F.G. Gallardo

Cholesterol reduction improves myocardial perfusion abnormalities in patients with coronary artery disease and average cholesterol levels

OBJECTIVES We sought to evaluate whether pravastatin treatment increases myocardial perfusion, as assessed by thallium-201 single-photon emission computed tomographic (SPECT) dipyridamole testing, in patients with coronary artery disease (CAD) and average cholesterol levels. BACKGROUND Previous studies in hypercholesterolemic patients have demonstrated that cholesterol reduction restores peripheral and coronary endothelium-dependent vasodilation and increases myocardial perfusion. METHODS This was a randomized, placebo-controlled study with a cross-over design. Twenty patients with CAD were randomly assigned to receive 20 mg of pravastatin or placebo for 16 weeks and then were crossed over to the opposite medication for a further 16 weeks. Lipid and lipoprotein analysis and dipyridamole thallium-201 SPECT were performed at the end of each period. The SPECT images were visually analyzed in eight myocardial segments using a 4-point scoring system by two independent observers. A summed stress score and a summed rest score were obtained for each patient. Quantitative evaluation was performed by the Cedars-Sinai method. The magnitude of the defect was expressed as a percentage of global myocardial perfusion. RESULTS Total and low density lipoprotein cholesterol levels during placebo were 214 +/- 29 mg/dl and 148 +/- 25 mg/dl, respectively. These levels with pravastatin were 170 +/- 23 mg/dl and 103 +/- 23 mg/dl, respectively. The summed stress score and summed rest score were lower with pravastatin than with placebo (7.2 +/- 2.3 vs. 5.9 +/- 2.3, p = 0.012 and 3.2 +/- 1.6 vs. 2.4 +/- 2.2, p = 0.043, respectively). Quantitative analysis showed a smaller perfusion defect with pravastatin (29.2%) as compared with placebo (33.8%) (p = 0.021) during dipyridamole stress. No differences were found at rest. CONCLUSIONS Reducing cholesterol levels with pravastatin in patients with CAD improves myocardial perfusion during dipyridamole stress thallium-201 SPECT.

Osteítis en sífilis secundaria

Resumen Introduccion El objetivo del presente trabajo es presentar dos casos de osteitis en sifilis secundaria. El aumento de la incidencia de sifilis, debido a los cambios en los comportamientos sexuales y al aumento de los inmigrantes procedentes de areas con elevada prevalencia de enfermedades de transmision sexual (ETS), y su relacion con el virus de la inmunodeficiencia humana (VIH), hace que sea importante familiarizarse con formas menos frecuentes de presentacion de esta infeccion sistemica. Pacientes Se presentan dos pacientes diagnosticados de sifilis secundaria, uno de ellos con infeccion por el VIH y el otro no. En el momento del diagnostico ambos tenian lesiones cutaneas que afectaban palmas y plantas, sintomas generales y fiebre. La gammagrafia osea demostro en ambos casos lesiones osteoblasticas multiples en los huesos parietales y frontal. Los dos enfermos respondieron con mejoria clinica al tratamiento con penicilina. Conclusiones En los pacientes con sifilis secundaria y sintomatologia osteoarticular se debe hacer el diagnostico diferencial de afectacion osea sifilitica. Recomendamos como tecnica de eleccion la gammagrafia osea debido a su gran sensibilidad y a la posibilidad de realizar rastreos corporales que permiten el diagnostico de lesiones sintomaticas.

Valor pronóstico de los estudios de perfusión miocárdica con Tl-201 normal en pacientes con ergometría positiva

El objetivo de este trabajo ha sido determinar el valor pronostico a medio plazo de los estudios de perfusion miocardica con Tl-201 normal en los pacientes con ergo-metria positiva. Se seleccionaron 85 pacientes consecutivos que desde enero de 1996 a diciembre de 2000 habian presentado gammagrafias normales con ergometrias electricamente positivas. La probabilidad pretest de enfermedad coronaria era intermedia o alta. Se efectuo seguimiento a 78 pacientes (89%) durante una media de 2,03 anos. Un total de 40 pacientes (51%) eran varones. La edad media fue de 56 anos. Se analizaron las siguientes variables: angina, revascularizacion, infarto no mortal y muerte cardiaca. Durante el periodo de seguimiento no se produjeron acontecimientos coronarios mayores; solo 8 enfermos refirieron episodios de dolor anginoso y uno de ellos angina inestable que requirio revascularizacion. En pacientes con probabilidad pretest de enfermedad coronaria intermedia que presentan una gammagrafia de perfusion miocardica normal, el pronostico a medio plazo es excelente, aunque la ergometria haya sido electricamente positiva.

Bone scintigraphy and secondary osteomalacia due to nephrotoxicity in a chronic hepatitis B patient treated with tenofovir

Tenofovir is a nucleotide analogue used for the treatment of chronic hepatitis B and HIV infection. The safety of tenofovir is high but it has been described that tenofovir produces tubular toxicity and Fanconis syndrome in some HIV-infected patients. To our knowledge this is the first documented case of bone involvement in Fanconis syndrome in a patient treated with tenofovir for chronic hepatitis B without HIV coinfection. Bone scintigraphy has proven to be very useful for the diagnosis of secondary osteomalacia. Normalization of the bone scan after the withdrawal of the drug and the decline in alkaline phosphatase and phosphate serum levels reinforce the cause-effect relationship.

Cuantificación del estudio de perfusión miocárdica en pacientes con baja probabilidad de cardiopatía isquémica. Valores normales de gated-SPECT con 201Tl

INTRODUCTION This study has aimed to establish quantitative normality parameters in the thallium-201 GATED SPECT and to assess the changes related to age, gender, risk factors and stress testing. METHODS A total of 427 patients with low pre-test likelihood of coronary artery disease were selected (45.5% men). The examinations were performed, by obtaining 32 25-second images on a 180% arc. The isotope used was thallium-201 and the SU SEGAMI software was using for the examination procedure. RESULTS Myocardial tracer uptake in each one of the vascular territories was: left descending artery 77%+/-4; circumflex artery 76%+/-5 and right coronary artery 70%+/-4 (P=.000). Uptake in the right coronary artery territory was lower in men (68.7% vs 70.5% in women, P=.000) and in the left descending artery territory in the obese. There were no gender-related differences in the post-stress ejection fraction for both genders (65.7% in men vs 66.8% in women). However, ventricular volumes were higher in men (end-diastolic volume 80ml+/-27 vs 61ml+/-22; P=0.000 and end-systolic volume 27.2ml+/-25 vs 19ml+/-8; P=0.000). There is an inverse relationship between age and end-diastolic volume. Smokers have higher end-diastolic volumes than non-smokers. CONCLUSIONS Quantification of T1201 uptake in patients having low pre-test probability of coronary artery disease and normal thallium GATED-SPECT in the RCA territory is lower in men. The ventricular function study shows that there are no differences in post-stress EF based on gender but that the end-diastolic and end-systolic volumes are higher in men.

Myocardial perfusion study in patients who do not reach submaximal frequency on ergometry

UNLABELLED The aim of the study was to evaluate the sensitivity and specificity of TI-201 myocardial perfusion SPECT for the diagnosis of ischaemic cardiopathy in a group of patients with chronotropic insufficiency. MATERIALS AND METHODS The examinations of 750 patients who had attended for the diagnosis of ischaemic cardiopathy during 2005-2006 were selected. 28 % (n = 209) did not reach submaximal frequency. Data on the diagnosis was collected in 112 by telephone interview. Ergometry and SPECT were carried out following the usual techniques. RESULTS Patients who reached submaximal frequency and patients with chronotropic insufficiency did not show differences in age and exercise time. The proportion of patients on beta-blocker treatment, with clinically positive ergometries and pathological SPECT was higher in the patient group which had not reached 85 % of their maximum frequency. The data obtained in the patient group which did not reach submaximal frequency and followed-up by telephone interview showed a SPECT sensitivity of 84 % and specificity of 96 %. The sensitivity of the ergometry was 25 % and its specificity was 96 %. CONCLUSIONS Ergometry with myocardial perfusion SPECT has adequate sensitivity and specificity for the diagnosis of ischaemic cardiopathy, even in patients with chronotropic incompetence. The proportion of pathological examinations is higher in those patients in whom tachycardia could not be sufficiently induced, which seems to indicate that the inability to reach submaximal frequency is related with a higher probability of having ischaemic cardiopathy.

La gammagrafía de reactividad hiperémica en el estudio de la función endotelial

Objective. The aim of this study was to compare a recently described method to evaluate endothelial function; the hyperemic reactivity scintigraphy (HRS) with the ultrasono- graphic flow-mediated dilatation (FMD) in brachial artery and its relationship with myocardial SPECT. Methods. 42 consecutive patients that underwent myocardial scintigraphy were included. Thirty-six patients had simultane- ous measurement of FMD. Both studies were obtained after 5 minutes occlusion of the upper arm with a blood pressure cuff inflated at 250 mmHg. HRS was performed dynamically at rate 1 frame/sec during 3 minutes after intravenous injection of 740 MBq of Tc-99 sestamibi. Time-activity curves allowed ob- taining the following indexes: medium hyperemic activity/medi- um contrallateral activity (MHA/MCA) and maximum hyperemic activity/maximum contrallateral activity (MxHA/CxHA). Results. In 13 patients SPECT was normal. Twenty-nine pa- tients had perfusion defects in scintigraphy. There was relation- ship between the FMD and the MHA/MCA (r = 0.23; p = 0.018) and the FMD and the MxHA/CxHA (r = 0.18; p = 0.05). Patients with alterations in the SPECT had an index MxHA/CxHA lower than patients with normal SPECT (1.8 ± 0.2 vs 1.5 ± 0.4; p = 0.04). We did not find relationship between FMD and alter- ations in SPECT. Conclusions. There is relationship between FMD and HRS. HRS is lower in patients with perfusion defects in the SPECT. HRS could provide additional value to myocardial scintigraphy.

Isquemia silente versus angina en la tomogammagrafía con Tl-201

Resumen —Introduccion El proposito del presente estudio fue describir las variables que se asocian a la isquemia silente en los pacientes a los que se les realiza ergometria con gammagrafia de perfusion miocardica y presentan defectos reversibles de la perfusion. Metodos Se analizan retrospectivamente de forma cuantitativa las gammagrafias con Tl201-SPECT de 522 pacientes que presentaban defectos de perfusion total o parcialmente reversibles durante la prueba de esfuerzo maxima. Se relaciono la aparicion de angina con el tamano del defecto de perfusion y la presencia de diferentes factores de riesgo. Resultados En 412 (73 %) pacientes la isquemia fue silente. En 176 (33 %) pacientes la ergometria fue electricamente positiva. No hubo diferencias en el tamano del defecto de perfusion entre los pacientes con y sin angina (27 ± 12 vs 27 ± 14), pero en los pacientes que presentaron angina durante la ergometria el grado de reversibilidad fue mayor sobre todo en el territorio de la arteria descendente anterior (ADA) (56 ± 40 vs 45 ± 40 p Conclusiones Una elevada proporcion de los pacientes con defectos de la perfusion reversibles en la gammagrafia tuvieron isquemia silente. En los pacientes con angina el grado de reversibilidad en el territorio de la ADA fue mayor. La isquemia silente es mas frecuente en los pacientes con IAM previo.

[Quantification of myocardial scintigraphy in patients with low probability of coronary artery disease. Normal values of thallium-201 gated SPECT].

Abstract Introduction This study has aimed to establish quantitative normality parameters in the thallium-201 GATED SPECT and to assess the changes related to age, gender, risk factors and stress testing. Methods A total of 427 patients with low pre-test likelihood of coronary artery disease were selected (45.5% men). The examinations were performed, by obtaining 32 25-second images on a 180% arc. The isotope used was thallium-201 and the SU SEGAMI software was using for the examination procedure. Results Myocardial tracer uptake in each one of the vascular territories was: left descending artery 77% ± 4; circumflex artery 76% ± 5 and right coronary artery 70% ± 4 (P = .000). Uptake in the right coronary artery territory was lower in men (68.7% vs 70.5% in women, P = .000) and in the left descending artery territory in the obese. There were no gender-related differences in the post-stress ejection fraction for both genders (65.7% in men vs 66.8% in women). However, ventricular volumes were higher in men (enddiastolic volume 80 ml ± 27 vs 61 ml ± 22; P = 0.000 and end-systolic volume 27.2 ml ± 25 vs 19 ml ± 8; P = 0.000). There is an inverse relationship between age and end-diastolic volume. Smokers have higher enddiastolic volumes than non-smokers. Conclusions Quantification of T1201 uptake in patients having low pre-test probability of coronary artery disease and normal thallium GATED-SPECT in the RCA territory is lower in men. The ventricular function study shows that there are no differences in post-stress EF based on gender but that the end-diastolic and end-systolic volumes are higher in men.