[The stability of solid food labeled with different radiopharmaceuticals for studying gastric emptying]. / Estabilidad de alimento sólido marcado con diferentes radiofármacos para vaciamiento gástrico.

OBJECTIVE: Sulfur colloid 99mTc-SC, the radiopharmaceutical of choice for solid gastric emptying studies, is not available in our country. It has led us to assess the solid binding stability of seven alternative radiopharmaceuticals that could present adequate fixation to it a priori. MATERIALS AND METHOD: The stability of labelled solid food with seven colloidal 99mTc-radiopharmaceuticals of different sizes and nature (MAA, tin colloid, rhenium sulphide macrocolloid, albumin microcolloid, sulfur nanocolloid, albumin nanocolloid and rhenium sulfur nanocolloid) has been studied by measuring their dissociated activity after two hours digestion in simulated gastric fluid (kept 120' in agitation, in HCl 0.1 M at 37). The survey also assesses radiopharmaceutical labelling stability after two hours digestion in identical conditions by measuring their radiochemical purity in ITLC. RESULTS: In these conditions, MAA, rhenium sulphide macrocolloid, albumin microcolloid and albumin microcolloid present the best behaviour, with an activity linked to food over 90 % of the previously fixed activity. CONCLUSIONS: According to the results, there is no relationship between the radiopharmaceutical size and nature and the stability of its binding to the solid food. Because rhenium sulphide macrocolloid is no longer manufactured and the other three radiopharmaceuticals which have a binding stability to the solid food over 90 % do not include digestive explorations amongst their indications, nowadays, there is a serious legal limitation to carry out this type of studies in our country.

[Scintigraphy with 99mTc-MIBI in the diagnosis of axillary lymph node invasion of breast cancer]. / Gammagrafía con 99mTc-MIBI en el diagnóstico de la invasión ganglionar axilar del cáncer de mama.

UNLABELLED: The presence of affected locoregional lymph nodes should be considered as one of the most important prognostic factors of breast cancer. At present, the clinician is conditioned by an absolute lack of an efficient methodology to evaluate the possible invasion of the axillary lymph nodes, which if negative, would make it possible to avoid surgical excision. In this study, we will evaluate the use of the 99mTc-MIBI scintigraphy in the pre-surgical diagnosis of axillary lymph node invasion and will analyze the relationship between the 99mTc-MIBI uptake and the number of lymph nodes affected. MATERIAL AND METHODS: 84 patients diagnosed of breast cancer were analyzed in this study. All of them underwent a 99mTc-MIBI scintigraphy, and the tumor/background ratio was determined semiquantitively for each image. The axillary lymph node invasion was determined following surgery. RESULTS: The sensitivity of the breast scintigraphy with 99mTc-MIBI for detection of lymph node invasion is 36% and the specificity is 100%. The positive predictive value is 100% and the negative one 48%. In the current study, we failed to detect correlation between the intensity of 99mTc-MIBI uptake in the primary tumor and the number of affected axillary lymph nodes. CONCLUSION: 99mTc-MIBI breast scintigraphy can provide complementary information for the presurgical diagnosis of breast cancer axillary lymph node invasion. 99mTc-MIBI breast scintigraphy shows high specificity and a high predictive value.

[Usefulness of quantification and visual analysis of the uptake of (99m)Tc-MIBI in the diagnosis of mammary lesions]. / Utilidad de la cuantificación y análisis visual de la captación de (99m)Tc-MIBI en el diagnóstico de lesiones mamarias.

OBJECTIVE: Scintigraphy studies with (99m)Tc-MIBI are widely used in the diagnosis of non-invasive breast cancer and their results have been verified by many studies. However, the scintigraphic technique produces erroneous false negative and positive results. This study aims to verify how the different characteristics of the uptake of (99m)Tc-MIBI (intensity, size, morphology, etc.) can help to increase sensitivity and specificity of breast scintigraphy. MATERIALS AND METHODS: We have studied 201 patients (84 breast cancer and 117 benign lesions). All of them underwent a breast scintigraphy with (99m)Tc-MIBI and anatomopathological study. A semiquantitative analysis (by T/F indexes) and visual study were performed in the lesions that presented radiodrug uptake. RESULTS: Eleven false positive results and 8 false negative results were obtained in the study of the 201 patients. The analysis of the T/F indexes did not demonstrate any significant differences between the benign and malignant lesions (p>0,05). There is a statistically significant correlation (p<0.05) between the tracer uptake morphology and the AP diagnosis and between the localization of the lesion in a breast quadrant and the uptake intensity. CONCLUSIONS: Quantification of (99m)Tc-MIBI uptake by T/F indexes does not provide any conclusive data on the lesion's malignancy, however, a more detailed analysis of the characteristics of the tracer uptake would permit us to make the correct diagnosis and would reduce the false positive and negative results of this technique.

[Usefulness of the quantification of (99M)Tc-MIBI uptake in breast neoplasms in the preoperative assessment of tumor aggressiveness]. / Utilidad de la cuantificación de la captación de (99m)Tc-MIBI en neoplasias mamarias en la valoración preoperatoria de la agresividad tumoral.

UNLABELLED: (99m)Tc-MIBI has been proposed as an imaging diagnostic method in a large variety of human malignant tumors. At present, the mechanism by which (99m)Tc-MIBI is uptaken and concentrated by the malignant cells is not totally known. Some mammary neoplasms do not show any uptake of (99m)Tc-MIBI. This study aims to determine if there is any correlation between the uptake of (99m)Tc-MIBI by the tumor and the different histopathological parameters involved in tumoral aggressiveness. To do so, we have studied 100 patients with breast cancer. All of them underwent a breast scintimammography with (99m)Tc-MIBI with semiquantitative analysis by means of a tumor-to-background ratio calculated in every projection. After surgery, an experienced pathologist determined tumor size, axillary lymph node metastases, histological grade (Scarff Bloom Richardson) (SCBR), nuclear grade, mitotic index, presence of cellular atypia and estrogen and progesterone receptor expression. RESULTS: A statistically significant correlation (p < 0.005) has been found between tumor-to-background (T/B) ratios of (99m)Tc-MIBI uptake and tumor SCBR histological grade. A correlation between (99m)Tc-MIBI uptake and the mitotic index, cellular atypia and nuclear grade has also been found. No correlation was found in our study with tumor size, hormone receptor expression or axillary lymph node metastases. CONCLUSIONS: (99m)Tc-MIBI uptake in breast cancer is correlated with the tumoral differentiation grade: the smaller the tumoral cellular differentiation (greater aggressiveness), the greater the uptake. On the other hand, no correlation was found between the uptake of (99m)Tc-MIBI and the classical pathological parameters that define tumoral aggressiveness, such as size and axillary lymph node metastasis.

[99m Tc-MIBI scintigraphy compared to mammography in the diagnosis of breast cancer in dense, operated and young women breasts]. / Gammagrafía con 99mTc-MIBI frente a la mamografía en el diagnóstico de cáncer de mama en mamas densas, mamas intervenidas y mujeres jóvenes.

UNLABELLED: Breast scintimammography with 99mTc-MIBI has proven to be a useful complement to mammography in the diagnosis of breast cancer in the female population. Although the mammography, along with a physical examination, is the backbone of breast cancer diagnosis, there are groups of patients in whom the mammography has an even lower specificity. OBJECTIVE: Our study has aimed to assess the usefulness of breast 99mTc-MIBI scintimammography in those situations in which the mammography was indeterminate, such as, in dense breasts, young females or breasts with architectural distortion after surgery or radiation therapy. MATERIALS AND METHODS: We studied 109 females with mammographically dense breasts, 8 young females under 30 and 24 patients who had undergone previous surgery or radiation therapy. All cases were studied to rule out breast cancer. Final diagnosis was established with excisional biopsy. RESULTS: In dense breasts MIBI scintimammography sensitivity was 88% and the mammography one 81%. MIBI scintimammography specificity was 90% and the mammography 28%. In young females MIBI scintimammography sensitivity was 100% and the mammography 50%, MIBI scintimammography specificity 100% and the mammography 20%. In previous surgery, MIBI scintimammography sensitivity was 80% and the mammography 80%, MIBI scintimammography specificity 100% and the mammography 42%. CONCLUSION: Breast scintimammography with 99mTc-MIBI is an excellent diagnostic technique with high specificity. Undoubtedly it is complementary to mammography in those cases where mammography has major limitations such as dense breasts, young females and breasts with severe scarring after surgery or radiation therapy.

[Nuclear cardiology: technical bases and clinical applications]. / Cardiología nuclear: bases técnicas y aplicaciones clínicas*

Although the role of nuclear cardiology is currently well consolidated, the addition of new radiotracers and modern techniques makes it necessary to continuously update the requirements, equipment and clinical applications of these isotopic tests. The characteristics of the radioisotopic drugs and examinations presently used are explained in the first part of this text. In the second, the indications of them in diagnostic and prognostic evaluation of the different coronary diseases are presented.

[The impact of the clinical data and the interhospital agreement in the interpretation of myocardial perfusion tomography]. / Impacto de los datos clínicos y concordancia interhospitalaria en la interpretación de la tomogammagrafía miocárdica de perfusión.

INTRODUCTION AND OBJECTIVES: The aim of this study is to analyze the impact of clinical data and the interhospital agreement in the interpretation of myocardial perfusion single photon emission tomography (SPECT) images and polar mapping. METHODS: 150 patients from 5 hospitals were studied. Each center contributed with tomographic images and polar maps of 99mTc-tetrofosmin exercise SPECT and clinical reports of 30 patients. Thus, 300 images (150 of tomographic images and 150 of polar maps) were interpreted by each center without knowledge of clinical data of the patient ("blinded" report). RESULTS: 90 (60%) out of 150 patients had a coronary stenosis > or = 50%. Sensitivity and specificity of "non blinded" report were 91% and 86%, respectively. Sensitivity determined by majority decision (three or more centers) was 82% for tomographic images and 83% for polar maps (p = 0.002 and p = 0.03, respectively, regarding the "non-blinded" report). Specificity was 88% for tomographic images and 79% for polar map (p = 0.05 with respect to tomographic images). Interhospital agreement was good not only for tomographic images (kappa: 0.625) but for polar maps (kappa: 0.7) as well. CONCLUSIONS: Sensitivity of clinical or "non blinded" report of myocardial perfusion SPECT is significantly higher than the "blinded" report. Specificity of the "blinded" report of polar mapping is lower than that of tomographic images. A good interhospital agreement in interpretation of both types of images was observed.

[The clinical management guidelines of the Sociedad Española de Cardiología. Nuclear cardiology: the technical bases and clinical applications]. / Guías de actuación clínica de la Sociedad Española de Cardiología. Cardiología nuclear: bases técnicas y aplicaciones clínicas.

Although the role of nuclear cardiology is currently well consolidated, the addition of new radiotracers and modern techniques prompt us to permanently update the requirements, equipment and clinical applications of these isotopic tests. Radioisotopic drugs, instrumentation and characteristics of radionuclide tests that are presently used are explained in the first part of this text. In the second part, diagnostic and prognostic indications of these tests are presented in detail.

[Isotopic ventriculography in patients with obstructive hypertrophic cardiomyopathy treated with dual chamber stimulation]. / Ventriculografía isotópica en pacientes con miocardiopatía hipertrófica obstructiva tratados con estimulación bicameral.

BACKGROUND: Dual pacing stimulation improves symptoms and reduces intraventricular pressure gradient in obstructive hypertrophic cardiomyopathy. The mechanisms proposed for these effects are a change in ventricular contraction sequence, a paradoxical movement of the interventricular septum and a reduction in ventricular contractility. However, dual chambers pacing stimulation effects on systolic and diastolic function are unknown, and the study of this is the aim of this work. PATIENTS AND METHODS: We performed a radionuclide ventriculography in 10 patients with obstructive hypertrophic cardiomyopathy at 2 days and 1 and 6 months after placing a dual chamber pacemaker. The phase images, ventricular volumes, left ventricular ejection fraction and segmentary contractility were evaluated. Diastolic maximum peak-filling-rate and time to-peak-filling-rate were also studied. RESULTS: In DDD pacing stimulation, parametric phase images show a reversal up-down contraction sequence starting from the apical segment. At 6 months radionuclide ventriculography, a reduction in ejection fraction was found (60.9 +/- 12 vs 73.4 +/- 9.1; p < 0.05) which was attributed to apical, apical-septum and mainly basal-septum segmentary contraction decrease. A paradoxical mid-systolic septum movement was also found during DDD stimulation. No differences on diastolic parameters were noted. CONCLUSION: During dual chamber stimulation, a reversal ventricular contraction sequence, a paradoxical septum movement, hypokinesis of the septal ventricular segments and a reduction on left ventricular ejection fraction was observed.

[The effect of a race 4 hours in duration on the production of beta-endorphin and adrenocorticotropic hormone]. / Efecto de una carrera de cuatro horas de duración sobre la producción de betaendorfina y hormona adrenocorticotropa.

BACKGROUND: Physiological hormone adaptation to a prolonged and submaximum exercise is not well known. The present study was designed to evaluate changes in plasma levels of beta-endorphin and ACTH before and after a 4 hour pedestrian race. SUBJECTS AND METHOD: Fourteen amateur athletes enrolled in a 4-hour race were studied. Beta-endorphin and ACTH determinations were performed (double antibody IRMA) 10 minutes before and after the race. Simultaneously, heart rate and blood pressure were registered. RESULTS: After the race beta-endorphin level increased 2.8 times with respect to basal values (X [DE]) (42.2 [20,5] VS 14.9 [5.1] pM/I; p < 0.0001), and ACTH level increased 3.5 times (110.8 [72.9] vs 31.4 [14.2] pg/ml; p < 0.0001). There was a positive correlation between the increase of beta-endorphin and ACTH and the distance covered by each athlete (r = 0.617, p < 0.001 and r = 0.533, p < 0.05, respectively), and between the increase of basal and post-race values of both hormones (r = 0.935; p < 0.001). CONCLUSION: Prolonged and submaximum exercise provokes beta-endorphin and ACTH increase, and is related to the amount of performed exercise. There is a positive correlation between the increase of plasma levels of both hormones. Therefore, exercise amount could be one of the main modulator mechanism of beta-endorphin and ACTH release.

Role of endogenous opioids in syncope induced by head-up tilt test and its relationship with isoproterenol-dependent and isoproterenol-independent neurally-mediated syncope.

This study was designed to evaluate the role of endogenous opioids in neurally-mediated syncope. Head-up tilt test was performed on 35 patients with syncope of unknown origin. Plasma beta-endorphin was measured (1) at baseline, (2) at the end of tilt test or at time of syncope, (3) 15 min before isoproterenol-test, (4) at the end of the isoproterenol-test or at time of syncope. Subjects with a positive tilt testing showed a larger rise in plasma beta-endorphin concentrations at time of syncope (baseline 13.7+/-8.0 vs. syncope 41.4+/-26.4 pmol l(-1); P<0.01). On the contrary, patients with a positive isoproterenol-test showed no rise in plasma beta-endorphin levels (baseline 7.9+/-3.6 vs. syncope 7.4+/-2.7 pmol l(-1); P=ns). Patients with a passive negative tilt test (baseline 6.7+/-2.8 vs. end of test 7.0+/-3.3 pmol l(-1); P=ns) and negative isoproterenol tilt test (baseline 7.4+/-3.8 vs. end of test 8.1+/-3.4 pmol l(-1); P=ns) showed no changes in beta-endorphin concentrations. To further examine the efficacy of i.v. naloxone to prevent syncope, 10 patients were randomized to naloxone (0.02 mg/kg) or placebo. Second head-up tilt testing was negative in 1/5 patients with naloxone and in 2/5 patients with placebo. We conclude that, (1) endogenous opioids seem to be involved in vasovagal syncope induced by baseline head-up tilt test, (2) changes in plasma beta-endorphin concentrations show significant differences between patients who have isoproterenol-dependent and isoproterenol-independent syncope, this finding might occur in the setting of different pathophysiologic mechanisms, and (3) intravenous naloxone at a dose of 0.02 mg/kg was not superior to placebo in order to prevent positive responses to baseline tilt test.

[Reperfusion arrhythmias in valvular patients undergoing extracorporeal surgery and pretreated with captopril]. / Arritmias de reperfusión en pacientes valvulares operados con cirugía extracorpórea y pretratados con captopril.

INTRODUCTION AND OBJECTIVES: After the ischemia-reperfusion process in extracorporeal cardiac surgery there are, among several phenomena, some reperfusion arrhythmias which are influenced by a varied series of mechanisms. These arrhythmias have been related to the release of oxygen-derived free radicals during the first moments of reperfusion. Thus, a previous administration of free-radical scavengers might be beneficial, among which captopril has been included with good results in human studies in vitro and in animals in vivo. The aim of this study was to evaluate the influence of pretreatment with captopril on the prevention of reperfusion arrhythmias in patients undergoing valvular cardiac surgery. METHODS: 30 patients were randomly allocated to pretreatment with either captopril (CTP group, n = 15) or without captopril (CON group, n = 15). Exclusion criteria (left ventricular ejection fraction < 40%, evidence of angiographic coronary disease, prior myocardial infarction and preoperatory myocardial infarction). The dose of captopril administered was 12.5 mg every 8 hours orally, from 24 hours before surgery. A Holter register was used to analyze the ventricular arrhythmias (extrasystoles, salvos, tachycardia and fibrillation) during the first hour of reperfusion. The need for cardioversion was examined and the number of shocks needed. These events were related to changes in blood analyses from coronary sinus samples to determine creatine phosphokinase, activity of the angiotensin converting enzyme and cyclic adenosine monophosphate, before aortic clamping and after the heart was rewarmed. RESULTS: No significant differences were found in the number of ventricular arrhythmias. 60% of the patients with captopril and only 40% of the patients without it (non significant) had spontaneous defibrillation without electric shock; in those cases in which it was necessary, the number of shocks was less in the captopril group (p < 0.05). Excepting the significant correlation (p < 0.01) that we have found between ventricular fibrillation and the cyclic adenosine monophosphate increase, there is no significant correlation between the other arrhythmias and the analytical data studied. CONCLUSIONS: These data suggest that captopril, given before cardiac surgery, has little or no protector effect on reperfusion ventricular arrhythmias in extracorporeal cardiac surgery, though in patients treated with captopril there is a greater possibility of spontaneous defibrillation and fewer shocks necessary for defibrillation, without negative effects.

[Follow-up of left ventricular systolic function in the first year following previous infarction]. / Seguimiento de la función sistólica ventricular izquierda en el primer año tras infarto anterior.

OBJECTIVES: To follow the left ventricular systolic function changes as assessed by global and regional ejection fraction during the first year of evolution after anterior myocardial infarction, as well as to analyse how the most relevant clinical and angio-graphic parameters influence them. MATERIALS AND METHODS: Sixty-six consecutive patients with a first infarction of anterior location, completed 1 year of follow-up with radionuclide ventriculography, T1-SPECT after exercise or dypiridamole and cardiac catheterization before discharge; radionuclide ventriculography was repeated 6 and 12 months later. Twenty-five patients underwent revascularization procedures at the time of predischarge, 16 using successful percutaneous angioplasty of the left anterior descending artery and 9 using aorto-coronary graft surgery. Dilated patients were controlled, from an angiographic point, of view 6 months after PTCA. RESULTS: Predischarge global EF (42.9 +/- 12.6) increased significantly between the 6-month (46.9 +/- 12.8; p < 0.001) and 12-month (47.6 +/- 12; p < 0.001) studies. Differences in these two last studies were minor and had no statistical significance. A significant increase was present in revascularized or medically treated patients; i.e. those who underwent thrombolytic therapy or conventional treatment at admittance as well as mono or multivessel disease patients. No significant differences were detected in the mean ejection fraction in patients without residual stenosis in the infarct-related artery (48.1 +/- 13.3 vs 50 +/- 12.6; NS) or those presenting a pre-discharge ejection fraction > or = 45% (53.5 +/- 7.5 vs 55.1 +/- 3.3; NS). Among different variables tested, predischarge global ejection fraction (negative coefficient) and, to a lesser extent, percutaneous angioplasty were independent predictors of a significant increase of ejection fraction during follow-up. Changes from predischarge to 12 month study were significant in the regional ejection fraction in the anteroseptal (33.1 +/- 14.7 vs 40.1 +/- 13.3; p < 0.001), inferoseptal (34.6 +/- 15.8 vs 42 +/- 16.9; p < 0.001), apical (46.3 +/- 19.1 vs 50.8 +/- 19.7; p < 0.01), antero-medial (50.6 +/- 22.4 vs 56.6 +/- 24.3; p < 0.01) and anteroapical (51.6 +/- 23.5 vs 58 +/- 27.5; p < 0.01) segments. In the anterobasal segment, regional ejection fraction only showed a statistical tendency to increase during follow-up and changes in inferior and lateral segments, distal to the infarcted area, were minor and without statistical significance. The most distinct infarct-related segments, antero- and inferoseptal, showed significant increases in the main group of patients, revascularized or nonrevascularized, undergoing thrombolitic or conventional therapy, with single or multivessel disease. Only patients without residual stenosis of the infarct-related artery (the left descending anterior) disclosed negligible or negative changes without statistical significance. Percutaneously dilated patients showed the highest increase of the infarct-related segments regional ejection fraction. In multivessel disease, the infarct-related segments regional ejection fraction did not increase significantly in surgically treated patients, conversely to those who underwent medical therapy. CONCLUSIONS: Global and regional ejection fraction of the infarcted area increased significantly during the first year after anterior myocardial infarction, mainly prior to six months patients with significant residual stenosis of the artery related to the infarct. Recovery is present both in patients who underwent thrombolysis or conventional treatment at admittance and revascularization or medical treatment before discharge and is inversely correlated to the predischarge global ejection fraction value. This evolution suggests that a significant amount of stunned myocardium is still present before discharge.

[Detection of residual ischemia after acute anterior myocardial infarction using Thallium-201 SPECT]. / Detección de isquemia residual tras infarto agudo de miocardio de localización anterior mediante SPECT con talio-201.

OBJECTIVES: To assess the utility of single photon emission computed tomography (SPECT) with Thallium-201 after anterior myocardial infarction at predischarge time in the detection of; a) the prevalence of isotopic redistribution in the infarct area or at a distance; b) the correlation between peri-infarction ischemia and the angiographic state of the infarct-related artery, and c) the correlation between ischemia at a distance and the presence of multivessel disease. MATERIAL AND METHOD: Seventy-three survivors of an uncomplicated anterior myocardial infarction, 67 men and 7 women, with a mean age of 56 +/- 9 years (34-70 range), underwent T1-SPECT after stress test (62 exercise test and 11 pharmacological Dipyridamole test) as well as coronarographic studies before discharge. Peri-infarction ischemia was defined as redistribution presence in the distribution territory of the left anterior descending artery (LAD) and was assessed in a semi-quantitative way scoring both stress and rest images that allowed the calculation of a redistribution index R (Stress Score-Rest Score/Stress Score). Ischemia at a distance was defined as redistribution presence in the territories of circumflex and right coronary arteries as assessed both by visual analysis (VA) and bull's eye polar maps (BE) or by washout imaging (WO). RESULTS: Peri-infarction ischemia (R > 0) was found in 48 (65.7%) patients; 43 with and 5 without significant residual lesions in the LAD and the absence of peri-infarction ischemia (R = 0) was found in 25 (34.3%) patients, 19 with and 6 without significant residual lesions in the LAD. Sensitivity and specificity for multivessel disease detection by ischemia at a distance was 64% and 85% respectively, for VA; 60% and 77% for BE; and 95% and 65% for WO. Combinations of different analytical methods (multiparametric approach) showed a decrease in sensitivity but improved specificity and positive predictive value: 60%, 90% and 75%, respectively, for BE & WO; 44%, 90% and 69% for VA & BE and 60%, 92% and 79% for VA & WO. CONCLUSIONS: TI-SPECT imaging is a useful diagnostic method to detect both peri-infarction ischemia and ischemia at a distance at predischarge time following anterior myocardial infarction. Redistribution presence in the non infarct-area shows a fair sensitivity and a high positive predictive value to detect residual multivessel disease.

[Long-term follow up of Doppler parameters of ventricular diastolic function after myocardial infarct]. / Evolución a largo plazo de los parámetros Doppler de función diastólica ventricular tras un infarto del miocardio.

Forty-two survivors of a first transmural, noncomplicated myocardial infarction underwent mitral flow pulsed-Doppler studies both at predischarge time and 1 year later, in order to assess the long-term evolution of diastolic parameters in the absence of reinfarction or revascularization procedures. Results showed a decrease of mean value of E wave peak velocity (59.6 +/- 14 cm/sec vs 46.8 +/- 13 cm/sec, p < 0.001). Mean value of A wave peak velocity remained stable (59.4 +/- 16 cm/sec vs 58.8 +/- 13 cm/sec, p = 0.86). The mean value of the E/A ratio showed a significant decrease during follow-up from an initial value > or = 1 to a final value < 1 (1.08 +/- 0.4 vs 0.82 +/- 0.2, p < 0.01). From the point of view of individual results, only 8 of 22 patients with an E/A ratio > or = 1 before discharge presented the same ratio value 1 year later, whereas only 1 patient with a E/A ratio < 1 before discharge presented a > 1 value of this ratio in the late study. It is concluded that during the first year of evolution after transmural, nonrevascularized, noncomplicated infarction, the left ventricle filling pattern displays a significant change from predischarge phase (mainly protodiastolic with predominant E wave) to late follow-up (mainly telediastolic with predominant A wave). Different hypotheses to explain these results are discussed.

Effects of early use of captopril on haemodynamics and short-term ventricular remodelling in acute anterior myocardial infarction.

To determine whether ventricular short-term enlargement following acute myocardial infarction is related to increased left filling pressures and whether early treatment with captopril alters this process we studied 68 patients with a first acute myocardial infarction. Forty patients with a pulmonary capillary pressure equal or above 17 mmHg were randomized to treatment with conventional therapy plus captopril (n 20) or placebo (n 20), in a double blind fashion. The remaining 28 patients (non-dysfunction group) were treated conventionally. During the first 72 h, afterload showed a prompt decrease in the captopril group as compared to placebo. Changes from baseline to 14 days in end-diastolic and end-systolic left ventricular volume indexes determined by radionuclide ventriculography were: non-dysfunction, 85.6 (+/- 21) vs 88 (+/- 20) and 44 (+/- 17) vs 44 (+/- 17) ml.m-2; captopril (n 20), 96.6 (+/- 18) vs 99 (+/- 19) and 66 (+/- 22) vs 65 (+/- 22) ml.m-2; placebo (n 20), 96 (+/- 25) vs 113 (+/- 19) (P < 0.001) and 63 (+/- 18) vs 74 (+/- 22) ml.m-2 (P < 0.01). This study indicates that short-term ventricular enlargement is related to the degree of ventricular dysfunction and that captopril may improve this process.