Quantitative exercise thallium-201 rotational tomography for evaluation of patients with prior myocardial infarction.

The utility of stress-redistribution thallium-201 myocardial perfusion single-photon emission computed tomography (SPECT) in patients with a prior single myocardial infarction was studied in 66 patients who were tested by both SPECT and coronary angiography. SPECT was quantified by comparing the patients' circumferential count profiles to a previously established normal data base and by plotting the results onto a polar coordinate map that localized defects to the 3 major coronary artery territories. The pattern of reversibility of the quantitatively detected defects was assessed by consensus visual analysis.

Quantification of left ventricular myocardial mass in humans by nuclear magnetic resonance imaging.

The ability of NMRI to assess LV mass was studied in 20 normal males. By means of a 1.5 Tesla GE superconducting magnet and a standard spin-echo pulse sequence, multiple gated short-axis and axial slices of the entire left ventricle were obtained.

Paradoxical motion of the posterior left ventricular wall seen in healthy subjects in the upright position.

Paradoxical motion of the posterior left ventricular wall in patients in the upright but not in the supine position was demonstrated in a high percentage of normal volunteers. There was no significant difference in age, body surface area, heart rate, and blood pressure between the groups, with or without paradoxical motion. This echocardiographic finding probably represents a physiologic phenomenon and should be taken into consideration during the interpretation of upright exercise echocardiograms.

Piretanide, a potent diuretic with potassium-sparing properties, for the treatment of congestive heart failure.

The diuretic and clinical efficacy and safety of piretanide, a new high-ceiling loop diuretic, was determined in patients with mild to moderately severe congestive heart failure. Piretanide (n = 20) administered orally in a daily dosage of up to 24 mg was compared with placebo (n = 18) for 28 days, using a double-blind, randomized, parallel design. Patients were hospitalized during the first 5 days of the study when dosage titration was established and 24-hour fractionated urine collections were obtained.

Utility of echocardiography for the early assessment of patients with nondiagnostic chest pain.

A two-dimensional (2D) echocardiogram was recorded shortly after admission in 46 patients with nondiagnostic chest pain. Eighteen patients were studied during chest pain and 28 were studied following the resolution of chest pain. Of the 18 patients studied during chest pain, six of the eight patients who had a regional wall motion abnormality (RWMA) evolved an acute infarction and the remaining two patients had evidence of significant coronary artery disease.

Intravenous streptokinase in evolving acute myocardial infarction.

Eighty-one consecutive patients presenting within 3 hours of the onset of acute myocardial infarction (AMI) and without contraindications to thrombolytic or anticoagulant therapy received a 15- to 30-minute intravenous infusion of 750,000 or 1.5 million units of streptokinase (STK) followed by anticoagulation. Treatment was instituted 130 +/- 41 minutes after the onset of symptoms and reperfusion was achieved 36 +/- 26 minutes later.

Improvement in regional and global left ventricular function after intracoronary thrombolysis: assessment with two-dimensional echocardiography.

After acute myocardial infarction, 23 patients undergoing intracoronary thrombolysis and 10 patients receiving conventional medical treatment were studied by 2-dimensional echocardiography to determine changes in regional and global left ventricular (LV) performance. Both quantitative and qualitative analysis of echocardiographic studies showed improvement in regional and global LV function in 18 patients with successful reperfusion immediately after thrombolysis to 10 days later (p less than 0.0005).

Simultaneous assessment of segmental and global left ventricular function by two-dimensional echocardiography in acute myocardial infarction.

Both segmental and global left ventricular performance were assessed simultaneously in 29 patients with acute myocardial infarction using two-dimensional echocardiography. Comparisons were made between left ventricular wall motion versus peak CK-MB, site of infarction, and occurrence of heart failure. Two-dimensional echocardiography identified areas of dyssynergy which corresponded to electrocardiographic areas of infarction in 89% of all cases.

Nonsurgical reperfusion in evolving myocardial infarction.

Nonsurgical recanalization of the occluded coronary artery has been performed in patients with evolving myocardial infarction since the late 1970s by intracoronary administration of thrombolytic agents at the ostium of the occluded artery or directly to the site of occlusion. The authors review the basic concepts underlying intracoronary thrombolysis, the method applied at their institution and the clinical results. Reperfusion of totally occluded arteries or termination of the ischemic state in subtotally occluded arteries was achieved in 71 (87.

Early diagnosis of nontransmural myocardial infarction by two-dimensional echocardiography.

Thirty patients with chest pain syndromes were studied on admission by two-dimensional echocardiography (2DE) to confirm or exclude acute myocardial infarction (AMI). Twelve patients suffered nontransmural AMI and 18 patients had no AMI. There was no significant difference between these groups in background characteristics.

Intracoronary thrombolysis in acute myocardial infarction: experimental background and clinical experience.

Occlusive intracoronary (IC) thrombosis was produced experimentally in dogs by placement of a copper coil. The thrombus was consistently lysed by application of Thrombolysin (streptokinase and plasminogen) at the site of occlusion, 1 to 6 hours after thrombosis. Thrombolysin has no toxic effect on the coronary artery wall or the myocardium.

Relationship between segmental abnormalities and global left ventricular function in coronary artery disease: validation of a theoretical model.

A theoretical model of the heart, which suggests a direct relationship between segmental abnormalities of left ventricular (LV) wall motion (WM) and LV ejection fraction (EF), was tested using two-dimensional echocardiography (2DE) and multiple-gated equilibrium blood pool scintigraphy (MGES) in a population of 25 coronary artery disease patients. MGES was used to determine EF, and 2DE was used to develop a method of analysis of LV segmental WM abnormalities. Two orthogonal apical 2DE views were analyzed.

Thallium-201 stress redistribution abnormalities of the right ventricle: a manifestation of proximal right coronary artery stenosis.

Thallium imaging in conjunction with electrocardiographic stress testing has become a widely utilized method for evaluating the presence and location of coronary artery disease. The literature has emphasized the appearance of the left ventricle with little mention of the right ventricle. This report presents the initial demonstration of abnormal right ventricular myocardial radionuclide visualization due to right coronary artery stenosis, as exemplified in two patients.

Intracoronary thrombolysis in evolving myocardial infarction.

After experimental studies in dogs confirmed the feasibility and safety of rapid intracoronary thrombolysis by local infusion of Thrombolysin (streptokinase and plasmin), intracoronary thrombolysis was attempted in 20 patients with evolving myocardial infarction who were hospitalized within 3 hours from the onset of symptoms during the day and within 2 hours at night. Thrombolysin was infused in the immediate vicinity of the site of coronary occlusion using a 0.85 mm outer diameter catheter advanced through the lumen of the Judkins catheter.

Ventricular aneurysm: cross-sectional echocardiographic approach.

Current angiographic indexes of ventricular function have proved inadequate for prognostication in patients with ventricular aneurysm. Cross-sectional echocardiography can visualize residual myocardium in all four walls of the left ventricle. A new echocardiographic technique of calculating residual myocardium is presented.