PubMed · 1117832
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R M Stein. 1975. Ventricular septal defect.. https://pubmed.ncbi.nlm.nih.gov/1117832/
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To assess the extent of myocardial necrosis and ischemia in patients with anterior wall healed myocardial infarction depending on whether ST-segment elevation was present on precordial leads during exercise testing, 62 consecutive patients (49 men and 13 women, age [mean +/- SD] 56 +/- 11 years) with anterior wall infarcts were assessed with exercise technetium-99m (Tc-99m) methoxy-isobutyl-isonitrile single-photon emission computed tomography and quantification of the extent of necrosis and ischemia on polar maps: 22 patients had > or = 1 mm ST-segment elevation during exercise, and 40 did not. The extent of the necrosis in the anteroseptal (p = 0.001) and apical (p = 0.002) regions, the extent of ischemia in the lateral region (p = 0.003) on polar maps, and the frequency of ventricular aneurysm as shown by cardiac catheterization (p = 0.001) were significantly greater in patients with ST-segment elevation. In a multiple logistic regression model, both extent of necrosis in the anteroseptal region (odds ratio 10.8; 95% confidence interval 2.7 to 44.0) and extent of ischemia in the lateral region (odds ratio 7.25; 95% confidence interval 1.6 to 32.7) were associated with exercise-induced ST-segment elevation. These data suggest that ST-segment elevation in anterior infarctions is associated with wider necrosis in the anteroseptal and apical regions, with a wider extent of ischemia in the lateral region and a higher frequency of ventricular aneurysm. Consequently, it cannot be used as a marker of viability.
Catheter-induced ventricular ectopy can limit assessment of contractility or anatomy. We compared the incidence of ventricular ectopy in infants and children undergoing left ventriculography using a 4F Halo catheter or a 4F pigtail catheter. For each group, 17 patients had 19 ventriculograms. Iopamidol 76% was used for each study. There was no statistical difference between the Halo and pigtail groups (mean+/-SEM) for age (16.2+/-3.8 vs. 12.9+/-1.8 mo), weight(8.1+/-1.0 vs. 8.0+/-0.7 kg), gender, left ventricular end diastolic pressure (9.6+/-1.1 vs. 9.8+/-1.3 mm Hg), catheter location in the ventricle, or volume of contrast (1.31+/-0.06 vs. 1.35+/-0.06 cc/kg). The Halo group had a more rapid injection rate (1.42+/-0.15 vs. 0.99+/-0.10 cc/kg/sec, P< 0.02). The Halo group had a lower overall incidence of ventricular ectopy (3 vs. 13 studies, P < 0.001), ventricular ectopy >1 beat (1 vs. 10 studies, P < 0.002), and ventricular couplets or tachycardia (1 vs. 9 studies, P < 0.008). The 4F Halo catheter is associated with less ventricular ectopy than a 4F pigtail catheter and should be considered for use during pediatric catheterization.