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Nitrate-enhanced thallium 201 single-photon emission computed tomography imaging in hibernating myocardium

AMERICAN HEART JOURNAL 1999年第2期138卷 369-375页

作者： Oudiz, RJ Smith, DE Pollak, A Mena, I Shapiro, SM Ginzton, LE Narahara, KA Univ Calif Los Angeles Harbor Med Ctr Dept Med Div Cardiol Torrance CA 90509 USA Univ Calif Los Angeles Harbor Med Ctr Res & Educ Inst St Johns Cardiovasc Res Ctr Torrance CA 90509 USA

Objectives This study tested the usefulness ai nitrate-enhanced thallium 201 imaging for detecting myocardial viability. Background Previous work suggests that nitrates enhance the ability of Tl-201 imaging to detect viable myocardium. Methods Eighteen patients with coronary artery disease underwent Tl-201 imaging at rest, after 4 hours of redistribution, and during intravenous nitroglycerine infusion (mean dose = 5.96 +/- 5.37 mu g/kg/min). Twelve patients had their echocardiograms repeated after revascularization. Perfusion and wall motion were scored from 0 to 2 (absent to normal). Results all the regions identified or viable by the rest/redistribution pair of scans were identified as viable by the rest/nitroglycerine pair of scans. Ninety-one percent of these regions were identified as viable by the single nitroglycerine scan alone. In patients who underwent revascularization, the total Tl-201 perfusion score improved from 193 to 214 after revascularization (P =.009). Wall motion score improved from 151 to 168 after revascularization (P =.09). Both the rest/nitroglycerine and rest/redistribution studies correctly predicted 14 (88%) of 16 regions that improved after revascularization. Most importantly, the rest/nitroglycerine and rest/redistribution studies were able to predict postrevascularization myocardial viability (absence of akinesis or dyskinesis after revascularization), with a sensitivity of 95% and 92%, respectively, and a predictive accuracy of 84.4%. Conclusions Nitroglycerine infusion during Tl-201 imaging is a useful technique for detecting underperfused, viable myocardium, requires less time to perform than rest/redistribution imaging, and may allow detection of viable myocardium with a single Tl-201 single-photon emission computed tomographic study.

关键词：图像增强心肌顿抑/放射性核素显像硝酸甘油/诊断应用敏感性与特异性铊放射性同位素/诊断应用体层摄影术发射型计算机单光子血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Effect of low molecular weight heparin on coronary endothelial function in acute cellular heart transplant rejection

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期86卷 117-+页

作者： Schlaifer, JD Mills, RM Univ Florida Coll Med Div Cardiovasc Med Gainesville FL USA

Nine heart transplant recipients with cellular rejection were randomized to (1) treatment with low molecular weight heparin in addition to enhanced corticosteroids, or (2) enhanced corticosteroids alone. Compared with patients who received only enhanced corticosteroids, those who received low molecular weight heparin had a significant improvement in microvascular endothelial function.

关键词：乙酰胆碱/诊断应用抗凝药/治疗应用活组织检查血流速度/药物作用细胞分裂/药物作用冠状动脉循环/药物作用冠状血管/药物作用冠状血管/病理生理学冠状血管/超声检查药物疗法联合超声心动描记术多普勒内皮血管/药物作用内皮血管/病理学内皮血管/病理生理学依诺肝素/治疗应用糖皮质激素类/治疗应用移植物排斥/药物疗法移植物排斥/病理生理学心脏移植免疫抑制剂/治疗应用注射皮下甲泼尼龙/治疗应用治疗结果血管收缩/药物作用血管舒张药/诊断应用成年人老年人人类中年人

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Evaluation of coronary flow reserve in hypertensive patients by dipyridamole transesophageal Doppler echocardiography

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第3期86卷 305-308页

作者： Hamouda, MS Kassem, HK Salama, M El Masry, M Shaaban, N Sadek, E Khandheria, BK Seward, JB Elhendy, A Mayo Clin Echo Dept Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Tanta Univ Hosp Dept Cardiol Tanta Egypt

This study evaluates the coronary flow reserve (CFR) in hypertensive patients with and without left ventricular (LV) hypertrophy. CFR was assessed by transesophageal Doppler echocardiography in 15 normal subjects (group I), 21 hypertensive patients without LV hypertrophy (group II), and 27 hypertensive patients with LV hypertrophy (group III). All hypertensive patients were complaining of typical anginal pain and had normal coronary angiograms. The sample volume was placed at the bifurcation of the left main and left anterior descending coronary arteries. Coronary blood flow velocities were evaluated at rest, 2 minutes after dipyridamole infusion, and 2 minutes after intravenous aminophylline. The ratios of dipyridamole to rest peak diastolic and systolic velocities were considered as indexes of CFR. Peak diastolic velocity ratio was significantly lower in group III than in groups I and II (1.6 +/- 0.2 2.7 +/- 0.4, and 2.1 +/- 0.2, respectively p <0.05), and it was significantly lower in group II then I (p <0.05). The peek systolic velocity ratio was significantly lower in group III than in groups I and II (1.7 +/- 0.3, 2.8 +/- 0.3, and 2.1 +/- 0.2, respectively;p <0.05), and it was significantly lower in group II than I (p <0.05). The peak diastolic velocity ratio was inversely related to systolic blood pressure, diastolic blood pressure, and LV mass index (r = -0.48, -0.51, and -0.37 respectively) in hypertensive patients. It is concluded that CFR is significantly impaired in hypertensive patients, especially those with LV hypertrophy, compared with healthy subjects. The degree of impairment of CFR is related to LV mass index. (C) 2000 by Excerpta Medica, Inc.

关键词：心绞痛/病理生理学心绞痛/超声检查血流速度/生理学冠状动脉循环/生理学冠心病/病理生理学冠心病/超声检查心舒期/生理学双嘧达莫/诊断应用超声心动描记术多普勒超声心动描记术经食管高血压/病理生理学高血压/超声检查肥大左心室/病理生理学肥大左心室/超声检查输注静脉内心缩期/生理学血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Acute effects of a high-fat meal with and without red wine on endothelial function in healthy subjects

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第6期84卷 660-664页

作者： Djoussé, L Ellison, RC McLennan, CE Cupples, LA Lipinska, I Tofler, GH Gokce, N Vita, JA Boston Univ Sch Med Evans Mem Dept Med Prevent Med & Epidemiol Sect Boston MA 02118 USA Boston Univ Sch Med Whitaker Cardiovasc Inst Evans Mem Dept Med Boston MA 02118 USA Boston Univ Sch Publ Hlth Dept Epidemiol & Biostat Boston MA 02215 USA Beth Israel Deaconess Med Ctr Inst Prevent Cardiovasc Dis Boston MA USA

It has been suggested that a high-far meal may acutely impair endothelium-dependent vasodilation and that this impairment may be prevented by concomitant intake of antioxidants. Because red wine contains antioxidant polyphenols and may reduce cardiovascular disease, we examined the effect of red wine on postprandial endothelial function. Using a crossover design, 13 healthy volunteers consumed a high-fat meal (0.8 g fat/kg body weight) with red wine (3 ml/kg) or an isocaloric control beverage on 2 separate days, 1 week apart. Flow-mediated dilation of the brachial artery wets examined by vascular ultrasound at baseline and at 2, 4, and 6 hours after the meal. At these times, flow-mediated dilation with the high-fat meal and control beverage was 9.5 +/- 5.0%, 7.9 +/- 5.1%, 6.8 +/- 3.6%, and 7.3 +/- 4.6%,respectively (nonsignificant trend). There was also a nonsignificant trend for flow-mediated dilation after the high-fat meal with wine: 8.0 +/- 4.1%, 5.7 +/- 4.7%, 6.4 +/- 3.1%, and 6.9 +/- 3.8%, respectively. There was no difference in the effects between wine and the control beverage (p = 0.77). Triglycerides increased 2- to 2.7-fold over baseline (p = 0.0001) with a peak occurring 5 hours after the high-fat meals. In contrast to previous studies, the present study did not demonstrate a significant effect of a high-fat meal on endothelial vasomotor function in healthy subjects. Under these conditions, we did not demonstrate a beneficial acute effect of red wine on endothelial function. (C) 1999 by Excerpta Medico, Inc.

关键词：血流速度/药物作用肱动脉/药物作用肱动脉/超声检查交叉研究膳食脂肪类/代谢超声心动描记术多普勒脉冲内皮血管/药物作用硝酸甘油/诊断应用血管阻力/药物作用血管舒张药/诊断应用葡萄酒成年人女(雌)性人类男(雄)性

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Safety, feasibility, and prognostic implications of pharmacologic stress echocardiography in 1482 patients evaluated in an ambulatory setting

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AMERICAN HEART JOURNAL 2001年第4期141卷 621-629页

作者： Cortigiani, L Picano, E Coletta, C Chiarella, F Mathias, W Gandolfo, N De Alcantara, M Mazzoni, V Gensini, GF Landi, P Osped Campo Marte Unita Operat Malattie Cardiovasc I-55032 Lucca Italy CNR Inst Clin Physiol I-56100 Pisa Italy Santo Spirito Hosp Div Cardiol Rome Italy Galliera Hosp Div Cardiol Genoa Italy Hosp Unicor Sao Paulo Brazil Sao Paulo Sch Med Sao Paulo Brazil Mauriziaro Hosp Div Cardiol Turin Italy PROECHO Rio De Janeiro Brazil S Giuseppe Hosp Div Cardiol Empoli Italy Univ Florence Internal Med Cardiol Dept I-50121 Florence Italy

Background The outpatient prognostic assessment of coronary artery disease (CAD) by exercise electrocardiography has limitations, including the feasibility of the test and its low positive predictive value in several clinical conditions, In the current study we investigated the safety, feasibility, and prognostic value of pharmacologic stress echocardiography in a large cohort of ambulatory patients. Methods The study group was mode of 1482 ambulatory patients (969 men, aged 60 +/- 10 years) who underwent stress echocardiography with either dipyridamole (n = 846) or dobutamine (n = 636) for evaluation of suspected or known stable CAD. The pretest likelihood of CAD was intermediate (<70%) in 709 patients and high (70%) in 773 patients. Results There was no complication during the dipyridamole test, whereas 2 ischemia-dependent, sustained ventricular tachycardias occurred during the dobutamine test. Limiting side effects were observed in 2% of dipyridamole and in 3% of dobutamine stresses. The echocardiogram was positive in 459 patients. During a mean follow-up of 28 +/- 24 months, 58 patients died, 33 had a nonfatal myocardial infarction, and 158 underwent early (less than or equal to3 months) and 64 late (>3 months) revascularization. Multivariate predictors of hard events (death, infarction) were positive echocardiographic results (hazard ratio [HR] 2.9) and resting wall motion score index (WMSI) (HR 2.3). In considering major events (death, infarction, late revascularization) as end points, positive echocardiographic result (HR 4.3), scar (HR 2.2), and resting WMSI (HR 1.7) were independent prognostic predictors. The 5-year survivor rates for the ischemic and nonischemic groups were, respectively, 80% and 91% (HR 3.6, 95% confidence interval [CI] 3.8-8.4;P < .0001) considering hard cardiac events and 65% and 88% (HR 2.6, 95% Cl 2.1-5.9;P < .0001) considering major events. Multivariate predictors of major events were positive echocardiogra

关键词：门诊医疗冠心病/超声检查双嘧达莫/诊断应用多巴酚丁胺/诊断应用心电描记术运动试验可行性研究试验预期值预后危险因素血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Comparison and combination of dipyridamole and dobutamine during echocardiography with thallium scintigraphy to improve viability detection

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第1期83卷 6-10页

作者： Sicari, R Varga, A Picano, E Borges, AC Gimelli, A Marzullo, P CNR Inst Clin Physiol I-56100 Pisa Italy

The aim of this study was to investigate the relation between radioisotopic and echocardiographic markers of myocardial viability and their correlation with functional recovery after coronary revascularization. Myocardial viability can be detected by techniques exploring various aspects of cell physiology: thallium-201 scintigraphy and dobutamine and dipyridamole echocardiography focus on cell membrane integrity, beta-l and adrenoceptor, and A2-adenosine receptor-mediated inotropic response, respectively. Fifty-seven patients (mean age 60 +/- 8 years) with previous myocardial infarction (>3 months), angiographically assessed coronary artery disease, and resting regional dysfunction underwent rest-redistribution 201-thallium scintigraphy and low-dose pharmacologic stress echo with dobutamine (up to 10 mu g/kg/min), very low dose regimen of dipyridamole (0.28 mg/kg over 4 minutes), and combined dipyridamole-dobutamine. Criteria for viability in a 13-segment model for both techniques were percent peak activity in redistribution images >55% for thallium-201 and a decrease in wall motion score >1 grade (1 [normal] to 4 [dyskinetic]) for stress echo. Thirty patients underwent coronary revascularization (bypass surgery in 8, angioplasty in 22) and were followed up at 4 weeks from intervention with a resting echocardiogram. The rate of agreement between thallium-201 and stress echo was 63% for dipyridamole, 66% for dobutamine, and 74% for combined dipyridamole-dobutamine (p <0.05 vs dipyridamole and dobutamine). In the 30 patients who underwent revascularization, a regional resting dyssynergy was observed in 225 segments, assuming that postrevascularization functional recovery (which occurred in 126 segments) was the gold standard;combined dipyridamole-dobutamine showed a higher sensitivity (90% confidence interval [CI] 85% to 95%) than thallium-201, dobutamine, or dipyridamole (87%, CI 81% to 92%;82%, CI 76% to 89%;and 82%, CI 76% to 89%, respectively). Specificity was low

关键词：强心药/诊断应用冠心病/放射性核素显像冠心病/超声检查双嘧达莫/诊断应用多巴酚丁胺/诊断应用超声心动描记术/方法随访研究试验预期值放射性核素心室显像术/方法敏感性与特异性铊放射性同位素/诊断应用血管舒张药/诊断应用人类

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Specificity of the stress electrocardiogram during adenosine myocardial perfusion imaging in patients laking digoxin

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AMERICAN HEART JOURNAL 2000年第6期140卷 937-940页

作者： Hart, CYT Miller, TD Hodge, DO Gibbons, RJ Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Div Biostat Rochester MN 55905 USA

Background In patients taking digoxin, the exercise electrocardiogram has a lower specificity For detecting coronary artery disease. However, the effect of digoxin on adenosine-induced ST-segment depression is unknown. The purpose of this study was to evaluate the specificity of the electrocardiogram during adenosine myocardial perfusion imaging in patients taking digoxin. Methods Between May 1991 and September 1997, patients (n = 99) taking digoxin who underwent adenosine stress imaging with thallium-201 or technetium-99m sestamibi and coronary angiography within 3 months were retrospectively identified. Exclusion criteria included prior myocardial infarction, coronary artery angioplasty or bypass surgery, left bundle branch block, paced ventricular rhythm, or significant valvular disease. Twelve-lead electrocardiograms were visually interpreted at baseline, during adenosine infusion, and during the recovery period. The stress electrocardiogram was considered positive if there was greater than or equal to1 mm additional horizontal or downsloping ST-segment depression or elevation 0.08 seconds after the J-point compared with the baseline tracing. Results ST-segment depression and/or elevation occurred in 24 of 99 patients. There were only 2 false-positive stress electrocardiograms, yielding a specificity of 87% and positive predictive value of 92%. All 8 patients with greater than or equal to2 mm ST-segment depression had multivessel disease by coronary angiography. Conclusions ST-segment depression or elevation during adenosine myocardial perfusion imaging in patients taking digoxin is highly specific for coronary artery disease. Marked (greater than or equal to2 mm) ST-segment depression and/or ST-segment elevation is associated with a high likelihood of multivessel disease.

关键词：腺苷/投药和剂量腺苷/诊断应用心房颤动/并发症心房颤动/药物疗法强心药/治疗应用冠心病/并发症冠心病/诊断冠心病/病理生理学诊断鉴别地高辛/治疗应用心电描记术便携式/药物作用心电描记术便携式/方法运动试验输注静脉内放射性核素心室显像术可重复性结果回顾性研究敏感性与特异性疾病严重程度指数血管舒张药/投药和剂量血管舒张药/诊断应用老年人女(雌)性人类男(雄)性

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Reproducibility of head-up tilt testing potentiated with sublingual nitroglycerin in patients with unexplained syncope

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第3期84卷 284-288页

作者： Foglia-Manzillo, G Giada, F Beretta, S Corrado, G Santarone, M Raviele, A Osped Gen Valduce Serv Cardiol Dept Cardiol I-22100 Como Italy Osped Gen Valduce Dept Neurol I-22100 Como Italy Osped Umberto 1 Dept Cardiol Mestre Italy

Head-up tilt testing (HUTT) potentiated with sublingual nitroglycerin has gained acceptance as means of diagnosing neurally mediated syncope. To evaluate the reproducibility of HUTT potentiated with sublingual nitroglycerin, 48 patients with unexplained syncope prospectively underwent 2 consecutive tests 1 to 28 days apart. The initial test ended in syncope in 34 patients (71%). In 9 patients (19%) the test was positive during the drug-free phase, whereas 25 patients (52%) had syncope after nitroglycerin administration. Of these 34 patients with an initial positive test result, 27 (79%) had a reproducible outcome on repeat testing. Of 12 patients (25%) with an initial negative test result, 10 (83%) had a reproducible outcome on repeat testing. Of 2 patients (4%) with a first test ending in exaggerated response, both had a negative repeat test response. The overall reproducibility of sublingual nitroglycerin tilt-table testing was 77%. In a group of 23 patients with both positive tests, 19 (83%) had the same response modality (2 vasodepressor, 4 cardioinhibitory, 13 mixed response). In the same group of patients, individual trough heart rates correlated well with each other between tests. Finally, in the 27 patients with both positive tests, intrapatient time of onset of symptoms did not significantly correlate between tests. Thus, in patients with syncope of unknown origin, HUTT potentiated with sublingual nitroglycerin provides an adequate reproducibility when repeated on different days. (C) 1999 by Excerpta Medico, Inc.

关键词：投药舌下诊断鉴别硝酸甘油/投药和剂量硝酸甘油/诊断应用可重复性结果晕厥/病因学倾斜台试验/方法时间因素血管舒张药/投药和剂量血管舒张药/诊断应用青少年成年人老年人儿童女(雌)性人类男(雄)性中年人

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Plasma adrenomedullin levels in the coronary circulation in vasospastic angina pectoris

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第5期85卷 656-+页

作者： Kamiya, H Okumura, K Sone, T Tsuboi, H Kondo, J Mukawa, H Matsui, H Toki, Y Ito, T Hayakawa, T Nagoya Univ Sch Med Showa Ku Nagoya Aichi 4668550 Japan Ogaki Municipal Hosp Dept Cardiol Ogaki Japan

This study evaluated the role of adrenomedullin in patients with vasospastic nagina pectoris. Adrenomedullin may be involved in regulating a basal tone of the coronary artery in these patients.

关键词：乙酰胆碱/诊断应用肾上腺髓质素心绞痛变异型/血液心绞痛变异型/病因学降钙素基因相关肽/血液病例对照研究冠状动脉循环肽类/血液肽类/生理学试点项目血管舒张药/血液血管舒张药/诊断应用老年人女(雌)性人类男(雄)性

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Usefulness of tilt test-induced patterns of heart rate and blood pressure using a two-stage protocol with glyceryl trinitrate provocation in patients with syncope of unknown origin

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AMERICAN JOURNAL OF CARDIOLOGY 1999年第6期84卷 665-670页

作者： Kurbaan, AS Franzén, AC Bowker, TJ Williams, TR Kaddoura, S Petersen, MEV Sutton, R Univ London Imperial Coll Sci Technol & Med St Marys Hosp Dept Cardiol London W2 1NY England Univ London Imperial Coll Sci Technol & Med Chelsea & Westminster Hosp London W2 1NY England Gloucestershire Royal Hosp Gloucester GL1 3NN England

This study assesses the vasovagal collapse pattern changes, i.e, heart rate (HR) and arterial blood pressure (BP) with a 2-stage tilt-test protocol using glyceryl trinitrate (GTN) provocation. With use of the 45-minute 60 degrees head-up Westminster protocol, 102 consecutive patients were studied. Sublingual GTN 300 mu g was given to those with a negative passive tilt. Heart rate and BP patterns were classified according to the Vasovagal International Study classification (VASIS)and then compared between those with a positive passive tilt and those with a positive tilt after having been given GTN. Twelve patients did not. tolerate tilt testing, and 16 herd a negative response despite taking GTN. Thirty-five patients (20 women and 15 men, mean age 45 +/- 21 years [mean +/- SD]) did not take GTN and 38 (26 women and 12 men, mean age 53 +/- 22 years) had positive passive test results. When comparing the VASIS classification between the 2 groups, results showed: type 1, mixed BP and HR decreased without severe bradycardia (31% [passive] vs 54% [with GTN], p = NS);type 2A, BP decreased before HR decreased (20% vs 22%, p = NS);type 2B, HR decreased before or coincident with BP (34% vs 8%, p = 0.003);type 3, BP decreased without HR decrease (9% vs 0%, p = NS);exception 1, chronotropic incompetence (0% vs 13%, p = 0.026);and exception 2, excessive HR increase (6% vs 3%, p = NS). Thus, GTN use increases frequency of positive results from 34% to 73%. Older people with chronotropic incompetence, who may benefit from pacing, were identified. In younger people there was an increase in those with cardioinhibition. (C) 1999 by Excerpta Medica, Inc.

关键词：投药舌下年龄因素血压/生理学诊断鉴别心率/生理学硝酸甘油/诊断应用性别因素晕厥血管迷走神经性/诊断晕厥血管迷走神经性/病理生理学倾斜台试验血管舒张药/诊断应用青少年成年人老年人老年人 80以上儿童女(雌)性人类男(雄)性中年人

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