technetium-tc-99m-pyrophosphate and Hypertension

Seventy eight patients with arterial hypertension were examined by echo-, radiocardiography and scintigraphy of the myocardium, using 99mTc pyrophosphate and 201Tl. A relationship was found between the development of hypertrophy of the left ventricle and the impairment of it perfusion and function. At the same time there was a correlation between the decrease in cardiac output and the deterioration of myocardial blood supply. It was demonstrated that 99mTc pyrophosphate or 201Tl myocardial scintigraphy yielded the coincident results when relative heart failure was evaluated in patients with arterial hypertension and left ventricular hypertrophy.

Topics: Adult; Cardiomegaly; Coronary Circulation; Diphosphates; Female; Heart; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Thallium Radioisotopes

The clinical value of myocardial scintigraphy with 99mTc-pyrophosphate in conjunction with bicycle ergometry was assessed through the correlation of the latter's results with the clinical course of coronary heart disease over 1 year in 21 patients with first myocardial infarction during its early healing stage and 17 anginal patients without a history of myocardial infarction. The disease ran a stable course at the time of the testing in all the patients; later on, 11 of those developed various complications associated with coronary heart disease, or died. Three scintigraphic recordings were made: prior to, at the peak of, and after the exercise. Thirteen scintigraphic patterns were identified. They are interpreted on the basis of presumed variation in the degree of myocardial damage and blood supply to affected areas under the effect of exercise; a relation is also noted with predicted risk of complications. The method has proved reliable in identifying patients at low risk for complications. Providing indirect evidence of the quality of blood supply to damaged myocardial areas during rationed exercise, it furnishes additional criteria for the assessment of the patients' working capacity.

Topics: Adult; Aged; Angina Pectoris; Coronary Circulation; Diphosphates; Exercise Test; Female; Heart; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Risk; Technetium; Technetium Tc 99m Pyrophosphate; Time Factors

In 18 consecutive patients without a history of myocardial infarction (MI), prolonged angina pectoris with persistent negative T waves in the precordial leads was associated with a high frequency of in-hospital spontaneous angina (14 of 18, 78%), usually accompanied by S-T segment elevation, and occasionally in-hospital MI (4 of 18, 22%). Angina and MI always involved the electrocardiographic leads with negative T waves. Coronary arteriography, performed in 16 patients, revealed greater than or equal to 90% proximal diameter reduction of the left anterior descending (LAD) coronary artery in 14 patients. No patient had severe narrowing of all 3 major coronary arteries, but the 3 who had 100% LAD occlusion lacked collateral circulation. The ejection fraction was greater than or equal to 50% in 13 patients. Atrial pacing performed in 11 patients at an average rate of 142 beats/min produced a 1.0 mm S-T segment change in only 5 patients (45%), 3 of whom had an associated lactate production. Arterial systemic hypertension induced by methoxamine in 14 patients caused reversal of negative T waves without significant S-T segment shifts or chest pain and failed to elicit lactate extraction abnormalities in each of the 5 patients in whom it was determined. Thus, prolonged angina with persistent negative T waves in the precordial leads is almost invariably associated with a critical and proximal LAD obstruction, severe narrowing of 1 or 2 coronary arteries, and poor or absent collateral vessels. The relatively preserved coronary reserve in 55% of our patients suggests that negative T waves do not represent active myocardial ischemia. The study also suggests that transient "positivization" of the negative T waves may not necessarily relate to myocardial ischemia when associated with acute systemic hypertension.

Topics: Adult; Aged; Angina Pectoris; Cardiac Pacing, Artificial; Collateral Circulation; Coronary Angiography; Electrocardiography; Female; Humans; Hypertension; Male; Methoxamine; Middle Aged; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tin Polyphosphates