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  • Thallium-201 scintigraphy  (3)
  • acute myocardial infarction  (3)
  • coronary artery disease  (2)
  • 1
    Electronic Resource
    Electronic Resource
    Evaluation of the long-term functional outcome assessed by myocardial perfusion scintigraphy following excimer laser angioplasty compared to balloon angioplasty in longer coronary lesions (2000)
    Springer
    The international journal of cardiovascular imaging 16 (2000), S. 267-277 
    Details
    ISSN: 1573-0743
    Keywords: balloon angioplasty ; coronary artery disease ; laser angioplasty ; laser-assisted balloon angioplasty ; percutaneous transluminal laser angioplasty ; randomized trial ; myocardial perfusion scintigraphy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Evaluation of the long-term functional outcome assessed by exercise myocardial perfusion imaging following excimer laser angioplasty compared to balloon angioplasty in coronary lesions 〉10 mm in length. Background: Previous randomized studies evaluating the effect of coronary interventions mainly focused on the long-term clinical and angiographic outcome. The functional outcome, assessed by myocardial perfusion scintigraphy, has not been evaluated in a randomized setting. Methods: A total of 308 patients with stable angina and a longer coronary lesion (〉10 mm) were randomized to excimer laser angioplasty or balloon angioplasty. A 99mTechnetium-2-methoxy isobutyl isonitrile (MIBI) single-photon emission computed tomography (SPECT) study was performed in 139 patients before the initial angioplasty procedure and at 6 months follow-up (73 patients in the laser group versus 66 patients in the balloon group, respectively). Exercise tolerance at follow-up was compared to baseline values by means of exercise duration and double product at peak exercise. Myocardial perfusion of the randomized vascular bed was assessed semi-quantitatively on the MIBI SPECT images. The reversible defects were graded as mild, moderate or severe. Myocardial perfusion at follow-up was expressed as a percentage reduction in incidence and grading of the reversible defects compared to baseline values. Results: Forty-four (61%) patients assigned to laser angioplasty were asymptomatic at 6 months follow-up compared to 34 (52%) patients assigned to balloon angioplasty (p = NS). Improvement in exercise duration and double product were 0.7 ± 2.1 min and 4.3 ± 6.2 min/mmHg/1000, respectively, in the laser group, versus 0.3 ± 2.5 min and 3.1 ± 5.5 min/mmHg/1000, respectively, in the balloon group (both p = NS). The percentage reduction of reversible defects was 23% in patients assigned to laser angioplasty vs. 29% in patients assigned to balloon angioplasty (Relative risk [RR]: 0.79, 95% confidence interval [CI]: 0.40–1.57; p = 0.50). The mild, moderate and severe reversible defects improved in 44.4, 63.6 and 66.6%, respectively, in the laser angioplasty group vs. 66.6, 53.8 and 90%, respectively, in the balloon angioplasty group. None of the comparisons were significantly different. Conclusion: Excimer laser angioplasty compared to balloon angioplasty in coronary lesions 〉10 mm in length yields a similar long-term functional outcome assessed by anginal status, exercise tolerance and myocardial perfusion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1026576223669
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  • 2
    Electronic Resource
    Electronic Resource
    Clearance of thallium-201 from the peripheral blood: Comparison of immediate and standard thallium-201 reinjection (1996)
    Springer
    European journal of nuclear medicine 23 (1996), S. 188-194 
    Details
    ISSN: 1619-7089
    Keywords: Thallium-201 scintigraphy ; Thallium-201 kinetics ; Thallium-201 reinjection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract As several reinjection procedures have shown encouraging results in terms of imaging, we investigated whether the kinetics of thallium-201 would differ between the standard stress-redistribution-reinjection approach and the stress-immediate reinjection approach. In 53 consecutive patients with undiagnosed chest pain, 75 MBq (2 mCi)201Tl was injected at maximal exercise. In 26 of these patients (group I), 37 MBq (1 mCi)201Tl was reinjected immediately after completing the exercise images (the immediate reinjection procedure) and in 27 patients (group II), 37 MBq (1 mCi)201Tl was reinjected after completing 3-h redistribution images (the standard reinjection procedure). Mean peak201Tl blood activity after exercise was 17.7±12.5 kBq/ml (4.8±3.4 mCi/ml) for group I versus 16.4±9.2 kBq/ml (4.4±2.5 mCi/ml) for group II (NS). The relative increase in201Tl blood activity after reinjection of half the initial dose [37 MBq (1 mCi)] exceeded 50% of the initial peak in both groups. The relative amount of201Tl delivered to the myocardium was assessed by the area under the curve after both exercise and reinjection, and was 117%±72% for group I and 112%±73% for group II (NS). Blood clearance of201Tl was at least biexponential. Mean early decay constants (λ1) after exercise and reinjection were 0.30±0.18 min−1 and 0.22±0.046 min−1 respectively for group I (T 1/2 2.3 min and 3.2 min respectively, NS), and 0.30±0.12 min−1 and 0.24±0.07 min−1 respectively for group II (T 1/2 2.3 min and 2.9 min respectively, NS). For both procedures no significant differences were found between λ1 after exercise and λ1 after injection. The mean late clearance (λ2) from the blood was 0.032±0.056 min−1 and 0.012±0.012 min−1 respectively for group I (T 1/2 21.6 min and 57.7 min respectively, NS), and 0.036±0.030 min−1 and 0.014±0.014 min−1 respectively for group II (T 1/2 19.3 min and 49.5 min respectively, NS). Also, no significant differences were found between λ2 after exercise for both groups and between λ2 after reinjection for both groups. We conclude that reinjection of 37 MBq (1 mCi)201Tl (half the initial dose) results in a relative increase in the initial peak and a relative increase in the amount of201Tl delivered to the myocardium of more than 50% for both the standard and the immediate reinjection procedure. The clearance of201Tl from the blood was not influenced by exercise or by the time of reinjection. Based on201Tl kinetics as measured in the peripheral blood, there is no reason to postpone reinjection until 3–4 h following exercise.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01731843
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  • 3
    Electronic Resource
    Electronic Resource
    Patients with a normal exercise thallium-201 myocardial scintigram : always a good prognosis? (1993)
    Springer
    European journal of nuclear medicine 20 (1993), S. 151-158 
    Details
    ISSN: 1619-7089
    Keywords: Thallium-201 scintigraphy ; Coronary artery disease ; β-Blocking agents ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The prognostic value of a normal exercise thallium-201 scintigram was determined in 211 patients with a normal exercise and resting scintigram. Endpoints were sudden cardiac death, non-fatal acute myocardial infarction and coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. Forty patients (19%) had a history of a previous myocardial infarction and 40 (19%) were known to have had a previous percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. Sixty-four patients (31%) were on treatment with β-blocking agents. After a mean follow-up period of 23.5 months, 22 patients had had a cardiac event (1 cardiac death, 6 myocardial infarction, 15 revascularization). For the total group, the 1-year event rate for cardiac death, myocardial infarction, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting was 7.0%. For cardiac death or myocardial infarction alone the event rate was 2.8%. The only parameter independently predictive for cardiac events was the regular use of β-blocking agents. The high event rate in patients on β-blocking treatment is partly due to the fact that these patients were more symptomatic for coronary artery disease. The sustained β-adrenergic blockade in this patient group, even in patients advised to stop medication, was suspected to interfere with the results of 201Tl scintigraphy. Therefore, more attention should be paid to patient instruction regarding the discontinuation of medication before the test.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00168876
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  • 4
    Electronic Resource
    Electronic Resource
    Comparison of technetium-99m sestamibi left ventricular wall motion and perfusion studies with thallium-201 perfusion imaging: in search of the combination of variables with the highest accuracy in predicting coronary artery disease (1996)
    Springer
    European journal of nuclear medicine 23 (1996), S. 550-559 
    Details
    ISSN: 1619-7089
    Keywords: Myocardial perfusion ; Cardiac wall motion ; Thallium-201 scintigraphy ; Technetium-99m sestamibi scintigraphy ; Coronary artery disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Measurements of myocardial perfusion and ventricular function are expected to provide additional information in the detection of coronary artery disease (CAD). The purpose of this study was threefold: (1) to determine to what extent technetium-99m sestamibi wall motion yields different information compared with99mTc-sestamibi and thallium-201 perfusion; (2) to test which information unique to either study is of value in diagnosing CAD; and (3) to assess the combination of variables with the highest diagnostic accuracy. Perfusion and wall motion scores (at rest and during exercise) obtained from visual and quantitative planar201T1 and99mTc-sestamibi scintigraphy of 60 patients with suspected CAD were compared with the angiographic results by means of a polytomous logistic regression model and the diagnostic values were compared with one another. All univariate variables were significantly related to the probability of CAD and its extent. Comparative studies revealed a large degree of correlation between201T1 stress and redistribution variables. The rest99mTc-sestamibi and wall motion studies contained partially different information. Stepwise logistic regression analysis showed the strongest diagnostic power for the combination of201Tl visual analysis of the stress images with quantitative redistribution images (sensitivity 93%, specificity 71%). The diagnostic power was similar for all combinations of visual and quantitative analyses of the exercise and redistribution images. The strongest diagnostic power of the99mTc-sestamibi variables was the score of the diastolic stress image (sensitivity 91%, specificity 79%). Comparable sensitivity and specificity estimates were found when both optimal models were compared. Wall motion studies did not have additional diagnostic power. Although99mTc-sestamibi wall motion studies, both at rest and during exercise, provide information in addition to the99mTc-sestamibi or201Tl myocardial perfusion variables, the information does not enhance the diagnostic power with regard to the prediction of CAD.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00833391
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  • 5
    Electronic Resource
    Electronic Resource
    Acute effects of intravenous nisoldipine on left ventricular function after acute myocardial infarction (1994)
    Springer
    Cardiovascular drugs and therapy 8 (1994), S. 345-351 
    Details
    ISSN: 1573-7241
    Keywords: nisoldipine ; acute myocardial infarction ; myocardial stunning ; left ventricular function ; radionuclide angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Nisoldipine is a calcium antagonist with potent coronary vasodilating effects in patients with chronic stable angina pectoris. In an initial study we showed that intravenous nisoldipine, given 24–72 hours after uncomplicated myocardial infarction, was a safe and feasible intervention that had beneficial effects on global and regional myocardial function. We subsequently studied the acute effects of nisoldipine in six patients within 24 hours (mean 14±4 hours) after the onset of myocardial infarction. Nisoldipine was administered as a 4.5 µg/kg intravenous bolus over 3 minutes, followed by intravenous infusion of 0.2 µg/kg over 60 minutes. Radionuclide angiography, cardiac output, and intraarterial blood pressure measurements were performed before and during nisoldipine. Left ventricular ejection fraction increased from 48.3±10.3% to 55.3±11.8% (p=0.034) during nisoldipine infusion. Regional wall motion score changed during nisoldipine infusion from 3.3±2.5 to 1.8±2.6 (p=0.027). Cardiac output increased from 5.5±1.0 to 7.3±1.3 1/min (p=0.0001). I eart rate increased from 78±12 to 88±11 min−1 (p=0.004). Mean arterial blood pressure decreased from 92±20 to 79±13 mmI g (p=0.038). The rate-pressure product did not change significantly during nisoldipine infusion. It is concluded that nisoldipine improves global and regional left ventricular function in patients with acute myocardial infarction within the first 24 hours.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00877319
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  • 6
    Electronic Resource
    Electronic Resource
    The acute effects of intravenous nisoldipine on left ventricular function 24 to 72 hours after uncomplicated acute myocardial infarction (1988)
    Springer
    Cardiovascular drugs and therapy 2 (1988), S. 673-678 
    Details
    ISSN: 1573-7241
    Keywords: nisoldipine ; acute myocardial infarction ; left ventricular function ; radionuclide angiography ; echocar-diography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The acute effects on left ventricular function of nisoldipine were studied in six patients 56±12 hours (range 44 to 72 hours) after the onset of uncomplicated acute myocardial infarction. Nisoldipine was administered as a 4.5 μg/kg intravenous bolus over 3 minutes followed by an infusion of 0.2 μg/kg during 60 minutes. Radionuclide angiography and two-dimensional echocardiography were performed before and during infusien with nisoldipine. The left ventricular ejection fraction increased significantly from 38%±10% to 49%±10% (P=0.028) during nisoldipine infusion. Regional wall motion index was determined both by radionuclide and by two-dimensional echocardiography and showed a significant change during nisoldipine infusion from 1.9±0.3 to 1.5±0.3 (p=0.028, radionuclide angiography) and from 0.7±0.2 to 0.3±0.2 (p=0.043, two dimensional echocardiography). Heart rate increased significantly from 78±12 min-1 to 92±13 min-1 (p=0.028), but mean double product did not change significantly during nisoldipine infusion. It is concluded that nisoldipine significantly improves global and regional left ventricular function in patients shortly after acute myocardial infarction. This beneficial effect may, however, be partially offset by an increase in heart rate. Since mean double product did not change, it is suggested that nisoldipine may improve coronary blood flow in patients with acute myocardial infarction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00054208
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  • 7
    Electronic Resource
    Electronic Resource
    Ischemic heart disease: value of MR techniques (1997)
    Springer
    The international journal of cardiovascular imaging 13 (1997), S. 179-189 
    Details
    ISSN: 1573-0743
    Keywords: coronary arteries ; coronary artery disease ; ischemic disease ; magnetic resonance imaging ; myocardial perfusion ; ventricular function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. The cardiovascular applications of magnetic resonance (MR) techniques in coronary artery disease have increased considerably in recent years. Technical advantages of MR imaging are the excellent spatial resolution, the characterization of myocardial tissue, and the potential for three-dimensional imaging. These characteristics allow the accurate assessment of left ventricular mass and volume, the differentiation of infarcted from normal tissue, and the determination of systolic wall thickening and regional wall motion abnormalities. Methods. In addition to the conventionally used spin-echo and cine-echo techniques, newer techniques such as myocardial tagging, ultrafast MR imaging and MR coronary angiography have been developed. These newer techniques allow a more accurate assessment of ventricular function (tagging), myocardial perfusion (ultrafast imaging), and evaluation of stenosis severity (MR coronary angiography). Particularly early detection and flow assessment of stenosed coronary arteries and bypasses by MR angiography would constitute a major breakthrough in cardiovascular MR imaging. Apart from the MR imaging techniques, cardiac metabolism may be well assessed using MR spectroscopy. This provides unique information on the metabolic behaviour of the myocardium under conditions stress-induced ischemia. However, the definite niche of cardiac MR spectroscopy has still to be settled. Conclusion. Currently, MR techniques allow the evaluation of anatomy and function (accepted use), perfusion and viability (development phase), and coronary angiography (experimental phase). A particular strength of MR imaging is that one single MR test may encompass cardiac anatomy, perfusion, function, metabolism and coronary angiography. The replacement of multiple diagnostic tests with one MR test may have major effects on cardiovascular healthcare economics and would outweigh the cost inherent to the MR angiography procedure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005871614387
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  • 8
    Electronic Resource
    Electronic Resource
    Improved detection of acute myocardial infarction by magnetic resonance imaging using Gadolinium-DTPA (1989)
    Springer
    The international journal of cardiovascular imaging 5 (1989), S. 1-8 
    Details
    ISSN: 1573-0743
    Keywords: Magnetic Resonance Imaging ; acute myocardial infarction ; Gadolinium-DPTA ; contrast agents
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To assess the value of the paramagnetic contrast agent Gadolinium (Gd)-DTPA in Magnetic Resonance Imaging (MRI) of acute myocardial infarction (AMI), we studied 20 patients with a first AMI by ECG-gated MRI before and after intravenous administration of 0.15mmol/kg Gd-DTPA. The MRI studies were performed after a mean of 98 hours (range 15–241) after the acute onset of AMI. Spin-echo measurements (TE 30 msec) were made using a Philips Gyroscan (0.5 Tesla). After performing the baseline MRI scans, the MRI procedure was repeated every 10 minutes for up to 40 minutes following injection of Gd-DTPA. In 18 (90%) patients contrast enhancement in the infarcted myocardial areas was observed after Gd-DTPA. In these patients intensity versus region curves, derived from 9 to 11 adjacent myocardial regions of interest, showed increased signal intensities in the infarcted areas after administration of Gd-DTPA. The precontrast signal intensity ratio between infarcted and normal myocardium was 1.14±0.15 (mean±SD); the postcontrast ratios at 10 minutes were 1.41±0.21 (P 〈0.05), at 20 minutes 1.61±0.19 (P 〈0.01), at 30 minutes 1.43±0.20 (P 〈 0.05), and at 40 minutes 1.33±0.20 (P=NS). It is concluded that MRI using the contrast agent Gd-DTPA significantly improves the visualization and detection of infarcted myocardial areas in patients with AMI and that optimal contrast enhancement is obtained 20 minutes after administration of Gd-DTPA.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01745226
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