Scintigraphic Demonstration of Tracheo-Esophageal Fistula LAO RAO
Thallium-201 scintigraphic evidence of ischemia in patients with myocardial bridges
1
ABSTRACTS COMPARISON OF PLANAR AND TOMOGRAPHIC THALLIUM-201 SCINTI- THALLIUM-201 SCINTIGRAPHIC EVIDENCE OF ISCHEMIA IN GRAMS FOLLOWING CORONARY VASODILATATION WITH DIPYRIDAMOLE PATIENTS WITH MYOCARDIAL BRIDGES Dan Francisco, MD; Raymundo Go, MD; Steve Collins, Ph.D; Masood Ahmad, MD; Steven L. Merry, MD; Helmut Haibach,MD, James Ehrhardt, Ph.D; Melvin Marcus, MD, FACC, University Veterans Administration and University Hospitals, of Iowa, Iowa City, Ia. Columbia, MO. The sensitivity and specificity of quantitative rnyocardi- al tomographic perfusion imaging was compared to planar thallium-201 (Tl2OI) ima es in 43 patients (pts) with coronary artery disease 9 CAD) defined as 70% obstruction or > in one or more vessels by arteriography (26-3VSD, 9- PVSD and 6-1VSD) and 17 pts with insignificant CAD (~30% obstruction in any vessel). Pts with coronary obstructions between 30-70% or systolic compression were excluded be- cause they probably represented a "gray zone". Coronary dilation was induced by dipyridamole (0.15 mg/kg/min i.v. x 4 min) which was well tolerated by all pts. The tomo- grams (7 pinhole collimator) were analyzed with an ap- proach similar to the CIRCLE program. The tomograms of CAD pts were considered abnormal if they exceeded the normal ranqe based on 16 normal pts (one obvious false positive excluded) at one or more points. Results: Tomographic Tl2OI Planar Tl2OI Sensitivity 39143 91% 35/43 81% Specificify 16/17 94% 11/17 65% Of the 18 pts with normal resting ventriculograms, the planar and tomographic images were positive in 61% and 78% respectively. In CAD pts with abnormal ventricles, the planar and tomographic images were positive in 96% and lOO%, respectively. In the 5 pts with CAD who also had left main obstruction, 5 of 5 tomograms were positive whereas 4 of 5 lanar images were positive. Conclusion: Tomographic T12gI perfusion scintigrams following coron- ary vasodilatation with dipyridamole are apparently more sensitive and specific in the detection of CAD than pla- nar images, particularly in pts with normal ventricular function at rest. DETECTION OF MULTIVESSEL DISEASE BY EXERCISE THALLIUM-201 SCINTIGRAPHY. George A. Belier, MD,FACC; Denny D. Watson, PhD; Bruce C. Berger, MD; Randolph P. Martin, MD; George J. Taylor, MD.; University of Virginia, Charlottesville, Vs. The goal of this study was to determine the accuracy of quantitative 201~~ exercise scintigraphy for predicting multivessel disease (VD) in 91 consecutive patients (pts) referred for angiography. 2olTL at peak exercise. All pts received 1.5 mCi of Images ;;;e obtained serially over 2% hrs. Abnormal regional TL uptake was ascer- tained by quantitative criteria applied to multiple scan segments (segs) corresponding to the vascular supply of the 3 major coronary arteries. Abnormal myocardial segs were defined as 1))225% persistent reduction in 2olTL uptake; 2) An initial defect with redistribution and 3) Abnormal 201TL washout. A coronary stenosis of >,50% was considered significant. Of 20 pts with angiographically normal coronary arteries, 2 were predicted to have 1VD (false positives). Of 18 pts with lVD, 12 had abnormal- ities appropriate to the single diseased vessel and 5 were predicted to have 2VD. All five 2VD readings were in the distribution of circumflex (Cx) and right coronary artery (RCA) segs, when only one of these vessels was diseased. The remaining pt had a normal scan. Of 20 pts with 2VD, 12 had abnormal segs confined to the 2 diseased vessels. 5 had anbormal segs confined to i vessel, and one had a normal scan. Of 25 pts with 3VD, 10 had abnor- mal scan segs in the distribution of all 3 vessels, 12 had abnormal segs appropriate to 2 diseased vessels and 1 had a single abnormal vascular seg. Two pts with 3VD had normal scans. Thus in 45 pts with 2 or 3VD, 36 demonstrated abnormal 2l31 TL uptake and/or washout in at least 2 vascular segs, yielding an 80% sensitivity for 2 or 3VD prediction. The lower specificity of 67% appears related to the inability to separate Cx and RCA vascular segs. 482 February 1980 The American Journal of CARDIOLOGY Volume 45 The role of myocardial bridges in producing ischemia is not clear. We studied 7 male patients (age range 45-63 years) with chest pain syndromes and cineangiographically documented systolic coronary artery narrowing due to myocardial bridges. All patients had 750% systolic coronary artery narrowing in the proximal left anterior descending vessel. None of the patients had evidence of significant atherosclerotic coronary disease, resting left ventricular wall motion abnormality, and/or mitral valve prolapse. Myocardial perfusion was evaluated at rest and during exercise by performing Thallium-201 myo- cardial scintigraphy. None of the patients had electro- cardiographic evidence of ischemia during or after exer- cise. Three patients with <75% systolic coronary artery narrowing had a normal resting and exercise Thallium-201 scintigram. In 3 of 4 patients with 775% systolic coronary artery narrowing, exercise induced perfusion deficits were observed in the distribution of the vessel. One of these 3 patients also developed chest pain on exercise. We conclude that a 775% systolic coronary artery narrowing may impair myocardial perfusion during exercise. In comparison to exercise electro- cardiography, Thallium-201 myocardial imaging appears to be more sensitive in detecting an abnormal response in these patients. REVERSIBILITY OF ADRIAMYCIN INDUCED REDUCTION IN MYOCAR- DIAL THALLIUM-201 UPTAKE BY INTRAVENOUS DIGOXIN David Forst, MD; Sherman Sorensen, MD; Robert O'Rourke,Mb FACC; Tuhin Chaudhuri, MD, University of Texas Health Science Center and Veterans Administration Hospital, San Antonio, Texas. The anthracycline antibiotic Adriamycin(AD) is a highly effective antineoplastic agentwhichmay produceacuteand chronic cardiac toxicity.Observationsthat AD is a glyco- side with cardiac effectsthatsimulate andmaybe altered by Digoxin (D) suggest a mechanism ofactioninvolving the Na-K pump.Totest this hypothesis,wequantitated myocar- dial uptake of thepotassiumanalog,Thallium-201 (TL), by whole heart imaging and sectioned heart well-counting (t-=.95).NewZealand rabbits were given IVTL (.12mCi/kg) without AD(control)and 5 min(AD-5),24 hrs (AD-24)and 48 hrs (AD-48) after IVAD (3mg/kg). TL uptake was quanti- tated as counts/sec/mCi/gm heart tissue. Mean (iSEM) normalized counts were: N Counts P Control 9 120?4 AD5 9123 .OOl AD24 : 77+5 .OOl AD48 5 112+9 NS Another group of rabbits received IV digoxin(D-24)or IV digoxin (0.29mg/kg) followed 1 hour later by IV AD(D-24AD) withTLuptake measured24hours later.Mean (+SEM)normal- ized counts and diqoxin levels were: N Counts P Serum Digoxin (ng/ml) Control 9 120?4 1 hrpD 24 hrPD D24AD z 123?10 NS D 129+7 ;*;:*;; NS ::;z NS Thiz.1) Adriamvcin causes an acute reversible deoression in myocdrdial Tiuptake that is prevented by pretreatment with digoxin. 2) Adriamycin may affect the myocardial Na-K pump.
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Transcript of Thallium-201 scintigraphic evidence of ischemia in patients with myocardial bridges
ABSTRACTS
COMPARISON OF PLANAR AND TOMOGRAPHIC THALLIUM-201 SCINTI- THALLIUM-201 SCINTIGRAPHIC EVIDENCE OF ISCHEMIA IN GRAMS FOLLOWING CORONARY VASODILATATION WITH DIPYRIDAMOLE PATIENTS WITH MYOCARDIAL BRIDGES Dan Francisco, MD; Raymundo Go, MD; Steve Collins, Ph.D; Masood Ahmad, MD; Steven L. Merry, MD; Helmut Haibach,MD, James Ehrhardt, Ph.D; Melvin Marcus, MD, FACC, University Veterans Administration and University Hospitals, of Iowa, Iowa City, Ia. Columbia, MO.
The sensitivity and specificity of quantitative rnyocardi- al tomographic perfusion imaging was compared to planar thallium-201 (Tl2OI) ima es in 43 patients (pts) with coronary artery disease 9 CAD) defined as 70% obstruction or > in one or more vessels by arteriography (26-3VSD, 9- PVSD and 6-1VSD) and 17 pts with insignificant CAD (~30% obstruction in any vessel). Pts with coronary obstructions between 30-70% or systolic compression were excluded be- cause they probably represented a "gray zone". Coronary dilation was induced by dipyridamole (0.15 mg/kg/min i.v. x 4 min) which was well tolerated by all pts. The tomo- grams (7 pinhole collimator) were analyzed with an ap- proach similar to the CIRCLE program. The tomograms of CAD pts were considered abnormal if they exceeded the normal ranqe based on 16 normal pts (one obvious false positive excluded) at one or more points. Results:
Tomographic Tl2OI Planar Tl2OI Sensitivity 39143 91% 35/43 81% Specificify 16/17 94% 11/17 65% Of the 18 pts with normal resting ventriculograms, the planar and tomographic images were positive in 61% and 78% respectively. In CAD pts with abnormal ventricles, the planar and tomographic images were positive in 96% and lOO%, respectively. In the 5 pts with CAD who also had left main obstruction, 5 of 5 tomograms were positive whereas 4 of 5 lanar images were positive. Conclusion: Tomographic T12gI perfusion scintigrams following coron- ary vasodilatation with dipyridamole are apparently more sensitive and specific in the detection of CAD than pla- nar images, particularly in pts with normal ventricular function at rest.
DETECTION OF MULTIVESSEL DISEASE BY EXERCISE THALLIUM-201 SCINTIGRAPHY. George A. Belier, MD,FACC; Denny D. Watson, PhD; Bruce C. Berger, MD; Randolph P. Martin, MD; George J. Taylor, MD.; University of Virginia, Charlottesville, Vs. The goal of this study was to determine the accuracy of quantitative 201~~ exercise scintigraphy for predicting multivessel disease (VD) in 91 consecutive patients (pts) referred for angiography. 2olTL at peak exercise.
All pts received 1.5 mCi of Images ;;;e obtained serially
over 2% hrs. Abnormal regional TL uptake was ascer- tained by quantitative criteria applied to multiple scan segments (segs) corresponding to the vascular supply of the 3 major coronary arteries. Abnormal myocardial segs were defined as 1))225% persistent reduction in 2olTL uptake; 2) An initial defect with redistribution and 3) Abnormal 201TL washout. A coronary stenosis of >,50% was considered significant. Of 20 pts with angiographically normal coronary arteries, 2 were predicted to have 1VD (false positives). Of 18 pts with lVD, 12 had abnormal- ities appropriate to the single diseased vessel and 5 were predicted to have 2VD. All five 2VD readings were in the distribution of circumflex (Cx) and right coronary artery (RCA) segs, when only one of these vessels was diseased. The remaining pt had a normal scan. Of 20 pts with 2VD, 12 had abnormal segs confined to the 2 diseased vessels. 5 had anbormal segs confined to i vessel, and one had a normal scan. Of 25 pts with 3VD, 10 had abnor- mal scan segs in the distribution of all 3 vessels, 12 had abnormal segs appropriate to 2 diseased vessels and 1 had a single abnormal vascular seg. Two pts with 3VD had normal scans. Thus in 45 pts with 2 or 3VD, 36 demonstrated abnormal 2l31 TL uptake and/or washout in at least 2 vascular segs, yielding an 80% sensitivity for 2 or 3VD prediction. The lower specificity of 67% appears related to the inability to separate Cx and RCA vascular segs.
482 February 1980 The American Journal of CARDIOLOGY Volume 45
The role of myocardial bridges in producing ischemia is not clear. We studied 7 male patients (age range 45-63 years) with chest pain syndromes and cineangiographically documented systolic coronary artery narrowing due to myocardial bridges. All patients had 750% systolic coronary artery narrowing in the proximal left anterior descending vessel. None of the patients had evidence of significant atherosclerotic coronary disease, resting left ventricular wall motion abnormality, and/or mitral valve prolapse. Myocardial perfusion was evaluated at rest and during exercise by performing Thallium-201 myo- cardial scintigraphy. None of the patients had electro- cardiographic evidence of ischemia during or after exer- cise. Three patients with <75% systolic coronary artery narrowing had a normal resting and exercise Thallium-201 scintigram. In 3 of 4 patients with 775% systolic coronary artery narrowing, exercise induced perfusion deficits were observed in the distribution of the vessel. One of these 3 patients also developed chest pain on exercise. We conclude that a 775% systolic coronary artery narrowing may impair myocardial perfusion during exercise. In comparison to exercise electro- cardiography, Thallium-201 myocardial imaging appears to be more sensitive in detecting an abnormal response in these patients.
REVERSIBILITY OF ADRIAMYCIN INDUCED REDUCTION IN MYOCAR- DIAL THALLIUM-201 UPTAKE BY INTRAVENOUS DIGOXIN David Forst, MD; Sherman Sorensen, MD; Robert O'Rourke,Mb FACC; Tuhin Chaudhuri, MD, University of Texas Health Science Center and Veterans Administration Hospital, San Antonio, Texas. The anthracycline antibiotic Adriamycin(AD) is a highly
effective antineoplastic agentwhichmay produceacuteand chronic cardiac toxicity.Observationsthat AD is a glyco- side with cardiac effectsthatsimulate andmaybe altered by Digoxin (D) suggest a mechanism ofactioninvolving the Na-K pump.Totest this hypothesis,wequantitated myocar- dial uptake of thepotassiumanalog,Thallium-201 (TL), by whole heart imaging and sectioned heart well-counting (t-=.95). NewZealand rabbits were given IVTL (.12mCi/kg) without AD(control)and 5 min(AD-5),24 hrs (AD-24)and 48 hrs (AD-48) after IVAD (3mg/kg). TL uptake was quanti- tated as counts/sec/mCi/gm heart tissue. Mean (iSEM) normalized counts were:
N Counts P Control 9 120?4 AD5 9123 .OOl AD24 : 77+5 .OOl AD48 5 112+9 NS
Another group of rabbits received IV digoxin(D-24)or IV digoxin (0.29mg/kg) followed 1 hour later by IV AD(D-24AD) withTLuptake measured24hours later.Mean (+SEM)normal- ized counts and diqoxin levels were:
N Counts P Serum Digoxin (ng/ml) Control 9 120?4 1 hrpD 24 hrPD D24AD
z 123?10 NS
D 129+7 ;*;:*;; NS
::;z NS Thiz.1) Adriamvcin causes an acute reversible deoression in myocdrdial Tiuptake that is prevented by pretreatment with digoxin. 2) Adriamycin may affect the myocardial Na-K pump.
