In-hospital management of elderly patients undergoing myocardial perfusion scintigraphy.

OBJECTIVE: To investigate the impact of myocardial perfusion scintigraphy results on the decision for invasive coronary angiography in elderly patients (≥75 years) with suspected coronary artery disease hospitalized in a single tertiary medical center. SUBJECTS AND METHODS: In the retrospective study, data of 276 (136 elderly) consecutive hospitalized patients referred to myocardial perfusion imaging were analyzed. The clinical characteristics, myocardial perfusion scintigraphy results, invasive coronary angiography and revascularization rates and in-hospital adverse events were identified by manually reviewing the patients' records. RESULTS: Ischemia was found in 40.2% of patients. There was no significant difference in the proportion of ischemia between elderly and younger patients (38.2% vs. 42.1%, P=0.508). Invasive coronary angiography was performed in 64.0% of patients with ischemia and in 6.8% of patients with normal myocardial perfusion imaging (P<0.001). The referral rate for invasive coronary angiography was not different between elderly and younger patients with ischemia (63.5% vs. 64.4%, P=0.848). Ischemia on myocardial perfusion imaging was the most predictive variable for a referral to invasive coronary angiography (odds ratio 31.8, 95% confidence interval 14.6-69.5, P<0.001). There was no significant difference between the younger and elderly patients in revascularization rate and adverse events until discharge (39% vs. 40%, P=0.99 and 7.1% vs. 8.8%, P=0.6, respectively). CONCLUSION: Ischemia on myocardial perfusion scintigraphy is a powerful predictor for in-hospital invasive coronary angiography independent of the patient's age. Elderly patients with ischemia received invasive coronary angiography equally as their younger counterparts and have similar rates of adverse events until discharge.

Endothelium-dependent and independent dilation capability of peripheral arteries in patients with systemic lupus erythematosus and antiphospholipid syndrome.

OBJECTIVES: The study evaluated the systemic inflammatory response and endothelium-dependent and independent function of the brachial artery (BA) in systemic lupus erythematosus (SLE) patients with and without antiphospholipid syndrome (APS). METHODS: The study group consisted of 42 women with SLE (21 without APS; mean age 36.1 ± 9.1, and 21 with APS; mean age 43.9 ± 13.1) and 22 healthy controls (mean age 43.5 ± 10.3). Endothelium-dependent functional response was evacuate using the flow-mediated vasodilatation (FMD) of brachial artery and endothelium-independent vasodilatation by application of glyceryl trinitrate (GTN). Using biochemical methods, circulating inflammatory markers were determined. RESULTS: In comparison to controls, in both groups of patients endothelium-dependent dilation of BA was significantly reduced, and there were no differences in FMD between patients with or without APS: SLE - 7.7% (11.9-12.1), SLE+APS 7.8% (2.4-12.8), controls - 14.6% (11.2-21.1), p<0.001. However, endothelium-independent dilation of the brachial artery was significantly lower in SLE-APS patients than in controls and also lower than in the SLE group: SLE - 24.3% (15.0-28.6), SLE+APS-17.4% (13.1-22.6), controls - 23.0% (17.8-30.1), p=0.015 vs. p=0.027. Patients with SLE had significantly higher values of VCAM-1, hs-CRP, and fibrinogen than controls. In patients with SLE+APS, an additional significant increase of inflammatory markers was registered. CONCLUSIONS: The results of our study indicate that patients with SLE have deteriorated endothelium-dependent and those with APS also independent vascular function which could be, together with increased inflammatory response, involved in vascular complications in these patients. The presence of APS aggravates systemic inflammatory response.

The usefulness of transcutaneous oximetry in assessing the success of percutaneous transluminal angioplasty.

OBJECTIVE: to identify whether monitoring transcutaneous oxygen pressure (TcpO(2)) can provide an objective method of assessing the results of PTA. MATERIALS AND METHODS: fifty-seven patients (39 Fontaine stage II, <18 stage III or IV) had ABI, TcpO(2) at rest (stages III and IV) or during exercise (stage II) and total work capacity of the leg (stage II) measured before, 24-48 h, 2 and 6 weeks after PTA. RESULTS: a significant increase of ABI in both groups of patients was detected immediately after successful PTA. TcpO(2) measured on the foot at rest increased in stages III and IV patients immediately after PTA (from 14 (IQR)18 to 25 (IQR)32 mmHg,p <0.05) and again after 6 weeks in comparison to follow up two (from 25 (IQR)32 to 35 (IQR)21 mmHg,p <0.05). In patients in stage II TcpO(2) decreased in a typical fashion during exercise. Total oxygen drop was most evident before treatment (352 (IQR)458 smmHg) and decreased significantly immediately after PTA (148 (IQR)175 smmHg, p<0.001). CONCLUSIONS: TcpO(2) measurement is an useful method for investigating the success of PTA. While the macrocirculation improves immediately after successful recanalisation, complete normalisation of the microcirculation may take some weeks, especially stages III and IV disease.