessment to define the onset of congenital toxoplasmosis, with another evaluation conducted at least at 12 months of life. Results: We collected data from 1,712 patients, and 183 (10.7%) were diagnosed with CT. Among these cases, 78 children (42.6%) presented with symptomatic CT at the onset, exhibiting ocular findings (21.1%), clinical cerebral manifestations (6.1%), and/or abnormal findings on neuroimaging (35.5%). Therapy was administrated at the onset in 164 patients (89.6%) with 115 of them starting treatment prior to 2.5 months of age (0-388, median 32.00 ± 92.352 days of life). Only one patient presented with SNHL at the onset, but this was apparently unrelated to CT. The median number of audiological assessments was 2.2 ± 1.543 (2-10). No patients developed any grade of delayed hearing loss, both in treated and untreated groups. The median age at last audiological evaluation was 2.3 ± 2.18 years (1-8), although the median follow-up period was 12.4 years (±6.3), ranging from 1 to 27 years. Conclusions: Based on these data, it appears that SNHL may be less frequent in CT than previously assumed. We recommend conducting an audiological assessment at the onset (within the first 2.5 months of life) to comprehensively define the type of CT onset, and then conducting another evaluation within 9 months of life.

Investigation of On-Farm Transmission Routes for Contamination of Dairy Cows with Top 7 Escherichia coli O-Serogroups.

Shiga toxin-producing Escherichia coli (STEC) are foodborne bacterial pathogens, with cattle a significant reservoir for human infection. This study evaluated environmental reservoirs, intermediate hosts and key pathways that could drive the presence of Top 7 STEC (O157:H7, O26, O45, O103, O111, O121 and O145) on pasture-based dairy herds, using molecular and culture-based methods. A total of 235 composite environmental samples (including soil, bedding, pasture, stock drinking water, bird droppings and flies and faecal samples of dairy animals) were collected from two dairy farms, with four sampling events on each farm. Molecular detection revealed O26, O45, O103 and O121 as the most common O-serogroups, with the greatest occurrence in dairy animal faeces (> 91%), environments freshly contaminated with faeces (> 73%) and birds and flies (> 71%). STEC (79 isolates) were a minor population within the target O-serogroups in all sample types but were widespread in the farm environment in the summer samplings. Phylogenetic analysis of whole genome sequence data targeting single nucleotide polymorphisms revealed the presence of several clonal strains on a farm; a single STEC clonal strain could be found in several sample types concurrently, indicating the existence of more than one possible route for transmission to dairy animals and a high rate of transmission of STEC between dairy animals and wildlife. Overall, the findings improved the understanding of the ecology of the Top 7 STEC in open farm environments, which is required to develop on-farm intervention strategies controlling these zoonoses.

Does orthodontic treatment affect caries levels?

Design A prospective cohort study.Exposure/sample selection In 2005/2006, the authors analysed data from participants in a previous oral epidemiological study conducted in 1988/1989. Children whom were clinically examined in the School Dental Clinics in South Australia in 1988/1989 were invited to a follow-up in 2005/2006. Respondents competed a questionnaire concerning their sociodemographic characteristics, dental health behaviours and the receipt of orthodontic treatment, and were invited for a clinical examination. Oral health information concerning decayed, missing and filled teeth (DMFT) and occlusal status using the Dental Aesthetic Index (DAI) were recorded by multiple trained calibrated dentists in accordance with the NIDR procedures. The study obtained ethical approval from the University of Adelaide and maintained informed consent at each stage of the study.Data analysis Data analysis was performed independently by the principle researcher. Analysis involved descriptive statistics, frequency distribution and cross tabulation. Explanatory variables for orthodontic treatment and dental outcomes were investigated for each DAI category using negative binominal regression using the online computer programme 'effect size calculator'. The statistical analysis was preformed using IBM SPSS statistics version 24. All explanatory variables were introduced into the adjusted negative binominal regression models based on their statistical significance from multiple linear regression models, with the p value set at 0.05.Results The response rate for the questionnaire was 34% (n = 632), with 74% (n = 473) of those attending for clinical examination. After exclusions, 24% (n = 448) of those originally contacted participated. Statistically significant differences in clinical outcomes were observed between those who had and had not visited the dentist in the last two years. These outcomes included missing teeth (MT), filled teeth (FT) and a higher DMFT score. In addition, brushing at least twice daily was associated with fewer decayed teeth (DT) and MT (p <0.001). Increased MT was observed among individuals who had orthodontic treatment across all DAI categories except for participants with very severe malocclusion. In this group, there were significantly more MT among the untreated participants (p <0.001). Thirty-five percent (n = 157) of participants reported a history of orthodontic treatment by the age of 30. No statistically significant associations were found between orthodontic treatment and all aspects of DMFT using adjusted models for participant self-reported sociodemographics, dental health behaviours and malocclusion.Conclusions Caries experience does not correlate with previous orthodontic treatment. Sociodemographic variables and dental health behaviours have a greater impact, and are associated with long-term disease outcomes, including numbers of DMFT. Caries experience is also associated with educational attainment and income level, frequency of tooth brushing and dental office attendance. In summary, orthodontic treatment does not provide superior long-term dental health outcomes in relation to caries. The hypothesis that those with previous orthodontic treatment would have lower caries experience was rejected.

10 year comparison of glass ionomer and composite resin restoration materials in class 1 and 2 cavities.

Data sources A prospective randomised, double-blinded controlled trial Study selection Those requiring routine dental care in Sihhiye, Turkey were eligible to participate. Eighty-seven participants were identified and assessed for eligibility by calibrated researchers who ensured that the inclusion and exclusion criteria were met. Fifty-nine participants were successfully recruited with an average age of 24 years (range 15-37).Restoration type were randomly allocated [glass ionomer (GI) or composite resin (CR)] using a table of random numbers with software 'Research Randomised Program' and four experimental groups were created.Two dentists with 5 years experience were calibrated by them placing ten trial restorations , which were not included in the study. One hundred and forty restorations were then placed adhering to a strict treatment protocol. Cavities which did not meet the specifications of the criteria were excluded. The study received ethical approval by the Human Ethics in Clinical Research Committee of the University.Data extraction and synthesis Restorations were assessed at baseline (1 week), 1, 2, 3, 4, 5, 6, 8 and 10 years by blinded calibrated examiners with the aid of colour photographs using an objective criteria. Scanning electron microscopy (SEM) analysis was performed for one randomly selected restoration per group at each assessment. Data analysis adhered to the intention-to-treat CONSORT protocol. The restoration retention rates were calculated, and statistical analysis preformed using IBM SPSS version 22.0. The performance of the restorative materials over the study period were analysed with Cochran's Q test, according to USPHS criteria. Whilst the McNemar test was used to assess aspects of each material with baseline for each cavity type in addition to difference between cavity types. Marginal adaption, marginal discolouration and colour scores in each study group were compared with the p value set at 0.05.Results Eighty-seven patients with 203 lesions were included in the study, with 59 (140 lesions) eligible. Eleven patients were excluded for not meeting the inclusion/ exclusion criteria with 17 refusing to participate. Four randomly allocated groups were created at baseline, as combinations of cavity type and restorative material. 86.4% (n=51) of participants were evaluated after 10 years. The cumulative failure rate (CRF) was 3.17%.Marginal discolouration was observed in all groups at 10 years. With a significant difference observed between Class I and Class II cavities with GI restorations (p = 0.022). In addition, a significant change in colour match in GI restorations after 10 years(<0.005) was found.Over the ten-year period, no significant change was observed in terms of marginal adaption, anatomical form, secondary caries, postoperative sensitivity, surface texture, and retention for either restorative material (p >0.05) or with SEM inspections.Conclusions Both GI and CR are suitable and similar restorative materials for class 1 and class 2 cavities. However, differences can occur in colour change within the materials with glass ionomer restorations showing greater colour change from baseline over this period.

Prevalence of Shiga toxin-producing Escherichia coli in pasture-based dairy herds.

Shiga toxin-producing Escherichia coli strains (STEC) are food-borne pathogens. While E. coli O157:H7 is commonly associated with cattle, less is known about the prevalence of non-O157 STEC serogroups in bovines. This study evaluated the prevalence and virulence status of O157:H7 and six E. coli O-serogroups (O26, O103, O45, O145, O121, O111) in New Zealand dairy farms using molecular as well as culture-based methods. Fresh farm dairy effluent (FDE) (n = 36) and composite calf faeces (n = 12) were collected over three samplings from 12 dairy farms. All seven target serogroups were detected through molecular techniques. Of the 202 isolates which were serologically confirmed following traditional culturing and immunomagnetic separation (IMS), O103, O26, O45 and O121 were the most common serogroups, being found in 81, 47, 42 and 32% of the FDE and in 17, 33, 25 and 9% of the calf faeces respectively. The majority (157/202) of the isolates were negative for stx and eae virulence genes. The prevalence of the seven target STEC was low, and only nine O26 isolates (4%) were recovered from four of the farms. The study has highlighted the need for improving the isolation of Top 7 STEC from the stx-negative populations present in fresh dairy effluent and calf faeces. SIGNIFICANCE AND IMPACT OF THE STUDY: Shiga toxin-producing Escherichia coli (STEC) are important food-borne pathogens that can cause severe illness in humans. Cattle are asymptomatic reservoirs for STEC, and transmission to humans can be by consumption of food products or water contaminated with cattle faeces. Our study investigated the prevalence of O157:H7 and six E. coli serogroups of STEC (O26, O103, O45, O145, O121, O111) over time in the dairy reservoir and increases the knowledge and understanding of these pathogens on pasture-based farms. Such information is required to develop risk-assessment models aiming at limiting transmission of these STEC to human.

Effects of 3 surface types on dairy cattle behavior, preference, and hygiene.

Muddy surfaces have negative effects on the health and welfare of dairy cattle, and if possible, cows will avoid this surface. However, it is unclear whether it is the moisture content or the contamination with manure that is aversive to the cows. This study aimed to assess the use and preference for different wood chip (0.4 m deep) surface types: (1) clean and dry (clean, dry matter content, DM: 44 ± 2.8%), (2) dirty (dirty, contaminated with manure, DM: 40 ± 3.7%), and (3) clean and wet (wet, wetted by water, DM: 23 ± 3.3%). Eighteen nonlactating, pregnant cows were tested individually (mean 24-h temperature: 9.9 ± 4.46°C, mean ± standard deviation for all preceding values). Cows were kept indoors in test pens for 18 h on wood chip without feed and 6 h on pasture to allow for daily feed intake. To ensure cows made informed choices and to measure changes in behavior and hygiene associated with each option, they were first exposed to each surface for 5 d (n = 12 cows per surface type when they were restricted on one surface; i.e., each cow was exposed to 2 treatment surfaces only). Cows on the wet surface spent the least amount of time lying when restricted to one surface for 18 h (wet: 21%, dirty: 57%, clean: 64%) and spent more time lying when on pasture for 6 h (wet: 13%, dirty: 4%, clean: 3%). The total lying times during the 5-d surface exposure were wet: 4.6 ± 1.04 h, dirty: 10.6 ± 0.25 h, and clean: 11.7 ± 0.25 h per 24 h. Cows restricted on the wet surface for 18 h had fewer bouts (no.) of lateral lying (wet: 0.9 ± 1.36, dirty: 6.3 ± 1.36, clean: 8.4 ± 1.38), spent less time lying with their heads supported (wet: 18.9 ± 7.17 min, dirty: 36.7 ± 7.17 min, clean: 39.1 ± 7.26 min), and spent less time with the front legs tucked (wet: 16 ± 4.3%, dirty: 41 ± 4.3%, clean: 50 ± 4.3% of time spent lying, mean ± standard error of the mean for all preceding values), than cows on the other surfaces. Cows on the dirty surface were less clean compared with the other treatment groups (0.6 of a score on a 5-point scale; standard error of the differences of means: 0.11 for both comparisons). They were then given a free choice between 2 known surfaces for 2 consecutive days (n = 6 per pairwise choice). Cows ranked the surfaces as clean > dirty > wet. In summary, there is compelling evidence that wet surfaces impair the welfare of dairy cattle by affecting the quantity and quality of rest. Rebound responses indicate that the motivation to rest is not fulfilled on wet surfaces. Finally, when given a choice, they show clearly that they will avoid wet and dirty surfaces. The combined results indicate that changes in affective state likely underlie these behavioral responses.

Pain sensitivity and injury associated with three methods of disbudding goat kids: Cautery, cryosurgical and caustic paste.

Pain sensitivity and skull/brain injury associated with cautery, cryosurgical and caustic paste disbudding were evaluated in goat kids. Kids (reared for meat; n=280) were randomly assigned to one of four treatments (n=70 per treatment): (1) sham-handling (SHAM) or (2) cautery (CAUT), (3) cryosurgical (CRYO) or (4) caustic paste (CASP) disbudding. A pain sensitivity test was carried out 15min pre-treatment and 1h post-treatment. Skull/brain injury was assessed at post-mortem examination. Kids with evidence of injury to the skull/brain, as well as a random sample of kids (n=15 per treatment) without evidence of skull/brain injury, were selected for histological examination of brain tissue. Average daily gains (ADG) were calculated from body weight measurements taken 10min pre-treatment and then at 2, 7 and 14days post-treatment as a measure of the potential effects of pain or injury on growth. CASP and CRYO kids displayed higher pain sensitivity post-treatment than CAUT or SHAM kids, suggesting that they experienced more acute pain 1h post-treatment. One of 70 CAUT kids had a perforated skull, but there was no histological evidence of brain injury in this animal; a further nine CAUT kids exhibited hyperaemia of the skull. The other treatments did not result in injury to the skull/brain. There was no evidence of a difference in ADG across treatments. Caustic paste and cryosurgical disbudding resulted in greater acute pain sensitivity than cautery disbudding; however, cautery disbudding has the potential to cause skull injury if performed incorrectly.

Prevalence, concentration and genotypes of Campylobacter jejuni in faeces from dairy herds managed in farm systems with or without housing.

AIM: To determine the faecal excretion of Campylobacter jejuni by dairy cows that used housing in combination with outdoor grazing. METHODS AND RESULTS: Campylobacter jejuni prevalence and concentration were measured in a total of 990 cow faecal samples collected from seven herd home farms (HH), seven stand-off pad farms (SOP) and seven pasture farms (P) over a 2-year period. On all the farms, cows had access to pasture but were restricted to narrow grazing strips in winter. The overall Camp. jejuni prevalence was 55, 49 and 54% on HH, SOP and P farms, respectively. The Camp. jejuni concentration ranged from 0 to 6·7 log10 g(-1) faeces and was not statistically different among the farm systems. However, Camp. jejuni prevalence (P = 0·014) and concentration (P = 0·0001) were significantly greater in winter and early spring after intensive use of HH, SOP and strip-grazing. Typing of 30 Camp. jejuni isolates revealed a dominance of ruminant types (MLST CC-61, CC-21, CC-42 and CC-48), which are associated with human disease. CONCLUSION: No overall difference was observed among systems, but seasonal management practices that force cows close together increased the prevalence and concentration of Camp. jejuni in faeces. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings are important when identifying farm practices that reduce Camp. jejuni excretion and the associated risk to human health.

Evaluation of microsatellites as a potential tool for product tracing of ground beef mixtures.

Microsatellite genotyping was evaluated as a potential tool for DNA-based tracing of ground beef product. DNA from mixtures containing different numbers of individuals was analysed with a set of cattle microsatellite markers frequently used for parentage testing. As samples contained DNA from several animals, the microsatellite markers showed multiple peaks. The method could distinguish between mixtures containing equal amounts of meat from three different individuals, meat from three individuals mixed in different proportions, ground beef mixtures purchased in different cities, and different batches of ground beef patties. Limitations occurred when batches contained large numbers of individuals (>10) and different batches used meat from the same individuals. We conclude that DNA microsatellites may be useful for DNA traceability of ground beef mixtures prepared from less than 10 individuals, but where larger numbers of animals contribute to a mixture the method is not consistently accurate.

Comparison of left ventricular performance in healthy young women and men during exercise.

BACKGROUND: Previous studies show sex-related differences in left ventricular (LV) response to exercise. It is not clear, however, whether these differences are also seen in younger healthy subjects. METHODS AND RESULTS: This study examined the changes in LV performance during dynamic upright exercise in 11 healthy men and 19 healthy young women according to the Bruce protocol and an individualized ramp protocol. There were no significant differences between the two protocols for either men or women in heart rate, blood pressure, LV ejection fraction (EF) (measured by ambulatory nuclear detector), and measured oxygen consumption. The peak oxygen consumption was higher in men than in women (44 +/- 13 vs 36 +/- 9 ml/kg/min; p < 0.05), but the peak heart rate, systolic blood pressure, and EF were similar. The change in EF (from rest to exercise) was 19% +/- 8% in men and 19% +/- 11% in women with the Bruce protocol (difference not significant) and 26% +/- 9% in men and 19% +/- 6% in women with the ramp protocol (difference not significant). At peak exercise, both men and women showed an increase in end-diastolic volume (29% +/- 14% vs 23% +/- 11%; difference not significant) and a decrease in end-systolic volume (41% +/- 15% vs 43% +/- 21%) (difference not significant). The increase in cardiac output during exercise was due to an increase in heart rate and stroke volume in both men and women. At submaximal exercise, however, the decrease in end-systolic volume was less in women than in men (p < 0.05). CONCLUSIONS: There are no sex-related differences in compensatory mechanism during dynamic exercise in healthy subjects. The changes in contractility and LV volume are not affected by the exercise protocol.

Results of adenosine single photon emission computed tomography thallium-201 imaging in hemodynamic nonresponders.

Systolic blood pressure typically decreases during adenosine infusion because of stimulation of A2b receptors, resulting in systemic vasodilation. This study examined the results of adenosine single photon emission computed tomography (SPECT) thallium-201 imaging in patients who did not show such a decrease in blood pressure during peak adenosine effect (nonresponders). The 102 nonresponders and 341 responders had no significant differences in age, gender, history of diabetes mellitus, hypertension, or previous myocardial infarction. The extent of coronary artery disease (CAD) by angiography was also similar. The sensitivity of SPECT thallium-201 imaging in patients with one-vessel disease was 82% in nonresponders and 84% in responders (p value not significant [NS]); in patients with multivessel disease, it was 90% in nonresponders and 94% in responders (p = NS) and for all CAD, it was 87% in non-responders and 91% in responders (p = NS). Thus lack of hemodynamic systemic response during adenosine infusion does not affect sensitivity for detecting CAD.

Assessment of myocardial viability by dynamic tomographic iodine 123 iodophenylpentadecanoic acid imaging: comparison with rest-redistribution thallium 201 imaging.

BACKGROUND: This study examined the ability of dynamic 123I-labeled iodophenylpentadecanoic acid (IPPA) imaging to detect myocardial viability in patients with left ventricular (LV) dysfunction caused by coronary artery disease. METHODS AND RESULTS: Serial 180-degree single-photon emission computed tomographic (SPECT) images (five sets, 8 minutes each) were obtained starting 4 minutes after injection of 2 to 6 mCi 123I at rest in 21 patients with LV dysfunction (ejection fraction [EF] 34% +/- 11%). The segmental uptake was compared with that of rest-redistribution 201Tl images (20 segments/study). The number of perfusion defects (reversible and fixed) was similar by IPPA and thallium (11 +/- 5 vs 10 +/- 5 segments/patient; difference not significant). There was agreement between IPPA and thallium for presence or absence (kappa = 0.78 +/- 0.03) and nature (reversible, mild fixed, or severe fixed) of perfusion defects (kappa = 0.54 +/- 0.04). However, there were more reversible IPPA defects than reversible thallium defects (7 +/- 4 vs 3 +/- 4 segments/patient; p = 0.001). In 14 patients the EF (by gated pool imaging) improved after coronary revascularization from 33% +/- 11% to 39% +/- 12% (p = 0.002). The number of reversible IPPA defects was greater in the seven patients who had improvement in EF than in the patients without such improvement (10 +/- 4 vs 5 +/- 4 segments/patient; p = 0.075). CONCLUSIONS: 123I-labeled IPPA SPECT imaging is a promising new technique for assessment of viability. Reversible defects predict recovery of LV dysfunction after coronary revascularization.

Serial changes in left ventricular function after coronary artery bypass: implications in viability assessment.

Improvement in left ventricular (LV) performance after coronary artery bypass surgery remains the gold standard in myocardial viability assessment. The time-related changes, however, are not well known. This study examined the LV ejection fraction (EF) by gated blood pool imaging early (6 +/- 4 days) and late (62 +/- 24 days) after surgery in patients with normal preoperative EF (group 1, n = 12) and those with LV dysfunction (group 2, n = 15). There were no changes in the clinical status between the early and late studies, and all patients had normal sinus rhythm. Group 1 had no significant change in EF (preoperatively 62%, early postoperatively 64%, late postoperatively 63%; p = NS). In group 2, EF was 26% +/- 8% preoperatively; 30% +/- 10% early postoperatively; and 34% +/- 8% late postoperatively (p < 0.05). Postoperatively there was > or = 5% improvement in EF in 4 patients early and 11 patients late (p < 0.05). Patients who showed early improvement continued to do so in the late study but, additionally, 7 patients showed improvement only in the late study. Thus the timing of EF measurement after surgery is important in patients with LV dysfunction but not in patients with normal LV function. Early assessment may underestimate the prevalence and degree of recovery.

Prognostic significance of silent ischemia.

This study examined the prognostic predictors in 521 patients with angiographic evidence of coronary artery disease (CAD). All patients underwent exercise single-photon emission computed tomographic thallium imaging. The patients were divided into those with symptomatic ischemia defined as reversible thallium defects, S-T segment depression (or both) and angina during exercise (n = 210, group 1), and silent ischemia defined as thallium defects or ST segment depression (or both) but no angina during exercise (n = 311, group 2). During a mean follow-up of 24 +/- 21 months, there were 30 cardiac events (death or nonfatal myocardial infarction). The extent of CAD (2.0 +/- 0.8 diseased vessels in group 1 and 2.1 +/- 0.8 diseased vessels in group 2), the left ventricular ejection fraction, the extent of perfusion abnormality (21% +/- 11% in group 1 and 24% +/- 12% in group 2), and the peak heart rate and double product were similar in the two groups. Survival analysis showed no significant difference in the event-free survival in patients with symptomatic or silent ischemia. The 2-year event-free survival rate was 95% in group 1 and 94% in group 2 (difference not significant). The extent of perfusion abnormality and history of diabetes mellitus were the most important predictors of events. Thus the prognosis of medically treated patients with CAD is comparable in those patients with silent or symptomatic ischemia and is dependent on the extent of myocardium at risk rather than presence or absence of angina pectoris during exercise.

Planar and tomographic imaging with technetium 99m-labeled tetrofosmin: correlation with thallium 201 and coronary angiography.

This study compared the results of planar and single-photon emission computed tomographic (SPECT) imaging with tetrofosmin with those of 201Tl and coronary angiography. In three normal volunteers the images were normal by both 201Tl and tetrofosmin (planar and SPECT). In 23 patients with coronary artery disease, the images were abnormal in 20 patients by SPECT tetrofosmin, in 19 by planar tetrofosmin, in 20 by SPECT thallium, and in 18 by planar thallium (difference not significant). Both planar and SPECT images were divided into five segments per patient. There were 58 perfusion defects by SPECT tetrofosmin, 50 by planar tetrofosmin (difference not significant), 47 by SPECT thallium, and 42 by planar thallium (difference not significant). Perfusion defects were reversible in 47 segments (36%) by SPECT tetrofosmin, 35 (27%) by planar tetrofosmin, 31 (24%) by SPECT thallium (p < 0.05 vs SPECT tetrofosmin), and 31 (24%) by planar thallium (difference not significant). Among the 23 patients with coronary artery disease, 19 underwent coronary angiography. In these patients there were 32 diseased coronary arteries. Perfusion defects were present in 21 territories (66%) by SPECT tetrofosmin, 19 (59%) by planar tetrofosmin, 20 (63%) by SPECT thallium, and 18 (56%) by planar thallium. There was agreement between thallium and tetrofosmin in 108 of 130 segments (kappa statistics = 0.69 +/- 0.06). The images, especially with SPECT, are better with tetrofosmin than with 201Tl. Thus myocardial imaging with tetrofosmin provides results that are at least as good as those of 201Tl. Slightly more abnormal segments and more reversible defects are detected by tetrofosmin than by thallium imaging, especially with SPECT imaging.

Prognostic value of adenosine single-photon emission computed tomographic thallium imaging in medically treated patients with angiographic evidence of coronary artery disease.

BACKGROUND: This study examined the prognostic value of adenosine single-photon emission computed tomographic thallium imaging in medically treated patients with angiographic evidence of coronary artery disease (CAD). METHODS AND RESULTS: Patients who underwent coronary revascularization within 3 months of this study were excluded. There were 177 patients aged 64 +/- 11 years; 74 had one-vessel, 57 had two-vessel, and 46 had three-vessel CAD (> or = 50% diameter stenosis). During a mean follow-up of 22 +/- 13 months, there were 14 events (cardiac death or nonfatal myocardial infarction). Cox survival analysis with important clinical, catheterization, and scintigraphic variables identified the size of perfusion abnormality as the strongest predictor of events (chi 2 = 9). Life-table analysis showed that patients with perfusion defects of 15% or greater of the myocardium had a worse prognosis than had patients with no or smaller defects (Mantel-Cox statistic = 13; p < 0.001). CONCLUSIONS: Thus adenosine single-photo emission computed tomographic thallium imaging provides important prognostic data in medically treated patients with CAD. The extent of thallium abnormality is the most important predictor of events.

Comparison of the treadmill exercise score and single-photon emission computed tomographic thallium imaging in risk assessment.

BACKGROUND: This study compared the prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging with that of treadmill exercise score in medically treated patients with coronary artery disease (CAD). METHODS AND RESULTS: The treadmill exercise score was derived from exercise duration, degree of ST segment depression, and the treadmill anginal index. There were 121 patients with no CAD and 316 patients with angiographically defined CAD (> or = 50% diameter stenosis of one or more vessels). During a mean follow-up of 29 months, there were 35 cardiac deaths or nonfatal myocardial infarctions. Multivariate Cox survival analysis showed the extent of thallium imaging abnormality and CAD to be independent predictors of prognosis. On the other hand, the treadmill exercise score was not a significant predictor even on univariate analysis. The results of thallium uptake were the strongest independent predictors of prognosis and in addition provided incremental prognostic power to coronary angiography (chi 2 = 29 for SPECT, 27 for coronary angiography, and 37 for both). CONCLUSIONS: Thus exercise SPECT thallium imaging is significantly better than the treadmill exercise score in risk assessment. The size of the perfusion abnormality is an important predicator of prognosis.

Age- and sex-related differences in the use of coronary angiography in patients undergoing adenosine SPECT thallium imaging.

BACKGROUND: Recent reports suggest sex-related differences in the management of patients with coronary artery disease. METHODS: This study examined the pattern of use of coronary angiography in 535 patients initially referred for adenosine single photon emission computed tomography (SPECT) thallium imaging. RESULTS: Coronary angiography was carried out more often in patients under 70 years of age than those over 70 years of age [107 out of 322 (33%) versus 50 out of 213 (23%), P < 0.01]. Even in patients with abnormal adenosine SPECT thallium results, coronary angiography was less frequently performed in the elderly [40 out of 130 (31%) versus 82 out of 178 (46%), P < 0.01]. Women underwent coronary angiography less often than men [56 out of 261 (21%) versus 101 out of 274 (37%), P < 0.0002]. This difference was due to differences in patients under 70 years of age [31 out of 138 women (22%) versus 76 of 184 men (41%), P < 0.003)], but not in patients over 70 years of age. In patients with abnormal adenosine thallium image results, the difference between men and women was still present: 37 out of 112 women (33%) versus 85 of 196 men (43%) underwent coronary angiography (P = 0.05). Stepwise discriminant analysis of clinical and scintigraphic variables identified four independent predictors of the need for coronary angiography; the abnormal thallium image results (chi 2 = 33, P < 0.0001); the size of the perfusion abnormality (chi 2 = 7, P < 0.01); sex (chi 2 = 7, P < 0.01) and age (chi 2 = 4, P < 0.05). CONCLUSION: Coronary angiography is less often performed in women and elderly patients even when initial screening results are abnormal. The relation of this observation to subsequent clinical course and events requires further studies.