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)

A series of 30 patients (25 males, 5 females, age = 28-73 years) with a clinical indication of thallium-201 stress/4 hours redistribution scintigraphy has been studied using stress/rest (n = 7) or rest/stress (n = 23) protocols with technetium-99m teboroxime (CARDIOTEC, Squibb Diagnostics) in order to assess the clinical usefulness of this new molecule and to compare it to thallium. In all cases coronary artery disease was known or highly suspected, with a history of myocardial infarction in 18 cases (subacute n = 6, remote n = 12) and/or previous by-pass surgery or PTCA in 5 cases. Medical treatment was not discontinued at the time of stress testing. Coronary angiography was available for 27 patients. Exercise tests for both tracers were carried out on an ergometric bicycle during the same day and the levels of exercise achieved for the thallium studies were very similar to those achieved for teboroxime. Imaging was performed in three planar projections and sudies were evaluated using a model with 4 territories: septal and anterior assumed to correspond to the LAD artery, lateral and latero-posterior (= LCX), inferior and posterior (= RCA) and apex. Classification of results was: normal, ischemic, infarcted and infarcted with ischemia. With reference to the thallium-201 results, agreement was found in 86% (37/43) of normal regions and in 82% (63/77) of abnormal regions. Relative to documented coronary artery lesions (27 patients) sensitivity and specificity of thallium and teboroxime for exact correspondence between arteries and territories were, respectively: thallium, se = 71%, sp = 64%, teboroxime, se = 67%, sp = 75%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical experience with technetium-99m teboroxime scintigraphy in patients referred for myocardial perfusion evaluation. 146 25

For the cases with the abruptly obliterated coronary artery during angioplasty or angiography, emergency bypass surgery is mandatory. However, a "bail-out" perfusion catheter with multiple side-holes, which maintains antegrade coronary flow, is not efficient in preventing the myocardium from developing ischemia, because blood flow is interfered due to pressure-dependent perfusion mechanism in the shock state. We developed a new perfusion catheter coupled with an extracorporeal circulating system and a perfusion pump. Its effectiveness and safety were tested experimentally in canine hearts. The system is composed of a perfusion catheter (125 cm in length) with 4 side-holes within 1.5 cm of the catheter tip, and a rolar pump. Maximum flow volumes were 123 ml/min, 84 ml/min, and 52 ml/min for 4.5F, 4.3F, and 4F perfusion catheters, respectively. The left anterior descending coronary artery (LAD) was ligated after the perfusion catheter was advanced into the proximal LAD under fluoroscopic control. To avoid formation of pericatheter intracoronary thrombi, 50 U/kg/hr heparin was continuously injected during a 5-hour ligation. In the nonperfusion group (n = 4), the ST segments elevated in all dogs; 2 died of ventricular fibrillation within 30 min, and one was confirmed to have myocardial necrosis by NBT staining. In the perfusion group (n = 4), neither ECG changes nor hemodynamic deterioration was observed. Intracoronary thrombi were not observed in any surviving dogs. Coronary perfusion using our new device was performed in 2 patients: one patient, a 73-year-old man with 99% stenosis in the very proximal portion of his LAD, had massive intimal dissection after PTCA, and angiography revealed total occlusion of his proximal LAD and LCX. Coronary perfusion was immediately initiated by advancing the perfusion catheter into his LAD. After that the patient recovered from shock. Emergency bypass surgery was successfully performed after 120 min coronary perfusion with the support of IABP and inotropics. The other patient, a 58-year-old man with effort angina, had intimal dissection in the proximal portion of his right coronary artery, which was supplying collaterals to the mid LAD and LCX. Successful bypass surgery was performed 320 min after the coronary perfusion without IABP and inotropics. In conclusion, coronary reperfusion with an extracorporeal circulating system proved to have a greater effect than did passive perfusion in such cases with cardiogenic shock.
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PMID:[Coronary reperfusion using an extracorporeal circulating system performed in cases with abruptly obliterated coronary arteries: a new method]. 184 11

This is the first report of re-aortocoronary bypass for Kawasaki's disease. The patient is a 22-year old female. She was afflicted with Kawasaki's disease at the age of 6 and had the symptom of angina pectoris at the age of 9. She went through the first aortocoronary bypass, to the left anterior descending artery (LAD) and the right coronary artery (RCA) with saphenous vein graft (SVG). After the first operation, the graft to LAD occluded totally, but she remained asymptomatic and well for 11 years. She had a sudden recurrence of anginal attack at the age of 20. The examinations confirmed ischemia of the anterior wall (LAD area) and the lateral wall (LCX area). Coronary angiography revealed patent SVG with a moderate sign of sclerotic change. We decided on re-aortocoronary bypass, left mammary artery to LAD and gastroepiploic artery to LCX, when she was 22-years old. LIMA was anastomosed to LAD, but LCX was not revascularized, because LCX was not identified and exposed in the operation. In spite of incomplete revascularization, postoperative stress ECG test was negative. Tl-myocardial scintigram confirmed no ischemia of the anterior wall and greatly reduced ischemia in the lateral wall. She became asymptomatic and returned to normal life.
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PMID:[A case report of redo A-C bypass for MCLS performed 13 years after initial surgery]. 226 33

For determining an indication of percutaneous transluminal angioplasty (PTCA), a 73-year-old-man with silent ischemia and with ventricular premature complexes (quadrigeminy) were performed cardiac nuclear studies. This case had 99% stenosis in LCX (#11) and 90% stenosis in RCA (#1), and demonstrated akinetic wall motion in left ventricular (LV) inferior and posterior regions. Exercise-redistribution Tl-201 studies indicated myocardial viability in a portion of the inferior wall but not in the posterior wall. To estimate the potential contractile function in the regions with akinesis, from the list-mode data of radionuclide ventriculography, those of postsinus beats and postextrasystolic beats were separately selected and were analyzed for investigating LV wall motion and LV ejection fraction (EF). With the post-extrasystolic potentiation, LVEF increased from 36% to 45% and the systolic wall motion was augmented in the inferior wall but not in the posterior wall. From these findings we recognized the existence of myocardial viability in a portion of the inferior wall. After PTCA for the RCA lesion, improvements of the myocardial Tl-201 distribution and LV wall motion in the inferior wall were definitely observed and hence LVEF increased by 16% to contribute to an increase in exercise performance. Thus, this case indicates that the postextrasystolic potentiation is useful for determining an indication of PTCA in patients with LV asynergy, demonstrating the myocardial viability and the potential LV function.
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PMID:[Estimation of myocardial viability in left ventricular regions with akinetic wall motion by postextrasystolic potentiation using list-mode radionuclide ventriculography in an interesting case with silent ischemia and with premature ventricular complexes (quadrigeminy)]. 252 68

The detection of multivessel disease (MVD) in patients with myocardial infarction (MI) was performed using exercise myocardial scintigraphy with qualitative and quantitative analysis, to compare the diagnostic ability of planar (PL), planar + washout rate (PL + WR), SPECT, Bull's eye + WR (BE + WR) and SPECT + BE + WR. Forty seven patients of anterior MI (SVD: DVD: TVD = 29: 8: 10) and thirty four patients of infero-posterior MI (SVD: DVD: TVD = 16: 8: 10) were reviewed. SPECT was superior to PL to detect ischemia of RCA in patients with anterior MI (50% vs. 100%) and to detect ischemia of diagonal branch in patients with infero-posterior MI (0% vs. 83%). The detection of ischemia of LCX in patients with anterior MI revealed low sensitivity in both PL and SPECT. SPECT + BE + WR showed the highest diagnostic ability to detect MVD in patients with both anterior (87%) and infero-posterior MI (82%). We conclude that SPECT with qualitative and quantitative analysis is the most useful to detect MVD in patients with MI.
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PMID:[Detection of multivessel disease in patients with myocardial infarct using exercise myocardial scintigraphy--usefulness of SPECT with qualitative and quantitative analysis]. 278 98

We studied the efficacy of coronary angioplasty (PTCA) of the infarct-related artery in 29 patients with prior myocardial infarction by stress thallium scan. Twenty-seven patients had anterior myocardial infarction (single LAD disease), one had inferior (single RCA disease) and one had posterior (single LCX disease). According to the stress-redistribution thallium scintigraphic finding before PTCA, the patients were classified in 4 groups; (A): three patients with complete redistribution. (B): fourteen patients with incomplete redistribution. (C): seven patients with partial redistribution. (D): five patients with no redistribution. After PTCA, the parameters of residual ischemia in the infarct area (% RD and Thallium ischemic score = TIS) were improved significantly but those of infarct size (RD% uptake and Defect Score = DS) were improved slightly in group A. In group B and C, % RD, TIS, RD% uptake and DS were all improved significantly. In group D, TIS was improved slightly and DS was improved slowly 3 months after PTCA. Group A had high probability of viable muscle and group D had high probability of scar at the infarct zone. Group B and C showed intermediate type between group A and D. The change of infarct area after PTCA was variable in 4 groups but both residual ischemia and infarct size decreased in all groups. Thus, PTCA of infarct-related coronary artery is useful even in the patients with prior myocardial infarction.
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PMID:[Usefulness of coronary angioplasty (PTCA) of the infarct-related artery in patients with prior myocardial infarction--follow up of infarct zone pre- and post-angioplasty by stress thallium scan]. 281 Sep 2

Contractile dysfunction of reversibly injured, reperfused myocardium can be enhanced by inotropic interventions. A decrease in the Ca-sensitivity of contractile proteins with slow recovery during reperfusion has been suggested as a potential mechanism underlying this postischemic dysfunction. We therefore tested the effects of the cardiotonic agent AR-L 57 (1 mg/kg i.v.) in six anesthetized, vagotomized dogs during constant atrial pacing at 192 +/- 6 beats/min. Before ischemia, AR-L 57 increased left ventricular pressure from 131 +/- 22 to 138 +/- 21 mm Hg and maximum dP/dt from 3,022 +/- 1,427 to 4,337 +/- 2,608 mm Hg/s. Mean systolic thickening velocity of the posterior myocardium was increased from 8.9 +/- 1.1 to 11.7 +/- 1.1 mm/s. After release of a 15 min LCX-occlusion which caused complete regional akinesia, baseline function in the posterior myocardium was severely depressed and only gradually returned towards control values over 8 h of reperfusion. AR-L 57 increased systolic thickening velocity at 10 min, 4 and 8 h reperfusion to a similar extent as before ischemia. With reference to a purported Ca-sensitizing mechanism underlying the positive inotropic action of AR-L 57, our data suggest no change in the Ca-sensitivity of reperfused myocardium.
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PMID:Recruitment of inotropic reserve in "stunned" myocardium by the cardiotonic agent AR-L 57. 322 76

The value and limitations of stress 201T1 myocardial single photon emission computed tomography (SPECT) for diagnosing ischemic heart disease (IHD) was studied. Using a dual-head rotating gamma camera system, stress SPECT and conventional planar imaging were performed for 138 patients while they were examined by symptom-limited graded bicycle ergometer exercise. All patients underwent selective coronary arteriography and left ventriculography, and 93 had myocardial infarction (MI), 30 had effort angina (EA) and 15 were normal (control). Sensitivities for detecting IHD (SPECT: planar = 96%: 89%, p less than 0.01), individual coronary arterial lesions (left anterior descending artery = LAD, 84%: 68%, p less than 0.005; left circumflex artery = LCX, 60%: 47%, NS; right coronary artery = RCA, 88%: 69%, p less than 0.01), multivessel disease (= LAD + LCX and/or RCA, 53%: 31%, p less than 0.025), and three vessel disease (60%: 13%, p less than 0.005) were significantly higher by SPECT than by planar imaging. In addition, detection of ventricular aneurysms by SPECT was possible with a reasonably high sensitivity (94%) and specificity (84%). Signs of aneurysm included 1) an extensive anterior permanent defect, 2) a large left ventricular cavity, and 3) widening of the angle composed by the septal and lateral walls toward the apex in transaxial images. Sensitivity for detecting IHD was significantly lower in patients without MI (i.e., EA) than in patients with MI (MI: EA = 100%: 83%, p less than 0.005). Sensitivity for detecting individual coronary arterial lesions was lower in the absence than in the presence of MI (LAD; 77%: 87%, LCX; 38%: 68%, RCA; 71%: 90%, respectively), with multivessel disease than with single vessel disease, and with mild than with severe grade of stenosis. Sensitivity for detecting multivessel disease was lower in patients without MI than in those with MI (31%: 61%, respectively), and in anterior MI than in posteroinferior MI, or both MIs (36%: 69%: 100%, respectively). Stress-induced ischemia of infarcted area (anterior MI, 36%; posteroinferior MI, 24%) and ventricular aneurysm (anterior MI, 21%; posteroinferior MI, 0) masked other coronary arterial stenoses in patients with previous MI. We concluded that stress 201T1 myocardial SPECT was a useful non-invasive technique for detecting IHD and individual coronary arterial lesions, multivessel disease (especially posteroinferior MI and anterior + posteroinferior MI), three vessel disease and ventricular aneurysms. However, there were limitations in detecting multivessel disease in patients with anterior MI and EA.
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PMID:[Stress Tl-201 myocardial single photon emission computed tomography in diagnosing ischemic heart disease: its value and limitations]. 350 47

The purpose of this study was to evaluate the detectability of stress-induced ischemic lesion in patients with previous myocardial infarction using single photon emission computed tomography (SPECT) producing thallium-201 (T1-201) myocardial perfusion imagings (MPI). Seventy patients underwent stress SPECT by symptom-limited graded bicycle ergometer exercise using a dual-headed rotating gamma camera (Toshiba GCA70A) equipped with a computer system (GMS90). After intravenous administration of 2.5 mCi of T1-201, stress SPECT data at 10 minutes and delayed SPECT data at 3 hours after the injection were collected in the 64 X 64 matrix form covering 360 degrees directions by camera sweep of 180 degrees in 6 minutes, which were immediately followed by conventional planar imagings (PL). Transaxial tomographic image reconstruction was performed by convolution method using a Shepp-Logan's filter. Thereafter, sagittal and coronal tomographic images were reconstructed for about 2 minutes. Image interpretation was assessed visually. The results were as follows: Sensitivity and specificity in detecting the affected vessel with more than 75% stenosis by segmental analysis of myocardial images were higher by SPECT than by PL (LAD 89% and 65%, LCX 68% and 56%, RCA 89% and 76% in sensitivity and LAD 94% and LCX 75%, 92% and 94%, RCA 81% and 59% in specificity, respectively). Sensitivity in detecting both single (82%) and multivessel disease (76%) was fairly high. Detectability of stress-induced ischemia (i.e. occurrence of a new defect in patients with previous myocardial infarction and ST-segment depression in ECG) was significantly higher in SPECT (67%) than in PL (39%, p less than 0.005) and in ECG (39%, p less than 0.005). A perfusion defect in the extensive anterior wall, marked left ventricular dilatation and the widening of the angle toward the apex composed of septal and anterolateral walls in transaxial images were the findings characteristic of anterior myocardial infarction with severe dyskinesis. We conclude that stress SPECT is a useful noninvasive technique for the documentation of the number of vessels affected and severe wall motion abnormality of the LV and for the detection of stress-induced ischemia in previous myocardial infarction.
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PMID:[Detectability of stress-induced ischemic lesion in previous myocardial infarction using 201T1 myocardial single photon emission computed tomography]. 633 58

To extend the usefulness of multi-lead ambulatory electrocardiography, we attempted to construct body surface isopotential maps of ST segment using our newly designed multi-lead ambulatory electrocardiograph. Material consisted of 40 patients (pts) with angiographically proven coronary arterial stenosis. By a commercially-available 4-channel recorder and a specially designed adapter, 30-lead ECGs were sequentially recorded together with body position signals for 24 hours. Compensation for ST distortion and interpolation of ST level on time scale techniques were performed before construction of ST maps. The extension of ST depression area in pts with single LAD disease were larger than in pts with single LCX or RCA disease. As time elapsed, after occurrence of ischemia the extension and location of ST depression area were changed. These results were thought to be reasonable. In conclusion, the ambulatory recording of body surface ST maps may become useful for study of myocardial ischemia in daily life.
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PMID:[Body surface ST mapping in daily life using multi-lead ambulatory electrocardiograph]. 789 42


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