37 results on '"Amanullah AM"'
Search Results
2. Heparin-induced thrombocytopenia: a practical review.
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Hong MS, Amanullah AM, Hong, Michael S, and Amanullah, Aman M
- Abstract
Heparin-induced thrombocytopenia (HIT) remains under-recognized despite its potentially devastating outcomes. It begins when heparin exposure stimulates the formation of heparin-platelet factor 4 antibodies, which in turn triggers the release of procoagulant platelet particles. Thrombosis and thrombocytopenia that follow comprise the 2 hallmark traits of HIT, with the former largely responsible for significant vascular complications. The prevalence of HIT varies among several subgroups, with greater incidence in surgical as compared with medical populations. HIT must be acknowledged for its intense predilection for thrombosis and suspected whenever thrombosis occurs after heparin exposure. Early recognition that incorporates the clinical and serologic clues is paramount to timely institution of treatment, as its delay may result in catastrophic outcomes. The treatment of HIT mandates an immediate cessation of all heparin exposure and the institution of an antithrombotic therapy, most commonly using a direct thrombin inhibitor. Current "diagnostic" tests, which primarily include functional and antigenic assays, have more of a confirmatory than diagnostic role in the management of HIT. Special attention must be paid to cardiac patients who are often exposed to heparin multiple times during their course of treatment. Direct thrombin inhibitors are appropriate, evidence-based alternatives to heparin in patients with a history of HIT, who need to undergo percutaneous coronary intervention. As heparin remains one of the most frequently used medications today with potential for HIT with every heparin exposure, a close vigilance of platelet counts must be practiced whenever heparin is initiated. [ABSTRACT FROM AUTHOR] more...
- Published
- 2010
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3. Prognostic implications of myocardial perfusion single-photon emission computed tomography in the elderly.
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Hachamovitch R, Kang X, Amanullah AM, Abidov A, Hayes SW, Friedman JD, Cohen I, Thomson LE, Germano G, Berman DS, Hachamovitch, Rory, Kang, Xingping, Amanullah, Aman M, Abidov, Aiden, Hayes, Sean W, Friedman, John D, Cohen, Ishac, Thomson, Louise E J, Germano, Guido, and Berman, Daniel S more...
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- 2009
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4. Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men. Impact of diabetes mellitus on incremental prognostic value and effect on patient management.
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Berman DS, Kang X, Hayes SW, Friedman JD, Cohen I, Abidov A, Shaw LJ, Amanullah AM, Germano G, Hachamovitch R, Berman, Daniel S, Kang, Xingping, Hayes, Sean W, Friedman, John D, Cohen, Ishac, Abidov, Aiden, Shaw, Leslee J, Amanullah, Aman M, Germano, Guido, and Hachamovitch, Rory more...
- Abstract
Objectives: This study was designed to assess the incremental prognostic value of adenosine stress myocardial perfusion single-photon emission computed tomography (MPS) in women versus men, and to explore the prognostic impact of diabetes mellitus.Background: Limited data are available regarding the incremental value of adenosine stress MPS for the prediction of cardiac death in women versus men and the impact of diabetes mellitus on post-adenosine MPS outcomes. Of 6,173 consecutive patients who underwent rest thallium-201/adenosine technetium-99m sestamibi MPS, 254 (4.1%) were lost to follow-up, and 586 with early revascularization < or = 60 days after MPS were censored, leaving 2,656 women and 2,677 men.Results: Women had significantly smaller adenosine stress, rest, and reversible defects than men. During 27.0 +/- 8.8 month follow-up, cardiac death rates were lower in women than men (2.0%/year vs. 2.7%/year, respectively, p < 0.05). Before and after risk adjustment, cardiac death risk increased significantly in both men and women as a function of MPS results. Multivariable models revealed that MPS results provided incremental prognostic value over pre-scan data for the prediction of cardiac death in both genders. Also, while comparative unadjusted rates of early (< or =60 days post-test) coronary angiography (17% vs. 23%) and revascularization (8% vs. 12%) were significantly lower in women (p < 0.05), after adjusting for MPS, these rates were similar in men and women. Importantly, diabetic women had a significantly greater risk of cardiac death compared with other patients. Also, after risk adjustment, patients with insulin-dependent diabetes mellitus (IDDM) had higher risk of cardiac death for any MPS result than patients with non-insulin-dependent diabetes mellitus.Conclusion: The findings suggest that adenosine MPS has comparable incremental value for prediction of cardiac death in women and men and that MPS is appropriately influencing subsequent invasive management decisions in both genders. Diabetic women and patients with IDDM appear to have greater risk of cardiac death than other patients for any MPS result. [ABSTRACT FROM AUTHOR] more...- Published
- 2003
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5. Prognostic Value of Left Ventricular Global Strain Analysis by Two-Dimensional Speckle-Tracking Echocardiography in Non-Hemodynamically Significant Intermediate Coronary Lesions.
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Rubio M, Lo KB, Ram P, Rubio CS, Co M, Varadarajan P, Amanullah AM, Truong HT, Khouzam RN, and Abudayyeh I
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- Echocardiography, Humans, Predictive Value of Tests, Prognosis, Reproducibility of Results, Ventricular Function, Left, Fractional Flow Reserve, Myocardial
- Abstract
Intermediate coronary lesions represent a major challenge for the invasive and noninvasive cardiologist. Left ventricular strain calculation by speckle tracking echocardiography has the capacity to analyze the motion of the cardiac tissue. This study aimed to evaluate its usefulness and prognostic significance in nonhemodynamically significant intermediate coronary lesions. We studied 247 patients who underwent a clinically indicated coronary angiogram. Each of the patients had a single nonrevascularized nonhemodynamically significant intermediate severity coronary lesion (ISCL) with a fractional flow reserve greater than 0.80. The left ventricular global longitudinal strain (GLS) was calculated using speckle-tracking echocardiography with TomTec 2D Cardiac Performance Analysis (Unterschleissheim, Germany). An abnormal GLS was defined as less than -20%. The primary endpoints were revascularization of the target lesion, admissions for major adverse cardiac events (MACE), and cardiac-related mortality, all within 2 years. On multivariate logistic regression data analysis, we found that patients with an ISCL and abnormal GLS had an increased risk for admissions due to MACE (odds ratio [OR] 1.06, P < 0.05, confidence interval [CI] 95%, 1.005-1.120], and an increased risk of cardiac-related death (OR 1.12, P < 0.05, CI 95% 1.012-1.275). There was no difference in the need for target lesion revascularization among individuals with normal and abnormal GLS (1.00, P 0.88, CI 95% .950-1.061). Left ventricular strain analysis by speckle-tracking echocardiography showed an independent prognostic value in patients with nonrevascularized nonhemodynamically significant coronary lesions., (Copyright © 2021 Elsevier Inc. All rights reserved.) more...
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- 2021
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6. Transient Ischemic Dilation Ratio in Regadenoson, Single Isotope Gated Single-photon Emission Computed Tomography Myocardial Perfusion Imaging.
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Rubio M, Dias A, Koshkelashvili N, Codolosa JN, Jalife-Bucay M, Rodriguez-Ziccardi M, and Amanullah AM
- Abstract
Single isotope 99mTc single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) is the most commonly used protocol for nuclear stress testing. Transient ischemic dilation of the left ventricle (TID) has been considered a specific marker of severe coronary artery disease (CAD). Recent publications have questioned the clinical utility of TID, specifically with regadenoson as a stressor and 4DM-SPECT software for TID analysis. These findings have not been demonstrated using other imaging packages. The goal of our study was to establish the TID threshold in the identification of Multi-vessel CAD using Quantitative Perfusion SPECT (QPS) software. Included in this study are 190 patients that had undergone regadenoson-stress, same day, single-isotope 99mTc MPI and had a coronary angiography within a designated 3-month period. QPS (Cedars-Sinai, LA, CA) automated image analysis software was used to calculate TID ratios which were compared across different CAD categories. Coronary angiograms were reviewed to identify both obstructive and nonobstructive CAD. The mean TID for patients with nonobstructive CAD ( n = 91) was 1.02 ± 0.11, and the threshold for TID was 1.24. A receiver operating characteristic curve showed that TID had a poor discriminatory capacity to identify MVD (area under the curve 0.58) with a sensitivity of 3% and a specificity of 97%. In our study with regadenoson MPI in a predominantly African-American population, TID was found to be a poor predictor of MVD using QPS software. The reason is unclear but possibly related to the significant decline in the prevalence of severe CAD in the area where our study took place., Competing Interests: There are no conflicts of interest. more...
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- 2017
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7. Utility of Dobutamine Stress Echocardiography in Cardiac Risk Stratification of Patients Undergoing Orthotopic Liver Transplantation.
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Agrawal A, Jain D, Feyssa EL, and Amanullah AM
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Cardiovascular diseases are a major cause of morbidity and mortality in patients after orthotopic liver transplantation (OLT). This review includes major original articles published in the English-language literature of patients who underwent dobutamine stress echocardiography (DSE) before OLT for cardiac risk stratification. Of a total of 10 original articles (total 1699 patients undergoing DSE), 6 studies used DSE to predict major adverse cardiac events (MACE) in patients undergoing OLT and 4 reported the role of DSE in coronary artery disease (CAD) prediction in patients with end-stage liver disease. The composite incidence of MACE was 11.4%. In predicting postoperative MACE, DSE had a composite sensitivity of 0.12 (95% CI, 0.07-0.19), a specificity of 0.96 (95% CI, 0.94-0.97), a positive predictive value (PPV) of 0.26 (95% CI, 0.16-0.38), and a negative predictive value (NPV) of 0.89 (95% CI, 0.88-0.91). The presence of known CAD in a patient was shown to increase the risk of cardiac events after OLT significantly in three of six studies. The average prevalence of CAD was 14.4%. In predicting CAD, DSE had a composite sensitivity of 0.47 (95% CI, 0.32-0.62), specificity of 0.74 (95% CI, 0.68- 0.79), PPV of 0.23 (95% CI, 0.15-0.33), and NPV of 0.89 (95% CI, 0.84-0.93). This review emphasizes the need for standardizing cardiac risk stratification protocol to screen and prevent cardiac morbidity after OLT, standardizing MACE definition to allow more uniform reporting, and the need for safer and efficacious alternatives to DSE in the evaluation of OLT candidates. more...
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- 2017
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8. Newer modalities for imaging nonischemic cardiomyopathy.
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Gupta S and Amanullah AM
- Abstract
Cardiomyopathies are practically classified as either ischemic or nonischemic based on the presence or absence of coronary artery disease. Although conventional twodimensional echocardiography can assess left ventricular ejection fraction, wall motion, and diastolic function, it does not fully capture myocardial mechanics or tissue characterization, and does not accurately identify patients with nonischemic cardiomyopathy (NICMP) at risk for sudden cardiac death. This article discusses advanced imaging modalities for assessment of NICMP, namely, three-dimensional echocardiography, strain imaging, cardiac magnetic resonance, cardiac computed tomography, and sympathetic innervation imaging. more...
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- 2015
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9. Therapeutic potentials of phosphodiesterase-5 inhibitors in cardiovascular disease.
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Nguyen H and Amanullah AM
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- Animals, Cardiovascular Diseases enzymology, Humans, Signal Transduction drug effects, Treatment Outcome, Cardiovascular Agents therapeutic use, Cardiovascular Diseases drug therapy, Cyclic Nucleotide Phosphodiesterases, Type 5 metabolism, Phosphodiesterase 5 Inhibitors therapeutic use
- Abstract
Phosphodiesterase-5 (PDE5) inhibitors have been approved by the US Food and Drug Administration for the treatment of erectile dysfunction and more recently for pulmonary arterial hypertension (World Health Organization functional class I). PDE5 inhibitors can induce vasodilation; in addition, through a complex pathway involving nitric oxide, cyclic guanosine monophosphate, and protein kinase G, it can reduce apoptosis and suppress cell proliferation. The presence of PDE5 inhibitors in various tissues and systemic vasculature make them potential targets in a variety of cardiovascular diseases. In many in vitro and in vivo studies, PDE5 inhibitors have been shown to have positive effects in systolic and diastolic congestive heart failure, ischemic heart disease, doxorubicin cardiomyopathy, and pulmonary arterial hypertension. They also improved vasoconstriction in Raynaud phenomenon, peripheral artery disease, and hypoxic brain conditions. This article reviews the therapeutic potentials of PDE5 inhibitors in different cardiovascular diseases. more...
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- 2014
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10. Infiltrative diseases of the heart.
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Moinuddin MJ, Figueredo V, and Amanullah AM
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- Disease Progression, Humans, Predictive Value of Tests, Prevalence, Treatment Outcome, Amyloidosis diagnosis, Amyloidosis epidemiology, Amyloidosis therapy, Cardiomyopathies diagnosis, Cardiomyopathies epidemiology, Cardiomyopathies therapy, Hemochromatosis diagnosis, Hemochromatosis epidemiology, Hemochromatosis therapy, Sarcoidosis diagnosis, Sarcoidosis epidemiology, Sarcoidosis therapy
- Abstract
Infiltrative diseases targeting the cardiovascular system are a subgroup of restrictive cardiomyopathies. An early diagnosis is critical in initiating therapy to mitigate the deleterious effects of the pathologic process underlying these forms of cardiomyopathies. Infiltrative cardiac disease is rare and therefore often underdiagnosed. This review outlines the prevalence of 3 of the most common forms of restrictive cardiomyopathy: sarcoidosis, hemochromatosis, and amyloidosis. Infiltrative cardiomyopathy can have a variable prognosis depending on its etiology. It is a progressive disorder that, if left untreated, can lead to early mortality. A summary of the pathology, diagnosis, disease course, and therapy is provided, along with the utility of noninvasive testing as a means of diagnosis. more...
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- 2010
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11. Acute aortic syndromes: pathophysiology and management.
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Alli O, Jacobs L, and Amanullah AM
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- Acute Disease, Aortic Dissection diagnosis, Aortic Dissection physiopathology, Aortic Dissection therapy, Aortic Aneurysm diagnosis, Aortic Aneurysm physiopathology, Aortic Aneurysm therapy, Diagnosis, Differential, Electrocardiography, Fibrinolytic Agents therapeutic use, Humans, Hypertension complications, Myocardial Ischemia diagnosis, Substance-Related Disorders complications, Syndrome, Tunica Intima physiopathology, Vascular Surgical Procedures, Aortic Diseases diagnosis, Aortic Diseases etiology, Aortic Diseases physiopathology, Aortic Diseases therapy
- Abstract
The acute aortic syndromes carry significant morbidity and mortality, especially when detected late. Symptoms may mimic myocardial ischemia, and physical findings may be absent or, if present, can be suggestive of a diverse range of other conditions. Maintaining a high clinical index of suspicion is crucial in establishing the diagnosis. All patients with suspected aortic disease and evidence of acute ischemia on electrocardiogram should undergo diagnostic imaging studies before thrombolytics are administered. The demonstration of an intimal flap separating 2 lumina is the basis for diagnosis. Tear detection and localization are very important because any therapeutic intervention aims to occlude the entry tear. The goals of medical therapy are to reduce the force of left ventricular contractions, decrease the steepness of the rise of the aortic pulse wave, and reduce the systemic arterial pressure to as low a level as possible without compromising perfusion of vital organs. Surgical therapy still remains the gold standard of care for type A aortic dissection, whereas in type B dissection, percutaneous aortic stenting and fenestration techniques have been developed and are sometimes used in conjunction with medical therapy in certain situations. more...
- Published
- 2008
12. Acute myocardial infarction in a patient with systemic lupus erythematosus and normal coronary arteries.
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Nijjar PS, Mountis M, and Amanullah AM
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- Adult, Coronary Angiography, Diagnosis, Differential, Echocardiography, Transesophageal, Female, Follow-Up Studies, Humans, Lupus Erythematosus, Systemic diagnostic imaging, Myocardial Infarction diagnostic imaging, Severity of Illness Index, Tomography, X-Ray Computed, Lupus Erythematosus, Systemic complications, Myocardial Infarction complications
- Abstract
Although cardiac manifestations such as pericardial, myocardial, and valvular involvement are common in patients with systemic lupus erythematosus (SLE), coronary artery involvement is less frequent. Clinical manifestations of coronary artery disease in SLE can result from accelerated atherosclerosis, arteritis, abnormal coronary flow reserve, spasm, and thrombosis. In SLE, the classic valvular abnormality consists of noninfective, verrucous vegetation. Thickening of the leaflets due to inflammation followed by fibrosis is common, occurring in about 50% of patients, whereas vegetations are present in about 40%. Mitral valve involvement is most common, with valvular regurgitation more frequent than valvular stenosis. The tricuspid valve and the aortic valve may also be affected. Its frequency varies widely: 13% to 74% in the general population. We report a case of a woman with acute myocardial infarction and normal coronary arteries, who was subsequently diagnosed with Libman-Sacks endocarditis and SLE. more...
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- 2007
13. Evaluation of anomalous aortic origins of the coronaries by 64-slice cardiac computed tomography.
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Singh Nijjar P, Parameswaran A, and Amanullah AM
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- Coronary Vessel Anomalies diagnostic imaging, Coronary Vessel Anomalies pathology, Humans, Magnetic Resonance Angiography, Male, Middle Aged, Aorta abnormalities, Aortography instrumentation, Coronary Vessel Anomalies diagnosis, Tomography, X-Ray Computed instrumentation
- Abstract
Approximately 20% of coronary artery anomalies produce sudden death or life-threatening symptoms, including arrhythmias, syncope, and myocardial infarction. The most common clinical symptom of coronary artery anomaly is angina or exertional syncope. Physical examination is usually unrevealing in the absence of myocardial infarction or symptoms of ongoing ischemia. The rapid advent of cardiac computed tomography (CT) technology has made it an important adjunct to the diagnosis of coronary anomalies by angiography. The authors describe the case of a 54-year-old white man who presented with gangrenous toes. He had severe peripheral vascular disease, a femoral-popliteal bypass graft, residual hemiparesis from an ischemic stroke, hypertension, deep vein thrombosis, and a recent myocardial infarction. He underwent a 64-slice cardiac CT angiogram, which showed an interarterial course of the left main coronary artery between the aorta and the pulmonary trunk. more...
- Published
- 2007
14. Differentiating constrictive pericarditis from restrictive cardiomyopathy.
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Yazdani K, Maraj S, and Amanullah AM
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- Cardiomyopathy, Restrictive etiology, Cardiomyopathy, Restrictive physiopathology, Diagnosis, Differential, Diagnostic Imaging, Humans, Pericarditis, Constrictive etiology, Pericarditis, Constrictive physiopathology, Prognosis, Cardiomyopathy, Restrictive diagnosis, Cardiomyopathy, Restrictive therapy, Pericarditis, Constrictive diagnosis, Pericarditis, Constrictive therapy
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Constrictive pericarditis and restrictive cardiomyopathy are 2 forms of diastolic dysfunction with similar presentation but different treatment options. Whereas constrictive pericarditis has the potential of being cured with pericardiectomy, restrictive cardiomyopathy is usually incurable. It is therefore crucial to differentiate between the 2 disorders. In the last few years, new diagnostic techniques have become available to differentiate these causes of diastolic dysfunction from each other. This review provides a complete, in-depth comparison of the 2 disorders with regard to their symptoms and clinical features, etiology, pathophysiology, hemodynamics, echocardiographic presentation, and finally the different available management options. more...
- Published
- 2005
15. Usefulness of complex atherosclerotic plaque in the ascending aorta and arch for predicting cardiovascular events.
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Amanullah AM, Artel BJ, Grossman LB, Espioneza A, and Chaudhry FA
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- Aorta, Thoracic, Aortic Diseases pathology, Arteriosclerosis pathology, Female, Follow-Up Studies, Humans, Male, Predictive Value of Tests, Proportional Hazards Models, Prospective Studies, Risk Factors, Aortic Diseases diagnostic imaging, Arteriosclerosis diagnostic imaging, Cardiovascular Diseases pathology, Echocardiography, Transesophageal
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- 2002
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16. Risk stratification in patients with remote prior myocardial infarction using rest-stress myocardial perfusion SPECT: prognostic value and impact on referral to early catheterization.
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Zellweger MJ, Dubois EA, Lai S, Shaw LJ, Amanullah AM, Lewin HC, Friedman JD, Kang X, Germano G, and Berman DS
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- Adenosine, Aged, Aged, 80 and over, Exercise Test, Female, Follow-Up Studies, Health Care Costs, Heart diagnostic imaging, Humans, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction complications, Myocardial Ischemia etiology, Outcome Assessment, Health Care, Prognosis, Retrospective Studies, Risk Assessment, Risk Factors, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon economics, Myocardial Infarction diagnostic imaging, Myocardial Ischemia diagnostic imaging, Tomography, Emission-Computed, Single-Photon methods
- Abstract
Background: Little is known about the prognostic value of myocardial perfusion single photon emission computed tomography (SPECT) in patients with remote prior myocardial infarction (MI)., Methods and Results: We identified 1413 consecutive patients with remote prior MI who underwent rest-stress myocardial perfusion SPECT. Semiquantitative visual analysis of 20 SPECT segments was used to define the summed stress, rest, and difference scores. The number of non-reversible segments was used as an index of infarct size. During follow-up (>or=1 year), 118 hard events occurred: 64 cardiac deaths (CDs) and 54 recurrent MIs. Annual CD and hard event rates increased significantly as a function of SPECT abnormality. For summed stress scores less than 4, 4 to 8, 9 to 13, and more than 13, the annual CD rates were 0.4%, 0.9%, 1.7%, and 3.5%, respectively (P =.002). Patients with small MI (<4 non-reversible segments) and no or mild ischemia (summed difference score
or=4 non-reversible segments) had moderate to high annual CD rates (3.7%-6.6%) regardless of the extent of ischemia. Nuclear testing added incremental prognostic information to pre-scan information. Compared with a strategy in which all patients are referred to catheterization, a strategy that referred only those patients with a risk for CD of greater than 1% by myocardial perfusion SPECT resulted in a 41.6% cost savings., Conclusions: Myocardial perfusion SPECT adds incremental value to pre-scan information and is highly predictive and cost-efficient in the risk stratification of patients with remote prior MI. Patients with normal or mildly abnormal scan results or small MI in combination with absent or mild ischemia have a low risk for CD. more...- Published
- 2002
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17. Enhanced prognostic stratification of patients with left ventricular hypertrophy with the use of single-photon emission computed tomography.
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Amanullah AM, Berman DS, Kang X, Cohen I, Germano G, and Friedman JD
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- Aged, Female, Follow-Up Studies, Humans, Hypertrophy, Left Ventricular pathology, Male, Middle Aged, Predictive Value of Tests, Prognosis, Radiopharmaceuticals, Risk Assessment, Technetium Tc 99m Sestamibi, Thallium, Coronary Disease etiology, Hypertrophy, Left Ventricular diagnostic imaging, Tomography, Emission-Computed, Single-Photon
- Abstract
Background: Patients with left ventricular hypertrophy (LVH) are at increased risk of future cardiovascular events. Little is known about risk stratification of these patients with the use of myocardial perfusion imaging. This study sought to assess the prognostic stratification of patients with LVH by using myocardial perfusion single-photon emission computed tomography (SPECT)., Methods and Results: We studied 633 consecutive patients with electrocardiographic evidence of LVH who underwent dual isotope myocardial perfusion SPECT (rest thallium 201/stress technetium 99m sestamibi) and were followed up for a mean period of 22 +/- 7 months. During the follow-up period, 67 events (35 cardiac deaths and 32 nonfatal myocardial infarctions) occurred (6% annual event rate). The results of the perfusion scan significantly risk-stratified the population; patients with normal scans had a low rate of nonfatal myocardial infarction and cardiac death (<1% per year of follow-up). The rates of cardiac events increased significantly as a function of the scan result: 4.9% in patients with mildly abnormal scans and 10. 3% in moderately to severely abnormal scans. Cox proportional hazards analysis demonstrated that after adjusting for pretest likelihood of coronary artery disease (the most predictive clinical variable; chi(2) = 15.5, P <.001), summed stress score (the most predictive nuclear variable; chi(2) = 18, P <.0001) added significant incremental prognostic information (global chi(2) increased from 15.5 to 36; P <.001)., Conclusions: In patients with LVH with an overall high cardiac event rate, SPECT provided enhanced stratification by adding significant incremental prognostic information over clinical and historic variables. more...
- Published
- 2000
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18. Diagnostic and prognostic value of myocardial perfusion imaging in patients with known or suspected stable coronary artery disease.
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Amanullah AM
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- Adult, Aged, Coronary Disease diagnosis, Coronary Disease physiopathology, Dobutamine, Exercise Test methods, Female, Humans, Male, Middle Aged, Perfusion methods, Prognosis, Sensitivity and Specificity, Coronary Disease diagnostic imaging, Technetium Tc 99m Sestamibi, Thallium Radioisotopes, Tomography, Emission-Computed, Single-Photon methods
- Abstract
Coronary artery disease is the leading cause of complications and death in the United States and other Western countries, and stress myocardial perfusion study is an important component of the clinical evaluation, stratification, and management. This imaging technique is a well-established modality and has been widely used for the past three decades. New quantitative techniques for the assessment of ventricular function using quantitative gated single-photon emission computed tomography in addition to myocardial perfusion will potentially enhance the role of nuclear cardiology in the management of these patients. This review summarizes the current knowledge of the diagnostic and prognostic uses of stress myocardial perfusion imaging using exercise and pharmacological stress in patients with stable coronary artery disease. more...
- Published
- 2000
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19. Comparison of dobutamine echocardiography, dobutamine sestamibi, and rest-redistribution thallium-201 single-photon emission computed tomography for determining contractile reserve and myocardial ischemia in ischemic cardiomyopathy.
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Amanullah AM, Chaudhry FA, Heo J, Galatro K, Dourdoufis P, Brozena S, Narula J, and Iskandrian AE
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- Adult, Aged, Cohort Studies, Coronary Circulation physiology, Exercise Test, Female, Heart Transplantation physiology, Humans, Male, Middle Aged, Myocardial Ischemia physiopathology, Myocardial Ischemia surgery, Myocardial Revascularization, Prospective Studies, Technetium Tc 99m Sestamibi, Tissue Survival physiology, Cardiotonic Agents, Dobutamine, Echocardiography, Myocardial Contraction physiology, Myocardial Ischemia diagnosis, Thallium Radioisotopes, Tomography, Emission-Computed, Single-Photon
- Abstract
Both dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy are used to assess myocardial viability. Few studies have compared the data on myocardial viability and ischemia by low and peak dose DSE and myocardial perfusion imaging in the same patients. Fifty-four patients (45 men and 9 women aged 65 +/- 9 years) with ischemic cardiomyopathy (mean ejection fraction 24 +/- 9%) underwent rest 4-hour redistribution thallium-201 single-photon emission computed tomography (SPECT), low and peak dose DSE, and dobutamine sestamibi SPECT. A total of 864 segments were analyzed (16 segments/patient). Wall motion abnormality was present in 796 segments (92%), and contractile reserve during dobutamine infusion was seen in 400 of these segments (50%). Contractile reserve was seen in 331 of 509 hypokinetic segments (65%) and 69 of 287 akinetic/dyskinetic segments (24%) (p <0.001). Contractile reserve was more frequent in segments with normal thallium uptake (64%), reversible thallium defects (42%), or mild to moderate fixed thallium defects (48%) than severely fixed defects (22%) (p <0.05 each). Concordant information about viability by thallium imaging and DSE was obtained in 62% of segments. Dobutamine sestamibi ischemia was seen in 518 of 796 segments (65%) compared with 265 segments (33%) by DSE (p <0.001). Scintigraphic ischemia was noted in 126 of 195 segments (65%) demonstrating biphasic response, 129 of 205 segments (63%) showing sustained improvement, 42 of 70 segments (60%) deteriorating during dobutamine infusion, and 221 of 326 (68%) demonstrating no change (p = NS). Thus, in patients with ischemic cardiomyopathy, contractile reserve is more frequent in hypokinetic segments than akinetic/dyskinetic segments. The number of segments with normal or near-normal thallium uptake or with scintigraphic ischemia is significantly greater than the number of those capable of increasing contractile function or demonstrating an ischemic response during dobutamine echocardiography. more...
- Published
- 1999
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20. Clinical validation of intravascular ultrasound imaging for assessment of coronary stenosis severity: comparison with stress myocardial perfusion imaging.
- Author
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Nishioka T, Amanullah AM, Luo H, Berglund H, Kim CJ, Nagai T, Hakamata N, Katsushika S, Uehata A, Takase B, Isojima K, Berman DS, and Siegel RJ
- Subjects
- Aged, Coronary Angiography, Exercise Test, Female, Humans, Male, Perfusion, Reproducibility of Results, Sensitivity and Specificity, Severity of Illness Index, Coronary Disease diagnostic imaging, Tomography, Emission-Computed, Single-Photon methods, Ultrasonography, Interventional
- Abstract
Objectives: To validate intravascular ultrasound (IVUS) measurements for differentiating functionally significant from nonsignificant coronary stenosis., Background: To date, there are no validated criteria for the definition of a flow-limiting coronary artery stenosis by IVUS., Methods: Preinterventional IVUS imaging (30-MHz imaging catheter) of 70 de novo coronary lesions was performed. The lesion lumen area and three IVUS-derived stenosis indixes comparing lesion lumen area with the lesion external elastic lamina (EEL) area, the mean reference lumen area and the mean reference EEL area were compared with the results of stress myocardial perfusion imaging., Results: The lesion lumen area and three IVUS-derived stenosis indexes showed sensitivities and specificities ranging between 80% and 90% using stress myocardial perfusion imaging as the gold standard. The lesion lumen area < or =4 mm2 is a simple and highly accurate criterion for significant coronary narrowing., Conclusions: Quantitative IVUS indices can be reliably used for identifying significant epicardial coronary artery stenoses. more...
- Published
- 1999
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21. Comparative ability of myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in patients with and without diabetes mellitus.
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Kang X, Berman DS, Lewin H, Miranda R, Erel J, Friedman JD, and Amanullah AM
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- Aged, Coronary Disease complications, Coronary Disease epidemiology, Exercise Test, Female, Humans, Incidence, Male, Reproducibility of Results, Retrospective Studies, Sensitivity and Specificity, Coronary Disease diagnostic imaging, Diabetes Complications, Perfusion, Tomography, Emission-Computed, Single-Photon methods
- Abstract
Background: Diabetics generally have more frequent and extensive silent myocardial ischemia than nondiabetics, increasing the importance of noninvasive detection of coronary artery disease (CAD) in this cohort. However, little is known regarding the diagnostic accuracy of myocardial perfusion single-photon emission computed tomography (SPECT) in patients with diabetes. This study was undertaken to compare the diagnostic value of rest thallium-201/stress technetium-99m sestamibi dual-isotope myocardial perfusion SPECT in patients with and without diabetes., Methods: Of the 203 patients with diabetes and 260 patients without diabetes who underwent dual-isotope myocardial perfusion SPECT with exercise or pharmacologic stress testing, 138 diabetics (12% type 1 diabetics) and 188 nondiabetics had coronary angiography within 6 months of the nuclear test, and 65 diabetics and 72 nondiabetics had a low likelihood (<10%, mean 6% +/- 3% and 6% +/- 3%) of CAD., Results: The angiographic data showed that patients with diabetes had less incidence of 1-vessel disease and a higher incidence of 3-vessel/left main artery disease than patients without diabetes (P <.05). The overall sensitivity and specificity, respectively, of SPECT for detecting CAD with the criterion of >/=50% diameter stenosis were 86% (95 of 111) and 56% (15 of 27) in diabetics, 86% (122 of 142) and 46% (21 of 46) in nondiabetics (P = not significant). With the criterion of >/=70% diameter stenosis the corresponding results were 90% (86 of 96) and 50% (21 of 42) in diabetics, and 91% (108 of 119) and 43% (30 of 69) in nondiabetics, respectively (P = not significant). The normalcy rate for low likelihood patients was 89% (58 of 65) in diabetics and 90% (65 of 72) in nondiabetics (P = not significant). The sensitivity and specificity for individual vessel detection were also similar in patients with and without diabetes (P = not significant) except for a lower sensitivity and a higher specificity for detecting left anterior descending coronary artery disease in the diabetic group (P <.05)., Conclusion: Dual-isotope myocardial perfusion SPECT has comparable accuracy for the diagnosis of CAD in diabetic and nondiabetic patients. more...
- Published
- 1999
- Full Text
- View/download PDF
22. Predictors of outcome of medically treated patients with left main/three-vessel coronary artery disease by coronary angiography.
- Author
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Amanullah AM, Heo J, Acio E, Narula J, and Iskandrian AE
- Subjects
- Adenosine administration & dosage, Coronary Disease drug therapy, Electrocardiography, Exercise Test, Female, Follow-Up Studies, Humans, Injections, Intravenous, Male, Middle Aged, Observer Variation, Retrospective Studies, Thallium Radioisotopes administration & dosage, Treatment Outcome, Vasodilator Agents administration & dosage, Cardiovascular Agents therapeutic use, Coronary Angiography methods, Coronary Disease diagnostic imaging, Tomography, Emission-Computed, Single-Photon
- Abstract
This study examined the prognostic value of single-photon emission computed tomography in angiographically high-risk patients with left main and/or 3-vessel coronary artery disease who were treated medically. Multivariable Cox survival analysis revealed the single-photon emission computed tomography score (based on size of perfusion abnormality, multivessel abnormality, left ventricular dilation, and lung uptake) as the only independent predictor of outcome. more...
- Published
- 1999
- Full Text
- View/download PDF
23. Incremental prognostic value of adenosine myocardial perfusion single-photon emission computed tomography in women with suspected coronary artery disease.
- Author
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Amanullah AM, Berman DS, Erel J, Kiat H, Cohen I, Germano G, Friedman JD, and Hachamovitch R
- Subjects
- Aged, Coronary Disease mortality, Exercise Test, Female, Follow-Up Studies, Humans, Image Processing, Computer-Assisted, Infusions, Intravenous, Perfusion, Prognosis, Radiopharmaceuticals administration & dosage, Retrospective Studies, Severity of Illness Index, Survival Rate, Technetium Tc 99m Sestamibi administration & dosage, Adenosine administration & dosage, Coronary Disease diagnostic imaging, Tomography, Emission-Computed, Single-Photon, Vasodilator Agents administration & dosage
- Abstract
Adenosine myocardial perfusion single-photon emission computed tomography (SPECT) is now increasingly used for risk stratification of patients with known or suspected coronary artery disease. However, the incremental prognostic value of this test over clinical and historical information in a large series of women has not been examined. Thus, we studied 923 consecutive women who underwent adenosine technetium (Tc)-99m sestamibi myocardial perfusion SPECT and were followed-up for a mean period of 26+/-8 months. During the follow-up period, 77 hard events (46 cardiac deaths and 31 nonfatal myocardial infarctions) occurred. The results of the perfusion scan significantly risk stratified the population; patients with normal scans had a low rate of nonfatal myocardial infarction and cardiac death (< 1%/year of follow up). Patients with mildly abnormal scans had low cardiac death rates (0.9%/year of follow up); these rates increased as a function of scan abnormality (4.1% and 7.5% mortality per year of follow up in moderate and severely abnormal scans). Cox proportional hazards analysis demonstrated that after adjusting for prior myocardial infarction and diabetes mellitus (the most predictive individual clinical variables [global chi-square=22.5, p <0.001]), as well as heart rate at rest (the most predictive physiologic variable [chi-square=3.8; p=0.05]), the most predictive nuclear variable (summed stress score [chi-square=48.5; p <0.0001]) added significant incremental prognostic information (global chi-square increased from 22.5 to 56.2 [p <0.0001]). In conclusion, adenosine myocardial perfusion SPECT added significant incremental prognostic information to clinical and physiologic variables in women. Normal scans were associated with an excellent prognosis. In contrast, patients with moderately to severely abnormal scans were at a higher risk for future cardiac events. more...
- Published
- 1998
- Full Text
- View/download PDF
24. Impact of exercise single-photon emission computed tomographic imaging on appropriateness of coronary revascularization.
- Author
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Amanullah AM, Heo J, and Iskandrian AE
- Subjects
- Aged, Chi-Square Distribution, Coronary Angiography methods, Exercise Test, Female, Humans, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Thallium Radioisotopes, Coronary Disease diagnosis, Coronary Disease diagnostic imaging, Myocardial Revascularization standards, Tomography, Emission-Computed, Single-Photon
- Abstract
This study examined the predictors of early coronary revascularization in 816 patients with chest pain syndromes who had coronary artery disease by angiography and exercise single-photon emission computed tomography (SPECT) thallium imaging. Multivariate analysis of clinical, stress, nuclear, and catheterization variables revealed the presence of SPECT reversibility as the most powerful predictor (chi-square = 43) of early revascularization. more...
- Published
- 1998
- Full Text
- View/download PDF
25. Clinical validation of automatic quantitative defect size in rest technetium-99m-sestamibi myocardial perfusion SPECT.
- Author
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Kang X, Berman DS, Van Train KF, Amanullah AM, Areeda J, Friedman JD, Kiat H, and Germano G
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Myocardial Infarction physiopathology, Rest, Stroke Volume, Ventriculography, First-Pass, Coronary Circulation, Myocardial Infarction diagnostic imaging, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon
- Abstract
Unlabelled: We examined the relationships of automatic quantitative perfusion defect size and defect severity to rest left ventricular ejection fraction and semiquantitative visual sestamibi defect size in rest 99mTc-sestamibi SPECT in 40 consecutive patients with a history of myocardial infarction more than 30 days prior to testing. The purpose of this investigation was to validate the use of automatic quantitative rest sestamibi SPECT as a clinical measure of assessing relative infarction size., Methods: All patients received 20-30 mCi of 99mTc-sestamibi followed by SPECT imaging. Quantitative defect analysis used previously developed resting normal limits and an automatic version of a commercially available quantitative program (CEqual). Semiquantitative visual defect interpretation used a 20 segment/scan and five-point scoring analysis. First-pass (FP) radionuclide ventriculography (RVG) and gated sestamibi perfusion SPECT were each performed in 31 patients., Results: LVEF assessed by FP RVG was 37% +/- 15% (range 14%-62%) and 37% +/- 16% (range 12%-63%) by gated perfusion SPECT with high linear correlation (r = 0.96, n = 22) between the two methods. Myocardial perfusion defect size was 24% +/- 15% of LV (range 0%-50%) and defect severity was 1103 +/- 864 (range 0 to 2825) by automatic quantitative rest sestamibi. Perfusion defect size and defect severity both had close correlations with LVEF by FP RVG (r = -0.78, r = -0.86) and by gated perfusion SPECT (r = -0.75, r = -0.79). High linear correlations were observed between quantitative defect size and summed visual score of segments with score > or = 2 (r = 0.82) and the number of visually abnormal segments (r = 0.77), as well as between defect severity and visual summed rest score (r = 0.86) and the number of visually abnormal segments (r = 0.76)., Conclusion: Quantitation of rest sestamibi SPECT defect extent and severity using automatic CEqual correlates well with rest LVEF and with semiquantitative expert visual analysis. Results of this study define a strong relationship between measurements of 99mTc-sestamibi perfusion defect as measured by an automatic software program and global left ventricular function. The automatic quantitative program appears to be a useful measure of assessing infarct size in patients with remote myocardial infarction. more...
- Published
- 1997
26. Identification of severe or extensive coronary artery disease in women by adenosine technetium-99m sestamibi SPECT.
- Author
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Amanullah AM, Berman DS, Hachamovitch R, Kiat H, Kang X, and Friedman JD
- Subjects
- Analysis of Variance, Cardiac Catheterization, Coronary Angiography economics, Costs and Cost Analysis, Female, Humans, Logistic Models, Risk Factors, Sensitivity and Specificity, Technetium Tc 99m Sestamibi, Adenosine, Coronary Disease diagnostic imaging, Tomography, Emission-Computed, Single-Photon economics
- Abstract
To assess the ability of adenosine technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) to identify high-risk women with severe or extensive coronary artery disease (CAD), we studied 130 consecutive women who underwent adenosine sestamibi myocardial perfusion SPECT and catheterization within 2 months. Severe (> or = 50% stenosis of left main coronary artery, > or = 90% stenosis in the proximal left anterior descending or in > or = 2 coronary arteries) or extensive (> or = 70% stenosis in 3 vessels) CAD was present in 54 patients, whereas 76 had no CAD or mild to moderate CAD. Semiquantitative visual SPECT analysis used 20 segments and a 5-point scoring system (0 = normal, 4 = absent uptake). Among the clinical, hemodynamic and nuclear variables analyzed, univariate predictors of severe or extensive CAD included a higher prescan likelihood of CAD, history of myocardial infarction, a higher heart rate at rest, a lower increase in heart rate during adenosine infusion, a higher summed stress score, summed reversibility score, and multivessel scan abnormality. Multivariate logistic analysis of the most predictive clinical (prescan likelihood of CAD), hemodynamic (increase in heart rate during adenosine infusion), and scan variables (summed stress score) revealed summed stress score (chi-square = 32; p <0.0001) and prescan likelihood of CAD (chi-square = 6.4; p <0.05) as the only independent predictors of severe or extensive CAD. Based on these logistic models, we determined the probability for the presence of severe or extensive CAD in patients with low, intermediate, and high prescan likelihood of CAD across the range of values of a summed stress score. This revealed that there were incremental increases in the probability for severe or extensive CAD both as a function of prescan likelihood of CAD and summed stress score. A severely abnormal scan (summed stress score > 8) during adenosine technetium-99m sestamibi myocardial perfusion SPECT had a high sensitivity of 91% and a moderately high specificity of 70% for identifying high-risk women with severe or extensive CAD. These results coupled with the previously defined prognostic significance of these findings suggest this test to be a useful diagnostic tool for the evaluation of CAD in women. more...
- Published
- 1997
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27. Usefulness of hemodynamic changes during adenosine infusion in predicting the diagnostic accuracy of adenosine technetium-99m sestamibi single-photon emission computed tomography (SPECT).
- Author
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Amanullah AM, Berman DS, Kiat H, and Friedman JD
- Subjects
- Aged, Coronary Disease physiopathology, Humans, Predictive Value of Tests, Adenosine, Coronary Disease diagnostic imaging, Hemodynamics drug effects, Radiopharmaceuticals, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon, Vasodilator Agents pharmacology
- Abstract
Whether adenosine myocardial perfusion single-photon emission computed tomography (SPECT) remains accurate for detecting coronary artery disease (CAD) in the absence of peripheral hemodynamic changes is unknown. To assess the hemodynamic correlates of perfusion defects, we studied 222 consecutive patients (age 71 +/- 11 years) without prior myocardial infarction or revascularization who underwent adenosine technetium (Tc)-99m sestamibi myocardial perfusion SPECT and cardiac catheterization within 6 months of adenosine study. The SPECT protocol used separate acquisition of rest thallium-201 and adenosine Tc-99m sestamibi, which was semiquantitatively analyzed in 20 segments with a visual 5-point scoring system (0 = normal, 4 = absent uptake). The overall sensitivity, specificity, and predictive accuracy of adenosine Tc-99m sestamibi SPECT for detecting significant CAD were 93% (159 of 171), 73% (37 of 51), and 88% (196 of 222), respectively. The study population was grouped into 6 categories as a function of peripheral hemodynamic changes: (1) increase in heart rate by < or = 10 beats/min (n = 135); (2) increase in heart rate by > 10 beats/min (n = 87); (3) decrease in systolic blood pressure by < or = 10 mm Hg (n = 108); (4) decrease in systolic blood pressure by > 10 mm Hg (n = 114); (5) increase in heart rate by < or = 10 beats/min and decrease in systolic blood pressure by < or = 10 mm Hg (n = 72); and (6) increase in heart rate by > 10 beats/min or decrease in systolic blood pressure by > 10 mm Hg (n = 150). The sensitivity, specificity, and predictive accuracy of adenosine sestamibi SPECT were similar in all 6 categories. The prevalence of left main or multivessel CAD and extent of scan abnormality were also similar among all groups. Thus, the diagnostic accuracy of adenosine Tc-99m sestamibi SPECT is high in patients with or without peripheral hemodynamic evidence of adenosine effect. more...
- Published
- 1997
- Full Text
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28. Impact of myocardial perfusion single-photon emission computed tomography on referral to catheterization of the very elderly. Is there evidence of gender-related referral bias?
- Author
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Amanullah AM, Kiat H, Hachamovitch R, Cabico JA, Cohen I, Friedman JD, and Berman DS
- Subjects
- Age Factors, Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary, Coronary Angiography, Coronary Artery Bypass, Coronary Disease diagnosis, Coronary Disease diagnostic imaging, Electrocardiography, Exercise Test, Female, Humans, Male, Multivariate Analysis, Cardiac Catheterization, Coronary Circulation, Coronary Disease therapy, Referral and Consultation, Sex Factors, Tomography, Emission-Computed, Single-Photon
- Abstract
Objectives: This study sought to assess the impact of myocardial perfusion studies on subsequent management in the very elderly with respect to referral to catheterization or revascularization., Background: The very elderly are a rapidly growing segment of the U.S. population, and myocardial perfusion studies are frequently performed in this patient subset for evaluation of coronary artery disease., Methods: The study utilized 1,006 consecutive patients > or = 80 years old (511 men, 495 women) who underwent stress myocardial perfusion single-photon emission computed tomography (SPECT) using pharmacologic stress (n = 605) or treadmill exercise (n = 401). Referral to catheterization or revascularization within 60 days of the nuclear scan was correlated with clinical and nuclear variables., Results: Catheterization and revascularization were performed in 119 and 77 patients, respectively. Stratification of referral rates showed a low rate in normal and mildly abnormal scan categories and significantly higher rates in patients with severely abnormal scan results irrespective of the presenting symptoms or pretest likelihood of coronary artery disease. Multiple logistic regression analysis of clinical and nuclear variables revealed that extent and severity of reversibility by SPECT and the final scan result were the two most powerful predictors of referral to catheterization and revascularization in men and women (catheterization: chi-square 65 and 78; revascularization: chi-square 37 and 68, respectively). Overall, referral rates to catheterization and revascularization were similar in men and women (catheterization: 13% vs. 11%; revascularization: 8% vs. 8%, respectively). However, women with severely abnormal scan results were more frequently referred to catheterization (28% vs. 18%, p < 0.03) and revascularization (21% vs. 12%, p < 0.01) than men., Conclusions: In patients > or = 80 years old, myocardial perfusion SPECT had a significant impact on patient management. The apparent discrepancy in referral rates for interventional management in men and women is unexplained but may be appropriate in light of our previous observations that women with severely abnormal scan results are at increased risk for hard cardiac events than are men with severely abnormal scan results. more...
- Published
- 1996
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29. Adenosine technetium-99m sestamibi myocardial perfusion SPECT in women: diagnostic efficacy in detection of coronary artery disease.
- Author
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Amanullah AM, Kiat H, Friedman JD, and Berman DS
- Subjects
- Aged, Aged, 80 and over, Coronary Disease etiology, Coronary Disease physiopathology, Female, Hemodynamics drug effects, Humans, Hypertension complications, Hypertrophy, Left Ventricular complications, Likelihood Functions, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Tomography, Emission-Computed, Single-Photon, Adenosine adverse effects, Coronary Disease diagnostic imaging, Heart diagnostic imaging, Technetium Tc 99m Sestamibi, Vasodilator Agents adverse effects
- Abstract
Objectives: This study sought to assess the diagnostic efficacy of adenosine technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) in a consecutive series of female patients., Background: The utility of adenosine myocardial perfusion SPECT for the detection of coronary artery disease is not well defined in women because most studies have described a predominantly male population with a high prevalence of coronary artery disease., Methods: Of the 201 consecutive female patients in the study group who had undergone adenosine Tc-99m sestamibi myocardial perfusion SPECT, 130 had coronary angiography within 2 months of the nuclear test, and the other 71 had a low likelihood (<10%, mean [+/-SD] 5 +/- 3%) of coronary artery disease. The SPECT protocol used separate acquisition of rest thallium-201 and adenosine Tc-99m sestamibi and was visually analyzed in 20 segments with a semiquantitative five-point scoring system (0=normal; 4=absent uptake)., Results: The normalcy rate in patients with a low likelihood of coronary artery disease was 93% (66 of 71). Among the catheterized group, the overall sensitivity, specificity and predictive accuracy of adenosine sestamibi SPECT for detecting coronary artery disease (> or = to 50% diameter stenosis) were 93% (87 of 94), 78% (28 of 36) and 88% (115 of 130), respectively. In the 103 patients without a prior myocardial infarction, the sensitivity, specificity and predictive accuracy were 91% (61 of 67), 78% (28 of 36) and 86% (89 of 103), respectively, for detecting > or = to 50% diameter stenosis. Of particular interest, the sensitivity and specificity were as high in patients with nonanginal symptoms (93% and 69%, respectively) as in patients with angina (92% and 83%, respectively, p=NS). The sensitivity and specificity among patients with a relatively low (<25%), intermediate (between 25% and 75%) or high prescan likelihood of coronary artery disease (>75%) were similar: 82% and 82%, 93% and 73%, and 95% and 100%, respectively. The sensitivity and specificity for detecting individual diseased vessels (> or = to 50% diameter stenosis) were, respectively, 76% and 81% for the left anterior descending coronary artery, 44% and 90% for the left circumflex coronary artery and 75% and 77% for the right coronary artery., Conclusions: Adenosine Tc-99m sestamibi SPECT is an efficient protocol with high sensitivity and specificity for the detection of coronary artery disease in women irrespective of presenting symptoms or pretest likelihood of coronary artery disease and a high normalcy rate. These findings are of particular clinical relevance because chest pain, anginal or otherwise, has been shown to be a frequent but a less specific marker for coronary artery disease among female patients. more...
- Published
- 1996
- Full Text
- View/download PDF
30. Diagnostic efficacy of stress technetium 99m-labeled sestamibi myocardial perfusion single-photon emission computed tomography in detection of coronary artery disease among patients over age 80.
- Author
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Wang FP, Amanullah AM, Kiat H, Friedman JD, and Berman DS
- Subjects
- Aged, Aged, 80 and over, Exercise Test, Humans, Sensitivity and Specificity, Coronary Disease diagnostic imaging, Heart diagnostic imaging, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon adverse effects
- Abstract
Background: Because symptoms of myocardial ischemia in elderly patients are often atypical, accurate noninvasive assessment of the presence, extent, and severity of coronary artery disease (CAD) would be especially useful to avoid unnecessary catheterization or invasive intervention. This study assessed the safety and diagnostic efficacy of 99mTc-labeled sestamibi (99mTc-sestamibi) exercise and pharmacologic myocardial perfusion single-photon emission computed tomography (SPECT) with adenosine or dipyridamole in patients age 80 years or older., Methods and Results: Stress 99mTc-sestamibi SPECT was performed in 75 consecutive patients who were 80 years old or older (range: 80 to 91 years) with suspected CAD and who underwent coronary angiography within 6 months of the nuclear study. Of these patients, 51 underwent a pharmacologic (adenosine = 42; dipyridamole = 9) stress study and 24 underwent an exercise treadmill study. A normalcy rate was derived from an additional 36 patients (ages 83 +/- 3 years) who had undergone stress 99mTc-sestamibi SPECT and who had a relatively low likelihood (< 20%) of CAD. No serious adverse events occurred during or after the exercise or the pharmacologic stress test. The overall sensitivity and specificity for detecting CAD with > or = 70% stenosis was 95% (52/55) and 75% (15/20), whereas the corresponding results were 87% (55/63) and 83% (10/12) for detecting patients with > or = 50% stenosis. The sensitivity and specificity for pharmacologic stress 99mTc-sestamibi SPECT were 95% (35/37) and 71% (10/14) for detecting > or = 70% stenosis, and 86% (37/43) and 75% (6/8) for detecting CAD with > or = 50% stenosis. The sensitivity and specificity of treadmill testing were 94% (17/18) and 83% (5/6) in detecting CAD with stenosis > or = 70% and 90% (18/20) and 100% (4/4) in detecting CAD with stenosis > or = 50%. The normalcy rate among the low likelihood patients was 83% (30/36). The accuracy of stress sestamibi testing was similar for patients with or without angina., Conclusions: Our findings suggest that exercise or pharmacologic myocardial perfusion SPECT with 99mTc-sestamibi is safe and diagnostically accurate for CAD detection in very elderly patients, irrespective of symptoms. Pharmacologic myocardial perfusion SPECT with adenosine or dipyridamole appears to be a valuable alternative to treadmill stress in very elderly patients incapable of performing adequate exercise. more...
- Published
- 1995
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31. Significance of ST segment depression during adenosine-induced coronary hyperemia in angina pectoris and correlation with angiographic, scintigraphic, hemodynamic, and echocardiographic variables.
- Author
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Amanullah AM and Aasa M
- Subjects
- Aged, Angina Pectoris physiopathology, Blood Pressure drug effects, Depression, Chemical, Female, Humans, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Regression Analysis, Reproducibility of Results, Sensitivity and Specificity, Adenosine pharmacology, Angina Pectoris diagnosis, Coronary Angiography, Coronary Circulation drug effects, Echocardiography, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon, Vasodilation drug effects
- Abstract
Factors determining myocardial ischemia during adenosine-induced coronary vasodilation in patients with angina pectoris are not well defined. To evaluate the angiographic, scintigraphic, hemodynamic, and echocardiographic determinants of ST segment depression during adenosine infusion, 40 patients with angina pectoris underwent technetium-99m sestamibi single photon emission computed tomography and simultaneous two-dimensional echocardiography. Ischemic ST depression occurred in 18 patients (45%). Coronary angiography was performed in all patients and a coronary artery jeopardy score was determined. The sensitivity, specificity, and the predictive accuracy of adenosine-induced ST segment depression in detecting significant coronary artery disease were 53%, 100%, and 60%, respectively, while the corresponding results for detecting reversible perfusion defects were 61%, 92%, and 70%, respectively. Univariate predictors of ST segment depression included the coronary artery jeopardy score, the presence and the extent of reversible perfusion defects, the presence of three-vessel and/or left main coronary artery disease, and diastolic blood pressure at peak adenosine infusion. There was a trend (P = 0.06) to a higher incidence of collateral vessels in patients developing ST segment depression. The coronary artery jeopardy score was found to be the only significant independent predictor of ST segment depression by stepwise multivariate logistic regression analysis. Thus, in patients with angina pectoris, the coronary artery jeopardy score, representing the extent of significant coronary artery disease, is the most important independent predictor of adenosine-induced ST segment depression. ST depression is unusual in the absence of reversible perfusion defects and is also associated with more extensive reversible defects. more...
- Published
- 1995
- Full Text
- View/download PDF
32. Noninvasive testing in the diagnosis and management of unstable angina.
- Author
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Amanullah AM
- Subjects
- Angina, Unstable physiopathology, Angina, Unstable therapy, Electrocardiography, Ambulatory, Humans, Angina, Unstable diagnosis, Coronary Angiography, Echocardiography, Exercise Test, Technetium Tc 99m Sestamibi, Thallium Radioisotopes, Tomography, Emission-Computed
- Abstract
Patients presenting with a clinical diagnosis of unstable angina comprise a heterogenous population and a wide spectrum of patients with varying degrees of underlying coronary artery disease, severity and prognosis are categorized in this syndrome. A very small number of patients with unstable angina who are refractory to adequate in-hospital medical therapy should undergo urgent coronary angiography and, if suitable, revascularization. The vast majority of patients do, however, stabilize on medical therapy and an invasive approach, such as a coronary angiography should not be performed routinely to all of these patients. Early recognition of clinical and non-invasive test variables indicating an adverse outcome is of paramount importance in unstable angina. This review focuses on the importance of baseline clinical markers and the usefulness of a non-invasive approach with exercise testing, myocardial perfusion imaging, stress echocardiography, and Holter monitoring in the diagnosis, risk stratification, and management of patients with unstable angina. more...
- Published
- 1994
- Full Text
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33. Assessment of left ventricular wall motion in angina pectoris by two-dimensional echocardiography and myocardial perfusion by technetium-99m sestamibi tomography during adenosine-induced coronary vasodilation and comparison with coronary angiography.
- Author
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Amanullah AM, Bevegård S, Lindvall K, and Aasa M
- Subjects
- Adult, Aged, Aged, 80 and over, Angina Pectoris etiology, Coronary Angiography, Coronary Disease complications, Coronary Disease physiopathology, Coronary Vessels drug effects, Exercise Test, Female, Hemodynamics, Humans, Male, Middle Aged, Myocardial Ischemia diagnostic imaging, Technetium Tc 99m Sestamibi, Vasodilation drug effects, Ventricular Function, Left, Adenosine adverse effects, Angina Pectoris physiopathology, Coronary Disease diagnosis, Echocardiography, Myocardial Contraction, Tomography, Emission-Computed, Single-Photon
- Abstract
Myocardial perfusion and regional wall motion during adenosine-induced coronary vasodilation were assessed in 40 patients with angina pectoris by technetium-99m sestamibi single-photon emission computed tomography (SPECT) and simultaneous 2-dimensional echocardiography. Adenosine was infused intravenously at a dose of 140 micrograms/kg body weight per minute for 6 minutes, and technetium-99m sestamibi was injected at 3 minutes. Adenosine caused a significant decrease in systolic and diastolic blood pressure and a significant increase in heart rate and the heart rate-blood pressure product. Adverse effects were mild and transient and no patient required aminophylline. Completely or partially reversible defects on SPECT were present in 28 patients, a fixed defect was seen in 4 patients, and no defect was seen in 8 patients. Two-dimensional echocardiography revealed a new or worsening wall motion abnormality in 21 patients, a fixed abnormality in 4 patients and no abnormality in 15. Transient perfusion defects were associated with transient wall motion abnormalities in 71% of cases. The overall sensitivity, specificity and predictive accuracy of adenosine echocardiography in detecting significant coronary artery disease (> 50% diameter stenosis) were 74, 100 and 78%, respectively, whereas those of adenosine SPECT were 94, 100 and 95%, respectively (p < 0.05, NS, and < 0.05, respectively). Thus adenosine technetium-99m sestamibi SPECT has a higher sensitivity and predictive accuracy than adenosine echocardiography, suggesting that adenosine-induced perfusion defects are not always associated with wall motion abnormality.(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1993
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34. Prevalence and significance of transient--predominantly asymptomatic--myocardial ischemia on Holter monitoring in unstable angina pectoris, and correlation with exercise test and thallium-201 myocardial perfusion imaging.
- Author
-
Amanullah AM and Lindvall K
- Subjects
- Actuarial Analysis, Aged, Angina, Unstable diagnosis, Chi-Square Distribution, Coronary Angiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Ischemia diagnosis, Prevalence, Prospective Studies, Tomography, Emission-Computed, Single-Photon methods, Angina, Unstable epidemiology, Electrocardiography, Ambulatory instrumentation, Electrocardiography, Ambulatory methods, Electrocardiography, Ambulatory statistics & numerical data, Exercise Test methods, Exercise Test statistics & numerical data, Heart diagnostic imaging, Myocardial Ischemia epidemiology, Thallium Radioisotopes
- Abstract
The prevalence and clinical significance of transient myocardial ischemia was evaluated prospectively in 43 patients with a clinical diagnosis of unstable angina. Continuous 2-channel Holter electrocardiographic monitoring was begun < 24 hours after admission. In 3,558 hours of recordings (mean 83 +/- 20 hours/patient), there were 1,671 episodes of transient ischemia; > 90% were asymptomatic. All patients but 1 had at least 1 episode of transient ischemia. Twenty-two patients (group 1) had a total ischemic duration of > or = 30 minutes/day, whereas 21 patients (group 2) had a total ischemic duration of < 30 minutes/day. A predischarge symptom-limited exercise test was performed in 40 of these patients after medical stabilization and 39 patients underwent exercise thallium-201 imaging, an average of 3 days after the exercise test. During a follow-up period of 39.9 +/- 9 months (range 28 to 49), 4 patients developed myocardial infarction and 22 required revascularization because of medically refractory angina. There were significantly more patients with total cardiac events (myocardial infarction or a need for revascularization) in group 1 than in group 2 (p < 0.05). Among patients undergoing an exercise test and exercise thallium-201 imaging, a positive exercise electrocardiogram and the presence of a reversible thallium-201 perfusion defect were also significant predictors of subsequent cardiac events (p < 0.05 and p < 0.001, respectively). The results of the Holter recordings did not add significantly more prognostic information.(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1993
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35. Prognostic significance of exercise thallium-201 myocardial perfusion imaging compared to stress echocardiography and clinical variables in patients with unstable angina who respond to medical treatment.
- Author
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Amanullah AM, Lindvall K, and Bevegård S
- Subjects
- Aged, Angina, Unstable physiopathology, Coronary Angiography, Coronary Artery Bypass, Coronary Circulation physiology, Electrocardiography drug effects, Female, Humans, Male, Middle Aged, Myocardial Infarction physiopathology, Prognosis, Prospective Studies, Treatment Outcome, Angina, Unstable drug therapy, Cardiovascular Agents therapeutic use, Coronary Circulation drug effects, Echocardiography drug effects, Exercise Test drug effects, Thallium Radioisotopes
- Abstract
The prognostic value of thallium-201 imaging in patients with unstable angina is not well established. Forty consecutive patients with unstable angina who had responded to medical therapy underwent predischarge symptom-limited exercise testing and 39 of them underwent exercise thallium-201 imaging, on average 3 days after the exercise test. Exercise echocardiography was performed in 36 of these patients in conjunction with the predischarge exercise test. Patients with previous myocardial infarction, coronary revascularization, left bundle branch block and dilated cardiomyopathy were not included in the study. An echocardiographic wall-motion score index was derived by analyzing left ventricular regional wall motion. During a follow-up period of 30 +/- 6.4 months, 3 patients had a non-fatal myocardial infarction and 20 required revascularization because of a recurrence of severe medically refractory angina. Univariate predictors of cardiac events (non-fatal myocardial infarction or a need for revascularization) during follow-up included ST-depression during exercise, positive exercise echocardiography, a low exercise wall-motion score index, the presence of thallium-201 redistribution and the number of myocardial segments with thallium-201 redistribution. However, stepwise logistic regression analysis revealed that the presence of thallium-201 redistribution was the only significant non-invasive predictor (P < 0.005) of a cardiac event among patients who underwent predischarge exercise testing and exercise thallium-201 imaging. Among patients undergoing exercise echocardiography and exercise thallium-201 imaging, the number of segments with thallium-201 redistribution was the only significant predictor (P < 0.0005) of future cardiac events.(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1993
- Full Text
- View/download PDF
36. Exercise echocardiography after stabilization of unstable angina: correlation with exercise thallium-201 single photon emission computed tomography.
- Author
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Amanullah AM, Lindvall K, and Bevegård S
- Subjects
- Angina, Unstable drug therapy, Angina, Unstable physiopathology, Cardiovascular Agents therapeutic use, Female, Humans, Male, Middle Aged, Patient Discharge, Thallium Radioisotopes, Angina, Unstable diagnosis, Echocardiography drug effects, Exercise Test drug effects, Tomography, Emission-Computed, Single-Photon
- Abstract
The diagnostic usefulness of predischarge exercise echocardiography in 35 patients with unstable angina who responded to medical therapy was correlated with exercise thallium-201 single photon emission computed tomography (TI-SPECT) performed, on the average, three days after the exercise echocardiography. None of the patients had myocardial infarction prior to hospitalization or before TI-SPECT and none had left bundle-branch block on their rest electrocardiogram (ECG). Exercise echocardiography was positive in 21 patients and TI-SPECT in 24. The results of the two techniques were concordant in 28 of 35 patients (agreement = 80%, k = 0.57 +/- 0.14, p less than 0.001). Wall-by-wall comparison of the distribution of exercise-induced wall motion abnormalities with reversible thallium defects showed complete or partial correlation in all of 19 patients in whom both the tests were positive. A positive exercise ECG and positive exercise echocardiography identified 11 of 11 patients with angiographically verified significant coronary artery disease (CAD) and 11 of 12 patients (92%) with positive TI-SPECT. Thus, exercise echocardiography is a valuable addition to routine predischarge exercise test in the noninvasive diagnosis of myocardial ischemia and shows a good correlation with TI-SPECT in detecting and localizing ischemia in patients with unstable angina stabilized on medical therapy. more...
- Published
- 1992
- Full Text
- View/download PDF
37. Predischarge exercise echocardiography in patients with unstable angina who respond to medical treatment.
- Author
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Amanullah AM and Lindvall K
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Adult, Aged, Angina, Unstable diagnostic imaging, Aspirin therapeutic use, Calcium Channel Blockers therapeutic use, Female, Follow-Up Studies, Humans, Male, Middle Aged, Myocardial Contraction drug effects, Myocardial Infarction diagnostic imaging, Nitrates therapeutic use, Patient Discharge, Angina, Unstable drug therapy, Cardiovascular Agents therapeutic use, Echocardiography drug effects, Exercise Test drug effects, Hemodynamics drug effects
- Abstract
The diagnostic and prognostic value of predischarge exercise echocardiography (echo) was assessed prospectively in 36 patients with unstable angina soon after stabilization on medical treatment. Two-dimensional echo was performed at rest and immediately after a symptom-limited exercise test. Patients with previous myocardial infarction, coronary revascularization, left bundle-branch block and dilated cardiomyopathy were excluded. Left ventricular regional wall motion was analyzed visually and a wall motion score index (WMSI) was derived. Patients were followed prospectively for an average period of 26 months (range 16-34 months). The study end points were a new cardiac event defined as acute myocardial infarction or a need for coronary revascularization because of a recurrence of severe medically refractory angina. Sixteen patients (44%) had positive exercise electrocardiography (ECG), while exercise echo was positive in 22 patients (61%). Of 28 patients undergoing coronary angiography, 23 had significant coronary artery disease (CAD). The sensitivity of exercise ECG in detecting CAD was 61% while the corresponding result was 83% for exercise echo. Cardiac events occurred in 21 patients (58%). Exercise ECG was positive in 12 of these patients (57%), while a positive exercise echo was found in 17 patients (81%). There were significantly more patients with positive exercise echo among patients experiencing cardiac events than among those without cardiac events (p less than 0.01). In patients with CAD, WMSI decreased significantly after exercise (p less than 0.05). Exercise WMSI was also significantly lower in patients with CAD than in those without CAD (p less than 0.02). Exercise WMSI also discriminated patients with cardiac events from those without such events (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) more...
- Published
- 1992
- Full Text
- View/download PDF
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