Improved detection of myocardial perfusion reversibility by rest-nitroglycerin Tc-99m-MIBI: comparison with TI-201 reinjection.

BACKGROUND: The role of nitroglycerin (NTG) in Tc-99m-methoxyisobutil isonitrile (MIBI) studies to improve the assessment of myocardial viability in patients with coronary artery disease and its comparison with TI-201 reinjection has not yet been clarified. This study aimed to test whether sublingual administration of NTG could improve the capability of Tc-99m-MIBI to detect reversibility in exercise-induced perfusion defects and to compare it with the TI-201 stress-redistribution-reinjection protocol. METHODS AND RESULTS: Thirty-eight patients (33 men, 5 women; mean age 49.3 +/- 8.2 years with previous myocardial infarction [mean evolution 7.1 +/- 3.9 months]) underwent exercise, redistribution, and reinjection TI-201 imaging, as well as exercise, rest, and NTG MIBI myocardial scintigraphy (3-day protocol). A total of 494 myocardial segments were assessed by quantitative analysis. Of the 136 myocardial segments with fixed defects on exercise-rest sestamibi imaging, 109 (80%) did not change after NTG MIBI study, and 27 (20%) demonstrated enhanced uptake. In the 140 myocardial segments with fixed defects on exercise-redistribution thallium imaging, 112 (80%) did not improve after TI-201 reinjection study, and 28 (20%) showed increased activity. The observed agreement on reversibility detection between NTG MIBI and TI-201 reinjection, with the 210 segments with perfusion defects used for this analysis on both studies, was 78%, with a significant kappa = .56 +/- .07 SE. CONCLUSION: Our data suggest that the use of an NTG MIBI protocol results in an incremental improvement for detecting exercise-induced perfusion defect reversibility and achieves results similar to those from a TI-201 reinjection protocol.

Long-term therapy with policosanol improves treadmill exercise-ECG testing performance of coronary heart disease patients.

This study examined the effects of long-term lipid-lowering therapy with policosanol on the clinical evolution, and exercise-ECG testing responses of 45 coronary heart disease (CHD) patients with myocardial ischemia, documented by exercise 201T1-myocardial perfusion scintigraphy, in an overall randomized, double-blind, placebo-controlled trial, made for different test endpoints. Fifteen patients were treated with 5 mg of policosanol twice daily; another 15 patients were administered the same drug dose plus 125 mg aspirin; and the other 15 patients received placebo plus equal aspirin dose. They were followed for 20 months, previous baseline observations, with treadmill exercise-ECG, besides serum lipid test. Beneficial changes on proportions among the 2 policosanol groups and the placebo group, showed an increment on functional capacity class, a decrement on rest and exercise angina, and a significant decrease in cardiac events, and in ischemic ST segment response, especially in the policosanol plus aspirin group (p = 0.05, X2(2df) = 5.8; p = 0.04, p = 0.02; Fisher). After treatment, sets of mean changes revealed an increase on maximum oxygen uptake, and a decline on double product simultaneously in both policosanol groups (p < or = 0.02, p < or = 0.002; Pillais, Hotellings' T2), while the placebo group was impaired. Aerobic functional capacity percent showed an increment in policosanol groups (p < or = 0.05, paired T). Lipid levels improved as other endpoints already reported. A supposed ergogenic effect of octacosanol, policosanol's main active compound, was not detected with this design. These results show that policosanol-treated CHD patients improved clinical evolution, and exercise-ECG responses, owing to the amelioration of myocardial ischemia, even more when administered with aspirin.

Usefulness of 99Tcm-tetrofosmin scintimammography in palpable breast tumours.

The aim of this exploratory study was to assess the potential of discriminating malignant from non-malignant lesions using 99Tcm-tetrofosmin scintimammography in the detection of palpable breast tumours. Nine patients with palpable masses were studied; seven had malignant lesions and two had non-malignant lesions. All diagnoses were established by fine-needle aspiration (FNA) biopsy cytology. Each patient received 925 MBq (25 mCi) 99Tcm-tetrosfosmin intravenously. Planar prone views were acquired in the right lateral, left lateral and anterior positions, and the axillary regions were included in the field of view. Scintimammography showed focally increased tracer uptake in seven patients with a positive FNA result. The two patients with a negative FNA result showed no increased uptake. We suggest that 99Tcm-tetrosfosmin shows promise as a radiopharmaceutical in the detection and discrimination of the nature of palpable breast tumours. Larger studies are required to confirm these findings.

Effect of policosanol on hyperlipidemia and coronary heart disease in middle-aged patients. A 14-month pilot study.

To find out the long-term lipid-lowering efficacy of policosanol in low dose and its influence in the evolution of coronary heart disease (CHD), a pilot clinical randomized single-blind, placebo-controlled trial was conducted on 23 middle-aged outpatients, with well documented diagnosis of chronic CHD and primary or marginal hyperlipidemia. Twelve patients received policosanol tablets of 1 mg twice daily, and 11 patients placebo in the same fashion, followed with rest and stress electrocardiogram (ECG), and serum lipid blood samples by 14 months. The treated group showed significant reduction of total cholesterol in 14.8% (p < or = 0.001) and of low density lipoprotein (LDL) in 15.6% (p < or = 0.05), against non significant increase of 3% and 5.5%, respectively, in the placebo group. No patient had new coronary events in both groups, but 5 of 12 treated patients exhibited a clinical tendency to improve their CHD, in comparison with no one in the placebo group (p < or = 0.05). These findings show the effectiveness of low dose of policosanol lowering total cholesterol and LDL levels and suggest a CHD improvement in middle-aged patients with primary or marginal hyperlipidemia.

[Risk of low birth weight in the Plaza de la Habana region]. / Riesgo de bajo peso al nacer en el área Plaza de la Habana.

The objective of this study was to confirm the risk factors (RF) for low birth-weight (LBW) and suggest new risk factors, which were analyzed separately and together, in order to define a program to be coordinated by family doctors to reduce the frequency of this problem. For this purpose, a retrospective cross-sectional survey was carried out with 57 cases (mothers who had had LBW babies) and 58 controls (mothers who had not had LBW babies). In addition, data were obtained from the prenatal records of mothers who received care at family doctors' offices and at the clinica in the Plaza de la Habana Area. Estimates were made of the relative risk and the percentage attributable risk of 107 hypothetical RF for LBW from a clinical-epidemiological and social standpoint. One-way analysis of variance, the chi-square test, multiple linear regression, and logistic regression were used to analyze the results, which suggested the following RF for LBW: family dysfunction, family crisis, lack of spousal support, extended family, failure to attend prenatal group sessions for pregnant women, and failure to receive education on how to prevent LBW. The multifactorial risk profile was the following: risk of [corrected] intrauterine growth retardation, family dysfunction, threat of preterm delivery, coffee-drinking, attendance at fewer than 11 prenatal checkups, and failure to attend prenatal group sessions for pregnant women. The variables excluded from the model were: low weight-for-height, lack of spousal support, smoking more than 10 cigarettes a day, and family history of LBW. The findings confirmed 10 of the suspected risk factors for LBW in Cuba and nine of those described in the international literature. Maternal age, spontaneous abortion, and alcohol consumption were not confirmed. Six RF for LBW preventable by the family doctor through his/her actions at the family and community level are identified, as is a multifactorial profile of six RF for LBW. On the basis of these results, proposals are made in regard to programming priorities and the implementation of strategies aimed at preventing LBW, and it is recommended that the study be continued with a larger sample.