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ABSTRACT: OBJECTIVE: To evaluate the evolutive changes in diastolic function after percutaneous coronary revascularization (PCR) in acute myocardial infarction (AMI), using myocardial perfusion gated SPECT. MATERIAL AND METHODS: Thirty-two patients (mean 61.9±9.7 years, 7 women) were studied by two at rest gated SPECT: the first gated-SPECT-1 was performed with an injection of a dose of (99m)Tc-tetrofosmin prior to PCR and the second gated-SPECT-2 between the fourth and fifth weeks after AMI. Changes of peak filling rate (PFR) and the time to peak filling rate (TTPF) were assessed between both studies, and were related to the extent of salvaged myocardium (SM), end-diastolic (EDV) and end-systolic (ESV) volumes, and left ventricular ejection fraction (LVEF) changes. RESULTS: An improvement was observed in diastolic function parameters Gated-SPECT-2: PFR increased significantly (P=0.011) while the TTPF decreased without reaching statistical significance (P=0.288). In multivariate analysis, adjusted by clinical and coronary variables, improvement of PFR was significantly associated with percentage of SM (P=0.030), increase in LVEF (P=0.004) and with ESV volume reduction (P=0.005). Improvement of TTPF was only related significantly to the percentage of SM (P=0.046). PFR increased 0.01 EDV/sec. and TTPF decreased 1.14ms for each cm(2) increase of the area of SM. CONCLUSIONS: After PCR in AMI, the myocardial perfusion gated SPECT makes it possible to assess the significant improvement in diastolic function mainly related to the amount of MS.
Revista espanola de medicina nuclear e imagen molecular. 11/2012;
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ABSTRACT: A 52-year old patient, with symptoms of angina in the last month, was referred to undergo a SPECT myocardial perfusion. At an early stage of the exercise test, he showed electrical changes suggestive of inferior ischemia and the scintigraphy images showed intense and extensive inferolateral hypoperfusion during the effort, with complete reversibility at rest. Cardiac catheterization showed a right coronary artery without obstructive lesions. An endothelial dysfunction test with acetylcholine provoked diffuse spasm of the artery, which retrograded completely with intravenous nitroglycerin. An acute coronary syndrome may have causes other than obstructive lesions in epicardial arteries that induce myocardium at risk. The ischemic tissue can be identified by imaging techniques that thus guides the invasive studies to recognize dysfunctional coronary arteries.
Revista espanola de medicina nuclear e imagen molecular. 05/2012;
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J Candell-Riera,
J Llevadot,
C Santana,
J Castell,
S Aguadé,
L Armadans,
B Bermejo,
G Oller,
H García-del-Castillo,
M Soler-Peter,
J Soler-Soler
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ABSTRACT: We evaluate the prognostic value of stress echo and gated single photon emission computed tomography (SPECT) after a first uncomplicated acute myocardial infarction.
We used predischarge maximal subjective exercise echocardiography and gated SPECT with technetium 99m tetrofosmin to prospectively study 103 patients younger than 70 years with a first acute myocardial infarction. During a 12-month follow-up period, 2 patients died, 9 had heart failure, and 29 had ischemic complications (4 reinfarction and 25 angina). Predictive variables for heart failure in multivariate analysis were ejection fraction evaluated by echocardiography (odds ratio [OR] 8.5, P =.016) or by gated SPECT (OR 10.7, P =.009). Predictive variables for ischemic complications in multivariate analysis were less than 5 metabolic equivalents (METS) in exercise test (OR 5.2, P =.007) and greater than 15% ischemic extent in the polar map (OR 3.6, P =.04) of SPECT.
Exercise echocardiography and Tc-99m tetrofosmin gated SPECT were predictive for heart failure, but exercise SPECT was the only test with predictive power for ischemic complications.
Journal of Nuclear Cardiology 04/2012; 8(2):122-8. · 2.67 Impact Factor
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ABSTRACT: We sought to determine the degree of interhospital agreement in the interpretation of exercise myocardial technetium-99m tetrofosmin single photon emission computed tomography (SPECT).
Five experienced hospital laboratories were asked to submit 2 sets of myocardial Tc-99m tetrofosmin SPECT images obtained in 150 patients undergoing coronary angiography: group A used a uniform color scale for all hospitals, and group B used the individual color scale in place at each hospital (uniform color scale, nonuniform color scale, and black-and-white scale). Thus a total of 300 images were interpreted by each center without knowledge of any other patient data. Angiographically significant coronary artery disease (< or =50% diameter stenosis) was present in 90 patients (60%). By a majority decision (3 or more centers), the sensitivity was found to be similar for groups A and B (82% and 84%, respectively), but the specificity was significantly higher for group A (87% vs 73%; P =.021). Four or all 5 of the centers agreed on abnormal or normal results of SPECT images in 87% of patients in group A (kappa 0.626) and in 78% of patients in group B (kappa 0.528). The kappa value of 0.617 was obtained for the uniform color scale, 0.467 for the uniform black-and-white scale, and 0.444 for the nonuniform color scale. Agreement on the left anterior descending artery territory (81% for group A and 78% for group B) was similar to that of the right coronary artery territory (79% for A and 75% for B) and to that of the left circumflex artery territory (91% for A and 85% for B). Agreement was similar in patients with 1-, 2-, and 3-vessel coronary artery disease (91%, 88%, and 86% for group A and 81%, 82%, and 82% for group B, respectively).
In the interpretation of myocardial Tc-99m tetrofosmin SPECT images, good interinstitutional observer agreement was found, mainly when the uniform display method was adopted.
Journal of Nuclear Cardiology 04/2012; 8(1):49-57. · 2.67 Impact Factor
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ABSTRACT: The purpose of this study was to analyze left systolic ventricular function and myocardial perfusion characteristics between short one day exercise-rest and long two days gated SPECT (Single Photon Emission Computed Tomography) protocols in patients with ischemic cardiomyopathy (ICM).
A prospective study of 40 patients (59.6±8.9 years, 3 women) with IHD (left ventricular ejection fraction (EF) ≤40%) was performed with myocardial perfusion gated SPECT. From 5 to 10 days after a one-day exercise-rest study (gated SPECT-1), patients were called back for a second rest study (gated SPECT-2) in order to compare EF and differences in perfusion summed rest score (ΔSRS=SRS1-SRS2) and summed difference score (ΔSDS=SDS1-SDS2) between both protocols.
Between rest-gated SPECT-1 (short protocol) and rest-gated SPECT-2 (long protocol) EF increased (34% vs 37%, P= 0.008) in 26 patients (65%), and in 11 patients (27.5%) the increase was ≥5%. There were no significant differences in clinical and coronary angiography variables between patients with and without increase of the EF ≥5%. In the multivariate analysis, ΔSRS (95% CI: -1.1 to -29.2) and ΔSDS (0.179-1.236) were predictors for this EF increase between both studies.
Exercise-rest short protocol can underestimate EF in patients with CM. Stunning but also contamination of rest images by previous exercise images in a short protocol could explain these results.
Revista Española de Medicina Nuclear 05/2010; 29(4):151-6. · 0.89 Impact Factor
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European journal of nuclear medicine and molecular imaging 09/2007; 34(8):1152-5. · 4.99 Impact Factor
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ABSTRACT: We aimed to evaluate the prognostic value of myocardial perfusion gated SPECT in patients with symptomatic intracranial large-artery atherosclerosis (ILA).
Seventy-two consecutive first-ever symptomatic ILA patients without known heart disease underwent a stress myocardial perfusion gated SPECT, and long-term follow-up was conducted thereafter.
During an average follow-up of 15.2 +/- 9 months, 9 patients (13.8%) presented major coronary events (CEs). Survival analyses (Kaplan-Meier and Cox regression) identified presence of moderate-to-severe myocardial perfusion defects (log rank p = 0.004) and ejection fraction <50% (p = 0.014) as predictors of future CEs. Neurovascular ischemic events were not predicted by SPECT variables.
Myocardial perfusion scintigraphy predicts future CEs in patients with symptomatic ILA and may be helpful to guide therapeutic strategies in this subgroup of stroke patients.
Cerebrovascular Diseases 01/2007; 24(2-3):247-54. · 2.72 Impact Factor
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ABSTRACT: The diagnostic value of myocardial perfusion scintigraphy in patients with left bundle branch block (LBBB) and previous acute myocardial infarction has not been evaluated.
To determine the utility of single photon emission computed tomography (SPECT) in patients with LBBB and previous acute myocardial infarction.
Seventy two consecutive patients with permanent LBBB and previous acute myocardial infarction were studied with stress-rest SPECT using 99mTc compounds. The same stress procedures were followed in all patients: (1) exercise alone when it was sufficient; (2) exercise plus simultaneous administration of dipyridamole if exercise was insufficient.
In 26 of 28 patients (93%) who had a Q wave acute myocardial infarct before the development of LBBB, there was concordance between abnormal Q waves and rest SPECT in the localisation of myocardial necrosis (kappa = 0.836; p = 0.0001). In 48 patients who had coronary angiography, the positive predictive value of exercise (+dipyridamole) myocardial SPECT for the diagnosis of left anterior descending coronary artery stenosis was 93%, for left circumflex coronary artery stenosis, 96%, and for right coronary artery stenosis, 89%. Specificity values were 83%, 91%, and 69%, respectively. However, sensitivity (69%, 64%, and 89%) and negative predictive values (48%, 46%, and 82%) were suboptimal.
Rest myocardial perfusion SPECT with technetium compounds is useful for localising healed myocardial infarction in patients with LBBB, and exercise (+dipyridamole) SPECT has a high positive predictive value and specificity for the diagnosis of coronary stenosis in these patients.
Heart (British Cardiac Society) 10/2003; 89(9):1039-42. · 4.22 Impact Factor
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ABSTRACT: A high number (30%-50%) of reversible defects have been detected early after coronary balloon angioplasty. Inadequate luminal enlargement despite a good angiographic appearance has been suggested as a possible mechanism of these perfusion abnormalities, and some reports have shown better coronary flow reserve after coronary stent implantation than after balloon dilatation. The primary objective of this study was to evaluate the frequency of early ischemic defects detected by maximal exercise (plus dipyridamole) with (99m)Tc-tetrofosmin SPECT after successful coronary angioplasty with stent implantation. A secondary objective was to determine the prognostic value of these early ischemic defects.
Thirty patients without previous myocardial infarction who successfully underwent 1-vessel coronary angioplasty with stent implantation were studied. Maximal-exercise (99m)Tc-tetrofosmin myocardial SPECT, with simultaneous dipyridamole if exercise was suboptimal, was performed at 6 +/- 1 d (mean +/- SD) after percutaneous transluminal coronary angioplasty. At 8 +/- 3 mo, all patients were followed up clinically, and 77% of them underwent follow-up angiography.
The percentage of stenosis decreased from 68.5% +/- 12.6% of luminal diameter to 9.3% +/- 8.8% after stent implantation, and minimal luminal diameter increased from 0.89 +/- 0.36 mm to 2.85 +/- 0.45 mm. Mild-to-moderate reversible myocardial defects in the territory of the dilated artery were detected in 5 patients (17%), with no angiographic or procedural differences occurring between them and patients without ischemic defects. At follow-up, the target lesion revascularization rates depending on the presence or absence of early ischemic defects were 40% and 8%, respectively (P = 0.18). Angiographic restenosis occurred in 3 of 4 patients who had early ischemic defects and underwent follow-up angiography and in 3 of 19 patients who had no early ischemic defects and underwent follow-up angiography (restenosis rate, 75% and 16%, respectively; P < 0.05).
Coronary angioplasty with stent implantation is associated with a 17% rate of ischemic defects early after the procedure. Patients with early myocardial perfusion defects after coronary stent implantation had a high rate of restenosis.
Journal of Nuclear Medicine 12/2001; 42(12):1768-72. · 6.38 Impact Factor
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G Romero-Farina, J Candell-Riera,
O Pereztol-Valdés,
J Castell,
S Aguadé,
E Galve,
J Palet,
G Oller-Martínez,
L Armadans,
D Reina,
J Soler-Soler
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ABSTRACT: To evaluate the role of myocardial perfusion SPET and radionuclide ventriculography in patients with hypertrophic cardiomyopathy (HC).
Exercise myocardial perfusion SPET with 99mTc-tetrofosmin and radionuclide ventriculography were performed in a consecutive series of 101 patients (54 15 years, 50 women, 55 with dynamic obstruction) diagnosed of HC by echo. Follow-up from the diagnosis was 9,9 6,7 years (1 to 28 years).
Thirty six percent of patients had perfusion defects (non reversible in 15 and reversible in 21). In non obstructive HC higher number of patients with non reversible defects (p = 0.01 was obseved and in patients with no reversible defects higher incidence of pathologic Q waves in ECG (p = 0.01), Higher ventricular volumes (p < 0.05), lower ejection fraction (p = 0,0001) and longer time to peak emptying velocity (p < 0.05). There were 4 cardiac deaths, 15 syncopes, 18 pacemakers and 6 myectomy. Ejection fraction was higher in patients with syncope (p = 0,034) and there was no isotopic variable predictive of mortality, pacemaker or myectomy.
Neither SPET nor radionuclide ventriculography have a prognostic role in patients with HC, but patients with syncope have higher values of ejection fraction. Patients with non reversible defects have higher rate of pathologic Q waves in ECG, higher ventricular volumes and lower ejection fraction. This is indicative of evolution to dilated form of HC.
Revista Española de Medicina Nuclear 12/2001; 20(7):530-6. · 0.89 Impact Factor
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J Candell-Riera,
G Oller-Martínez,
J Rosselló,
O Pereztol-Valdés,
J Castell-Conesa,
S Aguadé-Bruix,
M Soler-Peter,
M Simó,
C Santana-Boado,
A García-Burillo,
J Soler-Soler
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ABSTRACT: The objective of this study was to determine the prevalence of anterior and septal defects in patients with left bundle branch block (LBBB), and to assess the diagnostic accuracy of myocardial single photon emission computed tomography (SPECT) with technetium compounds in patients with and without LBBB using standard provocative manoeuvres.
Five hundred and nine consecutive patients (456 without LBBB and 53 with LBBB) without previous infarction who had a coronary angiography performed within <3 months of the scintigraphic study were retrospectively evaluated. The same stress procedures were followed in all patients. (1) Only exercise when it was sufficient; and (2) exercise + simultaneous administration of dypiridamole if exercise was insufficient. Only reversible defects were considered positive and > or =50% of coronary stenosis was considered significant.
Prevalence of reversible anterior and septal defects was low (33% and 12%, respectively) in patients with LBBB. Although lower values of global sensitivity (81%) and specificity (73%) were obtained in these patients, there were no significant differences with respect to the patients without LBBB (89% and 86%, respectively). Specificity values for the diagnosis of stenosis of left anterior descending (78%), left circumflex (96%) and right coronary artery (74%) in patients with LBBB were lower, but without significant statistical differences with respect patients without LBBB (90%, 96% and 82%, respectively).
Myocardial SPECT with technetium compounds, using standard provocation manoeuvres, can be used in patients with LBBB with only a mild decrease in diagnostic accuracy as compared to patients without LBBB.
Nuclear Medicine Communications 09/2001; 22(9):1029-36. · 1.40 Impact Factor
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ABSTRACT: The aim of this study was to analyse the influence of rest technetium-99m-methoxy-isobutyl-isonitrile (99mTc-MIBI) uptake, left ventricular ejection fraction (EF) and dysfunctional location in the prediction of myocardial viability. Rest 99mTc-MIBI single photon emission computed tomography (SPECT) was analysed in 82 patients (59+/-9 years, 70 men, 12 women) with one or more segments showing severe hypokinesia, akinesia or dyskinesia who had undergone coronary revascularization. Before and within 3-6 months after the revascularization, gated blood pool scintigraphy was performed. In the post-revascularization control, contractile recovery was observed in 48.7% (155/318) of the segments with severe hypokinesia, akinesia or dyskinesia. Significant increases in sensitivity (53%, 72% and 91%, P<0.0001) and negative predictive value (62%, 68% and 79%, P = 0.01) were observed with decreasing rest uptake 99mTc-MIBI levels of 50%, 40% and 30%, respectively. The decrease in specificity was also significant (67%, 53% and 32%, P<0.0001). The negative predictive value was higher than the positive predictive value mainly in patients with EF < or = 0.35 and with anterior dysfunction. In logistic regression analysis, uptake levels and EF were independent variables that influenced sensitivity and specificity. The negative predictive value was influenced by EF and the positive predictive value only by dysfunctional location. This study suggests that the negative predictive value of 99mTc-MIBI SPECT is higher than the positive predictive value, mainly in patients with EF < or = 0.35, and that the rest uptake level, EF and dysfunctional location are factors that must be considered when results of 99mTc-MIBI SPECT are analysed.
Nuclear Medicine Communications 08/2001; 22(7):795-805. · 1.40 Impact Factor
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J Candell Riera
Revista Española de Medicina Nuclear 05/2001; 20(2):113-5. · 0.89 Impact Factor
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ABSTRACT: This study evaluated the relationship between the location of the most severe myocardial perfusion defects, the most severe coronary artery stenosis, and the site of subsequent acute myocardial infarction (AMI).
Of 3,180 patients who were admitted with a diagnosis of AMI, we identified 44 patients who had undergone previous myocardial perfusion SPECT. Thirty-one of them also had previous coronary angiography. The relationship between the location of the myocardial perfusion defects, the coronary artery stenosis, and the site of subsequent AMI was studied in these patients.
The concordance between the location of the most severe reversible defects detected by SPECT and the site of subsequent AMI was 71% (kappa = 0.499). The concordance between the most severe stenosis detected by coronary angiography and the site of subsequent AMI was 64% (kappa = 0.451). However, kappa values for SPECT and coronary angiography were good when the interval between these investigations and subsequent AMI was <3 mo (0.724 and 0.661, respectively), for moderate to severe perfusion defects (0.719), and for 90%-99% coronary stenosis (0.626).
The culprit lesion is not always the one that is manifested by the most severe reversible perfusion defect or the most critical coronary artery stenosis. Myocardial SPECT and coronary angiography can predict the location of a future AMI in 71% and 64% of patients, respectively. The percentage is higher when the interval between investigations and subsequent AMI is <3 mo, for moderate to severe perfusion defects, and for 90%-99% coronary stenosis.
Journal of Nuclear Medicine 05/2001; 42(4):558-63. · 6.38 Impact Factor
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ABSTRACT: The aim of this study was to assess the value of Doppler-echocardiogram for the prognosis and follow up of a hospital-based series of adult patients with hypertrophic cardiomyopathy (HC).
One-hundred nineteen consecutive patients with HC (52 +/- 12 years, 60 women) were studied over a follow up period of 9.7 +/- 6.7 years. Echocardiographic evolution was analyzed in 104 patients (67 with dynamic obstruction) who had, at least, two echocardiograms performed within an interval of 3.7 +/- 3 years (1 to 7 years).
Seven patients died during follow up and 31 patients developed severe complications (7 deaths, 15 syncopes, 4 class IV angina, 3 class IV dyspnea and 2 acute myocardial infarctions). The presence of mitral insufficiency (p = 0.001) and dynamic gradient > 50 mmHg (p = 0.02) were predictive of mortality and a left atrial index > 25 mm/m2 was predictive (p = 0.028) of severe complications. Fifteen percent of the patients without dynamic obstruction in the first Doppler-echo showed a gradient > 25 mmHg in the last echo. A greater number of patients with mitral insufficiency (80% vs 66%; p = 0.01) and an increase in its severity (p = 0.038) was observed during follow up.
Mitral insufficiency, a dynamic gradient > 50 mmHg and a left atrial index > 25 mm/m2 are variables of a bad prognosis in adult patients with HC. An evolution to obstructive HC was observed in 15% of non obstructive HC, and a tendency to increased severity of mitral insufficiency was observed during follow up.
Revista Espa de Cardiologia 02/2001; 54(1):7-15. · 2.53 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the diagnostic accuracy of myocardial SPET in patients with hypertrophic cardiomyopathy (HC).
One hundred and six consecutive patients (aged 53 +/- 12 years, 50 women, 66 with dynamic obstruction) with an echocardiographic diagnosis of HC were studied with exercise-rest myocardial SPET with 99mTc-tetrofosmin. Forty-six (43%) of these patients had chest pain and in 31 (29%) a coronary angiography was performed. Fifty-six per cent of the patients were treated with beta-blockers and 23% with verapamil.
Angina during the exercise test was observed in only 8% of the patients. Perfusion defects were observed in 35% of the patients. Only 8 (26%) out of the 31 patients with angiography had coronary artery disease (stenosis > 50%). When fixed and reversible defects were considered as positive, the sensitivity was 50%, the specificity was 65%, the positive predictive value was 33% and the negative predictive value was 79%.
Myocardial perfusion defects can be observed in more than one third of medically treated patients with HC. Only a quarter of catheterized patients, even with chest pain, have associated coronary artery disease. The accuracy of SPET for the diagnosis of coronary artery disease in hypertrophic cardiomyopathy is low. Thus, the value of this technique is limited in these patients.
Revista Espa de Cardiologia 12/2000; 53(12):1589-95. · 2.53 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the efficacy of stress-rest 99mTc-MIBI SPET to predict wall motion improvement after revascularization.
A prospective and consecutive series of 82 patients (59 +/- 9 years, 12 women), who had some segment with severe impairment of the contractility and underwent coronary revascularization by surgery (n = 64) or angioplasty (n = 18) were studied with rest 99mTc-MIBI SPET. All patients had a rest 99Tc-MIBI SPET, and an exercise test was also performed on 40 of these patients. Before and within 3-6 months after the revascularization a gated blood pool scintigraphy of three projections was performed. The segmentary contractile recovery after revascularization was assessed in relation to the quantification of the 99mTc-MIBI uptake and to the exercise-rest reversibility (exercise uptake < rest uptake).
The mean value of the left ejection fraction did not change after the revascularization (41.1 +/- 14.5% vs 41.8 +/- 15.7%). In the post revascularization control a contractile recovery was observed in 40% (113/282) of the segments with severe hypokinesia, akinesia or dyskinesia. Exercise-rest reversibility and rest uptake > 30% were present in 62% (p = 0.002) and 89% (p < 0.0001) respectively of segments that improved contractility after revascularization.
For the 99mTc-MIBI SPET an exercise-rest reversibility and > 30% uptake at rest are predictive criteria of contractile recovery after revascularization.
Revista Espa de Cardiologia 07/2000; 53(7):903-10. · 2.53 Impact Factor
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ABSTRACT: Conventional ergometry has limitations in the evaluation of coronary artery bypass graft patency. The aim of the present study was to determine the efficacy of exercise single photon emission tomography with 99mTc-compounds for the diagnosis of coronary artery bypass grafts disease.
The state of sixty-seven coronary artery bypass grafts (31 with mammary artery, 36 with safein vein; 35 to left descending anterior artery, 15 to circumflex and 17 to right coronary artery) were analyzed retrospectively in 38 patients (mean age 63+/-8.7; 35 men). The time that elapsed between the coronary surgery and the exercise tomography was 9,7 years. In 16 cases, exercise tomography was performed with 99mTc-MIBI and in the 22 remaining with 99mTc-tetrofosmin. In 6 cases, dipiridamol was administred simultaneously during an insufficient exercise test.
Sensitivity (73.1%), specificity (93%), positive predictive value (86.3%), negative predictive value (84.4%), global value (85%), positive likelihood ratio (10.4) and negative likelihood ratio (0.29) of exercise tomography were significantly (p<0.01) better than those obtained with the exercise test alone (53.8%, 43.6%, 38.9%, 58. 6%, 47.7%, 0.95 and 1.06, respectively).
Exercise tomography with 99mTc-compounds is a highly effective for the detection of coronary artery bypass grafts disease.
Revista Espa de Cardiologia 06/2000; 53(5):611-6. · 2.53 Impact Factor
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ABSTRACT: The aim of this study was to compare different morphologic types of hypertrophic cardiomyopathy obtained by single photon emission tomography to those obtained by echocardiogram.
In 76 (64%) out of 119 patients with hypertrophic cardiomyopathy the echocardiogram permitted an optimal visualization of all left ventricular segments in the short axis view and consequent classification to one of the six morphological types: type I (septal anterior hypertrophy), type II (septal anterior and septal posterior hypertrophy), type III (septal and antero-lateral hypertrophy), type IV (antero-lateral and/or septal posterior hypertrophy), type V (concentric hypertrophy) and type VI (apical hypertrophy). Without knowledge of echo data, two experienced observers included the short axis of single photon emission tomography images at rest (99mTc-tetrofosmin) to one of those types.
Global concordance between echocardiogram and single photon emission tomography was 75%. Type III was the most frequent both in echo (76%) and in single photon emission tomography (74%) and type III produced the majority of discrepancies. SPET identified 4 patients with a predominant septal and inferior hypertrophy, that did not correspond to any of the 6 types of echocardiographic classification and had been previously classified as type III by echo in 3 cases and as type V in 1 case.
There was agreement between echo and single photon emission tomography in the morphological classification of most of the patients (75%) with hypertrophic cardiomyopathy. Nevertheless, some discrepancies were observed for the type III echocardiogram.
Revista Espa de Cardiologia 05/2000; 53(4):511-6. · 2.53 Impact Factor
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ABSTRACT: To demonstrate that the administration of dipyridamole at the end of an insufficient maximal subjective exercise test can improve the diagnostic accuracy of single-photon emission computed tomography in patients with previous myocardial infarction, 209 consecutive patients were studied with technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography and coronary angiography. Patients were divided in 3 groups: group 1, 107 patients with sufficient exercise testing; group 2, 55 patients with insufficient exercise testing; group 3, 47 patients with insufficient exercise testing in whom intravenous dipyridamole (0.56 mg/kg over 4 minutes) was administered at the end of exercise. In groups 1 and 3 the sensitivity values for the diagnosis of multivessel disease were significantly higher (80% and 76%, respectively) than those in group 2 (59% [p = 0.009 and p = 0.02, respectively]). Specificity and predictive values were not different among the 3 groups. Thus, in patients with previous infarction in whom adequate levels of exercise could not be achieved, dipyridamole administration at the end of exercise significantly increased the sensitivity for diagnosing multivessel disease.
The American Journal of Cardiology 04/2000; 85(5):532-5. · 3.37 Impact Factor
