The accuracy of myocardial perfusion SPECT imaging in the evaluation of coronary artery disease in women and men.

BACKGROUND: The purpose of this study is to compare sensitivity, specificity and accuracy of myocardial perfusion SPECT for the detection of coronary artery disease (CAD) in women and men. MATERIAL AND METHODS: 588 patients (455 males and 133 females, 273 after a previous myocardial infarction) underwent stress myocardial perfusion SPECT. The accuracy of myocardial perfusion SPECT was proved by coronary angiography (stenosis > 50% was considered as a CAD). RESULTS: The sensitivity of SPECT was slightly higher, but statistically not significant, in men than in women (94% versus 91%, p > 0.05). The specificity was higher in women than in men (93% versus 82%), but this difference was not statistically significant either (p > 0.05). The accuracy of SPECT was the same for both sexes (92%). In angiographically verified group of patients the selection bias was obvious--patients with CAD dominated (74%) and the fraction of patients with CAD in men's group (83%) was significantly higher than in women's group (50%), p < 0.05. CONCLUSIONS: No significant difference was revealed in the accuracy of myocardial perfusion SPECT in men and women. Our results are in accordance with the prevailing opinion in literature that discovered differences in sensitivity, specificity and diagnostic accuracy are usually not statistically significant or that they can be explained by the selection bias of patients in angiographically verified groups (significantly higher fraction of patients with CAD in men's group).

Short-term heart rate variability changes after exercise training in subjects following myocardial infarction.

Heart rate variability reflects the activity of autonomic nervous system. The aim was to evaluate the value of short-term spectral analysis of heart rate for monitoring the effects of exercise training on the autonomic nervous system in subjects following myocardial infarction. Short-term spectral analysis of heart rate variability was performed during standardised supine-standing-supine test in a group of 29 clinically stable patients after myocardial infarction and the same test was repeated after 2 months of exercise training (ergometry or rapid walking). Each subject exercised at 60-80% of his maximal performance for 30 minutes once a day. Short-term spectral analysis of heart rate variability was assessed in the frequency range of 0.02-0.5 Hz involving very low frequency (VLF, 0.02-0.05 Hz), low frequency (LF, 0.05-0.15 Hz) and high frequency (HF, 0.15-0.5 Hz) spectral bands. The influence of exercise training on the autonomic nervous system was registered in the physically active group (n = 16) as a decrease in sympathetic response to standardised orthostatic load. In conclusions the regular exercise influenced an altered neural autonomic regulation of heart rate in post-infarction patients shown by a decrease in sympathetic activity in the short-term heart rate variability. This method enables monitoring of the effects of physical training on the autonomic nervous system in patients following myocardial infarction.

Dynamics of some biochemical indices in myocardial infarction treated with thrombolysis and creatine phosphate.

There was studied the effect of intravenously administered creatin phosphate (Neoton-drug with cardioprotective effect, Alfa Schiapparelli Wassermann) in the group of 98 patients affected by their first attack of myocardial infarction. In the course of the treatment there were observed the serum level of many biochemical indices, including the cardioselective enzyme activity. We concluded that the patients treated with Neoton, compared with the control group, revealed the significantly higher elevation of the CK, AST and LDH activity levels and the shift of the CK peak activity towards to the earlier hours after the onset of anginal pain.