18F-FDG uptake and calcifications on positron emission tomography/computed tomography in octogenarians with severe aortic stenosis.

AIM: The degree of inflammation within the atherosclerotic plaque can be detected non-invasively by positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG). The incidence of aortic plaques with 18F-FDG increased uptake in octogenarians with aortic stenosis is unknown. Aim of this study was to evaluate the frequency of inflamed aortic atherosclerotic plaques in octogenarians with or without severe aortic stenosis and their correlations with calcifications. METHODS: The study group comprised 27 patients older than 80 years who underwent a 18FDG PET/CT. Nine patients with severe symptomatic aortic stenosis, eligible to TAVI procedure (TAVI Group), and 18 patients age and sex matched, without clinical evidence of aortic stenosis (No TAVI Group), were selected and analysed. RESULTS: In the whole population 4/27 patients (9.3%) had a significant focal aortic vessel wall 18F-FDG increased uptake: 1 patient (11.1%) in TAVI group and 3 in non-TAVI Group (16.7%). Overall 81 aortic segments were analysed. 18F-FDG uptake rates were similar in the two groups (1/27, 3.7% in TAVI Group and 3/54, 5.5% in No TAVI Group, P=0.7). At CT scan calcifications were significantly more frequent in the TAVI Group compared to non-TAVI Group (23/27, 85.2% and 28/54, 51.8% P=0.005). None of the sites of arterial calcification had an increased focal 18F-FDG uptake. CONCLUSION: Irrespectively to the presence of aortic stenosis, a significant FDG plaque uptake in octogenarians is rare while calcifications are extremely frequent.

Seguridad del Haemaccel/Solucel en pacientes sometidos a hemodilución normovolémica intencional preoperatoria (Estudio multicéntrico internacional)

El uso de Haemaccel/Soluccel en 305 pacientes sometidos a hemodilución preoperatoria normovolémica intencional, ha sido documentada en un estudio abierto, prospectivo, multicéntrico, controlado y multinacional (doce centros en 5 países). Los hallazgos reproducen el índice bajo de efectos adversos encontrados en la literatura corriente

[Clinical results and modification of left ventricular function after emergency revascularization for acute myocardial infarction]. / Risultati clinici e modificazioni della funzione ventricolare sinistra dopo rivascolarizzazione d'emergenza per infarto miocardico acuto.

Results of emergency revascularization for evolving myocardial infarction have been evaluated in 43 consecutive patients operated between January 1985 and March 1988. Time interval between onset of symptoms and coronary bypass averaged 6.7 +/- 0.5 hours (0.75-48). Intravenous or intracoronary thrombolysis was attempted pre-operatively in 26 cases. Overall hospital mortality was 6.9% (3/43) but this decreased to only 2.7% if patients in cardiogenic shock were excluded. Follow-up averaged 20.6 +/- 9.5 months (4-42). Actuarial survival was 82.9 +/- 7.3% at 36 months. Of the 36 survivors, 28 were free from angina and reinfarction at control. Nineteen patients were evaluated with angiography at follow-up (averaging 10.1 +/- 5.7 months). Left ventricular and regional ejection fraction were calculated on pre- and post-operative angiograms; regional ejection fraction was determined with the centerline method. Left ventricular ejection fraction increased from 0.49 +/- 0.15 to 0.52 +/- 0.19 (NS), regional ejection fraction improved from 0.20 +/- 0.1 to 0.27 +/- 0.16 (35% increment, p less than 0.05). The analysis of left ventricular and regional ejection fraction variations with the time elapsed from the onset of symptoms to surgery identified two subgroups of patients: those operated within and after six hours. In the first subgroup, left ventricular ejection fraction increased from 0.52 +/- 0.16 to 0.62 +/- 0.13 (p less than 0.005) and regional ejection fraction from 0.19 +/- 0.08 to 0.36 +/- 0.14 (89% increment, p less than 0.0005). In the second subgroup, both left ventricular and regional ejection fractions decreased from 0.44 +/- 0.13 to 0.36 +/- 0.11 (NS) and from 0.20 +/- 0.13 to 0.12 +/- 0.08 (NS), respectively. These results lead to the conclusion that improved left ventricular performance may be achieved in selected groups of patients if they undergo surgery within six hours of the onset of pain.

[Myocardial scintigraphy with thallium-201 in the evaluation of aortocoronary bypass patients]. / La scintigrafia miocardica con Tallio-201 nella valutazione dei pazienti operati di by-pass aorto-coronarico.

We have compared the results of 201-Thallium scintigraphy (201 TI Sc) and those of coronary angiography in 48 patients (Pts) at a mean time of 13 months after a coronary artery by-pass grafting operation (CABG). Forty-six pts were males and 2 females, with a mean age of 52 years (range 37-66). Eighteen pts (37%) had had a myocardial infarction (MI) before the operation, 4 (8%) had a perioperative and 3 (6%) a postoperative MI. Nineteen pts (40%) had angina, 9 (19%) atypical chest pain, 6 (12%) shortness of breath or easy fatigability and 14 (29%) had no symptoms. The overall CABG patency was 74% (left anterior descending: 73%, left circumflex: 71%, right coronary artery: 80%). The 201 TI was injected at peak exercise and its myocardial uptake was recorded immediately and after four hours at rest. The 201 TI Sc has shown a sensibility (SN), specificity (SP), positive predictive (PV-pos) and negative predictive value (PV-neg) of 86, 82, 64 and 94% respectively, compared to coronary angiography. In the single patient evaluation the 201 TI Sc has shown a SN, SP, PV-pos, PV-neg of 95, 85, 82 and 96% respectively versus 90, 82, 78 and 92% of the standard exercise test associated with a positive history for 1) residual angina and 2) peri or postoperative MI. The 201 TI Sc has not shown to be significantly superior to standard exercise testing and history in the evaluation of graft patency. However it allows a topographic localization of the disease which is not feasible with the latter techniques. The 201 TI Sc can better predict the patency rather than the occlusion of the grafts because there is a high number of false positives due to residual ungrafted native disease in the territory of a good functioning graft. The 201 TI scintigraphy can give a functional evaluation of borderline grafts stenoses beside the pure anatomic definition of angiography thanks to its capability to qualitatively assess the regional myocardial blood flow during stress.

The prognostic significance of clinical history, exercise testing and ambulatory electrocardiography in patients with uncomplicated myocardial infarction.

The prognostic value of early clinical history, exercise testing and ambulatory electrocardiography was assessed in 263 men (mean age 50 years) recovering from an uncomplicated myocardial infarction (MI). During a mean follow-up period of 31 months, 11 patients died of cardiac causes, 22 developed a non fatal recurrent MI, 16 unstable angina (UA) and 16 underwent coronary artery bypass surgery. The appearance at the exercise stress test of an ischemic S-T segment depression of 0.2 mV or greater (P less than 0.001) as well as the achievement of a work load of 360 Kg-m/m' or less (P less than 0.01) and of a rate-pressure product of 200 Units or less (P less than 0.01), were found to be predictive of the future development of UA, but neither of cardiac death nor of non fatal recurrent MI. The ischemic response was also seen to be predictive of cardiac death (P less than 0.05). S-T segment depression of 0.1 mV or greater, angina and ventricular ectopic activity during the stress test and clinical history were not of predictive value. Complex ventricular ectopic activity (multiform extrasystoles, couplets and ventricular tachycardia) recorded during 24 hour ambulatory electrocardiogram was seen to be predictive of death and non fatal MI. Whereas some parameters such as the ejection fraction and the extension of coronary artery disease are generally accepted as good predictors for cardiac events, others, such as those derived from exercise testing, history and ambulatory electrocardiography may change their predictive value from one survey to another. These discrepancies are due to differences in patient characteristics, in methodology and in medical management.(ABSTRACT TRUNCATED AT 250 WORDS)

[Blood pressure during exercise stress in young normal subjects with familial hypertension (author's transl)]. / Risposta pressoria allo sforzo di giovani normali con familiarita' ipertensiva.

The behaviour of Arterial Blood Pressure was evaluated, by treadmill stress testing, in a group of young subjects (15-30 years old) with one or two hypertensive siblings. The best fit of the interpolating slope function was used in interpretating the findings of haemodynamic data (A.B.P. during exercise). These data were analyzed in the same way in three control groups: normal subjects 15-30 years old; hypertensive patients aged 30-45; normal subjects aged 30-45. We compared function's coefficients and parameters in these selected groups. The results show no different response in the A.B.P during stress between the normal subject and the group, same aged, with hypertensive siblings. Significative differences in the function's coefficients, were found in the control hypertensive patients. The stress testing doesn't seem recommending in subjects at risk because of parenteral hypertension: no early alteration in A.B.P. seems to be unmasked during exercise stress. The males of the control normal subject show higher blood pressure exercise value than females. This different response is not present in the group with parenteral hypertension: a more strick familial resemblance in A.B.P. is suggested in female population.