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The dramatic decrease in mortality rates from coronary artery disease does not appear to be a result of a decline in the incidence of the disease. This was demonstrated by examining coronary angiograms in people planning surgery for heart valve disease between 1980 and 1989. None had any symptoms of coronary artery disease. The percentage of people with angiographically-confirmed atherosclerosis remained approximately the same throughout the time period. However, mortality rates from coronary artery disease dropped 23% during the same period.

Background: Gated single photon emission CT (SPECT) sestamibi imaging allows the simultaneous assessment of myocardial perfusion and left ventricular function. Objective: The purpose of this study was to evaluate a technique for quantitative regional wall motion assessment using gated SPECT 99mTc-sestamibi imaging. Patients and interventions: Fourteen subjects without cardiac pathology and 25 patients who had experienced myocardial infarction (MI) were studied. After tomographic reconstruction of gated short-axis slices, the identification of endocardial borders was made using a standard edge-detection program in systole and diastole in each of five selected slices. Regional ejection fraction (EF) and myocardial perfusion were determined for five regions within each slice. Ten patients underwent echocardiographic regional wall-motion analysis, the results of which were compared to corresponding regional EF results. Results: High interobserver reproducibility in the assessment of regional EFs was found, with r values ranging from 0.94 to 0.98. In patients with anterior and inferior MIs, the regional EFs were abnormal in the anterior and septal regions, and the inferior and lateral regions, respectively. The regional EFs correlated significantly with regional perfusion in the anterior walls (r = 0.71; p = 0.0001), the lateral walls (r = 0.66; p = 0.0001), and inferior walls (r = 0.54; p = 0.0004). There was a significant association between the regional EFs and the echocardiographic regional wall motion assessment at the base (p < 0.0001), mid-ventricle (p = 0.0004), and apex (p = 0.0003). Conclusions: Gated SPECT images obtained 99mTc-sestamibi can provide reproducible quantitative, segmental regional EFs for multiple left ventricular slices that are significantly associated with subjective regional wall motion assessment by echocardiography. [ABSTRACT FROM AUTHOR]

Background: Between 1980 and 1989, mortality due to coronary artery disease decreased considerably in the United States, suggesting a possible decrease in the prevalence of coronary atherosclerosis. We examined this possibility in patients with valvular regurgitation who, often in the absence of angina, underwent coronary angiography before valve-replacement surgery. Methods: We studied 601 patients with isolated, nonischemic valvular regurgitation who were operated on between 1980 and 1989 and who had undergone preoperative coronary angiography. From the angiograms we determined the prevalence of clinically significant coronary artery disease and of multivessel disease, assessed the mean degree of stenosis, and analyzed the trends in the data over the years of the study. Results: The prevalence of coronary artery disease (35 percent in 1980–1981, 37 percent in 1982–1983, 34 percent in 1984–1985, 37 percent in 1986–1987, and 35 percent in 1988–1989; P = 0.97) did not change significantly during the study period. We found no significant change in the prevalence of multivessel disease (24 percent in 1980–1981 and 23 percent in 1988–1989, P = 0.99) or in the mean (±SD) degree of stenosis (11±13 percent in 1980–1981 and 13±14 percent in 1988–1989, P = 0.07). When these measures of coronary atherosclerosis were adjusted for age and sex, there were still no significant changes over time (P = 0.39 for the prevalence of coronary artery disease, P = 0.81 for that of multivessel disease, and P = 0.57 for the mean degree of stenosis). The patients' mean total cholesterol level decreased from 219±48 mg per deciliter (5.66±1.24 mmol per liter) to 206±44 mg per deciliter (5.33±1.14 mmol per liter) between 1980 and 1989 (P = 0.04). Conclusions: From 1980 to 1989, no significant change was observed in angiographic measures of coronary atherosclerosis in patients with nonischemic valvular regurgitation, in contrast to the marked decrease in mortality due to coronary disease in the general population. These findings suggest that the well-documented reduction in mortality due to coronary disease may not be due to a reduction in the prevalence of coronary atherosclerosis. (N Engl J Med 1996;335:316-22.) [ABSTRACT FROM AUTHOR]