[Aneurysm-like wall motion abnormality in hibernating myocardium detected by stress thallium scintigraphy].

A 70-year-old female patient presented and ECG with QS patterns and ST elevation in V1-3. Left ventriculography showed severely abnormal wall motion of the anteroseptal similar to a left ventricular aneurysm. Based on previous experience that 201Tl myocardial scintigraphy revealed possible myocardial viability in a patient with left ventricular aneurysm suspected of having apparently no myocardial viability, percutaneous transluminal coronary angioplasty (PTCA) was performed for severe stenosis of the left anterior descending artery. Follow-up images 3 months later showed a remarkable improvement in parietal motility of the left ventricle and recovery of almost normal cardiac function. This case demonstrates that exercise myocardial scintigraphy is useful for diagnosing hibernating myocardium associated with severely abnormal parietal motility, such as left ventricular aneurysm.

Heart rate decline after exercise in patients with hypertrophic cardiomyopathy.

To evaluate the heart rate recovery, submaximal exercise, echocardiographic examination, and Holter monitoring were performed on 30 patients with hypertrophic cardiomyopathy and 11 controls. The time constant of heart rate decline after exercise was calculated. Spectral analysis was performed on Holter recordings. The time constant did not correlate with heart rate, left ventricular end-diastolic pressure, ejection fraction, or wall thickness. There was no correlation between the time constant and any mean spectral indices over 24 hours in patients. However, the time constant correlated with high frequency component in the night. Nocturnal high frequency component in patients with short time constant was significantly less than in those with long time constant, but did not significantly differ from that in controls. In conclusion, the heart rate decline after exercise does not primarily reflect the severity of hypertrophy or hemodynamic impairment but is associated with nocturnal parasympathetic modulation in patients with hypertrophic cardiomyopathy.