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Recent advances in drug therapy question as to the additional impact behavioral interventions may have on the prognosis of patients with clinically stable coronary heart disease (CHD). The aim of the study was to evaluate the effects of a multimodal, behavioral intervention on myocardial perfusion (MP) and cardiac events, compared to standardized cardiologic care, in patients with stable CHD. Seventy-seven CHD patients (age 54.2 ± 6.9 years, male 87%) were randomly assigned to a behavioral intervention plus standardized cardiologic care (INT, n = 39) or standardized cardiologic care alone (CO, n = 38). MP was assessed by 201Thallium MP-scintigrams (SPECT) at baseline, after 2, 3, and 7 years, respectively. Subsequent cardiac events (MI, PCI, CABG) were assessed using the cardiologists' charts. Sixty-five patients (84%) completed the study. In all patients, the course of MP was significantly better in INT analysis of variance (ANOVA group x time p = 0.001); this was also true for patients without subsequent PCI/CABG (ANOVA group x time p = 0.002). Incidence of cardiac events was significantly associated with INT (6 vs. 14; log rank test p = .047). The study suggests additional long-term benefits of a behavioral intervention on myocardial perfusion and cardiac events in patients with stable CHD compared to standardized cardiologic care only. [ABSTRACT FROM AUTHOR]

Reduced regional technetium-99m methoxyisobutylisonitrile ([sup 99m] Tc-MIBI) accumulation in patients with chronic non-Q-wave infarction (NQWI) but without significant coronary artery stenosis indicates non-transmural damage of the myocardial wall. The aim of this study was to characterise cardiac energy metabolism after NQWI using phosphorus-31 magnetic resonance spectroscopy ([sup 31] P-MRS) and to compare the biochemical remodelling with changes in regional [sup 99m] Tc-MIBI uptake and with morphological and functional parameters assessed by magnetic resonance imaging (MRI). Fifteen patients with a history of NQWI, exclusion of significant coronary artery stenosis (<50% diameter stenosis) and hypokinesia of the anterior wall (group A) were examined with [sup 31] P-MRS to study the effects of NQWI on myocardial energy metabolism. Spectroscopic measurements were performed in the infarct-related myocardial region. Corresponding gradient-echo MR images and myocardial [sup 99m] Tc-MIBI single-photon emission tomography images were acquired for exact localisation of the infarct region. All examinations were performed at rest under anti-ischaemic medication. Data were compared with those of patients in whom coronary artery disease had been excluded by angiography (group B, n=10). All patients of group A displayed anterior wall hypokinesia in the infarcted area on both ventriculography and MRI, with a reduced myocardial accumulation of [sup 99m] Tc-MIBI (66.3%±11.8% vs 95.6%±2.2% in group B). The mean wall thickness during the complete cardiac cycle (9.5±1.8 mm vs 13.1±1.1 mm in group B, P<0.001), the systolic wall thickening (2.6±1.4 mm vs 5.8±1.5 mm in group B, P<0.01) and the phosphocreatine/adenosine triphosphate ratio (1.12±0.22 vs 1.74±0.23 in group B, P<0.01) in the hypokinetic area were all significantly reduced. It is concluded that persisting hypokinetic myocardium after NQWI combined with reduced myocellular uptake... [ABSTRACT FROM AUTHOR]

Aims A substantial number of patients with dysfunctional but potentially viable myocardium cannot be accurately evaluated by transthoracic echocardiography due to a poor acoustic window. This study compares the diagnostic value of alternative functional imaging techniques, such as dobutamine–transoesophageal echocardiography (dobutamine–TEE) and dobutamine magnetic resonance imaging (dobutamine–MRI) for the detection of viable myocardium and the prediction of left ventricular functional recovery in patients with chronic coronary artery disease following successful revascularization procedures.Methods and Results Rest and low-dose (5, 10μg dobutamine.min−1.kg−1) multiplane dobutamine–TEE and ultrafast cine–MRI studies were performed in 103 patients. Contractile recovery of an infarct region was predicted if a dobutamine contraction reserve could be assessed visually by TEE or MRI in ≥50% of infarct-related a- or dyskinetic segments. Revascularization of the infarct-related vessel was successful in 88 patients, and 4·9±0·7 months later 52 patients still had an angiographically controlled open target vessel. These patients underwent another rest MRI study to assess left ventricular functional recovery. A dobutamine contraction reserve was observed in 27/52 (52%) patients by TEE and in 26/52 (50%) patients by MRI. Functional improvement of the infarct region was diagnosed in 28/52 (54%) patients. The positive and negative predictive accuracy of dobutamine–TEE and dobutamine–MRI for the prediction of left ventricular functional recovery was not significantly different (85% vs 92%, ns and 80% vs 85%, ns). Diagnosis of a predominantly viable infarct region by TEE and MRI predicted a significant increase in left ventricular ejection fraction (TEE: 12±8% vs 2±7%P<0·001, MRI: 13±7% vs 2±7%, P<0·001) compared to infarct regions graded as scar.Conclusion A qualitative visual analysis of TEE and MRI viability studies is highly accurate for the prediction of left ventricular functional recovery in patients with dysfunctional myocardium and proved to be a clinically valuable alternative if transthoracic dobutamine–echocardiography is unsuitable. To date, TEE is cardiologists' preferred choice for the assessment of myocardial viability but MRI may become significantly more attractive with increasing local availability and experience. [ABSTRACT FROM PUBLISHER]