Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The goal of this study was to determine the ability of exercise single-photon emission computed tomographic (SPECT) technetium-99m (Tc-99m) sestamibi imaging to predict adverse events in a population with a comparable distribution of men (n = 114) and women (n = 115). Consecutive patients referred for evaluation of chest pain syndrome, known coronary artery disease, or residual ischemia after acute myocardial infarction underwent imaging using a single-headed SPECT camera. Clinical readings were reviewed and scored by independent observers as normal or abnormal. Follow-up, defined as time from scanning until an event, late revascularization, or patient response averaged 19.2 +/- 5.2 months and was 90% complete (229 of 255 patients). Cardiac death and nonfatal infarction were corroborated by chart review or physician contact. Patients were excluded from analysis if a revascularization procedure was performed within 1 month of imaging. There were 172 patients with normal scans (67%) and 83 with abnormal scans (33%). Of the patients in whom followup was obtained, 2 of 155 with normal scans (0.8%/year) and 6 of 74 with abnormal scans (5.4%/year) had cardiac events. Statistical analysis using the Kaplan-Meier survival curves suggests a significant difference in event-free survival between normal and abnormal scans. Patients with abnormal scans portended a worse outcome (chi-square = 8.04, p <0.005). Thus, exercise SPECT Tc-99m sestamibi scintigraphy is useful for prognostication in a mixed population of patients with suspected or known coronary artery disease in which women comprised 50% of the patient cohort.
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PMID:Predicting adverse outcome with exercise SPECT technetium-99m sestamibi imaging in patients with suspected or known coronary artery disease. 903 43

Sustained left ventricular systolic dysfunction after transient myocardial ischemia is well known as "myocardial stunning", but little is known about the recovery in left ventricular diastolic function. Changes in left ventricular systolic and diastolic performance following dobutamine-induced ischemia were investigated in 13 patients with chest pain syndrome and normal coronary arteries (control) and 34 patients with coronary artery disease. Two-dimensional echocardiography and pulsed wave Doppler transmitral flow velocity curves were recorded at baseline, after infusion of a peak dose of dobutamine and at 20 min and 2 hours after dobutamine infusion. In control subjects, left ventricular ejection fraction and the peak early diastolic filling velocity increased at the peak dose of dobutamine. At 20 min after the cessation of dobutamine infusion, these values were restored to the baseline levels. In patients with coronary artery disease, ejection fraction and peak velocity increased at the peak dose of dobutamine but decreased at 20 min after infusion compared with baseline values despite the restoration of heart rate and blood pressure. Although ejection fraction increased at 2 hours compared with 20 min after infusion, peak velocity did not increase. Left ventricular diastolic dysfunction may be sustained longer than systolic dysfunction after transient myocardial ischemia.
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PMID:[Recovery process from myocardial stunning after transient ischemia: assessment with pulsed wave Doppler transmitral flow pattern]. 943 70

The arrival of a patient with chest pain syndrome (precordial) to the emergency represents a diagnostic challenge for the physician. Around 6 million persons are seen each year at the Emergency units in the USA. More than half of the patients are admitted for their cardiac evaluation. Its cardiac origin is confirmed in 10 to 15%, and about 15% of them develop myocardial infarction. However, 5 to 10% of patients are dismissed and develop myocardial infarction during the next 48 h. The diagnosis of the infarct is inadvertent and/or patients is not hospitalized in 2 to 8%. The mortality rate is duplicated in none hospitalized patients. Frequently, a conservative observation conduct and/or diagnostic expectation is taken, with the consequent saturation of the intensive care unit that looses its critical character and avoids quick mobilization of the patient with an increase in costs. The clinical judgment, a meticulous clinical history, and careful physical examination play a key role in the differential diagnosis of the precordial pain syndrome; however, pain can be atypical, absent or manifest as an equivalent of pain, which does not exclude the diagnosis of myocardial infarction or ischemia. Likewise, chest pain in the presence of a normal conventional ECG at rest, non-diagnostic or with minimal variations, does not rule out the possibility of a coronary obstruction and does not mean that the pain is not of coronary origin. Other characteristics of the ECG, such as T wave and ST segment alterations, bundle branch block (BBB), LV hypertrophy, interpretation discrepancies, can pose doubts or mistakes in the diagnosis. Although its diagnostic information is essential, other non-invasive laboratory tests are needed, such as the treadmill stress ECG, serial bioenzymatic markers, and myocardial perfusion scintigraphy (SPECT and Gated-SPECT) at rest or under physical or pharmacologic stress. The advantages and disadvantages of the stress ECG, the echocardiography, magnetic resonance and PET are mentioned. The advantages of the SPECT and Gated-SPECT in the diagnosis and prognosis are: 1) great diagnostic objectivity; 2) high sensitivity and specificity; 3) diagnosis does not depend on evolution time of the ischemia and/or infarction, since SPECT diagnoses the initial primary modifications of ischemia; 4) diagnosis is achieved within the established limit of time, in less than 4 to 6 hours. The designed protocols allow to obtain the diagnosis between 30 min and 1:30 h; 5) assesses the myocardium at risk; 6) stratifies the risk and prognosis; 7) defines the site and 8) the involved coronary artery(les); 9) provides the functional significance of the anatomic obstruction; 10) quantifies the ventricular function, i.e., ejection fraction, systolic and diastolic volumes, systolic thickening, ventricular failure signs; 11) provides three-dimensional visualization of the mobility of the left ventricular wall; 12) diagnoses simultaneously the associated presence of ischemia and/or infarction of the right ventricle; 13) its high negative predictive value allows to dismiss immediately and with a great safety margin those patients in whom SPECT revealed normal perfusion; 14) costs are reduced without adversely compromising the safety of the patients. We describe the algorithm used as guideline for the early diagnosis in the presence or absence of ischemic heart disease in the patient with precordial or chest pain syndrome with normal or non-diagnostic ECG at arrival to the emergency ward. It is necessary to modified the clinical educational patterns and to revaluate the advantages and limitations of the clinical history, physical exploration, as well as of the conventional ECG at rest and other diagnostic methods used specifically in relation to the chest pain syndrome with a normal or non diagnostic conventional ECG. SPECT and Gated-SPECT scintigraphy is considered as the best individual and isolated non-invasive test for the diagnostic solution of the precordial syndrome at the Emergency Unit.
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PMID:[Chest pain syndrome in normal or non-diagnostic conventional ECG at the emergency service. Assessment with myocardial perfusion (SPECT) and ventricular function (Gated-SPECT)]. 1521 44


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