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Home    Μελέτη της βελτίωσης της αιματώσεως και λειτουργικότητας του μυοκαρδίου με τομογραφικό(SPECT) σπινθηρογράφημα (με θάλλιο-201 σε κόπωση και ηρεμία) και ραδιοϊσοτική κοιλιογραφία (σε ηρεμία και μετά ισομετρική άσκηση) σε ασθενείς με στεφανιαία νόσο πριν και μετά την αγγειοπλαστική  

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Identifier uch.med.phd//1998georgoulias
Title Μελέτη της βελτίωσης της αιματώσεως και λειτουργικότητας του μυοκαρδίου με τομογραφικό(SPECT) σπινθηρογράφημα (με θάλλιο-201 σε κόπωση και ηρεμία) και ραδιοϊσοτική κοιλιογραφία (σε ηρεμία και μετά ισομετρική άσκηση) σε ασθενείς με στεφανιαία νόσο πριν και μετά την αγγειοπλαστική
Creator Georgoulias, Panagiotis A
Abstract Since the first application of the percutaneous transluminal coronary angioplasty in 1977, the spread of the method has been very rapid. The aim of the present study, was to assess the change in myocardial perfusion and mobility, in patients with coronary artery disease subjected to angioplasty, by using myocardial SPECT imaging (with 201Tl or 99mTc-tetrofosmin) both at stress and rest and radioisotopic ventriculography (at rest and after isometric exercise). Material: Forty-one patients (38 men and 3 women) of age ranging from 35 to 70 years were studied. Twenty-one patients had one-vessel disease and were subjected to successful revascularization of the stenosed artery, 16 had two-vessel disease and were subjected to one-stenosed vessel angioplasty and 4 patients had three-vessel disease. From these patients 3 were subjected to one-vessel revascularization and one was subjected to two-vessel re-opening. Sixteen of the patients had mentioned myocardial infarction in their history. Method: All the patients were examined, the month prior to angioplasty, by using myocardial tomographic imaging (29 with 201Tl and 12 with 99mTc-tetrofosmin), both at stress and rest and radioisotopic ventriculography - MUGA - (at rest and after isometric exercise). An angiographic checking was done to all patients prior to intervention. The function of the left ventricle, using radioisotopic ventriculography (at rest and after isometric exercise), was assessed 4 1 weeks after revascularization. Besides, a myocardial SPECT scan using 201Tl or 99mTc-tetrofosmin, at stress and rest, respectively, as well as radioisotopic ventriculography (at rest and after isometric exercise) 6 1 months after angioplasty, was performed. One patient who did not show any improvement of the total as well as regional wall motion of the left ventricle in the one month's checking, was subjected to myocardial SPECT imaging two months after the revascularization. Five patients who did not show improvement in the ejection fraction and the myocardial imaging 6 months after angioplasty, were again subjected to coronary angiography 7 1 months after the intervention. One patient, despite the improvement of the perfusion and the function of the left ventricle, as it was assessed by the above tests, was still complaining for precardiac distress and, for this reason, he was subjected to coronary angiographic checking 7 months after the intervention. Results: The vast majority of the patients showed an improvement both in the symptomatology and in the efficiency at the stress testing, following angioplasty. We found a strong correlation between the findings of the tomographic scan of myocardium with 201Tl and the coronary angiography prior to angioplasty with sensitivity, specificity, positive predictive value and negative predictive value: for the left anterior descending artery 96%, 75%, 96%, 75%, for the left circumflex artery 60%, 100%,100%, 79% and for the right coronary artery 100%, 70.5 %, 70.5% and 100%. Satisfactory were also the findings of an analogous study conducted by us in 52 patients that compared the results of the tomographic myocardial scan, with 99mTc-tetrofosmin, with the coronary angiographic checking with sensitivity, specificity, positive predictive value and negative predictive value: for the left anterior descending artery 91.1%, 83.3%, 88.5%, 83.3%, for the left circumflex artery 72.2%, 88.2%, 76.4%, 85.7% and for the right coronary artery 90.6%, 80%, 87.8% and 84.2%. Twenty-five (86.2%) of the 29 patients who were examined with 201Tl and 11 (91.6%) of the12 patients who were checked with 99mTc-tetrofosmin showed improvement of the myocardial image, at about 6 months after the intervention, whereas the rest (5 patients) were subjected again to coronary angiography which confirmed the existence of restenosis. All the patients showed improvement in the total and regional wall motion of the left ventricle, 1 month after the re-perfusion, except one to whom it was proven the existence of restenosis 6 months after the intervention. The improvement in the general and regional ejection fraction remained 6 months following angioplasty to most patients, accordingly to the myocardial scan improvement. Finally, there was a significant improvement to the «cardiopulmonary index» (in those patients who were examined with 201Tl) as well as of PER and PFR indices, of the curve indicating volume change of the left ventricle. Conclusion: The vast majority of the patients subjected to angioplasty, displays significant improvement not only to perfusion but also to the function of the left ventricle myocardium. The radioisotopic techniques (tomographic scan with 201Tl or 99mTc-tetrofosmin and radioisotopic ventriculography), consist important and non-invasive methods for assessing and monitoring of the aforementioned patients.
Issue date 1998-07-01
Date available 1998-10-30
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
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