PubMed · 6861843
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F Gross. 1983. A useless exercise.. https://doi.org/10.1007/bf00610042
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UNLABELLED: We tested the relationship of nitrate-induced changes in 99mTc-sestamibi perfusion tomography and first-pass radionuclide angiocardiography (FPRNA) with postrevascularization functional recovery of asynergic territories. METHODS: Twenty-eight patients, all with prior infarction and left ventricular dysfunction, underwent two 99mTc-sestamibi rest studies: one under baseline conditions and the other with nitrate infusion. The baseline study was repeated after revascularization. Changes in global and regional perfusion and ventricular function were evaluated by perfusion tomography and FPRNA. Hibermating myocardium was identified by functional recovery in postrevascularization FPRNA. RESULTS: Eleven patients and 31 segments in 19 coronary territories had functional recovery. Nitrate-induced FPRNA changes showed poor agreement with postrevascularization modifications: kappa = 0.24, ns, for the global and kappa = 0.32, p < 0.01 for regional function. The agreement between nitrate-induced and postrevascularization perfusion changes was good both considering the patients (k = 0.57, p < 0.01) and the abnormal coronary territories (k = 0.63, p < 0.0005). The agreement of nitrate-induced perfusion changes with postrevascularization functional outcome was excellent on a patient (k = 1, p < 0.0005), and coronary territory basis (k = 0.82, p < 0.0005). Conversely, the agreement between nitrate and postrevascularization FPRNA was poor: k = 0.18, ns. CONCLUSION: These data suggest that the nitrate-induced changes in 99mTc-sestamibi perfusion imaging are useful to detect hibernating myocardium which recovers its function after revascularization.
Left ventricular (LV) function and the electrocardiogram of 55 patients with coronary artery disease and angina were monitored for a mean of 3.2 +/- 1.9 hours with an ambulatory LV function monitor. During the monitoring interval, patients performed daily activities such as sitting, walking, climbing stairs, and eating. Sixty episodes of transient reduction in ejection fraction of > 5% lasting > 60 seconds were observed in 24 patients; 13 episodes were associated with typical angina, but 47 were asymptomatic. Asymptomatic episodes had a shorter duration of ventricular dysfunction (116 +/- 49 vs 189 +/- 113 seconds; p < 0.05), and smaller increases in relative end-diastolic and end-systolic volumes (end-diastolic 0.9 +/- 5.4% vs 4.6 +/- 4.9% [p < 0.05], and end-systolic 21 +/- 11% vs 35 +/- 20% [p < 0.05]) than did symptomatic ones. When a subset of patients with both symptomatic and asymptomatic episodes were analyzed, similar results were observed: in asymptomatic episodes, duration was shorter (82 +/- 31 vs 200 +/- 110 seconds; p < 0.005), ejection fraction decrease was smaller (-7.3 +/- 2.6% vs -11.0 +/- 4.7%; p < 0.05), and end-systolic volume increase was smaller (23 +/- 12% vs 37 +/- 19%; p < 0.05). The data suggest that asymptomatic transient LV dysfunction is less severe and of shorter duration in patients with angina pectoris.