Number Of Abnormal Segments Research Articles

Cognitive impairment in asymptomatic carotid artery stenosis is associated with abnormal segments in the Circle of Willis

ObjectiveOur group has previously demonstrated that patients with asymptomatic carotid artery stenosis (ACAS) demonstrate cognitive impairment. One proposed mechanism for cognitive impairment in patients with ACAS is cerebral hypoperfusion due to flow-restriction. We tested whether the combination of a high-grade carotid stenosis and inadequate cross-collateralization in the Circle of Willis (CoW) resulted in worsened cognitive impairment. MethodsTwenty-four patients with high-grade (≥70% diameter-reducing) ACAS underwent carotid duplex ultrasound, cognitive assessment, and 3D time-of-flight magnetic resonance angiography. The cognitive battery consisted of nine neuropsychological tests assessing four cognitive domains: learning and recall, attention and working memory, motor and processing speed, and executive function. Raw cognitive scores were converted into standardized T-scores. A structured interpretation of the magnetic resonance angiography images was performed with each segment of the CoW categorized as being either normal or abnormal. Abnormal segments of the CoW were defined as segments characterized as narrowed or occluded due to congenital aplasia or hypoplasia, or acquired atherosclerotic stenosis or occlusion. Linear regression was used to estimate the association between the number of abnormal segments in the CoW, and individual cognitive domain scores. Significance was set to P < .05. ResultsThe mean age of the patients was 66.1 ± 9.6 years, and 79.2% (n = 19) were male. A significant negative association was found between the number of abnormal segments in the CoW and cognitive scores in the learning and recall (β = −6.5; P = .01), and attention and working memory (β = −7.0; P = .02) domains. There was a trend suggesting a negative association in the motor and processing speed (β = −2.4; P = .35) and executive function (β = −4.5; P = .06) domains that did not reach significance. ConclusionsIn patients with high-grade ACAS, the concomitant presence of increasing occlusive disease in the CoW correlates with worse cognitive function. This association was significant in the learning and recall and attention and working memory domains. Although motor and processing speed and executive function also declined numerically with increasing abnormal segments in the CoW, the relationship was not significant. Since flow restriction at a carotid stenosis compounded by inadequate collateral compensation across a diseased CoW worsens cerebral perfusion, our findings support the hypothesis that cerebral hypoperfusion underlies the observed cognitive impairment in patients with ACAS.

Diagnosis of Cardiac Rehabilitation after Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients by Emission Computed Tomography Image Features under Filtered Back Projection Reconstruction Algorithm.

This study aimed to explore the application value of emission computed tomography (ECT) imaging technology based on filtered back projection reconstruction algorithm (FBP) in cardiac function examination after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Eighty patients with myocardial infarction diagnosed by medical history, electrocardiograph (ECG), and myocardial enzyme admitted to hospital from February 2018 to February 2019 were selected as the research objects. All patients underwent PCI seven days after the onset of myocardial infarction. ECT was performed for all patients before and after surgery. In addition, all ECT images were processed by the FBP reconstruction algorithm. On this basis, preoperative and postoperative cardiac surgery function and ischemia of the patients were diagnosed. Then, the diagnostic results were compared with the results of coronary angiography and echocardiogram. The results showed that all patients had a total of 541 segments before PCI surgery. ECT examination revealed 294 abnormal segments of the ventricular wall, with a total score of 585 points. A total of 100 segments were scored with 1 point, a total of 194 segments were scored with 2 points, and a total of 50 segments were scored with 3 points. After PCI, the number of abnormal segments was reduced to 58, with a total score of 193. There were 6 segments with a score of 1, 44 segments with a score of 2, and 5 segments with a score of 3. The left ventricular diastolic volume (EDV), left ventricular systolic volume (ESV), stroke volume (CO), and ejection fraction (EF) of the patients before the operation were 148 ± 16 mL, 77 ± 14.5 mL, 4.29 ± 0.37 L/min, and 41.9 ± 8%, respectively. The EDV, ESV, CO, and EF of the patients after surgery were 132 ± 16 mL, 62 ± 13 mL, 4.89 ± 0.71, and 53 ± 6%, respectively. Significant changes occurred in various systolic function parameters before and after surgery, P < 0.05. The standardized regression coefficients of the three groups were 0.32, 0.41, and 0.47, respectively, P < 0.05, which indicated that the greater the coronary artery stenosis rate, the higher the diagnostic coincidence rate of left anterior descending limb (LAD), left circumflex branch (LCX), and left coronary artery (RCA). The conformity of ECT imaging in the LCX group for diagnosis of myocardial ischemia was higher than that of UCG, P < 0.05. To sum up, the ECT technology based on the FBP reconstruction algorithm had a good application prospect in the diagnosis of cardiac function recovery in AMI patients after PCI.

Regional cardiac dysfunction and outcome in patients with left ventricular dysfunction, heart failure, or both after myocardial infarction.

Global measures of left ventricular (LV) function, in particular LV ejection fraction (LVEF) and global myocardial strain measures, are powerful predictors of outcomes in patients with LV dysfunction, heart failure, or both. However, less is known about the relationship between regional myocardial function, especially that assessed by strain echocardiography and clinical prognosis. We studied 248 patients with LV dysfunction, heart failure, or both 5 days after first myocardial infarction (MI) from the VALIANT study. We assessed peak longitudinal strain (LS) via B-mode speckle tracking in 12 segments from the apical 4- and 2-chamber views and visually assessed LV wall motion score (WMS). We related these measures of regional myocardial function to each other and to clinical outcomes over 20-month follow-up. Normal reference values for segmental LS were derived from 50 healthy controls. Regional LS (-7.7%, Q1: -11.2%, Q3: -4.9%) was worse in segments with abnormal WMS, although was significantly impaired even in segments scored as normokinetic compared with normal controls (-10.4 ± 5.2% vs. -20.0 ± 7.6%, P < 0.001). In multivariable Cox proportional hazards models, each additional abnormal LS segment was associated with an increased risk of all-cause mortality (hazard ratio: 1.42, 95% confidence interval: 1.06-1.90, P = 0.02) even after adjustment for clinical covariates, including LVEF, LV end-systolic volume, and number of abnormal segments by WMS. In patients with LV dysfunction, heart failure, or both after MI, regional LS is significantly depressed even in segments with normal WMS, and this measure was related to adverse outcome.

Оценка жизнеспособности миокарда после реваскуляризации у больных с ишемичекой болезнью сердца

Some aspects of the definition of medical tactics relating to the definition of myocardial viability before revascularization in patients with coronary heart disease are considered in detail in the article. Methods. A total of 65 patients with CHD, including 20 patients with type 2 diabetes are examined. The presence and severity of coronary artery lesion was performed by coronary angiography. Subsequent percutaneous coronary intervention (PCI) was performed in 32 patients. Strain echocardiography is made for all patients before PCI and one year after PCI. Result. According to coronary angiography in patients with CHD and type 2 diabetes in 25 % of case registered atherosclerotic lesions of a coronary artery and a 45 % loss of two or three coronary arteries, compared with 40 % and 20 %, respectively, in patients with CHD without type 2 diabetes (p˂0.05). Number of abnormal segments, restore function one year after PCI in the first group was significantly lower than in the second group (27 % vs 35 %). Assessment of left ventricular myocardial contractile function 1 year after revascularization showed that the recovery of the longitudinal (LongS, %), radial (RadS, %) and circular (CircS, %) strain in patients of group 1 is expressed to a much lesser extent. Conclusions. In patients with decreased global LV contractility requires assessment of myocardial viability is necessary before myocardial revascularization to confirm its feasibility. The presence of type 2 diabetes slows recovery of viable myocardium after revascularization compared with patients without diabetes. Carrying the strain echocardiography before and after myocardial revascularization is justified to assess the recovery of myocardial contractility

0150: Myocardial viability assessment by speckle-tracking echocardiography in patients with coronary artery disease & type 2 diabetes mellitus

to assess myocardial viability by speckle-tracking echocardiography (STE) in patients (pts) with coronary artery disease (CAD) and type 2 diabetes mellitus (DM2). We examined 65 pts with CAD (45 males, age 60.5±4.7 years), among them 20 pts with T2DM. Baseline characteristics of pts included history of CAD (7.2±2.3 years) and DM2 (4.7±0.5). The presence and extent of CA lesion were performed using coronary angiography. Consecutive percutaneous coronary intervention (PCI) was performed to 32 pts, including 10 pts with DM2 (1 st group (gr)) and 22 pts without concomitant DM2 (2 nd gr). All pts underwent STE before and one year after PCI. Coronary angiography demonstrated that among pts with CAD and DM2 in 25% cases (n=5) registered atherosclerotic lesion of one CA and in 45% (n=9) lesion of two or three CA compared with the 40% (n=18) and 20% (n=9) respectively in pts with CAD without concomitant DM2 (p<0.05). Total of 312 LV myocardial segments were analyzed by STE. The number of abnormal segments that recovered function in the 1 st gr was significantly lower than in the 2 nd gr (27% (n=24) vs 35% (n=79), p<0.05). Assessing LV functional recovery one year after revascularization pts of the 1 st gr demonstrated lower end-systolic longitudinal (LongS,%), radial (RadS,%) and circumferential (CircS,%) strains (LongS – 9.3±6.2 vs –12.7±6.7, p=0.033; RadS 16.3±10.8 vs 22.5±11.7, p=0.026; CircS – 8.2±7.9 vs –12.3±8.5, p=0.043) than in the 2nd gr (LongS – 11.8±7.2 vs –14.3±7.3, p=0.015; RadS 19.8±12.4 vs 23.5±11.3, p=0.025; CircS – 9.8±8.7 vs –12.5±8.1, p=0.021). pts with CAD and DM2 had lesser degree of LV functional recovery one year after revascularization compared to those without DM2 that can be explained by peculiarities of CA atherosclerotic lesion. Assessments of LV myocardial viability using STE is recommended for patients selection before revascularization and further follow up.

Prognostic value of coronary computed tomography angiography during 5 years of follow-up in patients with suspected coronary artery disease

Coronary computed tomography angiography (CCTA) has a high accuracy for detection of obstructive coronary artery disease (CAD). Several studies also showed a good predictive value for subsequent cardiac events. However, the follow-up period of these studies was limited to ~2 years and long-term follow-up data on prognosis out to 5 years are very limited. This study is based on 1584 patients with suspected CAD undergoing CCTA between December 2003 and November 2006. Among other CCTA parameters, the total plaque score defined as number of abnormal segments (having either a non-obstructive plaque or a stenosis) and the most severe stenosis were recorded. The primary endpoint was a composite of death and non-fatal myocardial infarction. Revascularization procedures later than 90 days after the CT study were assessed as secondary endpoints. During a median follow-up of 5.6 years (IQR: 5.1-6.3 years) 61 patients suffered death or myocardial infarction and 52 underwent late revascularization. The severity of CAD and the total plaque score were the best predictors of death and non-fatal myocardial infarction, both significantly improving prediction over standard clinical risk scores (multivariate c-index 0.60 and 0.66, respectively, P = 0.002 and <0.0001, respectively). The annual event rate ranged from 0.24% for patients with no CAD to 1.1% for patients with obstructive CAD and 1.5% for patients with CAD and extensive plaque load (>5 segments). Both parameters also improved prediction of need for subsequent revascularization (c-index 0.72 and 0.63, respectively, P < 0.0001 and P = 0.0013, respectively). Data from CCTA predict both death and myocardial infarction as well as need for subsequent revascularizations out to 5 years. CCTA imaging may be a valuable tool in the assessment of long-term prognosis in patients with suspected CAD.

The Prognostic Significance of Resting Regional Left Ventricular Function in Patients With Varying Degrees of Myocardial Ischemia.

BackgroundOur aim was to determine whether regional left ventricular (LV) function on a resting transthoracic echo (TTE) provides prognostic information in patients with varying degrees of ischemia on myocardial perfusion imaging.MethodsBetween 2004 - 2009, we identified 503 patients (mean age 69 (SD 11); 79% male) with reversible ischemia on a myocardial SPECT scan who had a TTE within 30 days. We evaluated the rate of subsequent revascularization and death for all patients.ResultsFollowing the SPECT scan and TTE, 246/503(49%) patients underwent revascularization, 64/503 (13%) patients died, 369 (73%) patients had a normal left ventricular ejection fraction (LVEF), 242 (48%) patients had a resting wall motion abnormality (WMA), 21/261 (8%) with no WMA died compared to 43/242 (18%) in patients with a WMA. In patients with a WMA (n = 242) there was no significant difference in mortality when comparing patients with small (< 6 segments) and large (> 6 segments) WMA (P = 0.44). In patients with moderate/severe ischemia, the presence of a resting WMA was associated with a higher mortality rate (18% v 7%; P = 0.005). In a multivariable model, LVEF (< 50%) was associated with a hazard ratio of 2.2 (P = 0.002, 95% CI 1.34 - 3.68) however, WMA and number of abnormal segments did not reach statistical significance.ConclusionA resting wall motion abnormality in patients with moderate/severe ischemia is associated with a higher mortality compared to patients with mild ischemia on myocardial perfusion imaging. Regional left ventricular dysfunction unlike LVEF was not an independent predictor of mortality.

Evaluation of the therapeutic effect of Tongxinluo for acute myocardial infarction using 99Tcm-MIBI SPECT imaging

Objective To investigate the treatment effect of Tongxinluo for revasculatization improvement after PCI using 99Tcm-MIBI SPECT imaging for AMI patients.Methods A total of 38 patients with AMI were randomly divided into a control group (PCI only,18 patients) and Tongxinluo treatment group (20 patients).99Tcm-MIBI myocardial SPECT was performed 7 d and 180 d after PCI.The left ventricular myocardium was divided into 17 segments.The myocardial 99Tcm-MIBI uptake was scored semiquantitatively.The number and scores of abnormal perfusion segments were evaluated in all patients.T-test and x2 test were used to compare the difference between the two groups using SPSS 11.5.Results The total number of abnormal segments in the treatment group was 59 at 7 d after PCI,among which 37 (62.7％,37/59) had improved perfusion at 180 d after PCI.In the control group,64 abnormal segments were found at 7 d after PCI; however,the perfusion was improved in only 26 (40.6％,26/64) segments at 180d after PCI.By comparing the myocardial perfusion defect scores,there was a significant difference (x2 =5.994,P ＜ 0.05) between the control and treatment groups.The total scores of treatment and control groups were 6.2±8.4 and7.4 ±6.9 (t =0.5,P＞0.05),respectively,at7 d after PCI and 3.4 ±4.6 and 6.8 ±5.9(t =2.1,P ＜ 0.05),respectively,at 180 d after PCI.The changes in scores were 2.9 ± 5.7 and 0.6 ±3.3(t =1.5,P ＞0.05) in the treatment and control groups between 7 d and 180 d after PCI.Conclusion Tongxinluo can reduce the number of persistent perfusion defects after PCI treatment in patients with AMI,and thus has a potential role in preventing revascularization failure. Key words: Myocardial infarction; Myocardial reperfusion; Tongxinluo; Tomography,emission-computed, single-photon; MIBI

Comparison between CT angiography based scoring system and coronary angiography based scoring system in predicting major coronary events

PurposeAcute coronary events often occur suddenly without warning. The mortality and morbidity are high. There has been many scoring system to predict coronary events. However, none is in combination with...

Early and late-onset acute GvHD following hematopoietic cell transplantation: CT features of gastrointestinal involvement with clinical and pathological correlation

Objective With the introduction of non-myeloablative hematopoietic cell transplantation, acute graft-versus-host-disease (GvHD) is frequently observed beyond the traditional 100 days cut-off. The aim of this study was to describe and compare CT features of gastrointestinal early and late-onset GvHD and to correlate findings with clinical and pathology grading. Subjects and methods Abdominal CT scans were obtained in 20 patients with early and 15 with late-onset GvHD. Examinations were assessed for intestinal and extraintestinal abnormalities and findings compared between the two subgroups of GvHD. Distinct CT abnormalities as well as a CT-score integrating multiple pathologies were correlated with gut, clinical or pathology grading. Results Frequent intestinal abnormalities included wall thickening, abnormal enhancement, and excessive fluid-filling (94%, 89%, and 94%). 86% of patients showed concomitant small and large bowel involvement. A discontinuous distribution was observed in 54%. Bile tract abnormality was the most common extra-intestinal finding (74%). The distribution of pathologies was equal between subgroups of early or late-onset disease. Wall thickening and mucosal attenuation in non-enhanced scans were significantly related to clinical and pathology scores ( P ≤ 0.018). Number of abnormal segments, small bowel dilatation, engorgement of the vasa recta, mesenteric fat stranding and ascites were linked to clinical grading ( P ≤ 0.019). A CT-score integrating multiple abnormalities was correlated to gut, overall clinical and pathology grading ( r = 0.64, 0.57, 0.50). Conclusion CT morphology of acute GvHD is independent of its time of onset and, thus, facilitates differential diagnosis of late-onset acute GvHD. Correlation of CT morphology with clinical and pathological grading is important in terms of prognosis and may help guiding the therapeutic approach.

Incremental Value of Strain Rate Imaging to Wall Motion Analysis for Prediction of Outcome in Patients Undergoing Dobutamine Stress Echocardiography

Wall motion score at dobutamine stress echocardiography is an independent predictor of mortality. We sought to determine whether quantification of DSE by strain rate imaging was incremental to wall motion score for predicting outcome. In 646 patients undergoing dobutamine stress echocardiography for the evaluation of known or suspected coronary disease, customized software was used to automatically measure peak systolic strain rate (SR(s)) and end-systolic strain (S(es)) in 18 segments. Results were expressed as the number of abnormal segments and the mean SR(s) and S(es) per patient. All-cause mortality was identified over 7 years of follow-up (mean, 5.2+/-1.5 years). Contributions of clinical, wall motion, and SR(s) and S(es) data to outcome were analyzed with Cox models, which also were used to define cut points for SR(s) and S(es). Ischemia (new or worsening wall motion abnormalities) was detected in 45%, and 39% had a previous myocardial infarction. In patients with no ischemia, annualized mortality without and with previous myocardial infarction were 2% and 3% compared with 5% in patients with ischemia. Peak wall motion score index, mean SR(s), segmental S(es), and segmental SR(s) were all predictors of mortality, but only segmental SR(s) (hazard ratio, 3.6; 95% CI, 1.7 to 7.2) was independently predictive. In sequential Cox models, the model based on clinical data (overall chi2, 12.7) was improved by peak wall motion score index (18.4, P=0.002) and further increased by either segmental SR(s) (31.8, P<0.001) or mean SR(s) (25.7, P=0.009). Segmental analysis by SR(s), derived from automated strain rate imaging analysis of dobutamine stress echocardiography response, offers prognostic information that is independent and incremental to standard wall motion score index.

Incremental value of cardiac imaging in patients presenting to the emergency department with chest pain and without ST-segment elevation: a multicenter study

Background We hypothesized that imaging of regional myocardial function (RF) and perfusion (PER) will add incremental value for both diagnosis and short-term prognosis to routine demographic, clinical, and electrocardiographic findings in patients presenting to the emergency department (ED) with chest pain and without ST-segment elevation on the electrocardiogram. Methods We compared contrast echocardiography (CE) with gated single-photon emission computed tomography (SPECT) for this purpose. Both CE and SPECT readings included separate and composite assessments of both RF and PER. Adverse events in the first 48 hours after ED presentation included acute myocardial infarction, emergent revascularization, and cardiac-related death. Results Concordance between CE and SPECT was 77% (73% to 82%) for all territories, with a higher concordance for the anterior wall of 84% (78% to 89%). Of the 203 patients recruited for the study, 38 (19%) had a cardiac event within 48 hours of ED presentation: 21 had acute myocardial infarction, 16 underwent an urgent revascularization procedure, and 1 died. In multivariate logistic regression models, the number of abnormal segments on CE and SPECT were significant predictors ( P < .05) of cardiac events. The composite scores on CE provided 17% incremental information ( P = .009, n = 203) and gated SPECT provided 23.5% additional information ( P = .020, n = 163) for predicting cardiac events compared with routine demographic, clinical, and electrocardiographic variables. RF and composite evaluation was superior on SPECT compared with CE, whereas PER alone was not. Conclusions Cardiac imaging of RF and PER at the time of ED presentation offers substantially greater diagnostic and prognostic information for early cardiac events in patients presenting to the ED with chest pain and no ST elevation than does the routine demographic, clinical, and electrocardiographic assessment.

Symptom-limited arm exercise increases detection of ischemia during dipyridamole tomographic thallium stress testing in patients with coronary artery disease

Exercise combined with dipyridamole during thallium stress testing in patients with coronary artery disease (CAD) increases the frequency of angina and ischemic ST changes in the electrocardiogram. Evidence for an increase in thallium abnormalities has been inconclusive. We prospectively examined 54 consecutive patients who underwent coronary angiography and tomographic thallium with dipyridamole (0.57 mg/kg) alone and combined with symptom-limited dynamic arm exercise. Most patients presented with a history of chest pain and 49 had angiographic evidence of significant coronary stenosis (50% diameter narrowing). Thallium abnormalities were scored blindly by consensus. The number of abnormal segments (total and ischemic) and indexes of left ventricular dysfunction, such as increased lung uptake or ischemic dilation, were compared in the 49 patients with CAD. During arm exercise more patients had evidence of ischemia (39 vs 30; p < 0.001), and the number of ischemic segments increased significantly from 1.3 ± 1.5 to 2.5 ± 2.2 (p < 0.001). There was also a significant increase in the indexes of left ventricular dysfunction, ischemic dilation (10 vs 4 patients; p < 0.03) and increased lung uptake (16 vs 5 patients; p < 0.001). Patients who exercised had increased thallium evidence of extent and severity of ischemia and more frequent indexes of left ventricular dysfunction. Thus, symptom-limited arm exercise improves detection of extent and severity of ischemia in patients with CAD undergoing dipyridamole thallium stress testing.

A comparison of adenosine and exercise stress 201Tl scintigraphy

A detailed comparison of stress thallium images utilizing exercise (symptom-limited bicycle ergonometer) and adenosine (infused at 50 micrograms kg-1 min-1 increasing by 25 micrograms kg-1 min-1 every 2 min to a maximum tolerated dose) was performed in 20 patients with angiographically documented coronary disease. Ten patients were receiving beta-blockade at the time of both tests. Triple-, double- and single-vessel disease was present in eight, seven and five patients, respectively. Exercise produced a large increase in double product (8970 +/- 288 to 20,-984 +/- 690 mm Hg min-1) while adenosine produced no significant change (8440 +/- 280 to 9086 +/- 600 mm Hg min-1). Each of the three gated planar images (anterior 40 degrees and 70 degrees left anterior oblique) was divided into five equal segments. Exercise produced 44/90, 44/95 and 45/95 abnormal segments in the anterior, 40 degrees and 70 degrees views while adenosine produced 53/100, 44/100 and 52/100 abnormal segments for the same views. The total number of abnormal segments was similar in both groups (133/280 exercise and 149/300 adenosine). Each abnormal segment was analysed for degree of change between stresses using a five-point scoring system. Exercise produced eight segments which were larger by one point and 44 segments larger by two points while adenosine produced 17 and 44 segments larger by one and two points respectively. Left ventricular uptake (as % injected dose) was significantly greater in the adenosine group (1.12 +/- 0.06% versus 0.64 +/- 0.05%, P < 0.01) but right ventricular uptake was similar (0.15 +/- 0.1% versus 0.14 +/- 0.09%).(ABSTRACT TRUNCATED AT 250 WORDS)

Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect: Study in 1,926 patients with foilow-up at 33 months

Objectives. This study was designed to assess the prognostic value of thallium-201 single-photon emission computed tomographic (thallium SPECT) perfusion imaging in patients evaluated for stable angina pectoris and to examine the relation, if any, between the preface and extent of myocardial defect and future fatal or nonfatal cardiovascular events (revascularization, secondary myocardial infarction).Background. Compared with planar scintigraphy, thallium SPECT enables better evaluation of the extent of mayocardial perfusion defect. However, its prognostic value has not yet been studied in a large population of patients.Methods. Between 1987 and 1989 we studied 3,193 patients. After exclusion of patients with unstable angina, myocardial infarction during the previous month or earlier revascularization, 1,926 patients were followed up for 33 ± 10 (mean ± SD) months after stress thallium SPECT imaging (performed after exercise in 1,121 patients or during dipyridamole infusion in 805 patients). Thallium SPECT imaging of the left ventricle was divided into six segments.Results. After normal thallium SPECT imaging (715 patients), the annual total and cardiovascular mortality rates were, respectively, 0.42%/year and 0.10%/year and were significantly higher after abnormal thallium SPECT imaging (respectively, 2.1%, relative risk 5, p = 0.012; 1.5%, relative risk 15, p < 0.0001 [log-rank test]). There was a significant relation between the number of abnormal segments and cardiovascular mortality during follow-up (p < 0.02) or the occurrence of nonfatal events (p < 0.001). The extent of defect on the initial scan provided the best SPECT variable for long-term prognosis. Thallium SPECT imaging provided additive prognostic information compared with other clinical variables (gender, previous myocardial infarction) and exercise electrocardiogram.Conclusions. In patients with stable angina, normal thallium SPECT imaging indicates a low risk patient, and the extent of myocardial defect is an important prognostic predictive factor.

Assessment of regional myocardial perfusion with thallium imaging during transient left anterior descending coronary arterial occlusion during angioplasty

To define the jeopardized territory perfused through a single coronary arterial stenosis, thallium-201, 2 mCi, was injected into the pulmonary artery at the onset of the last of a series of percutaneous transluminal coronary angioplasty (PTCA) balloon inflations in 10 patients with single-vessel left anterior descending coronary artery disease. Imaging was begun immediately after PTCA. Arterial thallium activity peaked 30 seconds after injection and decreased to 34 ± 6% (mean ± standard error of the mean) of peak activity at the time of balloon deflation. Regional thallium activity during exercise vs PTCA was scored qualitatively and quantitatively. A computer quantification program was used that permitted automatic realignment and normalization of the 2 initial thallium images. Only mean quantitative posterior activity was lower (93 ± 1% vs 86 ± 2%, p < 0.05) on exercise scans compared with PTCA scans. The other 5 segments showed no difference in mean scores. There were no qualitative differences in initial thallium distribution, nor were there qualitative or quantitative differences in the number of abnormal segments or severity of reduction in activity in the segment with the lowest activity. In conclusion, regional thallium myocardial distribution with a single severe stenoses with injection during peak exercise is similar to that after complete coronary occlusion.

Location of myocardial necrosis as an independent determinant of left ventricular performance: Analysis of 96 patients

This study determines whether the location of myocardial scarring has an effect independent of its size on left ventricular (LV) ejection fraction (EF) in patients with coronary artery disease. Two groups of patients were studied: Group I (n = 44) had resting thallium-201 perfusion defects involving the anterior wall or septum or both, and Group II (n = 52) had perfusion defects involving the inferior wall or posterior wall or both. The thallium images were divided into 5 segments in each of 3 projections, and the thallium score was determined from the number of abnormal segments and the degree of reduction of thallium uptake; the higher the score, the more severe the perfusion deficit. If the thallium score was <- 10, EF was 45 ± 14% (mean ± standard deviation) in Group I and 47 ±11% in Group II (p = not significant [NS]). If the thallium score was > 10, EF was 30 ± 12% in Group I and 32 ± 11% in Group II (NS). Similarly, EF was not significantly different between the 2 groups when the perfusion defects were assessed by the number of abnormal segments. In each group EF was significantly lower as the number of abnormal segments increased or as the thallium score was higher (p < 0.01). The results were unchanged when patients with resting ischemic defects or women were excluded. Thus, the location of myocardial scar itself is not important in determining LV function. However, the size of the scar is important in determining LVEF. Therefore, the fact that LVEF is lower in patients with anterior infarction than in those with inferior infarction must be related to the extent of muscle necrosis rather than to an anatomic factor.

A comparative study of two—dimensional echocardiography and systolic time intervals in the evaluation of left ventricular function in coronary heart disease

In this study, we attempt to analyze the data of two-dimensional echocardiography and systolic time intervals in 21 patients with documented coronary artery disease. No dysfunction of ventricular wall motion was found in any of the 4 patients with angina pectoris at rest. Abnormal segmental ventricular wall motions were observed in the other 17 patients with myocardial infarction. The apical region was involved in 13 cases and the dyskinesis accounted for 33.9 per cent of the total number of abnormal segments. Left ventricular wall motion index was closely correlated with systolic time intervals, including PEP, LVET and PEP/LVET. The correlation coefficients were-0.72, 0.85 and-0.80 respectively. It has been suggested that left ventricular wall motion index is a valuable one for evaluating left ventricular function and that systolic time intervals can reflect indirectly the presence and severity of abnormal ventricular segmental motion in patients with myocardial infarction.

The Effect of Collateral Circulation on Segmental Left Ventricular Contraction

The anatomy of the coronary circulation was correlated with left ventricular segmental contractile motion in 162 patients: 43 with normal coronary arteriograms, 119 with significant (&gt; 75%) obstruction of the right coronary artery and/or left anterior descending coronary artery. Collateral vessels were identified in 69% of the patients with coronary artery disease (82/119). The cases with collaterals were graded poor, fair, or good according to the number of vessels and the quality of opacification. Segmental contractile motion was determined angiographically by the percent shortening of each of the six chords of the left ventricle in the right anterior oblique projection. The range of normal shortening (mean ± one standard deviation) for each chord was established in the 43 normal patients as follows: [See Equation in PDF File] Patients were grouped according to the site of coronary artery obstruction and quality of collateral circulation to the area supplied by the obstructed coronary artery. The percent shortening and number of abnormal segments were determined for each patient; there was no consistent difference in segmental contraction between patients with and without collaterals. The quality of collateral vessels did not correlate with either the number of abnormal segments or the percent of chord shortening. In summary, the development of collateral vessels is not associated with the restoration of normal segmental wall motion in patients with coronary artery disease.