Localization of 99mTc-Sn-pyrophosphate in left ventricular aneurysms.

Concentration of 99mTc-pyrophosphate (99mTc-PPi) in the area of left ventricular aneurysms is discussed. In three cases clinical, laboratory, and electrocardiographic (ECG) evidence did not indicate that these patients currently had an acute myocardial infarction, but each patient had a clinical history and an ECG picture compatible with an old myocardial infarction. Cardiac catheterization revealed a large left ventricular aneurysm in all three cases. The reason for the preferential uptake of the radionuclide in the area of these aneurysms is not certain at this time.

Comparison of Tc-99m pyrophosphate and Tc-99m methylene diphosphonate in acute myocardial infarction: concise communication.

This study compared Tc-99m pyrophosphate (PPi) and Tc-99m methylene diphosphonate (MDP) for myocardial infarct imaging in 24 patients with diagnosed acute myocardial infarction. The radiopharmaceuticals were administered randomly and interpreted without knowledge of the sequence used. Twenty-three patients (96%) had positive Tc-99m PPi scintigrams, but only 17 (71%) had a positive Tc-99m MDP study (P less than 0.05). In addition, a comparison of the relative intensity with each agent revealed greater intensity with Tc-99m in 21 cases, equal intensity in two cases, and less intensity in only one case (p less than 0.001). These findings support the superiority of Tc-99m PPi as the agent of choice for myocardial scintigraphy in acute infarction.

Evaluation of aortocoronary bypass graft status by computed tomography.

The efficacy of contrast-enhanced computed tomography to define graft patency status was studied in 42 patients with 100 aortocoronary vein grafts. The status of each graft had been determined earlier by angiography. A rotary fan beam whole body scanner with a 2 second scan duration was used. Initial scans determined the optimal level for study of the graft; patency was assessed by computed tomographic enhancement of the graft after intravenous bolus injection of 30 ml meglumine and sodium diatriazoate. The computed tomographic studies were evaluated without knowledge of the angiographic findings; graft status by computed tomography was interpreted as patent, occluded or equivocal. Overall, computed tomography correctly defined graft patency status in 79 of the 100 grafts and incorrectly identified it in 9; in 12 grafts, the computed tomographic diagnosis was equivocal. Computed tomography correctly identified 61 of 74 patent grafts and 18 of 26 occluded grafts. Patency status was correctly defined by computed tomography in 35 of 37 grafts to the left anterior descending artery, 23 of 30 grafts to circumflex branches and 19 of 31 grafts to the right coronary artery. These data indicate that computed tomography is a promising noninvasive method of determining patency of aortocoronary bypass grafts, especially of grafts to the left anterior descending artery.

Comparison of hospital and neighborhood controls in a study of coronary artery disease.

Case-control studies of risk factors for coronary artery disease (CAD) have almost invariably employed hospital controls, with minimal or no coronary artery stenosis. Although there is an important advantage in knowing the CAD status of controls, such groups are subject to bias related to hospitalization. To evaluate the generalizability of results obtained from studies using hospital controls, we compared risk factors in 342 hospital controls free of angiographic evidence for CAD, 168 neighborhood controls without symptoms of CAD, and 450 CAD patients. Coronary artery disease in cases and hospital controls was established arteriographically. No significant differences were found between the male control groups for total and low density lipoprotein (LDL) cholesterol, LDL apo-B, pack-years of smoking, body mass index, proportion with hypertension, diabetes and family history of coronary heart disease. Compared with neighborhood controls, male hospital controls had significantly lower high density lipoprotein (HDL) cholesterol, higher triglycerides and uric acid and scored higher on the Framingham Type A behavior pattern scale. Among women, the hospital control group had significantly lower LDL cholesterol and fewer pack-years of smoking, and a greater prevalence of hypertension than the neighborhood group. A greater proportion of both male and female hospital controls had left ventricular hypertrophy, and there were more current smokers among the neighborhood controls in both sexes. Age adjustment did not change these comparisons. While very few neighborhood controls were treated with beta-blockers, 32.7% of male and 41.4% of female hospital controls were so medicated. Control for beta-blocker use eliminated the difference in HDL cholesterol and triglycerides between the two male control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in pharmacologic treatment of hyperlipidemia.

We evaluated the changes in frequency of pharmacologic treatment of hyperlipidemia in 345 hyperlipidemic patients with symptomatic cardiovascular disease requiring cardiac catheterization between 1982 and 1987. The frequency of pharmacologic treatment increased from 13% (1982) to 59% (1987), with the major increase occurring in 1984. Increases in the frequency of treatment were paralleled by increases in prescriptions for lipid-lowering drugs nationwide. During this period the percentage of hyperlipidemic patients we evaluated who were treated with various agents changed, and at the end of the study the use of gemfibrozil, bile acid-binding resins, and nicotinic acid had increased, whereas clofibrate and probucol use decreased. Although the data showed an increase in prevalence of treatment, almost half the patients remained untreated, and of those treated over half remained hypercholesterolemic despite treatment. The results suggest increasing but incomplete physician awareness of hyperlipidemia as a cardiovascular disease risk factor and the need for further physician education in the pharmacologic management of hyperlipidemia.

Double cardiomyopathy: coexistent cardiac amyloidosis and hypertrophic obstructive cardiomyopathy.

A combination of hypertrophic obstructive cardiomyopathy (HOCM) and cardiac amyloidosis in the same patient is very rare. Clinical diagnosis could be extremely difficult and may require myocardial biopsy. We are reporting a patient with this combination who was referred to our institution because of features of HOCM based on clinical, echocardiographic and Doppler criteria. Cardiac amyloidosis was only recognized after myocardial biopsy that failed to reveal evidence of HOCM. Only after the patient expired from severe, intractable heart failure did the autopsy findings confirm the association of HOCM. We believe that the combination of the two cardiomyopathic processes is very rare and makes treatment extremely difficult.

En face demonstration of a prosthetic mitral valve orifice during left ventriculography.

Direct demonstrate of the orifice of a prosthetic mitral valve was obtained using an en face projection of the mitral valve during left ventriculography. With a dimensional reference and planimetry, the mitral valve area was directly measured. The value for the mitral valve area derived from en face demonstration of the mitral valve during left ventriculography agreed well with valve area estimates obtained by the Gorlin and Gorlin formula and by direct examination of the surgical specimen.

Left ventricular to right atrial defect and tricuspid insufficiency secondary to nonpenetrating cardiac trauma.

We present a report of a 28-year-old male patient who developed a left ventricular to right atrial communication associated with tricuspid insufficiency secondary to nonpenetrating cardiac trauma. The patient's heart block was clarified by serial observation of electrocardiograms and the use of HIS bundle electrocardiography. The patient's fistula was surgically repaired, and 20 months postinjury he is asymptomatic and pacemaker dependent. Echocardiography may aid in the early diagnosis of a left to right shunt and/or tricuspid insufficiency in the setting of possible cardiac trauma.

Coronary artery thrombus: rapid resolution shown by serial coronary arteriography.

Resolution of a coronary artery thrombus within two weeks was demonstrated by serial coronary arteriography in a man with atherosclerotic coronary artery disease. This observation indicates that subtotal coronary artery thrombosis does not invariably progress to complete occlusion of the affected vessel and that the resolution of coronary artery thrombus can occur rapidly.

Spasm of the aortocoronary venous graft.

Two cases of spasm of the coronary artery bypass graft are reported, and the angiographic and clinical findings are discussed. Few previous reports of this entity were found in a search of the literature. The therapeutic implications are also presented.

Differential shunting in the diagnosis of patent ductus arteriosus with Eisenmenger physiology by radionuclide angiography.

Radionuclide angiography and static whole body imaging performed with technetium-99m-labeled particulates can clearly demonstrate differential shunting in patients with patent ductus arteriosus (PDA) with Eisenmenger physiology. The anatomic arterial relationships in this condition which direct deoxygenated blood into the lower body (differential cyanosis) produce specific radionuclide images characterized by differential shunting of the technetium-99m-labeled particulates into the abdomen and lower extremity.

Studies of low density lipoprotein molecular weight in human beings with coronary artery disease.

Low density lipoprotein molecular weight (LDL MW) correlates positively with coronary artery disease in cholesterol-fed nonhuman primates. To evaluate this in human beings with coronary artery disease (CAD) we measured LDL MW in 93 volunteers undergoing coronary angiography (47 controls and 46 CAD patients). LDL MW of CAD patients was less than that of controls (patients, 2.79 +/- 0.17 g/mumol; controls, 2.93 +/- 0.19 g/mumol; P less than 0.001). However, LDL MW decreased as plasma triglyceride increased and concentrations of triglyceride were greater in CAD patients than in controls. Since decreased LDL MW is likely to result, in part, from increased plasma triglyceride concentrations, we attempted to determine the effect of triglyceride on the relation of LDL MW to CAD in this study. After covariance adjustment for triglyceride, there was no LDL MW difference between CAD patients and controls. Because LDL heterogeneity has been identified in other studies and was apparent on inspection of agarose column profiles of LDL of these volunteers, we sought differences in the profiles that might distinguish coronary disease cases from controls. No differences could be found. In addition, we used density gradient ultracentrifugation to characterize LDL in more detail in a subset of volunteers who had a wide range of plasma triglyceride concentrations (50 mg/dl to 900 mg/dl). LDL mean hydrated density was inversely related to LDL MW and increased as triglyceride increased. The increase in peak density was reflected in an increase in percent of total protein in LDL found to have d greater than 1.045 g/ml and a decrease in protein in LDL of d 1.035-1.040 g/ml. These interrelationships were not apparently influenced by coronary artery status.

Central adipose distribution is related to coronary atherosclerosis.

A "male" distribution of adipose tissue in women (excess of fat in the abdomen compared with that in the hips; i.e., elevated waist/hip ratio) has been related to symptomatic cardiovascular disease. An elevated waist/hip ratio has also been related to symptomatic cardiovascular and cerebrovascular diseases in men, as well as to risk factors for these diseases and various metabolic conditions. To determine whether adipose distribution was related to coronary atherosclerosis, we performed a case-control study in patients with angiographically documented coronary atherosclerosis (cases) and in angiographically normal hospital and neighborhood controls. The data show that distribution of adiposity as assessed by waist/hip ratio is significantly related to coronary atherosclerosis in both females and males. Waist/hip ratio is significantly greater in female cases compared with either control group; in males, waist/hip ratio is significantly greater in cases compared with asymptomatic neighborhood controls but not compared with patients with normal coronary arteries. These results persist after control for age, plasma concentrations of lipids and lipoproteins, body mass index, history of hypertension, history of diabetes, and smoking status. The connection between the male adipose distribution in females and coronary atherosclerosis partly explains the greater likelihood of symptomatic cardiovascular disease in them. Males with excess deposition of fat in the abdominal region are also likely to experience increased risk.

Reevaluation of transient ischemic attacks as a risk factor for early mortality.

The prevailing belief that transient ischemic attack is a risk factor for cardiovascular morbidity and mortality is based primarily on comparisons of survival of patients after transient ischemic attacks to that of an age-, race-, and sex-adjusted general population. Concomitant conditions that carry a high risk of premature mortality or morbidity, such as ischemic heart disease, hypertension, and diabetes, are very prevalent among patients with transient ischemic attacks. Hence, the poor prognosis of such patients may be attributable to these factors rather than their transient ischemic attack per se, which may only serve to bring patients into the medical system. We compared the survival of 336 patients after transient ischemic attack to that of a control group with a similar risk factor profile consisting of 6,710 patients evaluated for cardiac catheterization. Survival estimates, both unadjusted and adjusted for risk factors, did not differ between the two groups. Three-year survival estimates, after adjustment to the mean value of covariates, were 94% for the patients with transient ischemic attacks and 91% for the controls. These results suggest that the transient ischemic attack may not be an independent risk factor for mortality, although it may identify patients already at increased risk from coexisting conditions.

Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis.

The extent of carotid artery atherosclerosis as measured by B-mode ultrasound has been shown to be strongly and independently correlated with the presence or absence of coronary atherosclerotic disease (CAD), but no studies to date have used carotid B-mode ultrasound to compare the extent of atherosclerotic disease in the two arterial circulations. We used data from a registry of patients undergoing cardiac catheterization and B-mode ultrasound of the carotid arteries to compare the extent of CAD (number of major coronary vessels with 50% or greater stenosis as judged by a consensus interpretation) with the extent of extracranial carotid atherosclerosis. Four hundred thirty-four patients (234 men, 200 women) greater than 40 years of age were stratified by gender and then divided into quartiles on the basis of a B-mode score that was derived by summing arterial wall thickness at nine sites in the left and nine sites in the right carotid arteries. Evaluation of extent of CAD for the four B-mode quartiles showed that men in the lowest B-mode quartile were over six times more likely to have normal coronary arteries than three- to four-vessel CAD, while men in the highest B-mode quartile were over 10 times more likely to have three- to four-vessel CAD than normal coronary arteries. The findings were similar for women but not as dramatic. Gender-specific discriminant function models using traditional risk factors alone or in combination with B-mode score were developed to predict the extent of CAD.(ABSTRACT TRUNCATED AT 250 WORDS)