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Effects of infusion of glucose-insulin-potassium on myocardial function after a recent myocardial infarction.

We studied the effects of glucose, insulin, and KCI infusion (GIK), on regional myocardial perfusion and function by 99m-Tc-tetrofosmin-gated SPECT. Methods - we studied 21 male patients with their first uncomplicated acute myocardial infarction (AMI). All patients underwent a rest and submaximal stress perfusion study before and after 24-hour infusion of GIK-solution (group A) or saline solution (group B). Results - Group A showed better stress tolerance and ischaemic threshold improvement after GIK infusion whilst no statistical differences were found between basal and post-infusion test in group B. At first the stress test in group A, of the 192 segments analysed, 52 (27%) showed reversible perfusion defect. In group B, of 144 segments analysed, 31 (21%) showed reversible perfusion defect. A postinfusion analysis in group A showed a post-GIK end-diastolic significant count improvement in 21 segments, and a post-GIK end-systolic count improvement in 22 segments. In group B, perfusion increase was observed only in 4 segments, whilst systolic thickening increase was observed only in I segment. Conclusion - these data demonstrate the efficacy of GIK infusion to improve regional myocardial perfusion and function mainly in segments adjacent to the recently infarcted area.

Comparative quantitative evaluation of hepatic clearance of diethyl-IDA and para-butyl-IDA in jaundiced and non-jaundiced patients

A method for comparative measurement of hepatic clearance of different hepatobiliary agents is described and the clinical use of diethyl-IDA and parabutyl-IDA is discussed. The study was performed with both radiopharmaceuticals in 13 patients with hepatobiliary disease with serum bilirubin ranging from 0.3 to 16.4 mg/100 ml.Diethyl-IDA is preferable for a qualitative evaluation of hepatobiliary disease, because of its higher hepatic clearance and faster biliary excretion rate. Parabutyl-IDA is superior for measuring the hepatocytic uptake function, due to the low urinary excretion and the absence of an apparent re-entry from liver to plasma, even in patients with obstructive jaundice. In contrast, an appreciable re-entry can be demonstrated for diethyl-IDA.

Clinical value of phase and amplitude images and left ventricle time-activity curves in assessing patients with acute myocardial infarction

The purpose of this study was to assess the clinical usefulness of phase and amplitude images and of the left ventricle time-activity curve (LVTAC) obtained by equilibrium gated radionuclide ventriculography (EGRV) in patients with acute myocardial infarction (AMI).Fifty-six patients were studied within 4 days of the onset of AMI by EGRV; of these 49 also underwent first-pass (FP) angiocardiography, for comparison with EGRV, and 21 underwent repeated EGRV 3 months after AMI. Phase and amplitude images were obtained by Fourier analysis. LVTAC analysis was performed by a third degree polynomial fitting to determine peak ejection rate (PER) and peak filling rate (PFR).A substantial equivalence of EGRV and FP methods was demonstrated, as regards left ventricle ejection fraction (LVEF), while a sharp superiority of EGRV with Fourier analysis was shown with regard to the sensitivity of RWM abnormality detection. With only one exception all the cases showed RWM abnormalities, while LVEF was normal in 21 of 27 patients with less than three affected segments. The most sensitive global function index was the LVPFR. In the acute phase regional dyskinesis was observed in 14 of 56 patients.About 40% of our cases showed an improvement of the kinetic abnormalities 3 months after AMI. The highest rate of improvement was observed in the group with ECG patterns of limited infarction and with normal LVEF.

Assessment of ventricular function in arterial hypertension with radionuclide ventriculography

Diastolic function of the left ventricle was assessed in 29 untreated patients with mild to moderate hypertension and in 21 normotensive control subjects using gated radionuclide ventriculography. In hypertensive patients, the time to peak filling rate was significantly longer (p less than 0.01) than that in control subjects, and first-third filling fraction and peak filling rate were significantly reduced (p less than 0.001). The ejection fraction and peak ejection rate were also significantly reduced in hypertensive patients (p less than 0.001). No relation was observed between diastolic functional impairment and age, cardiac hypertrophy, or severity of hypertension. Thus, early impairment of ventricular filling is present in hypertension, even in young patients without evidence of cardiac hypertrophy.

Severe Cortical and Trabecular Osteopenia in Secondary Hyperparathyroidism

Background:  Peripheral quantitative computed tomography (pQCT) provides real volumetric bone density values, not only of the total, but also of trabecular and cortical bone, separately. In addition, it provides data on bone geometry that can be related to the risk of fracture.

Tc-99m tetrofosmin lymph node uptake in myocardial perfusion imaging

A 60-year-old man, who was believed to have angina, underwent Tc-99m Tetrofosmin SPECT imaging during rest myocardial perfusion study, which showed an abnormal uptake with visualization of left axillary lymph nodes. Further Investigation with Tc-99m nanocolloid lymphoscintigraphy and left axillary echography did not show neoplastic axillary lymph node enlargement. Abnormal lymph node uptake was probably due to lymphatic drainage after partial extravasation of radiopharmaceutical during left arm intravenous injection.

Computerized analysis of equilibrium radionuclide ventriculography time-activity curve in the assessment of left ventricular performance: comparison of two methods

AbstractTwo methods for the analysis of left ventricle time-activity curve (TAC) of equilibrium gated ventriculography were compared in three groups of subjects [8 controls, 13 patients with coronary artery disease (CAD), 11 patients with myocardial infarction (MI). The first method was based on third-degree polynomial fitting, the second on Fourier analysis. The following parameters were calculated: peak ejection rate (PER), peak filling rate (PFR), time to PER and PFR, and filling fraction at the first third of diastole.A preliminary study of changing values of PER and PFR and of the mean error with increasing number of harmonics summed in order to obtain the best fitting of TAC demonstrated that beyond the sum of the first four harmonics there was no further significant improvement.The advantages of Fourier analysis are as follows:1)it is independent of the operator and fits only one function to the whole cardiac cycle;2)it requires less computer time;3)it provides better differentiation between controls and CAD patients. All of the 13 CAD patients had abnormal PFR on Fourier analysis, only 9 on polynomial analysis. At rest, 9 of the CAD patients had wall motion abnormalities, while only two had an abnormal ejection fraction.

Detection of left atrial myxoma by Fourier phase image

A case of left atrial myxoma shown on an equilibrium radionuclide ventriculography is presented. A peculiar abnormality of the Fourier phase image appears more reliable than the other findings previously revealed by first-pass or equilibrium studies. The findings were perfectly consistent with the gross anatomy of the tumour.

Radionuclide assessment of right-ventricular involvement in inferior acute myocardial infarction: clinical correlations and in-hospital follow-up

We studied 33 patients (28 males, 5 females) with first inferior acute myocardial infarction (AMI) and 12 normal volunteers. They underwent first-pass (FP) and equilibrium-gated radionuclide angiography (EGRA) within 4 days of the onset of symptoms. The parameters [ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR)] of the time-activity curve (TAC) of both ventricles [left ventricle (LV), right ventricle (RV)] were computed. The regional wall motion (RWM) was evaluated by parametric images (amplitude and phase). In 43% of the patients with AMI, we found a depressed RVEF, while the LVEF was decreased in only 33%. The sensitivity of diastolic parameters was shown to be clearly superior to that of the systolic parameters (RVPFR, 78%; LVPFR, 79%). The abnormalities of the overall performance of both ventricles were significantly correlated with those of the RWM. The abnormal RVEF allwed us to assess the necrotic involvement of the RV, while a depressed RVPFR suggested an impaired RV compliance mostly on an ischemic basis. Congestive heart failure (CHF) and shock syndrome were significantly correlated with depressed RV parameters, while the LVEF, despite RWM abnormalities, was in the normal range. EGRA with computation of the TAC parameters of both ventricles appeared to be useful for in-hospital prognostic evaluation, therapeutic planning and clinical follow-up of patients with inferior myocardial infarction.

A rare case of hepatic carcinoid.

A 49-year-old woman was thought to have an echino-coccus cyst of the liver based on borderline antibody titers and findings of magnetic resonance imaging (MRI). Increased activity consistent with tumor was seen on In-111 octreotide imaging, and a biopsy indicated carcinoid tumor of the liver.