[Electrocardiography and serum CK-MB determination in myocardial infarction and reperfusion in patients treated with intravenous streptokinase or placebo].
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Aged↗
Biomedical subjects
F Pedersen
Publications and source records attributed to F Pedersen.
Planar 201Tl scintigraphy in ischaemic heart disease: a critical re-evaluation of qualitative and quantitative data analysis.
The aims of the present study were to examine the observer agreement of qualitative (visual) and quantitative (computer-assisted) analysis of planar 201Tl imaging and to compare the diagnostic values of these methods in the detection of infarcted and exercise-induced ischaemic myocardium. The study population comprised of 119 patients (aged 24-77 years) referred consecutively for stress thallium scintigraphy for either diagnostic reasons (n = 42, 35%) or for further evaluation of known coronary artery disease (CAD) (n = 77, 65%). The interobserver agreement was low with the qualitative method and significantly higher with the quantitative method: Kappa-values 0.29-0.39 vs. 0.80-0.92, P < 0.00001. Sensitivity and specificity for the detection of previous Q-wave infarct was significantly higher with the quantitative method (94% and 94%) compared to the qualitative method (77% and 74%), P < 0.01. The corresponding predictive values of a positive and a negative test were 96% and 92% vs. 80% and 70% (P < 0.01). In 86 patients in whom coronary angiography was performed the two methods did not differ significantly regarding sensitivity, specificity and predictive values for the diagnosis of reversible ischaemia or rather CAD. However, when 22 patients with a maximal exercise heart rate < 80% of the predicted target heart rate were excluded the sensitivity was increased with both techniques and was significantly higher with the quantitative method. We conclude that qualitative image analysis has an unacceptably low reproducibility and that quantitative image analysis increases the diagnostic value of 201Tl scintigraphy considerably in both the detection of previous infarcts and, provided a sufficient exercise level is achieved, in the disclosure of reversible myocardial ischaemia.
Adult↗
[Magnesium and ischemic heart disease].
Our knowledge about magnesium in health and disease has increased during the past ten years. Many authors have demonstrated possible magnesium depletion in the population as a whole and particularly among cardiac patients receiving diuretics. Evidence suggests that this magnesium depletion may play a role in the development of arteriosclerosis. It has been demonstrated that long term supplementation of the diet with magnesium reduces the frequency of heart disease. However, the matter is still not proven. It is postulated further that magnesium depletion aggravates the outcome of acute myocardial infarct and has a tendency to provoke arrhythmia. Finally, it has been shown that the potassium depletion frequently observed among cardiac patients may actually arise from magnesium depletion. On this basis, many authors have employed magnesium therapy in various cardiac diseases. Some authors have demonstrated that magnesium therapy reduces the mortality in AMI patients. These studies are, however, too few and too limited to be conclusive. In order to investigate this question, an international multicentre trial (ISIS-4) will be conducted to investigate the influence of magnesium therapy on the mortality after acute myocardial infarction.
Coronary Disease↗
Effect of thrombolytic therapy on exercise response during early recovery from acute myocardial infarction: a placebo controlled study.
Several studies have shown that infarct size is reduced following thrombolytic treatment in patients with acute myocardial infarction. Exercise test variables, such as an impaired heart rate response during exercise, are known to be related to left ventricular function and patient prognosis following acute myocardial infarction. The present study was performed to compare exercise test variables in acute myocardial infarction patients following either intravenous thrombolysis or placebo. Symptom-limited bicycle ergometer tests, carried out 1-2 weeks from the infarction, were performed in 85 patients randomized to intravenous streptokinase (N = 41) or placebo (N = 44) given within 12 h from onset of symptoms. At rest heart rate, systolic blood pressure and rate-pressure product were similar in the two groups. At maximum workload the streptokinase treated patients had a higher median maximal heart rate than controls (136 vs. 126 b.min-1, P less than 0.01) but only a trend towards higher systolic blood pressure was seen (175 vs. 163 mmHg, P = 0.09). Rate-pressure product at maximal exercise was 23,620 vs. 20,100 mmHg.b.min-1 respectively, (P less than 0.01). Total exercise time, ST-segment deviation, occurrence of angina pectoris and left ventricular ejection fraction were similar in the two groups. The trend towards an increased heart rate at maximum workload in streptokinase-treated patients was seen at all levels of left ventricular ejection fraction, and at all levels of exercise capacity.(ABSTRACT TRUNCATED AT 250 WORDS)
Blood Pressure↗
Compliance with the rules of kidney exchange in Scandiatransplant.
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Histocompatibility Testing↗
[A national database for information on disease prevention and health promotion in USA].
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Databases, Factual↗
Prevalence and significance of an abnormal exercise ECG in asymptomatic males. Outcome of thallium myocardial scintigraphy.
During a 3-year period 2500 asymptomatic male aviators were screened routinely for coronary artery disease by maximal bicycle exercise testing. In 55 cases (2.1%) the exercise ECG was abnormal (40 subjects exhibited ST depression, 14 ventricular ectopic activity and in one subject both abnormalities were observed). Further non-invasive studies (Thallium scintigraphy, echocardiography and ambulatory ECG monitoring for arrhythmias) identified nine out of the 55 aviators (16%, 95% CL = 7-26%) with an abnormal exercise test as having cardiac disease. We conclude that standard exercise ECG by itself is a poor predictor of coronary artery disease in asymptomatic subjects because of too many false-positives when the pre-test likelihood of disease is low. Therefore, exercise electrocardiography cannot be recommended as the single routine screening test for coronary artery disease in such individuals.
Adult↗
Continuous oral N-acetylcysteine treatment and development of nitrate tolerance in patients with stable angina pectoris.
The presence of sulfhydryl (SH) groups appears to be fundamental to nitrate-induced vasodilation and N-acetylcysteine (NAC), a sulfhydryl (SH)-donor substance, potentiates hemodynamic responsiveness to nitrates. We investigated the effect of simultaneous administration of NAC and isosorbide dinitrate (ISDN) on development of nitrate tolerance. In a double-blind, randomized, placebo-controlled cross-over study, seven patients with stable angina pectoris were treated for two 8-day periods with ISDN (40 mg four times daily, q.i.d.) together with NAC (controlled release 600 mg q.i.d.) or matching placebo. Bicycle exercise tests were performed before treatment was started, 1 h after treatment was started, and at day 8. After 8-day treatment with ISDN + placebo, responses determined by exercise testing were diminished as compared with responses obtained during acute therapy and did not differ from baseline values, suggesting development of tolerance to ISDN. During treatment with ISDN + NAC, time to 1-mm ST depression was significantly prolonged (441 +/- 44 vs. 381 +/- 40 s, mean +/- SEM) and total ST segment depression significantly reduced (1.9 +/- 0.7 vs. 3.5 +/- 0.8 mm) as compared with baseline values. The reduction in ST segment depression was significantly more pronounced during ISDN + NAC (46%) as compared with ISDN + placebo (23%). Although exercise time and time to angina pectoris were unaffected. NAC augmented the antiischemic effects of ISDN as assessed by ECG. This finding may suggest that development of nitrate tolerance is modified by chronic oral high-dose NAC administration.
Acetylcysteine↗
High-frequency amplification with ITC-HA and BTE-HA. A comparative investigation.
The purpose of the present investigation was to evaluate the magnitude of selective high-frequency amplification obtained by an in-the-canal hearing aid (ITC-HA), and to compare it with that obtained with a conventional behind-the-ear hearing aid (BTE-HA) with an open mould. 22 subjects (20 males, 2 females) at a median age of 66 years (range 46-84) were included in the investigation. All suffered from a bilateral high-frequency hearing loss with normal or near-normal hearing thresholds at 0.5 and 1 kHz. Insertion gain measurements demonstrated that the ITC-HA gives a significantly higher amplification in the high-frequency area, when compared with the BTE-HA, though neither of the hearing aids amplified as much as indicated by the POGO strategy. Although a better amplification in the high-frequency area was obtained with the ITC-HA, it did not result in significantly better speech recognition when compared with the BTE-HA. At the hearing aid fitting, all subjects preferred the ITC-HA, and after an observation period of one year, 68% of those fitted used the aid continuously. Based on the investigation it is concluded that hearing-impaired persons can be fitted with an ITC-HA, even if they have pronounced high-frequency hearing loss, and that this type of aid is preferred by the hearing-impaired to the conventional BTE-HA.
Aged↗
Microvascular right-to-left pulmonary shunt demonstrated by a radionuclide method.
A 37-yr-old man with angiolymphoid hyperplasia (Kimura's syndrome), who had been treated unsuccessfully for suspected asthma, was investigated due to a decrease in arterial oxygen saturation (86%). Right heart catheterization and angiography of the pulmonary artery failed to demonstrate any right-to-left shunts. However, simultaneous scintigraphy over the lungs, kidneys, and head after injection of 150 MBq technetium-99m-labeled macroaggregated albumin i.v. and inhalation of 150 MBq krypton-81m demonstrated a right-to-left shunt in the lungs probably caused by precapillary pulmonary arteriovenous shunts.
Adult↗
[Use of fibrinolytics in the treatment of acute myocardial infarction in Denmark. A questionnaire study].
Questionnaires were sent to all Danish departments admitting patients with acute myocardial infarction (AMI) in order to investigate the attitudes of the departments to thrombolytic therapy in AMI. Two questionnaires were used: one with few questions which was answered by all 68 departments, and a more comprehensive questionnaire which was answered by 51 departments. The study shows that thrombolytic therapy now is use in all departments as opposed to 25% two years ago. In connection with introduction of thrombolytic therapy scientific studies are performed in 75% of the departments. In all departments, streptokinase (SK) is the drug of first choice and recombinant tissue plasminogen activator (rt-PA) is used in 2/3 of the departments in cases where SK-antibodies are suspected.
Denmark↗
ECG and enzymatic indicators of therapeutic success after intravenous streptokinase for acute myocardial infarction.
Thrombolytic therapy has been documented to result in reperfusion of jeopardized myocardium and reduction in the size of the acute myocardial infarction (AMI). The effect of intravenous streptokinase on a creatine kinase-MB (CK-MB) reperfusion index and an ECG estimate of myocardial salvage was therefore studied in 65 patients with a first AMI, randomized to treatment with streptokinase (n = 33) or placebo (control group, n = 32). Reperfusion was defined as a CK-MB appearance rate constant (k1) greater than 0.185. The final AMI size was first predicted from the admission standard ECG by previously developed formulas based on ST segment elevation. The final AMI size was estimated from the QRS score on the predischarge ECG. Myocardial salvage was defined as a greater than or equal to 20% decrease from predicted to final AMI size. The k1 value in the control group was significantly lower than that in the streptokinase group (median 0.157 versus 0.328; p = 0.0001). Accordingly the reperfusion rate was higher in the streptokinase group than in the control group (88% versus 34%; p = 0.0002). The difference in AMI size (final-predicted) was significantly greater in the streptokinase group than in the control group (median -7% versus +1%; p = 0.0001). Myocardial salvage occurred in 60% and 19%, respectively (p = 0.004). A significant correlation was found between CK-MB reperfusion and ECG salvage: 19 of 20 streptokinase-treated patients with salvage also had reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
Creatine Kinase↗
Effect of intravenous streptokinase on the relation between initial ST-predicted size and final QRS-estimated size of acute myocardial infarcts.
Thrombolytic therapy has been documented to reduce acute myocardial infarct size. The previously established relation between initial ST segment elevation and final electrocardiographic (ECG) myocardial infarct size in patients without coronary reperfusion might therefore be altered by thrombolytic therapy. The effect of intravenous streptokinase on this relation was therefore studied in 73 patients with initial acute myocardial infarction who had participated in the Second International Study of Infarct Survival (ISIS-2). Patients who received streptokinase were considered as one group and patients who did not receive streptokinase as a control group. Final myocardial infarct size, which was estimated from the QRS score, was predicted from the admission standard ECG by previously developed formulas based on ST segment elevation. In the 40 control patients there was no change from ST-predicted to final QRS-estimated infarct size (median 17.7% versus 18.3%; p = NS). In the 33 patients in the streptokinase group, there was a highly significant decrease from predicted to final myocardial infarct size (median 21.9% versus 16.2%; p less than 0.0002). This decrease was found for both anterior (median 23.7% versus 19.5%; p less than 0.03) and inferior (median 21.9% versus 12.0%; p = 0.001) infarct locations. Multiple regression analysis adjusting for differences in predicted infarct size confirmed the significance of streptokinase on the difference in infarct size (p = 0.006). Based on the variability of the percent change from predicted to final infarct size in the control group, a threshold decrease greater than or equal to 20% is required for identification of salvage.(ABSTRACT TRUNCATED AT 250 WORDS)
Aspirin↗
Effects of acupuncture in moderate, stable angina pectoris: a controlled study.
In order to evaluate the effects of acupuncture in moderate, stable angina pectoris, 49 patients were randomized to either genuine or sham acupuncture. In sham acupuncture needles were inserted into points within the same spinal segment as in genuine acupuncture, but outside the Chinese meridian system. The effect was evaluated from exercise tests, anginal attack rate and nitroglycerin consumption. There were no significant differences between the effects of genuine and sham acupuncture either on exercise test variables or on subjective variables. In patients receiving genuine acupuncture there was a significant increase in exercise tolerance (median 9%) and in delay of onset to pain (median 10%). No significant changes were observed in patients receiving sham acupuncture. Within both groups there was a median reduction of 50% in anginal attack rate and nitroglycerin consumption, and there was no significant difference between the results achieved in the two groups. It is concluded that with the present design it was not possible to demonstrate any significant differences between the effect of genuine and sham acupuncture.
Acupuncture Therapy↗
[Reduction of mortality in acute myocardial infarction with streptokinase and aspirin therapy. Results of ISIS-2].
This investigation includes 17,187 patients in 417 hospitals in 16 countries admitted within 24 hours of the commencement of symptoms of acute myocardial infarction (AMI). The patients were allotted at random to the following treatments 1) intravenous infusion of 1.5 million International Units streptokinase (SK) during one hour, 2) 160 mg acetyl salicylic acid (ASA) daily for 30 days, 3) both SK and ASA and 4) placebo treatment only. The five-week cardiovascular mortality was reduced by 25% following infusion of streptokinase from 12.0% to 9.2% and by 23% during ASA treatment from 11.8% to 9.4%. The combination of SK and ASA resulted in 42% reduction in the cardiovascular mortality after five weeks compared with the placebo. The effect of SK was greatest if treatment was instituted within six hours but effects were obtained after all of the first 24 hours. The preliminary results show that the reduction in mortality obtained by both SK and ASA appears to continue during the subsequent one to two years. SK treatment resulted in haemorrhage requiring treatment in 0.5% as compared with 0.2% in the placebo group, more cases of proved cerebral haemorrhage, 0.1% as compared with 0.0%, but fewer cases of cerebral apoplexy, 0.7% as compared with 0.8%. It is concluded that thrombolysis with SK combined with prophylaxis of repeated thrombosis with ASA is the indicated treatment in cases of AMI and less than 6-24 hours duration.
Aged↗
[Prevention of thrombosis and rethrombosis in acute myocardial infarction].
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Fibrinolytic Agents↗
[Streptokinase in acute myocardial infarction].
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Humans↗
[Bone scintigraphy in patients with hip joint prostheses. Use of bone scintigraphy in hip pain after total hip replacement].
A retrospective investigation was undertaken to assess the value of bone scintigraphy with 99mtechnetium methylene-diphosphonate in patients referred with hip pain after total hip replacement. The material comprized 68 patients with a total of 68 prostheses. This review revealed that 10/25 of the patients with pathological scintigrams and 6/28 of the patients with normal scintigrams were submitted to replacement of the prostheses. In the way in which it was carried out and interpreted in this department, scintigraphy was of limited value in selection of the patients who required replacement of the prostheses.
Aged↗