The long-term predictive value of an exercise thallium-201 scintigraphy for patients with acute chest pain but without myocardial infarction.

BACKGROUND: Patients who are hospitalized because of chest pain and suspected acute myocardial infarction, but in whom the diagnosis is ruled out, are at high risk for subsequent cardiac events (cardiac death or nonfatal acute myocardial infarction). Risk stratification was done for 158 such patients who underwent exercise thallium-201 scintigraphy at the time of discharge. METHODS: Thirty-eight patients (24%) were women, and all patients were followed for 7 years. The diagnostic sensitivity, specificity, and predictive value of thallium scintigraphy for the identification of patients having subsequent cardiac events during follow-up was calculated. RESULTS: A cardiac event occurred in 41 patients during the follow-up period. Presence of both transient and permanent defects and abnormal ST-segment responses during thallium scintigraphy were significantly associated with an impaired prognosis (P < 0.0001). The highest sensitivity (85%) was achieved by the combination of transient defect with or without persistent defect and with or without abnormal ST-segment response. The highest specificity was provided by a transient defect (90%), and the predictive value of a positive test result was 60%. Seventeen of 29 patients with a transient defect had a cardiac event during follow-up. Patients with normal test results had excellent prognoses; 93% of 82 patients were free of cardiac events during follow-up. CONCLUSIONS: Exercise thallium-201 scintigraphy is suitable for long-term risk stratification in patients with chest pain and suspected but unconfirmed myocardial infarction, because high- and very low-risk subsets can be identified at the time of discharge.

[Long-term prognosis in patients with acute chest pain. The predictive value of myocardial scintigraphy]. / Langtidsprognosen for patienter med akutte brystsmerter. Den proediktive voerdi af myokardieskintigrafi.

UNLABELLED: In order to perform risk stratification 158 patients with acute chest pain, but without myocardial infarction (non-AMI) underwent exercise 201-thallium scintigraphy at the time of discharge. The patients, of whom 38 (24%) were women, were followed for seven years. The diagnostic sensitivity, specificity and predictive values of the outcome of the examination for identification of patients, who had a cardiac event (cardiac death or later non-fatal AMI) during follow-up, was calculated. Forty-one had a cardiac event during follow-up. The highest sensitivity (85%) was achieved by the combination of transient defect and/or persistent defect and/or abnormal ST-segment response. The highest specificity was provided by a transient defect (90%) and the predictive value of a positive test was 60%-17 of 29 patients with a transient defect had a cardiac event during follow-up. Patients with a normal test had an excellent prognosis, 94% of 82 patients were free of cardiac events during follow-up. CONCLUSIONS: Exercise 201-thallium scintigraphy is suitable for long-term risk stratification in patients with chest pain and suspicion of but unconfirmed myocardial infarction, because high and very low risk subsets can be identified at the time of discharge.

Hepatic and extrahepatic elimination of ethanol in cirrhosis. With estimates of intrahepatic shunts and Km for ethanol elimination.

In eight patients with cirrhosis of the liver the hepatic and the extrahepatic ethanol elimination rate (EER) were studied by steady-state infusion during hepatic venous catheterization. EER measured by single injection overestimated total body EER by 15%. Hepatic and extrahepatic EER were significantly decreased to about two thirds in cirrhosis and were correlated to other variables indicating the severity of the disease. Differences in EER, however, diminish considerably when corrected for body weight, for reasons that are poorly understood. A maximal value of intrahepatic shunted blood could be calculated to 15% (3-38%) of hepatic blood flow. It was correlated to the transsinusoidal pressure gradient (r = 0.91). A rough estimate of the apparent Michaelis constant (Km) of hepatic and extrahepatic EER was in the range of 0.1--0.3 mmol x 1(-1). Forty percent of ethanol elimination occurred outside the liver. The large extrahepatic EER may be important in the development of extrahepatic organ injuries.

Prednisone effect on microvascular permeability in patients with inflammatory rheumatic diseases.

The transcapillary escape rate of albumin was measured in 27 consecutive patients with inflammatory rheumatic diseases before and after 1 and 7 days of prednisone treatment in doses of 45 mg/day. The transcapillary escape rate decreased from 7.33%/h (range 5.11-9.55) before prednisone treatment to 3.11%/h (0.04-6.18) (p less than 0.05) after 1 day of treatment and 5.80%/h (4.36-7.24) after 7 days of treatment. It is concluded that prednisone inhibits vascular permeability in patients with inflammatory rheumatic diseases.

A gamma camera method for the evaluation of deep-vein thrombosis in the leg. Application of 99mTc-labelled heparin.

99mTc-labelled heparin was used to examine acute deep-vein thrombosis in the leg. 99mTc-heparin (4 mCi) was injected into a dorsal foot vein. Rapid-sequence scintiphotos were taken of the lower legs and thighs. One hour after the injection, images were taken to reveal possible late accumulation of 99mTc-heparin in the thrombi. The venous outflow was assessed by a strain gauge technique. X-ray phlebography was performed on the same or the subsequent day. All patients having an abnormal X-ray phlebography also had an abnormal isotope phlebography. Acute deep-vein thrombosis in the leg can be diagnosed reliably with the combined method of 99mTc-heparin scintigraphy and measurement of venous outflow. Late accumulation of 99mTc-heparin in thrombi of the deep veins was seen in 6 of 12 patients with acute thrombosis. Patients with chronic changes were difficult to evaluate, since the resolution of the scintillation camera does not allow detection of minor changes.

Prognosis and thallium-201 scintigraphy in patients admitted with chest pain without confirmed acute myocardial infarction.

Exercise and rest thallium scintigraphy and exercise electrocardiography were performed after discharge in 158 patients aged less than 76 years admitted with chest pain in whom a suspected diagnosis of acute myocardial infarction had not been confirmed. During a follow up of 12-24 months (median 14 months) there were 10 cardiac events--that is, non-fatal acute myocardial infarction or cardiac deaths. Transient thallium defects and abnormal ST response (that is ST segment deviation or uninterpretable ST segment) during exercise were correlated significantly with an unfavourable prognosis. One hundred and four patients with neither of these characteristics were at lower risk of a cardiac event than the 19 patients with both of these characteristics. The percentages of patients in these two groups without a cardiac event after one year were 98.1 and 78.8 respectively. Thallium scintigraphy, alone or in combination with exercise electrocardiography, can be used to identify groups at high and low risk of future cardiac events, in patients with chest pain in whom acute myocardial infarction is suspected but not found.