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

AMERICAN JOURNAL OF CARDIOLOGY 2000年第8期85卷 1007-1011页

作者： Del Rosso, A Bartoletti, A Bartoli, P Ungar, A Bonechi, F Maioli, M Ieri, A Osped San Pietro Igneo Div Cardiol Fucecchio Italy Osped Santa Maria Annunziata Div Cardiol Florence Italy Univ Florence Inst Geriatr & Gerontol Inst Florence Italy

Shortened head-up tilt testing (HUT) potentiated with sublingual nitroglycerin (60 degrees passive standing for 20 minutes followed, if negative, by 400 mu g of sublingual nitroglycerin spray with the test continuing for another 20 minutes) differs from conventional nitroglycerin HUT for a shorter drug-free phase (20 vs. 45 minutes). To compare the positivity rate of the 2 protocols, both tests were performed in a randomized sequence in 10 patients with unexplained syncope (study 1), and another 42 patients were randomly assigned either to conventional or to shortened nitroglycerin HUT (study 2). To evaluate the reproducibility of the shortened nitroglycerin HUT, another 38 patients with unexplained syncope underwent 2 consecutive tests within a 7 +/- 8 day interval (study 3). Finally, to evaluate the specificity of the test, 47 control subjects underwent shortened nitroglycerin HUT (study 4). Seven positive responses were observed during shortened nitroglycerin HUT, and there were 8 positive responses during conventional nitroglycerin HUT (p = NS) in the study 1 group. Fifteen positive (71%) responses, 5 negative responses, and 1 exaggerated response were observed during shortened nitroglycerin HUT;16 positive (76%, p = NS vs shortened nitroglycerin HUT), 3 negative, and 2 exaggerated responses were observed during conventional nitroglycerin HUT in the study 2 group. During the first test, 21 patients (55%) had a positive, 15 patients had a negative, and 2 patients had an exaggerated response in study group 3. During the second test, 15 positive (39%), 19 negative, and 4 exaggerated responses were observed. Thus, the reproducibility was 67% for a positive and 94% far a negative test. In control subjects, 2 positive (4%) responses, 38 negative, and 7 exaggerated responses were observed with a specificity of 96% in study group 4. In patients with unexplained syncope, shortened nitroglycerin HUT allowed a positivity rate similar to that of the conventional test. Moreo

关键词：投药舌下硝酸甘油/投药和剂量硝酸甘油/诊断应用可重复性结果敏感性与特异性晕厥/诊断晕厥/病因学倾斜台试验/方法血管舒张药/投药和剂量血管舒张药/诊断应用成年人女(雌)性人类男(雄)性

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Dipyridamole administration at the end of an insufficient exercise Tc-99m MIBI SPECT improves detection of multivessel coronary artery disease in patients with previous myocardial infarction

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第5期85卷 532-535页

作者： Candell-Riera, J Santana-Boado, C Castell-Conesa, J Aguadé-Bruix, S Bermejo-Fraile, B Soler-Soler, J Hosp Gen Univ Vall dHebron Serv Cardiol Barcelona 08035 Spain Hosp Gen Univ Vall dHebron Nucl Med Serv Barcelona 08035 Spain Hosp Gen Univ Vall dHebron Serv Med Preventiva Barcelona 08035 Spain

To demonstrate that the administration of dipyridamole at the end of an insufficient maximal subjective exercise test can improve the diagnostic accuracy of single-photon emission computed tomography in patients with previous myocardial infarction, 209 consecutive patients were studied with technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography and coronary angiography, Patients were divided in 3 groups: group 1, 107 patients with sufficient exercise testing;group 2, 55 patients with insufficient exercise testing;group 3, 47 patients with insufficient exercise testing in whom intravenous dipyridamole (0.56 mg/kg aver 4 minutes) was administered at the end of exercise. In groups 1 and 3 the sensitivity values for the diagnosis of multivessel disease were significantly higher (80% and 76%, respectively) than those in group 2 (59% [p = 0.009 and p = 0.02, respectively]). Specificity and predictive values were not different among the 3 groups. Thus, in patients with previous infarction in whom adequate levels of exercise could not be achieved, dipyridamole administration at the end of exercise significantly increased the sensitivity for diagnosing multivessel disease. (C)2000 by Excerpta Medica, Inc.

关键词：病例对照研究冠心病/并发症冠心病/流行病学冠心病/放射性核素显像双嘧达莫/投药和剂量双嘧达莫/诊断应用运动试验心脏导管插入术心肌梗死/并发症试验预期值前瞻性研究放射性药物/诊断应用敏感性与特异性 99m锝甲氧基异丁基异腈/诊断应用体层摄影术发射型计算机单光子血管舒张药/投药和剂量血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Serum cholesterol level, cigarette smoking, and vasomotor responses to L-arginine in narrowed epicardial coronary arteries

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期85卷 500-503页

作者： Tentolouris, C Tousoulis, D Davies, GJ Stefanadis, C Toutouzas, P Univ London Imperial Coll Sci Technol & Med Sch Med Cardiol Unit Hammersmith Hosp London W12 0NN England Univ Athens Sch Med Cardiol Unit Hippokrat Hosp GR-11527 Athens Greece

It has been shown that infusion of L-arginine into the brachial artery augments endothelium-dependent forearm vasodilation and reverses the defective endothelium-dependent vasodilation associated with an elevated plasma low-density lipoprotein level or hypercholesterolemia.1–3 L-arginine administration improves the coronary blood flow response to acetylcholine in patients with normal coronary arteries and hypercholesterolemia.3 It enhances nitric oxide generation and inhibits lesion formation after balloon angioplasty.4,5 A recent study showed vasodilation of coronary stenoses with intracoronary L-arginine, and another demonstrated that L-arginine improves flow-mediated dilation in hypercholesterolemic subjects and smokers, but not in diabetic subjects.6–8 In this study we therefore have investigated the impact of smoking and hypercholesterolemia on the vasomotor effects of L-arginine in epicardial coronary arteries in patients with stable angina and coronary artery disease.

关键词：精氨酸/投药和剂量精氨酸/诊断应用生物学标记/血液胆固醇/血液冠状血管造影术冠状血管/药物作用冠状血管/病理生理学运动试验高胆固醇血症/血液高胆固醇血症/并发症注射动脉内硝酸甘油/投药和剂量硝酸甘油/诊断应用预后血管舒张/药物作用血管舒张药/投药和剂量血管舒张药/诊断应用女(雌)性人类男(雄)性中年人

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Comparison of nitroglycerin magnetic resonance imaging with dobutamine echocardiography for predicting recovery of function after revascularization

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第10期85卷 1250-+页

作者： Martinez, RR Bennett, J Eikman, EA Fontanet, HL Sayad, DE Univ S Florida Dept Internal Med Div Cardiovasc Tampa FL 33612 USA Univ S Florida Dept Radiol Tampa FL 33612 USA Tampa VAMC Tampa FL USA

Nitroglycerin magnetic resonance imaging provides a novel assessment of regional contractile reserve and predicts improvement in end-systolic wall thickness after revascularization. Nitroglycerin magnetic resonance imaging was superior to dobutamine echocardiography in identifying segments that improved in function after revascularization.

关键词：血管成形术经腔经皮冠状动脉强心药/诊断应用冠状动脉分流术冠心病/分类冠心病/诊断冠心病/治疗多巴酚丁胺/诊断应用超声心动描记术/方法磁共振成像/方法硝酸甘油/诊断应用试验预期值预后治疗结果血管舒张药/诊断应用成年人老年人人类男(雄)性中年人

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Formation of platelet aggregates after attacks at coronary spastic angina pectoris

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期85卷 494-497页

作者： Miyamoto, S Ogawa, H Soejima, H Takazoe, K Sakamoto, T Yoshimura, M Kugiyama, K Yasue, H Kumamoto Univ Sch Med Dept Cardiovasc Med Kumamoto 8608556 Japan

In the present study, using a novel laser-light scattering method, we examined platelet aggregability at baseline and after spontaneous coronary spastic attacks in patients with coronary spastic angina, and before and after acute myocardial ischemia induced by an exercise test in patients with stable exertional angina. We also compared the results with the data from the conventional optical density method.

关键词：乙酰胆碱/投药和剂量乙酰胆碱/诊断应用心绞痛变异型/血液心绞痛变异型/诊断心绞痛变异型/病因学冠状血管造影术冠状动脉血栓形成/血液冠状动脉血栓形成/并发症冠状动脉血栓形成/诊断冠状血管心电描记术运动试验心脏导管插入术注射动脉内血小板聚集/生理学预后血管舒张药/投药和剂量血管舒张药/诊断应用成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Hyperdynamic circulation in liver cirrhosis: No evidence for peripheral vasodilation detected by ultrasound of the brachial artery

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第2期95卷 551-552页

作者： Gaenzer, H Sturm, W Neumayr, G Vogel, W Patsch, J Univ Innsbruck Hosp Dept Internal Med A-6020 Innsbruck Austria Univ Innsbruck A-6020 Innsbruck Austria

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

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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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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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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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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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