ABSTRACTS

WEDNESDAY, APRIL 28, 1982 PM SCINTIGRAPHY IN MYDCARDIAL ISCHEMA 4:00-5:oo

Dm ?ATlZRN OF 0xIRAcPILITYANDPERFusION IN F?ESTIMGANGIMANITHST ~.~ELEvATIoNANDDHPRE'SSION. Oberdsn Parodi,MD;Paolo Marzullo,~);Michele Galli,MD;Wal- ter Hencivelli,Dr;Fabio Agostini,MD;Antonio L'Ahbate,m, FACC.CIiR Institute of Clinical Physiolcgy,Univ. Pisa,Italy

Aim of this study was to correlate regional myocardial perfusion and contractility during episodes of angina at rest(AF,).In the same patient(pt)gated blood pool scan(Q3P) and 2Ol-Tl scintigraphy(TlS)were performed in separate epi s&es of AR with reproducible ST segment elevation (SF+) (4 pts)or ST segment depression(STJ)(6pts).None of these pts had previous myocardial infarction;among pts with ST+, 3 had 1 and 1 had 3 vessel coronary artery disease(CAD).In ptswithST+,2had1,2had2and2had3vesselCAD. TlS was performedduring AFt and 4 hourslater.GHP,was per- formed in the basal state,during AP.(list tie acquisition for at least 4')and after nitrcglycerin.In all pts control TlS and GE@ sh& IXXTM~ perfusion and contraction.During AR with ST+,TlS sho%xl a localized,severe defect in the sa me area where GBP showed a definite deterioration of con-- tractility(a-diskinesis)and in agreemen t with E@S sites of ischemia.In AR with SI'+,TlS showed a diffuse and apparen- tly non transnxal defect,while GE%P showed a global hypoki nesis and marked enlargement of the LV;sites of ECG,TlS - and GBP abnormalities ware not necessarily in full agree- ment.Ejection fraction was relatively mxe impaired in ST+ These findings suggest that in AR with STJ the angina1 epi scdes are associated with a rmre severe aqxcxnission of - cardiac function and support the worse long-term prognosis in pts with AR and SIJ.

VALUE OF RADIONUCLIDE TECHNIQUES IN THE ASSESSMENT OF ISCHRMIA IN PATIENTS WITH PREVIOUS MYOCARDIAL INFARCTION. E. Madsen, MD, .I. Tubau, MD, V. Froelicher, MD, FACC, W.L. Ashburn, MD, University of California, San Diego. The limitations of exercise electrocardiogram for the de- tection and location of ischemia in patients(pts) with previous myocardial infarction(M1) are well established. The performance of Thallium rest-exercise(Th-EX), regional ejection fraction during exercise(REF-EX)and Phase analy- sis(PH) was assessed in 27 pts with MI. REF-EXwas derived from multigated radionuclide angiograms. The LAO images were divided into four regions at the center of mass. A decrease >5% from rest to exercise was considered abnor- mal. The presence of ischemia(ISH)byclinical and angio- graphic data(ANGIO), was related to abnormalities appear- ing or worsening during exercise. Stenosis 275% of the intraluminal diameterwas present in

1 vessel in 9, in 2 or 3 vessels in 17 and 1 pt had minor disease. The left anterior descending(LAD)wasinvolved in 17 pts (with corresponding MI in 10 pts), the right coro- nary(RCA) in 18 (14 MI)and the left circumflex(CX) in 13 (4 MI). ANGIO demonstrated akinesis/dyskinesis in 71%(20/ 28). Q waves were present in 89X(25/28). EXT ST-segment depression >lmm in the corresponding area was seen in 2 pts (9%) but 10 other pts had ischemic changes in unre- lated leads (43%). Of 27 vessels causing ISH (7 with MI),Th-EX detected 56% (15/27) and PH and REF-RX 52%(14/27). Of 28 vessels with MI, Th-EX detected 26(93%) and PH 24(86%). REF-RX was ab- normal in 8/21(38%) of MI regions without ischemia. In the IAD region the detection was: Th-EX 75X, REF-EX: 75% and PH: 58%. In the CX region: Th-RX: 44%. REF: 11% and PH: 67%. In the RAO region: Th-RX: 33%, REF: 67% and PH: 16%. Of 33 vessels without disease, Th-FX was normal in 19 (58%), PH in 24(73X) and REF-RX in 25(76%). We conclude that in presence of MI, radionuclide methods

help little for the precise location of ischemia.

EVALUATION OF EMPTYING AND FILLING FOLLOWING PACING IN- DUCED ISCHEMIA USING RADIONUCLIDES Julio F. Tubau, MD; Kirk Peterson MD; William L. Ashburn MD, University of California, San Diego, California

Twenty-one patients (pts) were studied during cardiac catheterization using short acquisition (30 sec.) list mode radionuclide ventriculography (RN). Ejection Fraction (EF), peak emptying (peak -dV/dt) and peak filling (peak +dV/dt) were obtained at control (C) and after pacing induced ischemia (P). Heart rate was artificially maintained constant. RN EF, correlated well with contrast angiography (r=.95, SEM=3.5) and was re- producible (i-=.93). Coronary artery disease (CAD) with stenosis >75% was present in 3 vessels in 7 pts, in 2 vessels in 6 pts and in 1 vessel in 3 pts; 5 pts were normal (NL).

EF -dV/dt +dV/dt C P c P c P

NL x 63.4 65.8 3.42 3.48 2.99 3.09

(n-5) S$M 5.7 6.3 .34 .45 .34 .60

CAD x 58 50.9 3.37 2.64 2.52 2.10

(n=16) S&f 3.6 2.9 .I9 .19 .24 .23

P< .OOl .OOl .05

Following pacing induced ischemia, EF and peak -dV/dt, were markedly decreased and both parameters showed good correlation (r=.89). Peak +dV/dt although significantly reduced, correlated poorly with either EF or -dV/dt. We conclude that global ejection indices better reflect acute ischemia. The relative discrepancy of +dV/dt may reflect segmental asynchrony.

INCREASED INCIDENCE OF “PERSISTENTLY POSITIVE” TECH- NETIUM PYROPHOSPHATE MYOCARDIAL SCINTIGRAMS FOL- LOWING MYOCARDIAL INFARCTION IN DIABETICS Pascal Nicod, MD; Samuel E. Lewis, MO; L. Maximilian Buja, MD, FACC; James Corbett, MD; Gene Henderson, BA; Robert E. Rude, MD, FACC; Robert W. Parkey, MD, FACC; Frederick J. Bonte, MD; James T. Willerson, MD, FACC, University of Texas Health Science Center, Dallas, TX.

Persistently positive technetium-99m stannous pyrophosphate myocardial scintigram(s) (PYP+) at least 3 months following myocardial infarction appear to indicate a poor prognosis. The incidence and implications of PYP+ in diabetics and nondiabetics were assessed in 54 patients (29 diabetic, 25 non-diabetic). There were no significant differences between diabeticand non-diabetic patients in age, incidence of transmural or nontransmural myocar- dial infarction, myocardial infarct location, frequency of previous myocardial infarction, or the degree of left ventricular dysfunc- tion assessed by radionuclide ventriculography. PYP+ occurred more commonly in diabetics (D) (lS/29, 62%) than non-diabetics (ND) (3/25, 12%), (p&l.OOl). Major cardiac complications during follow-up (mean 14.2 mos) included death, recurrent myocardial infarction, unstable angina, or life threatening arrhythmias.

All Patients PYPt PYP- D ND Major cardiac complications 17154 12121 5133 14129 3125 Death 7154 6121 l/33 6129 l/25 Patients with PYP+ had significantly more major complications (pdi.005) and death (p&.03) than those with PYP-. Major cardiac complications were more frequent in diabetics than in non- diabetics (p=O.OOS). Postmortem examination in 2 diabetics with PYP+ revealed myocytolysis and fibrosis in the myocardium. Thus, 1) PYP+ occur more frequently in diabetics than in non- diabetics following myocardial infarction; 2) PYP+ have a poor prognosis; and 3) PYP+ are associated in diabetics with myocyto- lysis on histologic examination.

1016 March 1982 The American Journal of CARDIOLOGY Volume 49