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  • 1
    ISSN: 1619-7089
    Keywords: Unstable angina ; Nifedipine ; Thallium-201 ; Radionuclide angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 1981, a large, double-blind, randomibbed trial was started in The Netherlands to evaluate the therapeutic effects of nifedipine and/or metoprolol in patients with unstable angina. This study has been called the Holland Interuniversity Nifedipine/metoprolol Trial (HINT) and required several hundred patients to establish potential therapeutic effects. From December 1982 to January 1984 the effects of nifedipine on left ventricular (LV) performance in a subgroup of 52 HINT patients were studied using radionuclide techniques. All patients (23 on nifedipine, 29 controls) underwent thallium-201 scintigraphy or radionuclide angiography just before and 48 h after the start of experimental medication. The radionuclide angiographic studies were also performed at 1 and 4 h after treatment. Nifedipine did not influence the incidence or disappearance of perfusion defects on the 48-h thallium images. No significant differences in overall LV ejection fraction (EF) were seen at any time between nifedipine-treated patients and controls. However, paired observation in 37 patients showed improvement of LVEF after 48 h in 8 patients on nifedipine and in only 1 control patient. Scintigraphic measurements on admission were not related to clinical outcome after 48 h. Concomitant administration of metoprolol did not influence LVEF in either group. It is concluded that nifedipine improves LVEF after 48 h in a subset of patients with unstable angina without affecting myocardial perfusion. This finding indicates that nifedipine has a predominant effect on afterload reduction in patients with unstable angina. However, early scintigraphic measurements had no significant predictive value for subsequent cardiac events.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1619-7089
    Keywords: Thallium-201 ; Reinjection ; Q-wave ; Q-wave myocardial infarction ; Myocardial viability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a clinical study, the value of thallium-201 reinjection was studied in 139 patients with suspected or known coronary artery disease who showed one or more persistent defects after conventional stress-redistribution imaging. Fifty-nine (42%) patients had sustained a Q-wave myocardial infarction. Sixty-eight (49%) patients showed a reversible defect in at least one myocardial segment at redistribution, while 71 (51%) had persistent defects only. Following reinjection additional segmental filling-in was seen in 95 (68%) patients, including 50 of the 68 (74%) patients with reversible defects and 45 of the 71(63%) with persistent defects only. On the immediately post-exercise images, 458 (47%) of 973 segments showed perfusion defects. At redistribution 105 (23%) of the 458 defects showed filling-in, whereas of the remaining 353 persistent defects 164 (46%) resolved additionally after reinjection. Thirteen (10%) of 133 Q-wave related defects showed filling-in at redistribution compared with 22 (27%) of 82 remote defects (P = 0.001). After reinjection additional filling-in of defects was seen in 47 (39%) of 120 Q-wave related defects compared with 35 (58%) or 60 remote defects (P = 0.015). Overall, 60 (45%) of 133 Q-wave related defects resolved compared with 57 (70%) of 82 remote defects (P = 0.005). Thus reinjection of thallium-201 (1) revealed reversible defects in 63% of patients with only persistent defects at redistribution, (2) demonstrated additional filling-in in 74% of patients who already showed reversible defects at redistribution, (3) showed viability in 46% of segments initially classified as persistent, and (4) demonstrated filling-in in 39% of Q-wave related segments, although this was less conspicuous than in remote segments.
    Type of Medium: Electronic Resource
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