ABSTRACTS

TOE TEMPERATURE AS A PROGNOSTIC INDICATOR OF CIRCULATORY SHOCK Robert Henning, MD; Sergio Valdes, MD; Fred Wiener, Ph.D. ; Marcia Thompson, RN; Max Harry Weil, MD, FACC, University of Southern California, Los Angeles, California

Peripheral skin perfusion may be objectively assessed in patients in circulatory shock by the measurement of the gradient between toe and ambient temperatures (T-A). Thermistor probes were applied to the ventral surface of the first toe of each foot and were inserted into the rec- tum for a distance of at least 8 cm. Thermistor probes were also mounted at the bedside for ambient temperature monitoring. Toe, rectal, and ambient temperatures were measured at 15 min. intervals in 68 patients in shockdue to myocardial infarction (32), blood culture proven bac- teremia (21), and hypovolemia (15) with measured blood volume reduced to <70% of normal. Changes in T-A were compared to changes in intraarterial pressure, cardiac index, and arterial blood lactate. In 36 survi- vors, T-A increased 5.2C but only 1. 3C in 32 fatalities (p <. 001). T-A proved to be a better discriminator be- tween survivors and fatal cases in cardiogenic shock than blood lactate, cardiac index, or arterial pressure. In bacterial shock, T-A was comparable to arterial blood lactate in assessing the severity and likelihood of survival and significantly better than measurement of cardiac in- dex and arterial pressure. In the instances of hypovole- mic shock, T-A was comparable to measurements of arterial pressure and better than the measurement of cardiac output in distinguishing between survivors and fatal cases. When T-A was consistently 2C or less, the outcome was fatal. The T-A temperature gradient pro- vides an inexpensive, a uniquely simple, non-invasive, and quantitative indicator of the severity of cardiogenic shock.

THURSDAY, MARCH S, 1978 PM CLINICAL APPLICATION OF CARDlAC ISOTOPES 1:45 to 4:oo

TOMOCRAF’HIC MYOCARDIAL IMAGING WITH POSITRON EMITTING AGENTS Harischandra Karunaratne, MB; Paul Harper, MD; Sems Cantes, MD; Leon Resnekov, MB, FACC; Frank Atkins University of Chicago, Chicago, Illinois. We have utilized the potential tomographic character-

istics of detecting positron decay annihilatiop photons in coincidence by an imaging device consisting of two opposed uncollimated gamma cameras, to obtain myocardial tomograms and compare them with conventional gamma camera images in the same patient. In 5 patients with healing infarcts and 2 normal volunteers 300,000 count immediate consecutive tomographic images were compared with 201Tl images, containing the same number of counts. In 6 fur- ther patients with healing infarcts, 13NHq+ myocardial tomograms were compared with conventional gamma camera 13NHq+ images using tungsten collimation. Unprocessed *lRb myocardial tomograms were not superior to 201Tl images in detecting and delineating uptake defects. In 3 of the 6 patients with healing Infarcts studied with 13NHq+. uptake defects not seen in the conventional gamma camera images were visualized in the tomographic images. These additional defects were seen even in unprocessed back projection tomograms. With computer processing to remove out-of-focus data, the delineation and contrast of the tomographic images were markedly improved. Such pro- cessing also has the potential of quantitating the extent of myocardial uptake defects. It is concluded that posi- tron emission tomography of the heart--a) even when un- processed, gives myocardial images of at least comparable quality to conventional gamma scintigrams. and b) when processed, provides greatly improved contrast and delinea- tion of uptake defects.

PROGNOSTIC VALUE Of POSITIVE Tc99m PYROPHOSPHATE SCINTI- GRAMS IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Masood Ahmad, M.D.; K. William Logan, Ph.D.; Richard H. Martin, M.D., FACC. VA Hospital and University Medical Center, Columbia, Missouri.

We followed 30 patients (pts), age range 52-75 years, with acute myocardial infarction (MI) and positive Tc99m Pyrophosphate (Tc99m-PYP) myocardial scintigrams for a mean time of 25 months. None of the patients had pre- vious MI and all survived the initial hospitalization. We examined the long term prognostic significance of the positive scintigrams. Development of angina, congestive failure, ventricular arrhythmias and recurrent MI were listed as complications. The intensity of uptake in all scintigrams with 3+ to 4t. Based on the extent and pat- tern of uptake following types of scintigrams were iden- tified. Type A: uptake localized to one area; Type B: extensive uptake involving more than one area; Type C: doughnut pattern uptake; Type D: diffuse uptake. Data in various patient groups based on the type of scintigram are tabulated below:

Scintigram # of pts % Complications % Mortality Type A 11 45 0

" B 5 60 20 " c 6 lop 83 " D a 12 0

The high mortality rate in patients with a Type C scin- tigram as compared to patients with Types A and D was significant (pcO.001 Fisher's exact test). These data indicate a poor long term prognosis for patients with acute myocardial infarction and a doughnut shaped Tc99m- PYP uptake.

PROGNOSTIC IMPLICATIONS OF A TECEEETIDM-9Vm-PYEOPEOSPEATE

PEESISTENTLY POSITIVE MYOCMIDIAL SCIETIGEAM AFTEE

ACUTE! MYCCARDIAL INFARCTION Harold Olson, M.D.; Kenneth Lyone, M.D.; Wilbert Aronow, M.D., F.A.C.C.; Joan Orlando, M.D.; John Kuperum, M.S.; and David Hughes, M.D.; Univereity of California, Irvine

To asasss the independent prognostic value of teohne- tium-gym-pyrophosphate myooardial sointigraphy (PYPS) after acute myooaxdial infarction (AMI), 109 clinically stable ambulatory (31.1 f 43.3 weeks P

atiente (pts) had a PYPS 6-288 weeks after AMI. Of the 109 pta, 61 (56%)

had a positive PYPS (1ooaIieed pattern 30 pts, diffuse pattern 31 pta). At follow-up 4-89 weeks (49.8 + 21.1 weeks) after their PYPS, 11 of 109 pts (log6) had a osrdiac death, and 7 of the 109 pta (6%) had a nonfatal AMI. Ten of 61 pts (16%) with a positive Pyps had cardiac death corn arsd to 1 of 48 pts (2%) with a nega- tive PYPS (m,027. Six of 61 pts (10%) with a positive Pyps had a nonfatal AMI compared to 1 of 48 pts (2%) with a negative PYPS (P not eigaifioant). Of 61 pta with a positive PYPS, 16 (2696) had either cardiac death or non- fatal AMI compared to 2 of 48 pts (I&) with a negative PYPS (PuO.01). At follow-up, 34 of the 98 surviving pte

had either compensated oongestive heart failure or Functional Class III angina. Twenty-six of 51

pts (51%) with a positive PYPS had CSF or‘l?onotionsl Class III angina oompared to 8 of 47 pte (1%) with a negative PYPS (P&.001). We oonolude from our follow-up data that pts with a persistently positive PYPS follow- ing AMI have an increased incidence of severe angina, CEF, nonfatal AMI, and cardiac death.

440 February 1979 lfte American Journal of CARDIOLOGY Volume 41