Postural electrocardiographic abnormalities.

False-positive stress testing is a common problem in daily practice. We present a young male patient with pseudo-ischaemic ST-segment changes due to upright position. (Neth Heart J 2010;18:99-102.

[Diagnostic image (200). A woman with acute pain between the scapulae].

A 71-year-old woman presented with an acute onset of interscapular pain due to an intramural haematoma of the ascending part of the aorta. She was treated with an emergency ascending aorta graft replacement.

The accuracy of 1-day dual-isotope myocardial SPECT in a population with high prevalence of coronary artery disease.

Background: In order to evaluate the diagnostic efficacy of the 1-day separate acquisition dual-isotope single-photon emission computed tomography (SPECT) protocol, using 201Tl for the rest and 99mTc-tetrofosmin for the stress images, a consecutive series of patients with suspected or known coronary artery disease (CAD) was studied that also underwent coronary angiography.

Methods: The results of myocardial SPECT, using a semi-quantitative visual analysis, were acquired in 123 patients and compared with the results of coronary angiography. Sensitivity and specificity were calculated, using thresholds of > or = 50 and > or = 70% stenosis.

Incremental prognostic value of myocardial SPET with dual-isotope rest (201)Tl/stress (99m)Tc-tetrofosmin.

The incremental prognostic value of dual-isotope myocardial perfusion scintigraphy using technetium-99m tetrofosmin for the stress images was evaluated in 597 consecutive patients with known or suspected coronary artery disease. We used semi-quantitative visual analysis with a five-point scoring system and calculated the summed stress score, the summed rest score and the summed difference score. During the 2-year follow-up period, 46 "hard" cardiac events occurred: 16 cardiac deaths and 30 non-fatal myocardial infarctions.

Prognostic value and quality of life in patients with normal rest thallium-201/stress technetium 99m-tetrofosmin dual-isotope myocardial SPECT.

Background: The prognostic value of normal dual-isotope single photon emission computed tomography (SPECT), with technetium 99m-tetrofosmin for the stress images, is not well known. Furthermore, thallium-201 cross talk in the Tc-99m window may reduce the defect severity of the Tc-99m images.

Methods And Results: In a consecutive series of 610 patients, 246 patients with normal rest and stress SPECT images by means of visual semiquantitative analysis were included.

Worse clinical outcome but similar graft patency in women versus men one year after coronary artery bypass graft surgery owing to an excess of exposed risk factors in women. CABADAS. Research Group of the Interuniversity Cardiology Institute of The Netherlands. Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole and Acenocoumarol/phenoprocoumon Study.

Objectives: This retrospective study sought to assess differences in graft patency and clinical outcome between women and men after coronary artery bypass graft surgery (CABG).

Background: A less favorable clinical outcome has been reported in women as compared with men. Its relation to graft patency has not been studied.

SPECT versus planar 99mTc-sestamibi myocardial scintigraphy: comparison of accuracy and impact on patient management in chronic ischemic heart disease.

A head-to-head comparison between 99mTc-sestamibi SPECT and planar myocardial imaging using dipyridamole low-level exercise stress was performed for the assessment of coronary artery disease (CAD) and for the impact on patient management in 78 patients (pts) who underwent coronary arteriography. Overall sensitivity and specificity for detection of CAD were 82% and 82% for SPECT, and 78% and 73% for planar imaging, respectively (both NS). Compared to planar imaging the sensitivity of SPECT imaging was significantly higher for detecting left anterior descending (p = 0.

Exercise capacity after His bundle ablation and rate response ventricular pacing for drug refractory chronic atrial fibrillation.

Objective: To evaluate exercise capacity of patients with chronic atrial fibrillation in whom His bundle ablation followed by ventricular rate response pacing (VVIR) was carried out because of drug refractoriness.

Design: Prospective study.

Patients: 25 consecutive patients, all with chronic symptomatic drug refractory atrial fibrillation, underwent His bundle ablation.

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.

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 with 99mTc-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 planar 201Tl and 99mTc-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.

Comparison of adenosine and high-dose dipyridamole both combined with low-level exercise stress for 99Tcm-MIBI SPET myocardial perfusion imaging.

Intravenously administered adenosine and high-dose dipyridamole, both combined with low-level exercise stress, were compared in a head-to-head fashion using 99Tcm-methoxyisobutyl isonitrile (99Tcm-MIBI) single photo emission tomography (SPET) myocardial perfusion imaging. Thirty-nine consecutive patients who had undergone coronary arteriography underwent 99Tcm-MIBI (740 Mbq) SPET after dipyridamole (0.84 mg kg-1) and after adenosine (0.

Aprotinin in aortocoronary bypass surgery: increased risk of vein-graft occlusion and myocardial infarction? Supportive evidence from a retrospective study.

To assess the thrombotic risk of aprotinin in aortocoronary bypass surgery, we retrospectively analyzed the results of a trial, originally designed to compare the effects of one-year treatment with various antithrombotic drugs in the prevention of vein-graft occlusion. Graft patency at one year was assessed by angiography. Myocardial infarction, thromboembolism, major bleeding, and death were clinical endpoints.

Quantitative analysis of planar technetium-99m Sestamibi myocardial perfusion images. Clinical application of a modified method for the subtracton of tissue crosstalk.

Application of the Thallium-201 quantitative analysis method to Tc-99m Sestamibi planar myocardial perfusion images results in oversubtraction of tissue crosstalk, defined as 'activity within the myocardial image, which originated outside the heart'. A modified algorithm, specific for Tc-99m Sestamibi, was applied in 60 patients and the results of quantitative analysis to estimate the risk of coronary artery disease were compared with coronary angiographic findings and with visual analysis. New crosstalk planes were generated based on the results in 20 male healthy volunteers.

Head-to-head comparison between technetium-99m-sestamibi and thallium-201 tomographic imaging for the detection of coronary artery disease using combined dipyridamole-exercise stress.

Aim: The purpose of this study was a head-to-head comparison of tomographic imaging (SPECT) with technetium-99m (Tc-99m)-sestamibi and thallium-201 (Tl-201) using dipyridamole-low-level bicycle exercise stress for the assessment of coronary artery disease.

Methods: We studied 38 consecutive patients referred for the evaluation of chest pain who had undergone coronary angiography. The patients were randomly allocated to Tc-99m-sestamibi SPECT followed by Tl-201 SPECT or vice versa.

99Tcm-sestamibi SPECT with combined dipyridamole and exercise stress in coronary artery disease.

In order to evaluate the clinical value of 99Tcm-methoxyisobutylisonitrile (sestamibi) single photon emission computed tomography (SPECT) after dipyridamole infusion in combination with low level bicycle exercise for the assessment of the presence, localization and extent of coronary artery disease (CAD), myocardial perfusion imaging was performed in 76 patients. Low level bicycle exercise was used to supplement the standard dipyridamole infusion protocol because of the lower incidence of non-cardiac side effects. The results were compared to arteriographic findings obtained within 3 months of the SPECT studies.

Prevention of one-year vein-graft occlusion after aortocoronary-bypass surgery: a comparison of low-dose aspirin, low-dose aspirin plus dipyridamole, and oral anticoagulants. The CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands.

Aspirin, alone or in combination with dipyridamole, is known to prevent occlusion of aortocoronary vein grafts. The benefit of dipyridamole in addition to aspirin remains controversial, and the efficacy and safety of oral anticoagulants for prevention of vein-graft occlusion have not been established. We assessed one-year angiographic vein-graft patency after aortocoronary-bypass surgery in 948 patients assigned to receive aspirin, aspirin plus dipyridamole, or oral anticoagulants in a prospective, randomised trial.

Exercise 201Tl scintigraphy: evaluation of the additional diagnostic value.

The additional diagnostic yield of exercise 201Tl scintigraphy using both visual and quantitative analysis was determined in 221 patients with known or suspected coronary artery disease (CAD). The coronary arteriogram was adopted as the gold standard. After pretest clinical and exercise electrocardiographic data were taken into consideration, scintigraphy added diagnostic accuracy both in the diagnosis of CAD and of multivessel disease.

Evaluation of the incremental diagnostic value and impact on patient treatment of thallium scintigraphy.

The incremental diagnostic yield of exercise 201Tl scintigraphy with visual and quantitative analysis was determined in 191 patients with known or suspected coronary artery disease (CAD). The coronary arteriogram was used as the gold standard. After pre-test clinical and exercise electrocardiographic data were taken into consideration, scintigraphy was found to have additional diagnostic value both in the diagnosis of CAD and of multivessel disease, with quantitative analysis being superior to visual analysis.

Mediastinal lymph node enlargement as a result of mitral valve stenosis.

Two patients are described with severe MVS, pulmonary venous hypertension and enlarged mediastinal, pulmonary and hilar lymph nodes. These enlargements were diagnosed on a preoperative chest CT. After MV replacement these enlarged lymph nodes nearly all resolved.

Initial and long-term results of percutaneous transluminal coronary angioplasty in patients 75 years of age and older.

In 212 patients aged 75 years and older the immediate and long-term results of percutaneous transluminal coronary angioplasty (PTCA) were assessed. For 293 stenoses the primary angiographic success rate was 96% and the overall clinical success rate was 90.6%.

Determinants for early mortality in patients awaiting coronary artery bypass graft surgery: a case-control study.

A total of 1124 consecutive patients who were selected for coronary artery bypass graft surgery were studied. Of patients awaiting surgery (mean waiting time 98 days) 25 patients (2.2%) died before operation (mean waiting time 63 days).

Combined assessment of technetium-99m SESTAMIBI planar myocardial perfusion images at rest and during exercise with rest/exercise left ventricular wall motion studies evaluated from gated myocardial perfusion studies.

The favorable physical characteristics of technetium-99m-labeled 2-methoxy-2-methylisopropyl-1-isonitril (Tc-SESTAMIBI) enable the combined evaluation of both myocardial perfusion and left ventricular wall motion. To assess the potential of rest and exercise regional myocardial function as an adjunct to planar myocardial perfusion imaging, 60 patients with coronary artery disease and documented arteriographic findings were studied with both protocols during a single study. Exact segmental concordance between myocardial perfusion and wall motion studies was 77% (701/900 segments).

Inadequate exercise leads to suboptimal imaging. Thallium-201 myocardial perfusion imaging after dipyridamole combined with low-level exercise unmasks ischemia in symptomatic patients with non-diagnostic thallium-201 scans who exercise submaximally.

This study was undertaken to establish the additional value of 201TI imaging after dipyridamole in combination with low-level exercise in 15 symptomatic patients with non-diagnostic 201TI scans, who exercised submaximally. Most patients had angina, ST-segment depression and even exertional hypotension and were referred for stress 201TI testing for determining the functional significance of known coronary artery disease. Six patients with a normal exercise 201TI test and one patient with an apical defect only were found to have 37 segments (of 105 segments) with reversible perfusion defects after dipyridamole infusion.

Comparative effects of pacing-induced and balloon coronary occlusion ischemia on left ventricular diastolic function in man.

Background: Effects of pacing-induced and coronary occlusion myocardial ischemia on left ventricular (LV) function have been compared only in anesthetized dogs. Diastolic properties of the same LV anterior wall segment were therefore compared in 12 patients with single-vessel proximal left anterior descending coronary artery stenosis at rest, immediately after 7 +/- 1.2 minutes of pacing, and at the end of a 1-minute balloon occlusion of coronary angioplasty (CO).