sodium-pertechnetate-tc-99m and Angina-Pectoris

Technetium-99m pertechnetate equilibrium ventriculography was used to evaluate the effects of captopril in a single dose of 50 mg on the changes in ST segment depression during the identical bicycle ergometer exercise, as well as on systemic and regional hemodynamic parameters in 10 patients (mean age 52 years) with Functional Classes II-III exercise-induced angina pectoris. During exercise performed 45 and 90 minutes after captopril, ST segment depression decreased by 30 +/- 0 (p less than 0.05), and 32 +/- 10% (p less than 0.02), respectively as compared to baseline ST segment displacement. Following 90 minutes after the drug administration, end-systolic volume reduced both at rest and during exercise, resting stroke volume increased from 71 +/- 4 to 76 +/- 4 ml (p less than 0.01), whereas exercise stroke volume rose from 69 +/- 3 to 74 +/- 3 ml (p less than 0.03); with the drug, ejection fraction showed a 5% increase (p less than 0.02) at rest and a 4% increase (p less than 0.02) on exercise. Thus, captopril had a beneficial effect on the hemodynamics and reduced myocardial ischemia in patients with exercise induced angina.

Topics: Adult; Aged; Angina Pectoris; Captopril; Coronary Circulation; Electrocardiography; Heart Ventricles; Hemodynamics; Humans; Middle Aged; Myocardial Contraction; Radionuclide Ventriculography; Sodium Pertechnetate Tc 99m; Ventricular Function, Left

It has been demonstrated in animal experiments that heparin accelerates the coronary collateral development induced by repeated coronary occlusion. We used this effect of heparin for the treatment of patients with stable effort angina. In 10 patients, treadmill exercise was performed according to standard Bruce protocol twice a day for 10 days. A single intravenous dose of heparin (5000 IU) was given 10 to 20 min before each exercise period. Exercise with heparin pretreatment increased the total exercise duration from 6.3 +/- 1.9 (SD) to 9.1 +/- 2.2 min (p less than .001) and the maximal double product (DP) from 18,900 +/- 5100 to 25,500 +/- 6800 mm Hg.beats/min (p less than .001). The DP at the onset of angina was also increased by 35% (p less than .01) and the DP at which ST depression (0.1 mV) first appeared was 19% (p less than .05) greater after treatment. Repeat coronary cineangiography revealed an increase in the extent of opacification of collaterals to the jeopardized myocardium. In an additional six patients, treadmill exercise was performed with no medication twice a day for 10 days. All of the above-mentioned variables of treadmill capacity remained unchanged, despite 20 exercise periods without heparin pretreatment. Thus, heparin accelerates exercise-induced coronary collateral development by promoting angiogenesis. The development of such a therapeutic modality will open a new field for the treatment of patients with ischemia.

Topics: Angina Pectoris; Cineradiography; Collateral Circulation; Combined Modality Therapy; Coronary Angiography; Drug Evaluation; Exercise Test; Exercise Therapy; Female; Heart Ventricles; Heparin; Humans; Male; Physical Exertion; Radionuclide Imaging; Random Allocation; Sodium Pertechnetate Tc 99m; Time Factors

With the use of equilibrium radionuclide ventriculography the effects on left ventricular (LV) function of 160 mg oral propranolol daily and 360 mg verapamil daily alone and in combination were compared in 18 patients with chronic exertional angina. A randomized, double-blind, placebo-controlled, crossover protocol was used. The reduction in exercise rate-pressure product induced by the combination (118 +/- 28 mm Hg/min) was significantly greater (p less than .05) than that by propranolol (135 +/- 27 mm Hg/min) or verapamil alone (163 +/- 28 mm Hg/min). In patients at rest, neither single nor combined therapy altered global or regional left ventricular ejection fractions (EFs). Verapamil, but not propranolol, increased (p less than .05) cardiac volumes of resting subjects; used in combination, no further increase in LV volume occurred. With placebo, exercise global EF did not decrease from the level at rest and therefore no drug effect could be demonstrated for this parameter of LV function. By an evaluation of normalized regional EF measurements the combination was shown to reduce exercise-induced hypokinesis (placebo 52 +/- 20%, combination 61 +/- 23%; p less than .01). No significant improvement was noted with propranolol or verapamil alone; only the combination prevented a significant increase in end-systolic and end-diastolic volumes during exercise. Thus, propranolol and verapamil, used alone in moderate doses, exert no beneficial effect on exercise LV function as measured by EF and volume changes, and resting function deteriorates slightly with verapamil.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Angina Pectoris; Blood Pressure; Double-Blind Method; Drug Therapy, Combination; Electrocardiography; Female; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Physical Exertion; Propranolol; Radionuclide Imaging; Random Allocation; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Verapamil

Topics: Adult; Angina Pectoris; Coronary Artery Bypass; Dose-Response Relationship, Drug; Exercise Test; Hemodynamics; Humans; Male; Middle Aged; Myocardial Ischemia; Nifedipine; Postoperative Complications; Radionuclide Ventriculography; Sodium Pertechnetate Tc 99m; Verapamil

The intracardiac hemodynamics was studied in 33 patients with exertional angina pectoris undergoing an acute drug test with verapamil (n-15) and nifedipine (n-18) by using radionuclide ventriculography both at rest and during exercise. All the patients were divided into 2 groups by the increase in exercise duration with the two drugs: 1) those who exhibited a marked antianginal effect and 2) those without it. At rest, the calcium antagonists enhanced ejection fraction in the two groups. Exercise ejection fraction also increased, but in a subgroup of patients who displayed no higher exercise tolerance with verapamil. Verapamil and nifedipine in Group 1 patients resulted in lower left ventricular end diastolic volume. It is suggested that the antianginal effect of calcium antagonists is to a certain degree associated with decreased afterload, as manifested by diminished left ventricular end systolic volume.

Topics: Adult; Angina Pectoris; Cardiac Output; Exercise Test; Humans; Male; Middle Aged; Myocardial Contraction; Nifedipine; Radionuclide Ventriculography; Sodium Pertechnetate Tc 99m; Verapamil

50 patients after coronary artery bypass grafting were matched with 50 not-operated patients. After a follow-up period of four years they were investigated by first pass radionuclide angiography. Revascularized myocardial areas showed significantly higher regional ejection fraction during exercise and in territories with prior myocardial infarction. The results proved the hemodynamic benefits of coronary artery bypass grafting even in territories with poor myocardial function.

Topics: Angina Pectoris; Cardiac Output; Coronary Artery Bypass; Coronary Disease; Gold Radioisotopes; Humans; Myocardial Contraction; Postoperative Complications; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

In order to investigate the clinical significance of ST-T changes in resting ECG in angina pectoris, symptom-limited ergometer exercise radionuclide angiocardiography with ECG was performed in 60 patients with exertional angina. In those with normal ECG at rest (Group N), left ventricular ejection fraction (EF) did not change during exercise (71 +/- 5% to 71 +/- 6%). In those with only ST change at rest (Group ST) and those with only T change at rest (Group T), EF decreased significantly during exercise (68 +/- 5% to 63 +/- 7%, p less than 0.01; 68 +/- 6% to 61 +/- 7%, p less than 0.001). In those with ST and T changes at rest (Group ST + T), EF was low at rest (58 +/- 11%) and decreased further at exercise (52 +/- 8%, p less than 0.001). In those whose negative or flat T wave became more negative during exercise, EF was low both at rest and at exercise. In conclusion, ST and T changes at rest in patients with exertional angina might suggest a depressed reserve of myocardial function for exercise.

Topics: Adult; Aged; Angina Pectoris; Electrocardiography; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

Forty-one patients (25 male, 16 female) were studied by RNCA in our institution. There were 42 rest studies and 24 stress studies (66 studies total). Sixteen patients were normal, 15 had ASHD, seven had a cardiomyopathy, and three had left-sided valvular regurgitation. Each study was preprocessed using both the standard nine-point smoothing method and Fourier filtering. Amplitude and phase images were also generated. Both preprocessing methods were compared with respect to image quality, border definition, reliability and reproducibility of the LVEF, and cine wall motion interpretation. Image quality and border definition were judged superior by the consensus of two independent observers in 65 of 66 studies (98%) using Fourier filtered data. The LVEF differed between the two processes by greater than .05 in 17 of 66 studies (26%) including five studies in which the LVEF could not be determined using nine-point smoothed data. LV wall motion was normal by both techniques in all control patients by cine analysis. However, cine wall motion analysis using Fourier filtered data demonstrated additional abnormalities in 17 of 25 studies (68%) in the ASHD group, including three uninterpretable studies using nine-point smoothed data. In the cardiomyopathy/valvular heart disease group, ten of 18 studies (56%) had additional wall motion abnormalities using Fourier filtered data (including four uninterpretable studies using nine-point smoothed data). We conclude that Fourier filtering is superior to the nine-point smooth preprocessing method now in general use in terms of image quality, border definition, generation of an LVEF, and cine wall motion analysis. The advent of the array processor makes routine preprocessing by Fourier filtering a feasible technologic advance in the development of the RNCA study.

Topics: Adult; Aged; Angina Pectoris; Cardiomyopathy, Dilated; Coronary Disease; Female; Filtration; Fourier Analysis; Heart; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Tin Polyphosphates

To investigate the function of coronary collateral vessels, especially from view point of supplying arteries, radionuclide angiocardiography was performed before and during a symptom-limited ergometer exercise in 54 patients with effort angina. In single vessel disease, during exercise, left ventricular ejection fraction (EF) (%) increased in the cases with coronary collateral vessels (supplied from patent arteries) (72 +/- 7----77 +/- 8, p less than 0.025), but decreased in those without (66 +/- 10----61 +/- 10, P less than 0.001). In multivessel disease, EF decreased during exercise even in those with collaterals (supplied from stenosed arteries) (67 +/- 10----59 +/- 8, p less than 0.001). It is concluded that angiographic appearance of the coronary arteries supplying collateral vessels is a major predictive factor of the function of coronary collateral vessels and of left ventricle during exercise.

Topics: Adult; Aged; Angina Pectoris; Angiocardiography; Blood Pressure; Collateral Circulation; Coronary Circulation; Coronary Disease; Coronary Vessels; Female; Heart Rate; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

We studied 30 consecutive patients with unstable angina during pain-free intervals with gated blood pool scintigraphy. The initial study was performed within 18 hours of admission to the coronary care unit. A second study was performed near the time of hospital discharge, after stabilization with medical therapy. Three months thereafter patients were categorized according to their worst anginal status following hospital discharge. Fifteen patients were New York Heart Association functional class I or II (group A); 15 patients were in functional class III or IV (group B). Left ventricular ejection fraction was similar at the time of initial study (55.9 +/- 2.18% and 56.0 +/- 3.55% for groups A and B respectively). At the time of hospital discharge the ejection fraction had risen to 60.3 +/- 1.85% (p less than 0.01) in group A and in group B it had fallen to 48.1 +/- 3.4% (p less than 0.005). End-systolic volume index in group B rose from 37 ml/m2 +/- 6.1 to 43 +/- 6.2 ml/m2 (p less than 0.005) at the time of the follow-up study. There were no significant intergroup patients during the two scintigraphic examinations. Eleven group B patients subsequently underwent coronary artery bypass surgery. A significant increase in ejection fraction and a significant decrease in end-systolic volume index were noted when these patients were restudied an average of 3.2 months after surgery. This study suggests that changes in left ventricular function during the course of unstable angina pectoris are common and may be detected by serial gated blood pool scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Electrocardiography; Heart; Heart Ventricles; Hemodynamics; Humans; Middle Aged; Postoperative Period; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Time Factors

After in-vivo labeling of red blood cells with 99mTcO4, the radioactivity of different parts of the body is proportional to the regional blood volume. This technique allows the simultaneous registration of drug-induced changes of the local blood volume. We examined the influence of nitroglycerin on the blood volume distribution in patients with coronary artery disease (n = 10) and chronic heart failure (n = 8). Compared with the controls (n = 8) we observed in the nitroglycerin-groups a significant decrease of blood volume over the heart and the liver, whereas there was an increase of the blood volume over the extremities. It is pointed out that functional whole-body scanning is a useful radiological technique for the non-invasive study of pharmacologically caused changes of the local blood volume in man.

Topics: Adult; Aged; Angina Pectoris; Blood Volume; Blood Volume Determination; Erythrocytes; Heart Failure; Humans; Middle Aged; Nitroglycerin; Sodium Pertechnetate Tc 99m; Technetium

In 19 patients (mean age 55.3 years) with severe, diffuse coronary artery disease and stable angina pectoris, coronary artery bypass surgery was performed with an average of 5.36 anastomoses per patient. At 15.5 +/- 8 months postoperatively, radionuclide ventriculograms were obtained in the RAO projection (first-pass-technique) at rest and during maximal exercise by means of a multicrystal camera. To assess the effects of revascularization on the myocardial function, analysis was performed for global ejection fraction (GEF) as well as three regional ejection fraction (GEF) as well as three regional ejection fractions (REF) corresponding to the vascular beds of the three major coronary arteries. During exercise global ejection fraction increased in 13 patients (68.4%) an average of 9.5%-points from 51.5 to 61.0%, in one patient (5.2%) remained unchanged and in five patients (26.3%) decreased an average of 9.6% %-points from 62.6 to 53.0% (all changes p less than 0.05). The classification of the various myocardial regions was based on the preoperative coronary angiogram as well as intraoperative in-situ findings according to the status of the coronary vessels, the extent of revascularization and the presence of remote myocardial infarctions. Regions of group I had a significantly higher fraction of complete revascularizations, that is 79.9%. 61.1% of group-II-territories were incompletely revascularized. The weighted balance of the three regions supplied by the left anterior descending artery, the circumflex and the right coronary artery explains the postoperative response of the global ejection fraction to exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angina Pectoris; Cardiac Output; Coronary Artery Bypass; Coronary Disease; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

The cardiovascular responses to combined static-dynamic effort, postprandial dynamic effort and dynamic effort alone were evaluated by upright bicycle ergometry during equilibrium-gated blood pool scintigraphy in 24 men, mean age 59 +/- 8 years, with chronic ischemic heart disease. Combined static-dynamic effort and the postprandial state elicited a peak cardiovascular response similar to that of dynamic effort alone; work load 643 +/- 156 and 638 +/- 161 vs 650 +/- 153 kg-m/min, respectively; heart rate 147 +/- 14 and 145 +/- 14 vs 143 +/- 17 beats/min; systolic pressure 195 +/- 26 and 200 +/- 25 vs 197 +/- 25 mm Hg; and rate-pressure product 286 +/- 48 and 292 +/- 55 vs 282 +/- 52. Heart rate, intraarterial systolic and diastolic pressures, rate-pressure product and ejection fraction were similar for the three test conditions at the onset of ischemia and at peak effort. The prevalence and extent of exercise-induced ischemic left ventricular dysfunction, ST-segment depression, angina pectoris and ventricular ectopic activity were also similar during the three test conditions. Direct and indirect measurements of systolic and diastolic blood pressure were highly correlated. The onset of ischemic ST-segment depression and angina pectoris correlated as strongly with heart rate alone as with the rate-pressure product during all three test conditions. The cardiovascular response to combined static-dynamic effort and to postprandial dynamic effort becomes more similar to that of dynamic effort alone as dynamic effort reaches a symptom limit. If significant ischemic and arrhythmic abnormalities are absent during symptom-limited dynamic exercise testing, they are unlikely to appear during combined static-dynamic or postprandial dynamic effort. This simplifies, the task of formulating guidelines for physical effort in patients with chronic ischemic heart disease, especially in providing "clearance" to perform avocational and vocational tasks involving combined static-dynamic and postprandial dynamic effort.

Topics: Aged; Angina Pectoris; Blood Pressure; Coronary Disease; Eating; Erythrocytes; Exercise Test; Heart; Heart Rate; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Adult; Aged; Angina Pectoris; Cardiac Output; Cineangiography; Coronary Artery Bypass; Female; Humans; Male; Middle Aged; Myocardial Infarction; Physical Exertion; Prognosis; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Angina Pectoris; Coronary Disease; Electrocardiography; Evaluation Studies as Topic; Exercise Test; Heart Ventricles; Humans; Physical Exertion; Prognosis; Radiography; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thallium

Left ventricular ejection fraction (LVEF) was measured by radionuclide angiography at rest and during supine bicycle exercise before and 3 months after coronary artery bypass graft surgery (CABG) in 20 patients with chronic stable angina. The right anterior oblique gated first-pass technique was used to assess LVEF response to maximal exercise (Wmax), while the left anterior oblique equilibrium-gated technique was used to assess LVEF and relative LV volume changes during graded submaximal exercise. Mean LVEF was unchanged at rest after CABG by both the first-pass (60 +/- 12% vs 60 +/- 12%) and equilibrium-gated (61 +/- 13% vs 62 +/- 13%) measurements. At Wmax, mean first-pass LVEF was significantly higher postoperatively than preoperatively (63 +/- 17% vs 53 +/- 17%; p less than 0.01) with a higher Wmax (750 +/- 182 vs 590 +/- 202 kpm/min; p less than 0.001) and higher rate-pressure product (302 +/- 59 vs 222 +/- 57 units; p less than 0.001). Similarly, equilibrium-gated LVEF levels during graded exercise, using stepwise regression analysis, were significantly higher postoperatively than preoperatively (p less than 0.001); at the highest graded work load, they averaged 63 +/- 19% postoperatively and 53 +/- 17% preoperatively, with higher work loads (500 +/- 190 vs 417 +/- 155; p less than 0.05) and higher rate-pressure products (271 +/- 55 vs 207 +/- 53; p less than 0.001). The increase in exercise LVEF after surgery was due to a marked decrease in the ratio, relative to resting values, of counts-based end-systolic volumes during submaximal exercise (preoperatively 1.91 +/- 1.04; postoperatively 1.14 +/- 0.46; p less than 0.01). The five subjects in whom LVEF decreased significantly during exercise postoperatively all had one or more blocked or stenosed grafts. This study documents, by two independent radionuclide techniques, an improved LVEF during exercise at an increased maximal work capacity and rate-pressure product 3 months after successful CABG.

Topics: Adult; Aged; Angina Pectoris; Cardiac Output; Coronary Artery Bypass; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Postoperative Period; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Rest and exercise radionuclide angiocardiographic measurements of left ventricular function were obtained in 496 patients who underwent cardiac catheterization for chest pain. Two hundred forty-eight of these patients also had an exercise treadmill test. An ejection fraction less than 50% was the abnormality of resting left ventricular function that provided the greatest diagnostic information. In patients with normal resting left ventricular function, exercise abnormalities that were optimal for diagnosis of coronary artery disease were an injection fraction at least 6% less than predicted, an increase greater than 20 ml in end-systolic volume and the appearance of an exercise-induced wall motion abnormality. The sensitivity and specificity of the test were lower in patients who were taking propranolol at the time of study and in patients who failed to achieve an adequate exercise end point. In the 387 patients with an optimal study, the test had a sensitivity of 90% and a specificity of 58%. Radionuclide angiocardiography was more sensitive and less specific than the exercise treadmill test. The high degree of sensitivity of the radionuclide test suggests that it is most appropriately applied to patient groups with a high prevalence of disease, including those considered for cardiac catheterization.

Topics: Adult; Aged; Angina Pectoris; Blood Volume; Cardiac Catheterization; Coronary Disease; Coronary Vessels; Female; Heart Ventricles; Humans; Male; Physical Exertion; Propranolol; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium