[Influence of hypertensive left ventricular hypertrophy on detection of ischemic area with exercise thallium-201 myocardial scintigraphy].

Sixty-four patients with single left anterior descending artery disease having effort angina (group A: 40 patients without hypertension, group B: 10 patients with hypertrophic hypertension, group C: 14 patients with non-hypertrophic hypertension) were assessed the influence of hypertensive left ventricular (LV) hypertrophy on detection of ischemic area. The criterion of hypertrophy by two-dimensional echocardiography was > 12 mm in the wall thickness of interventricular septal or posterior wall. Population in Group B might show low detectability in ischemic area by 201Tl myocardial scintigraphy (positive thallium rate 60%, defect score 2.

Pathogenesis, treatment and prognosis of impending myocardial infarction and early post-infarction angina--relation between ST-segment shift during myocardial ischemia and the pathogenesis.

We studied 141 patients to evaluate the pathogenesis and clinical picture of high-risk unstable angina (UA), designated as impending myocardial infarction (IMI) in this study, or severe early post-infarction angina (PIA). IMI and PIA were diagnosed when chest pain appeared at rest and lasted 15 min or more despite extensive pharmacological therapy during hospital stay among consecutive 510 patients with UA. All patients underwent coronary angiography urgently within 72 h after chest pain, and were divided into 2 subgroups according to ST segment shifts during chest pain.

[Dipyridamole-thallium myocardial imaging in patients unable to exercise adequately: comparison with arm and bicycle ergometer].

We assessed the usefulness of dipyridamole-thallium myocardial imaging in patients unable to exercise adequately, compared with arm-ergometer and standard (bicycle) ergometer. Fifty-six patients with arteriosclerosis obliterans, aortic aneurysm, aortic dissection and so on, who were revealed normal imaging, were studied. Only one of 13 cases with arm-ergometer and two of 14 with bicycle ergometer reached target heart rate.

Assessment of myocardial viability by using newly developed myocardial SPECT imaging.

Thallium myocardial imaging has been widely available for the detection of myocardial ischemia and assessment of myocardial viability in coronary artery diseases. However, myocardial imaging using SPECT and gamma-emitting radiopharmaceuticals has been developed for accurate evaluation of myocardial infarction and ischemia. The present study was undertaken to clinically evaluate myocardial necrosis, metabolism and sympathetic nerve activity.

[A case of unstable angina pectoris associated with an active phase of polymyositis].

We report a case of unstable angina in an active phase of polymyositis. A 51 year-old man was admitted with a diagnosis of polymyositis and unstable angina with ST elevation on prolonged rest chest pain. Rest anginal attack which had been refractory to conventional antianginal medications was controlled by high dose of glucocorticosteroid.

[Usefulness of 201Tl myocardial scintigraphy after dipyridamole infusion in patients with atherosclerotic vascular disease].

To determine the utility for detecting ischemic heart disease (IHD), Dipyridamole thallium myocardial images (DIP-Tl) have been performed in the 103 patients with atherosclerotic vascular disease who can't exercise fully. Of 103 patients, there were 36 patients with arteriosclerosis obliterans (ASO), 31 patients with aneurysm of the abdominal aorta (AAA), 24 patients with aneurysm of the thoracic aorta (TAA) and 12 patients with dissecting aortic aneurysm (DAA). Clinical evidence of IHD was found in 20 patients with ASO, 10 with AAA, 7 with TAA and 4 with DAA respectively.

[Diagnostic utility of myocardial imaging using 123I-labeled beta-methyl-iodophenyl pentadecanoic acid in ischemic heart disease].

We evaluated the myocardial metabolism in the acute and subacute phases of myocardial infarction or unstable angina using 123I-labeled beta-methyl-iodophenyl pentadecanoic acid (BMIPP). We then compared those findings with (1) myocardial perfusion images obtained with 201TlCl and (2) the regional and global left ventricular function determined by left ventriculography. Thirty-one patients were examined, consisting of 16 with acute myocardial infarction (6.

[Thallium-201 scintigraphy after dipyridamole infusion in patients with ischemic heart disease--comparison with maximal exercise].

Myocardial images after dipyridamole infusion (DIP-Tl) were compared with maximal thallium-201 images (Ex-Tl) to determine the utility for detecting coronary artery disease and the ischemic level in ischemic regions. Ex-Tl was performed in 36 patients of angina pectoris (Group 1), and DIP-Tl was performed in 22 patients of angina pectoris (Group 2), who were divided into two groups (Group 2a: 15 patients with low level exercise, Group 2b: 7 patients without low level exercise). Each group had normal controls (41, 27 and 31 people).

Transient increase of plasma lipoprotein(a) in patients with unstable angina pectoris. Does lipoprotein(a) alter fibrinolysis?

It has been shown that lipoprotein(a) (Lp[a]) may interfere with the fibrinolytic system and that the Lp(a) level in an individual remains constant. To evaluate the effects of Lp(a) on the fibrinolytic system in patients with unstable angina, we measured plasma levels of Lp(a), the alpha 2-plasmin inhibitor-plasmin complex, and the thrombin-antithrombin III complex. The latter is a marker of thrombin generation, and the alpha 2-plasmin inhibitor-plasmin complex is an indicator of plasminogen activation.

[Invasive treatment in patients with prior coronary artery bypass grafting].

In eight hundred eighty three patients with prior coronary bypass grafting (CABG), cardiac symptoms were recurred in 179 patients in late follow-up period (mean 5 +/- 2.8 years). Of 179 patients, 43 patients had PTCA eventually.

[Prognostic significance of scintigraphic silent myocardial ischemia detected by stress thallium scan in patients with recent myocardial infarction].

To evaluate the prognostic significance of scintigraphic silent myocardial ischemia (SMI) detected by stress thallium scan in patients with myocardial infarction (MI), we performed a retrospective investigation on cardiac events (CE) during a two-year follow-up period in 149 patients with MI within three months of onset (34 +/- 19 days). SMI was defined as asymptomatic redistribution (RD) in the infarcted area. The patients were divided into three groups based on results of stress thallium scan as follows: 50 patients with neither chest pain nor RD (Group A), 46 patients with SMI (Group B) and 53 symptomatic patients (Group C).

[Clinical significance of ST segment shifts during chest pain in predicting the pathogenesis of impending myocardial infarction].

To know whether the pathogenesis of impending myocardial infarction(IMI) could be predicted by the direction of ST segment shifts during an ischemic chest pain, we studied 62 patients with IMI and undergoing emergent coronary angiography(CAG). They were selected from a consecutive number of 474 patients with unstable angina. IMI was defined when patients had more than 2 episodes of chest pain at rest under intensive pharmacological interventions after their CCU admission, and at least one of those was not relieved by nitroglycerin given intravenously.

[Medical therapy in patients with left main coronary artery stenosis].

To elucidate the long-term prognosis of medically-treated patients with left main coronary artery (LMCA) lesions, 119 consecutive patients with LMCA lesions undergoing coronary angiography were analyzed retrospectively. Among these, 3 patients died soon after angiography and were excluded from this study. Among the remaining 116 patients, 22 were treated medically (Group M) for the following reasons: profound left ventricular (LV) dysfunction (3 patients), effective pharmacological treatment (10), and patients' refusal of surgical therapy (9).

[Clinical and anatomical features of acute myocardial infarction associated with double rupture of the interventricular septum and ventricular free wall].

Four patients with acute myocardial infarction (MI) complicating double rupture; interventricular septum and ventricular free wall ruptures, were studied. All patients had histories of hypertension, and pre-infarction angina pectoris of short duration less than 8 days without previous MI. The sites of infarction were anteroseptal in 2 patients and inferoposterior in the other 2.

[Continuous monitoring of mixed venous oxygen saturation during exercise using fiberoptic pulmonary artery catheter].

We measured the mixed venous oxygen saturation (SvO2) continuously using a fiberoptic thermodilution pulmonary artery catheter to analyze the time course of SvO2 during exercise, and evaluated the relationship between SvO2 and exercise load, SvO2 and cardiac output. Five patients with old myocardial infarction and one healthy man underwent pulmonary arterial catheterization and then performed an incremental steady state exercise test using a supine cycle ergometer. There was a rapid fall in SvO2 43.

Kinetic analyses of creatine kinase release patterns in patients with acute myocardial infarction undergoing emergency coronary arteriography.

To quantify the effects of early reperfusion on the size of infarcts, an enzyme indicator was developed: myocardial creatine kinase (CK) release rate (kr), based on a compartmental kinetics model. In 59 patients with acute myocardial infarction (MI) who received intracoronary thrombolysis therapy in the acute phase, the kr showed a good correlation with the flow condition of infarct-related coronary artery and the time required to reach peak enzyme activity. Apparent serum CK disappearance rate (kd') was estimated by using the method of Norris.

Effect of intravenous propranolol on coronary vasomotion at rest and during dynamic exercise in patients with coronary artery disease.

Coronary vasomotion was studied at rest and during bicycle exercise with biplane quantitative coronary arteriography in 28 patients with coronary artery disease. Patients were divided into two groups; the first 18 patients served as controls (group 1), and the next 10 patients were treated with propranolol 0.1 mg/kg, which was infused intravenously before exercise (group 2).

Estimation of left-ventricular systolic performance and its determinants in man from pressures and dimensions of one beat: effects of aortic valve stenosis and replacement.

Within a thick heart-chamber wall, there is a midwall element or layer whose displacements best express systolic performance. The volume enclosed by that midwall element (Vm) and the average stress in that element (sigma m) can be calculated accurately by simple formulae. From simultaneous left-side pressure tracings and contrast cine-ventriculograms, Vm and sigma m were calculated at 20-ms intervals for an entire cardiac cycle in five normal subjects and in eight patients before and one year after replacement of stenotic aortic valves.

Coronary stenosis vasomotion during dynamic exercise before and after PTCA.

Coronary vasomotion was evaluated in eight patients (age 50 +/- 8 years) with coronary disease before and 3.3 +/- 1.9 months after successful percutaneous transluminal coronary angioplasty (PTCA).

Effect of intracoronary and intravenous propranolol on human coronary arteries.

The effect of intracoronary and intravenous propranolol on coronary vasomotion was evaluated in 28 patients with coronary artery disease. Luminal area of a normal and a stenotic coronary vessel segment was determined at rest, during submaximal bicycle exercise and 5 min after 1.6 mg sublingual nitroglycerin administered at the end of the exercise test involving biplane quantitative coronary arteriography.

Diltiazem alone and combined with nitroglycerin: effect on normal and diseased human coronary arteries.

The vasodilatory effect of diltiazem and nitroglycerin on the large epicardial coronary arteries was evaluated in 26 patients with coronary artery disease. The luminal area of a normal and a stenotic coronary artery was determined at rest, after intracoronary administration of diltiazem, during submaximal exercise as well as 5 min after 1.6 mg sublingual nitroglycerin using biplane quantitative coronary arteriography.

Coronary vasomotor tone during static and dynamic exercise.

Coronary vasomotion is an important determinant of myocardial perfusion in patients with angina pectoris, and it influences not only normal but also stenotic coronary arteries. The ability of a stenotic coronary artery to change its size is dependent on the presence of a normal musculo-elastic wall segment within the stenosis (i.e.