Immediate lingual flange extension.
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Denture Bases↗
Biomedical subjects
R Hosokawa
Publications and source records attributed to R Hosokawa.
Effect of long-term cholesterol-lowering treatment with HMG-CoA reductase inhibitor (simvastatin) on myocardial perfusion evaluated by thallium-201 single photon emission computed tomography.
Fifteen patients with either angina pectoris or old myocardial infarction, who had positive 201Tl single photon emission computed tomography (SPECT) imaging and coronary sclerosis of more than 50%, were treated with an HMG-CoA reductase inhibitor (simvastatin) for more than 1 year. They were compared with an untreated control group (n = 25). Total cholesterol decreased 22% and high-density lipoprotein (HDL) increased 9% with simvastatin; both changes were significantly different from those in controls. Long-term simvastatin induced improvement of myocardial perfusion on 201Tl SPECT images both during exercise and at rest, which was also significantly different from controls. In addition, the improvement of myocardial perfusion on 201Tl SPECT images was clearly related to the improvements in cholesterol values, especially nonHDL cholesterol. Thus, the greater the decrease in nonHDL cholesterol, the greater the improvement in myocardial perfusion at rest or during exercise with long-term treatment using an HMG-CoA reductase inhibitor. These findings indicate that the improvements in cholesterol values caused by HMG-CoA reductase inhibitor therapy are related to improvements of myocardial perfusion seen on 201Tl SPECT images.
Angina Pectoris↗
Accurate procedure for transferring a cast replacement clasp arm to a removable partial denture.
This article describes a simple, quick and accurate procedure to replace a broken bar-type clasp with a new clasp arm. This procedure involves a resin matrix that transfers a new clasp arm from a working cast to a removable partial denture. This simple procedure enables quick and precise replacement of a broken clasp arm.
Dental Casting Technique↗
Basic kinetics of 15-(p-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) in canine myocardium.
BMIPP is a radioiodinated fatty acid analogue used for myocardial single photon emission CT (SPECT) imaging based on high cardiac fatty acid metabolism. In normal dogs, 74% of the injected BMIPP was instantly extracted and was then retained in 65.3%. The washout of the retained radioactivity was low, and most of the washout was alpha- and beta-oxidation metabolites. ATP concentration plays an important role in the myocardial uptake and retention of BMIPP. The ATP-dependent BMIPP uptake at the TG pool was strongly regulated by etomoxir with modifying mitochondrial beta-oxidation and subsequent ATP production. Thus, myocardial viability was reflected on the BMIPP uptake in acute ischemia. In spite of insignificant changes in early extraction and retention. BMIPP back diffusion (r = -0.92) and full-oxidation metabolite (r = 0.78) were correlated with the severity of ischemia. Mismatched region of BMIPP with flow (Tl-201) showed decreased metabolic enzymes such as citrate synthase and 3-hydroxyacyl-CoA dehydrogenase. These data suggest that BMIPP would be feasible for detecting cellular energy state from lipid metabolism.
Animals↗
Effect of long-term exercise training on regional myocardial perfusion changes in patients with coronary artery disease.
The cardiac rehabilitation of patients with coronary artery disease (CAD) promotes exercise tolerance, improves left ventricular function, and decreases the heart rate and systolic blood pressure at the same load intensity. Several studies have shown that cardiac rehabilitation improves myocardial perfusion in CAD patients. However, the long-term (> or = 1 year) effect of cardiac rehabilitation on myocardial perfusion is still controversial. The effect of long-term exercise training on myocardial perfusion in CAD patients was assessed using thallium-201 (201Tl) exercise studies at a baseline (4 months after the onset of CAD) and at a 1-year or more follow-up in 58 patients with stable CAD. The subjects had been divided into a training group (n=35) participating in supervised exercise 2 times per week for the follow-up period, and the control group (n=23). There was an improvement in the myocardial perfusion on stress 201Tl scintigraphy in 20 of the 35 (57.1%) trained patients and in 3 of the 23 (13.0%) of the control patients (p<0.001). The number of 201Tl stress myocardial perfusion defect segments was significantly decreased after the cardiac rehabilitation training (231 to 153 segments), but showed no change in the control group (158 to 156 segments) (p<0.01). In spite of no significant differences in the number of involved coronary arteries, it improved (12/17 patients: 70.6%) more in the patients who had trained for more than 2 years compared to the patients who had trained for less than 2 years. The exercise tolerance increased in 25 of the 35 training group patients (71.4%), and in only 3 of the 23 control group patients (13.0%). The peak double products increased from 20,131+/-6,010 to 28,370+/-5,600 (p<0.01) in the training group, and showed no change in the control group (20,567+/-5,112 to 20,964+/-7,728 (NS)). The results indicated that the long-term physical training increased exercise tolerance and the double products of CAD patients. In addition, the training resulted in improved cardiac perfusion as evidenced by 201Tl scintigraphy. The findings suggest that exercise training is an advisable and effective treatment for patients with CAD.
Aged↗
Direct bone induction in the subperiosteal space of rat calvaria with demineralized bone allografts.
In order to clarify the understanding of bone induction with crude bone morphogenetic protein (BMP)-containing allografts in subperiosteal conditions, chondrogenesis and osteogenesis were histologically evaluated following the implantation of the demineralized bone (DB) in the subperiosteal space of calvaria of 30 Wistar rats. On the forehead of the rat, DB particles were placed onto the denuded calvarial bone and covered by the skin-periosteum flap without any perforations of the marrow space of the calvaria. Sintered hydroxylapatite particles (HA) were also placed as a control. In the DB group, new bone formation on the surface of calvaria was achieved between 2 and 8 weeks after the operation. However, no chondrogenesis was seen throughout the experimental period. In the HA implantation group, fibrous tissue encapsulation of HA particles was generally seen. These results suggest that DB containing crude BMP might have the capacity for direct osteoblast induction from undifferentiated mesenchymal progenitor cells in vivo in specific situations, that is, in a subperiosteal space of uninjured rat calvaria.
Animals↗
Myocardial metabolism of 123I-BMIPP in a canine model with ischemia: implications of perfusion-metabolism mismatch on SPECT images in patients with ischemic heart disease.
UNLABELLED: 123I-(rho-iodophenyl)-3-R,S-methylpentadecanoic acid (BMIPP) is a fatty acid analog for SPECT imaging. This radiopharmaceutical possesses the unique property, that is, perfusion-metabolism mismatch on SPECT images in patients with ischemic heart disease. However, the reason of this mechanism remains unclear. METHODS: Using open-chest dogs under anesthesia, we made a system to release all the blood of the great cardiac vein outside without recirculation, if necessary. Left anterior descending artery (LAD) was occluded for 30 min after reperfusion. After the injection of BMIPP into LAD, blood samplings from the cardiac vein and abdominal aorta (6 dogs) or serial biopsy specimens from the LAD region (5 dogs) were performed, and then compared with the normal control. The catabolites of BMIPP, including backdiffusion of nonmetabolized BMIPP, were evaluated with high-performance liquid chromatography (HPLC) in the efflux study. Thin-layer chromatography (TLC) technique was introduced in the tissue analytical study. RESULTS: Although the rapid extraction of BMIPP from the plasma into the myocardium and the subsequent retention were unchanged, the early washout (8 min) of radioactivity significantly increased (51% +/- 12% to 65% +/- 7%; P < 0.05) with ischemia. The metabolites from the myocardium consisted of backdiffusion of nonmetabolized BMIPP, alpha, intermediate, and full oxidation metabolites. Among these metabolites, backdiffusion of nonmetabolized BMIPP in blood significantly increased (27.9% +/- 7.7% to 42.3% +/- 8.1%; P < 0.05), especially in the early phase with ischemia. In tissue, the radioactivity was concentrated in the triglyceride pool even in the early phase, and in addition, BMIPP and alpha-oxidized metabolite significantly decreased in the early phase with ischemia (t = 1 min after BMIPP injection, 25.9% +/- 8.6% to 14.5% +/- 2.1%, P < 0.01; t = 2 min, 8.9% +/- 5.0% to 4.5% +/- 1.7%, P < 0.05). CONCLUSION: These results show that backdiffusion of nonmetabolized BMIPP from the myocardium increased and BMIPP (long-chain fatty acids) in tissue decreased with ischemia, suggesting backdiffusion of nonmetabolized BMIPP might play an important role in myocardial perfusion-metabolism mismatch on SPECT images in patients with ischemic heart disease.
Animals↗
Comparison between freestanding and tooth-connected partially stabilized zirconia implants after two years' function in monkeys: a clinical and histologic study.
STATEMENT OF PROBLEM: Partially stabilized zirconia implants placed by a 1-stage procedure have been previously shown to obtain initial osseointegration under clinically unloaded condition. However, it is unknown whether freestanding and tooth-connected partially stabilized zirconia implants can maintain a long-term direct bone-implant interface. PURPOSE: This study examined the possibility of the long-term stability of osseointegration around partially stabilized zirconia implants with a 1-stage procedure with different loading designs. MATERIAL AND METHODS: Thirty-two partially stabilized zirconia implants were placed into the mandibles of 8 monkeys. Three months after implant placement, 3 types of superstructure were provided in each animal to obtain different concepts of support as (1) single freestanding implant support, (2) connected freestanding implant support, and (3) a combination of implant and tooth support. At 12 and 24 months after loading, clinical, histologic, and histomorphometric evaluations of peri-implant tissues were performed on 28 implants. RESULTS: No clear difference in clinical features was observed among the different types of support. Direct bone apposition to the implant was generally seen in all groups. Histometrically, bone contact ratio ranged between 66% and 81%, and bone area ratio varied between 49% and 78% at 24 months after loading. These values showed almost no difference among single freestanding, connected freestanding, and implant-tooth supports of partially stabilized zirconia implants. CONCLUSION: In a primate model, partially stabilized zirconia implants placed with a 1-stage procedure achieve long-term stability of osseointegration with the use of single freestanding, connected freestanding, and implant-tooth supports.
Analysis of Variance↗
RGD peptides regulate the specific adhesion scheme of osteoblasts to hydroxyapatite but not to titanium.
Hydroxyapatite (HA) is a bioactive dental implant material which accelerates bone formation on its surface. The mechanism of this acceleration is not clear. The elucidation of the cell adhesion might be the key to the understanding of the bioactive mechanism of HA. In this study, we analyzed the adhesion of HOS human osteoblasts onto HA and titanium to find the particular adhesion to HA. In short-term cultures in fetal bovine serum-pre-coated materials, a significantly higher number of cells adhered to HA than to titanium. In addition, serum-free conditions with phosphate-buffered saline pre-coating or bovine serum albumin pre-coating materials were tested. The results were nearly the same among all pre-coating conditions, suggesting that the quantity of cell adhesion was not affected by serum components. However, in the morphological observations by SEM, the form of adhesion was found to differ among pre-coating conditions. The osteoblasts tightly adhered and spread onto both HA and titanium with serum pre-coating, whereas the cells loosely adhered and did not spread without serum. To evaluate the Arg-Gly-Asp (RGD) sequence-specific adhesion, we used synthetic RGD peptides for a competitive inhibition test. The results showed that RGD peptides remarkably inhibited the tight adhesion and spreading of osteoblasts onto HA, whereas they did not strongly inhibit adhesion and spreading onto titanium. These results demonstrate that the regulation of cell adhesion to HA is different from that to titanium. Our study suggests that the RGD-containing serum proteins might have a major role in regulating the specific adhesion of osteoblasts to HA, and in inducing enhanced cell growth and differentiation.
Amino Acid Sequence↗
Continuous administration of basic fibroblast growth factor (FGF-2) accelerates bone induction on rat calvaria--an application of a new drug delivery system.
Some studies have shown that locally applied basic fibroblast growth factor (FGF-2) enhances bone regeneration at a fracture site, while others have not been in agreement. We developed a new continuous FGF-2 delivery system designed to accelerate cytokine-induced new bone formation. A subperiosteal pocket was surgically formed in 36 eight-week-old male Wistar rats. The rats were administered 0, 1, 10, or 100 ng of FGF-2 contained in a collagen minipellet, mixed with allogeneic demineralized bone matrix in a dome-shaped Millipore filter and then placed into the pocket. New bone formation in the dome was evaluated at 2, 4, and 8 wks after placement. Soft x-ray radiographs disclosed an apparently larger radiopaque region in the 1-ng group at 4 wks compared with those in the other groups. Morphometrical analysis revealed that the new bone area in the 1-g group was significantly larger than that in the 0-g group (p<0.01). In the 100-ng FGF-2 group, new bone formation seemed suppressed. We concluded that continuous slow administration of a small amount of FGF-2 accelerates bone-derived osteogenic cytokine-induced new bone formation.
Animals↗
Three-dimensional alveolar bone morphology analysis using computed tomography.
The purpose of the present study was to determine whether the use of 3-dimensional computed tomography (3DCT) is an effective method of imaging bone defect morphology caused by periodontal disease. A total of 186 sites from 9 patients were examined. Periodontal parameters were recorded after initial therapy. For the evaluation of bone resorption and root morphology, computed tomography (CT) scanning was performed and then CT images were reconstructed for 3-dimensional evaluation. Immediately prior to the surgery, bone sounding measurements were done under local anesthesia. The denuded bone measurement during periodontal surgery represented the true bone level. To compare the bone level obtained from 3DCT images with the true bone level, the examiner, without being informed of the patient's condition, traced the cemento-enamel junction (CEJ) and apical extent of the bone levels on the images of 3DCT, and measured the vertical distance between the CEJ and bone. The mean difference between 3DCT and the true bone level was 0.41+/-2.53 mm (mean+/-SD). The correlation between them showed a highly significant linear regression (R=0.75). However, the mean difference between the bone sounding level and the true bone level was 0.22+/-1.49 mm (R=0.91). Thus, bone sounding was slightly more accurate than 3DCT, but there was no significant difference between these two assessments (P >0.05). The results of present study indicate that 3DCT has the potential to allow precise assessment of bone defect caused by periodontal disease.
Adult↗
First-pass radionuclide angiography using iodine-123 myocardial tracers and a multicrystal gamma camera.
UNLABELLED: The purpose of this study was to validate the accuracy of the assessment of ventricular function by first-pass radionuclide angiography (FPRNA) with 123I myocardial tracers and a multicrystal gamma camera. METHODS: Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction were measured in 69 patients by FPRNA using 123I myocardial tracers (126 +/- 7 MBq) and 99mTc tracers (541 +/- 141 MBq) on a multicrystal gamma camera with a high-sensitivity collimator. For 44 patients, ejection fraction values measured by 123I-FPRNA were compared to those estimated by equilibrium radionuclide angiography (ERNA). Visual wall-motion analysis was also performed to judge clinical acceptability of 123I-FPRNA images for identification of wall-motion abnormality. RESULTS: Mean LVEFs (%) estimated by 123I-FPRNA and by 99mTc-FPRNA were 49.6 +/- 13.6 and 49.1 +/- 14.1, respectively (nonsignificant p value). An excellent correlation was found between LVEFs estimated by 123I-FPRNA and 99mTc-FPRNA (r = 0.96, s.e.e. = 1.9%). Values of LVEF measured by 123I-FPRNA also demonstrated excellent correlation with those measured by ERNA (r = 0.95, s.e.e. = 2.2%). A good correlation was also noted between right ventricular ejection fractions measured by 123I-FPRNA and 99mTc-FPRNA (r = 0.72, s.e.e. = 4.0%). The Spearman rank correlation coefficient between 123I-FPRNA and ERNA wall-motion scores was 0.87 (n = 135, p < 0.001). CONCLUSION: Resting ventricular function can be reliably measured with 123I-FPRNA in combination with a multicrystal gamma camera. This indicates that the assessment of ventricular function is feasible in conjunction with 123I myocardial imaging without an increase in cost or radiation dose to patients.
Adult↗
Effect of metabolic substrate on BMIPP metabolism in canine myocardium.
UNLABELLED: The lipid tracer 1 5-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) is clinically useful, and its basic metabolism is being analyzed. Because the pharmacokinetics of this lipid tracer may be affected by blood concentrations of fatty acid or glucose, this study evaluated the effects of excess levels of lipid or glucose on BMIPP uptake and metabolism. METHODS: A technique using an open-chest dog model was used. Blood sampling was performed from the left anterior descending coronary artery and great cardiac vein after an injection of 123I-BMIPP either with a glucose infusion (n = 6) or a lipid infusion (n = 5). High performance liquid chromatography and double-tracer kinetic analyses clarified the extraction, retention, backdiffusion and further metabolism of BMIPP. These results were compared with data from control dogs (n = 6). RESULTS: In this experiment, a 10-fold increase over the normal lipid blood concentration and twofold increase over the normal blood glucose concentration were evaluated with either intralipid or glucose infusion, respectively. In the lipid infusion studies, the extraction significantly decreased compared with the control values (74% +/- 12% to 58% +/- 8%; p < 0.05), and the washout increased from 50% +/- 13% to 68% +/- 16% (p < 0.05). The BMIPP backdiffusion increased (p < 0.05), and the levels of the further metabolites decreased (p < 0.05), while the retention level remained constant (normal, 89% +/- 9%; lipid infusion, 91% +/- 3%; ns). In the glucose infusion studies, the BMIPP extraction, retention and washout showed no statistical differences compared to controls; however, these parameters showed the same tendencies as those in the lipid infusion group. In addition, the BMIPP backdiffusion increased significantly (control, 25.1% +/- 8%; glucose infusion, 48.7% +/- 25.6%; p < 0.05) as it did after the lipid infusion. CONCLUSION: BMIPP metabolism and uptake are affected by excess concentrations of lipid and glucose in the blood. However, the retention of BMIPP was not affected by either type of infusion. The BMIPP backdiffusion and the further metabolite comprising 10% of the tracer extracted were affected both by the lipid and glucose infusions. These results indicate that an excess fat concentration and glucose affect BMIPP uptake, especially the extraction of BMIPP and BMIPP backdiffusion.
Animals↗
Periodontal parameters of osseointegrated dental implants. A 4-year controlled follow-up study.
The aim of this study was to evaluate the periodontal parameters of osseointegrated dental implants. The condition of the peri-implant mucosa was assessed using periodontal parameters, i.e., of plaque index, bleeding on probing, probing pocket depth, probing attachment level and Periotest scores as well as a radiographic parameter, over a 4-year follow-up period. 32 non-submerged ITI dental implants, all placed in the mandible, were studied in 12 patients who had good oral hygiene. All patients were regularly recalled at 6-month intervals. The overall implant success rate was 100%. None of the implants showed any signs of inflammation, radiographic bone loss or any detectable mobility during the follow-up period. Methods similar to those used to evaluate the natural dentition were effectively employed to assess the clinical status of the dental implants. The diagnostic value of these parameters could not, however, be determined from this study due to the absence of any peri-implant tissue complications. The results indicated that some periodontal parameters of healthy peri-implant mucosa might be slightly different from healthy periodontal tissue.
Alveolar Process↗
Assessment of cardiac sympathetic function with iodine-123-MIBG imaging in obstructive sleep apnea syndrome.
UNLABELLED: Iodine-123-MIBG imaging has been used to evaluate myocardial sympathetic function in various cardiac diseases. In patients with obstructive sleep apnea syndrome (OSAS), increased sympathetic activity has been widely recognized, as assessed by measuring the plasma concentration and urinary excretion of catecholamines and by measuring muscle sympathetic nerve activity. However, these measurements are not specific indices of cardiac sympathetic function. Therefore, this study was undertaken to assess cardiac sympathetic function in patients with OSAS using MIBG cardiac scintigraphy. METHODS: This study consisted of 11 patients (10 men, 1 woman; mean age 43 +/- 16 yr) with a diagnosis of OSAS established by polysomnography, and 8 age-matched normal control subjects (7 men, 1 woman; mean age 45 +/- 18 yr). Early (15 min) and delayed (3 hr) planar images were taken after the injection of 111 MBq of [123I]MIBG. The mean counts of the whole heart and the mediastinum were obtained to calculate heart-to-mediastinum count ratios from the early images (H/Me) and from the delayed images (H/Md) and the myocardial washout rate (WR). Eight patients were restudied after 1 mo of nasal continuous positive airway pressure treatment. RESULTS: The H/Me and H/Md ratios were significantly lower in the patients than in the control subjects (H/Me, 2.49 +/- 0.32 versus 2.84 +/- 0.34, p = 0.0207; and H/Md, 2.33 +/- 0.30 versus 3.02 +/- 0.36, p = 0.0013). The WR was higher in the patients than in the control subjects (36.2 +/- 9.0% versus 23.6 +/- 4.9%, p = 0.0022). The H/Me and H/Md ratios in the patients were significantly correlated with the apnea-hypopnea index and the degree of hypoxemia during sleep. After treatment, H/Me and H/Md remained unchanged, but WR significantly recovered (from 34.9 +/- 10.4% to 26.3 +/- 7.7%, p = 0.0357). CONCLUSION: Cardiac sympathetic function and integrity are impaired in subjects with OSAS when compared with age-matched control subjects. MIBG cardiac imaging can be helpful in evaluating cardiac involvement and efficacy of therapy in OSAS.
3-Iodobenzylguanidine↗
Myocardial kinetics of iodine-123-BMIPP in canine myocardium after regional ischemia and reperfusion: implications for clinical SPECT.
UNLABELLED: To evaluate the clinical utility of 123I-(rho-iodophenyl)-3-R,S-methylpentadecanoic acid (123I-BMIPP) for ischemic heart disease, we investigated the metabolic fate of 123I-BMIPP in canine models with mild and severe ischemia and evaluated the clinical utility of this tracer. METHODS: Using open-chest dogs under anesthesia, we assembled a system that would release all the blood from the great cardiac vein without recirculation, if necessary. After injection of BMIPP into the left anterior descending coronary artery, blood samplings from cardiac vein and abdominal aorta were performed for 10-min ischemia (mild ischemia, five dogs) and 30-min ischemia (severe ischemia, six dogs), after reperfusion and for normal controls (six dogs). The catabolites of BMIPP, including backdiffusion of nonmetabolized BMIPP, were evaluated using high-performance liquid chromatography. RESULTS: Although the rapid extraction of BMIPP from the plasma into the myocardium and the subsequent retention were unchanged among three groups, the early washout (at 8 min) of radioactivity significantly increased (from 50% +/- 13% to 61% +/- 8%; p < 0.05) in severe ischemia. The metabolites from the myocardium consisted of backdiffusion of nonmetabolized BMIPP and alpha-oxidation, intermediate-oxidation and full-oxidation metabolites. For mild ischemia, these values were not significantly changed from the normal control, although the respective proportions of metabolites showed some variation. Lactate production after reperfusion on mild ischemia, which indicates the severity of ischemia, was closely correlated with the level of backdiffusion of BMIPP (r = -0.92) and the full-oxidation metabolite (r = 0.78). On the other hand, for severe ischemia, the level of backdiffusion of nonmetabolized BMIPP increased (from 25.1% +/- 8.0% to 34.7% +/- 8.7%; p < 0.05), and the full-oxidation metabolites decreased (from 21.4% +/- 10.9% to 14.8% +/- 7.3%). CONCLUSION: The metabolism of BMIPP was closely associated with the severity of myocardial ischemia. Thus, 123I-BMIPP might be a promising and sensitive radiopharmaceutical for the evaluation of ischemic heart disease.
Animals↗
Noninvasive assessment of myocardial viability by positron emission tomography with 11C acetate in patients with old myocardial infarction. Usefulness of low-dose dobutamine infusion.
BACKGROUND: When patients with severely depressed left ventricular function are treated, it is crucial to know in advance how much functional recovery is expected from coronary revascularization. METHODS AND RESULTS: We compared the results of 11C acetate positron emission tomography (PET) with dobutamine infusion with changes in regional wall motion evaluated by left ventriculography in 28 patients with old Q-wave anterior myocardial infarctions. Dysfunctional but viable myocardium (group A, n = 13) was separated from nonviable myocardium (group B, n = 15) by echocardiographic assessments of regional wall motion before and after successful coronary revascularization. 11C acetate PET was performed to characterize normalized myocardial blood flow and oxidative metabolism (the clearance rate constant, k mono). While the baseline k monos of the infarct areas of the two groups were different with overlap, the responses to dobutamine infusion were directionally different. In addition, relative perfusion by 11C acetate PET could predict recovery of left ventricular function as well as or better than dobutamine 11C acetate kinetics. The extent of the increase in k monos of the infarct area with dobutamine infusion correlated well (P < .01) with the degree of the increase in the percentage of systolic segment shortening in the infarct area (left ventriculography) after coronary revascularization. CONCLUSIONS: 11C acetate PET with dobutamine infusion can predict not only the reversibility of dysfunctioning myocardium after coronary revascularization but also the extent of improvement of regional wall motion in patients with old Q-wave infarction.
Acetates↗
Comparative study of 201Tl-scintigraphic image and myocardial pathologic findings in patients with dilated cardiomyopathy.
The objective of the present study was to characterize the production of 201Tl myocardial perfusion defects, the relation between the 201Tl multiple small defects and the myocardial damage indicated by myocardial fibrosis shown histopathologically in patients with dilated cardiomyopathy (DCM). Rest 201Tl scintigraphy was performed in thirty-seven patients with myocardial tissue fibrosis by endomyocardial biopsy, and without stenosis of the coronary artery. 201Tl myocardial SPECT images were visually classified into 4 grades according to the severity of inhomogeneous perfusion defects (IPD), 0: none, 1: slight, 2: moderate, 3: severe. 201Tl uptake, defect regions (DR), and coefficient of variation % (CV%) were also quantified by Bull's eye quantification in nineteen patients. During cardiac catheterization, three biopsy specimens were obtained from the lateral wall to the apical region of the left ventricle and the amount of fibrosis was assessed by means of light microscopic morphometry. The myocardial fibrosis was also classified into 4 grades by a point-counting method. Autopsy study was also assessed in six patients. 201Tl perfusion defects were observed in 35 (94.6%) patients, of whom 29 (78.4%) showed inhomogeneous perfusion defects. Twenty-four (64.9%) showed Stage 0 and 201Tl findings, and 21 (62.2%) had myocardial fibrosis in stage 1. Clinically, the correlation between the grades of the IPD, % 201Tl uptake, DR and CV% of myocardial uptake, which were calculated semiquantitatively by Bull's eye image, and the histological grades of fibrosis were also good (IPD vs. fibrosis: r = 0.7014; % 201Tl uptake vs. fibrosis: r = -0.6542; DR vs. fibrosis: r = 0.7027; CV% vs. fibrosis: r = 0.6985). The 201Tl SPECT findings were in close agreement with the severity of myocardial fibrosis confirmed by autopsy, but the grading of the IPD was not related to the ejection fraction or left ventricular diameter. It showed a higher rate of inhomogeneous 201Tl myocardial perfusion defects (78.4%) in patients with DCM. This result may contribute to the clinical evaluation of DCM or differentiation from other diseases. Furthermore, the grading of 201Tl inhomogeneous perfusion defects related to the myocardial fibrosis of left ventricular myocardium may contribute to speculation of the myocardial degenerative stage in clinical settings.
Adult↗