An "optimal" lead system for the diagnosis of coronary heart disease and hypertrophies using multivariate analyses. Quantitative comparison with other commonly used lead systems.
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Biomedical subjects
Publications and source records attributed to P Block.
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Thallium-201 scintigraphy of the exercised myocardium was performed in 70 male patients admitted for coronary arteriography and left-ventricular angiography. Left ventricular scintigrams were collected in left lateral, left anterior oblique (65 degrees, 45 degrees, and 25 degrees), and anterior views, and the images were divided into eight segments: apical, anteroseptal, anterior, antero-lateral, posterolateral, posterior, inferior, and posteroseptal. A correlative study between segmental hypoperfusion on scintigram and coronary-artery stenosis visualized by contrast artriorgraphy allowed selection of specific segments for each main coronary artery. Hypoactivity in the apical and posterior segments did not appear reliable. Using selected segments, we were able to identify LAD disease in 84%, LCx disease in 49%, and RCA disease in 79% of documented significant stenosis, with specificity of 95%, 89%, and 88%, respectively. Coronary-artery disease could be detected in 95% of patients having more than 50% coronary-artery stenosis, with 93% specificity. In most cases, patients with two-vessels disease and three-vessel disease could not be distinguished from each other. Multiple-vessel disease suggested by segmental analysis of myocardial scinitgrams after exercise was confirmed artriographically in 88% of the patients, but 52% with scintigrams suggesting signle-vessel disease had, in fact, multiple-vessel disease.
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The observations of surface electromaps recorded at rest and during exercise in two examplative cases are reported: the first one deals with a normal man while the second refers to a patient suffering from an old inferior myocardial infarction with bouts of angina pectoris; these surface maps are compared with myocardial scanning also performed at rest and during exercise. Special attention is devoted to the possible relation of the above described, non-invasive, techniques to the anatomical description of coronary lesions as demonstrated by coronary angiography. A close relationship is found between the surface potential distribution pattern and the area of hypofixation observed on the scan as far as the presumed location of ischemic myocardial tissue is concerned.
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