[Role of Gated-SPECT in the early diagnosis of ischaemic cardiopathy in the diabetic patient]. / Ruolo della Gated-SPECT nella diagnosi precoce della cardiopatia ischemica del paziente diabetico.

Diabetes presents a higher risk of both symptomatic and asymptomatic coronary artery disease (CAD). Myocardial perfusion SPECT, particularly associated with Gated acquisition, makes it possible to diagnose CAD on the basis of the presence and extent of perfusion defects, and to carry out the stratification of the cardiological risk (infarction or cardiac death) by analyzing the results of perfusion and of the functional data (ejection fraction, EF, and wall movement). Gated myocardial SPECT in the diagnosis and stratification of risk has proved superior to clinical evaluation or the exercise test alone, and it is also superior to echostress/dobutamine in the evaluation of monovasal disease. These data have been confirmed not only in the population at large but also in the diabetic population, making the technique important also in such patients also affected by coronary disease which is earlier and more advanced in diagnosis. Scintigraphic data make it possible to classify patients into various risk categories (low, intermediate and high) on the basis of which a specific therapeutic approach can be established. The present review develops the above concepts, taking into consideration the consolidated studies present in the literature, for the purpose of pinpointing the diagnostic approach in which exercise or SPECT myocardium-scintigraphy can be assigned.

Clinical and technical determinants of the complexity of percutaneous transluminal coronary angioplasty procedures: analysis in relation to radiation exposure parameters.

Few data are available on the quantitative assessment of complexity (C), especially in relation to a patient's exposure to radiation. The relationship between several clinical (CFs), anatomic (AFs), and technical factors (TFs) versus fluoroscopy time (FT) was evaluated in 402 random percutaneous transluminal coronary angioplasty (PTCA) procedures. CFs were age, sex, single or multivessel disease, ejection fraction, and previous coronary artery bypass graft. AFs were assessed based on the American Heart Association / American College of Cardiology classification. TFs were multivessel PTCA, use of the double wire or double balloon technique, stenting, ostial stenting, bifurcation stenting, and intravascular ultrasonography. No CFs significantly influenced FT, whereas all AFs and TFs (except multivessel PTCA) did significantly influence FT. A scoring system was developed, and two complexity indexes (CI) were conceived, based on which the procedures were divided into three groups: simple, medium, and complex. The mean FTs were 471+/-289, 805+/-532, and 1,190+/-641 (P <0.0001), respectively. Total cine frame recordings were 1,119+/-572, 1,265+/-644 (P = 0.0355), and 1,418+/-785 (P<0.0001 vs. simple; P = NS vs. medium). The dose/area product measurement was 65.8+/-41.4, 93 +/-58.5 (P<0.0001), and 116.7+/-72.8 (P<0.0001 vs. simple; P = 0.00159 vs. medium), respectively. In our series, CI was directly related to AF and TF, but not to CF. Comparison of PTCA procedures and definition of appropriate FT should consider CIs.

Follow up after spontaneous coronary artery dissection: a report of five cases.

Five cases of spontaneous coronary artery dissection (SCAD) are reported, three in women and two in men (mean age 44 years; range 28-65), all of whom suffered a myocardial infarction. Common risk factors for coronary artery disease were present in the two men; in the female group one patient was taking an oral contraceptive, one was in the postpartum period, and the third was a smoker. Only the three women received intravenous alteplase and their ejection fraction was normal; both men had impaired left ventricular function. Two patients had SCAD of the left anterior descending coronary artery and three of the right coronary artery. Only the two men had angiographic features of coronary atherosclerotic involvement. No patients required surgical revascularisation or percutaneous transluminal coronary angioplasty. At a mean follow up of 27 months (range 6 to 40) all patients were alive and all but one were asymptomatic.

Diagnostic accuracy of right ventriculography in arrhythmogenic right ventricular cardiomyopathy.

Diagnostic sensitivity and specificity of cineangiography were evaluated by multivariate logistic discriminant analysis in 32 patients with arrhythmogenic right ventricular (RV) cardiomyopathy, 27 patients with biventricular dilated cardiomyopathy, 28 patients with atrial septal defect and 18 normal subjects. In patients with arrhythmogenic RV cardiomyopathy and biventricular dilated cardiomyopathy, the diagnosis was confirmed by endomyocardial biopsy. All RV values overlapped for the diagnosis of atrial septal defect and arrhythmogenic RV cardiomyopathy; overlapping extended to dilated cardiomyopathy for end-diastolic volume and infundibular dimensions. RV ejection fraction appeared reduced in all the diseases; in particular, mean values in dilated cardiomyopathy and arrhythmogenic RV cardiomyopathy were 38 and 53%, respectively (p less than 0.05). Left ventricular quantitative studies showed a significant difference between dilated and arrhythmogenic RV cardiomyopathy, both in terms of pumping indexes (mean end-diastolic volumes 180 vs 91 ml/m2 and mean ejection fraction 33 vs 60%), and indexes of contractility (stress/end-diastolic volume 3.7 vs 6.7). Multivariate analysis disclosed that transversally arranged hypertrophic trabeculae, separated by deep fissures, were associated with the highest probability of arrhythmogenic RV cardiomyopathy (p less than 0.001). Posterior subtricuspid and anterior infundibular wall bulgings were the only other independently significant variables. Coexistence of these signs was associated with 96% specificity and 87.5% sensitivity. Thus, arrhythmogenic RV cardiomyopathy presents quantitative volumetric and hemodynamic as well as qualitative features that clearly distinguish it from dilated cardiomyopathy and confirm its nosographic autonomy among the primary diseases of the myocardium.