BACKGROUND AND OBJECTIVES: Dual isotope myocardial SPECT, rest thallium-201/dipyridamole stress Tc-99m sestamibi is used to diagnose coronary artery disease. We examined predictive value of myocardial SPECT for the prognosis of patients having or suspected coronary artery disease. MATERIALS AND METHOD: We examined 692 patients referred for dipyridamole stress myocardial perfusion SPECT. Cardiac events (hard and soft events) were followed up with medical record review and telephone interview. Survival analysis and multivariate Cox proportional hazard model were used to find significant predictors and the incremental predictive value of myocardial SPECT. Patients with coronary angiography (n=246) were analyzed in separate group. RESULTS: There were 4 hard events and 3 soft events in 341 normal SPECT group (1.20%/yr). There were 5 hard events and 21 soft events in 351 abnormal SPECT group (4.69%/yr). Survival curve was separated between normal SPECT group and abnormal SPECT group (p<0.01). In univariate analysis, smoking, history of myocardial infarction, typical chest pain and SPECT findings were important variables. In multivariate analysis, SPECT result was the single most independent predictor. Large reversible perfusion abnormality predicted worse prognosis. In patients with coronary angiography, SPECT did not add statistically significant predictive value to the coronary angiography. CONCLUSION: Dipyridamole stress Tl-201/ MIBI dual isotope myocardial perfusion SPECT provided excellent prognostic information. Extent of reversible perfusion decrease was the independent predictor of future cardiac events.
Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Dipyridamole ; Humans ; Interviews as Topic ; Medical Records ; Multivariate Analysis ; Myocardial Infarction ; Perfusion ; Prognosis ; Proportional Hazards Models ; Smoke ; Smoking ; Tomography, Emission-Computed, Single-Photon*

Imipramine(Tofranil(R)) is one of the tricyclic antidepressants commonly used in depressive symptoms or enuresis. An accidental or nonaccidental poisoning of imipramine is common today. A 16 years old girl was admitted to Seoul National university Hospital because of unocnsciousness and frequent attacks of seizure after the impulsive ingestion of 1.4gm of imipramine. She showed variable arrhythmias such as complete RBBB, secod degree AV block and ventricular tachycardia and recovered from poisoning without residual myocardial damage. We present a case of imipramine poisoning with cardiac arrhythmias with review of literatures.
Adolescent ; Antidepressive Agents, Tricyclic ; Arrhythmias, Cardiac* ; Atrioventricular Block ; Depression ; Eating ; Enuresis ; Female ; Humans ; Imipramine ; Poisoning* ; Seizures ; Seoul ; Tachycardia, Ventricular

No abstract available.
Myocardial Infarction*

BACKGROUND AND OBJECTIVES: We investigated if gated and/or attenuation-corrected SPECT improved performance of experienced or in-experienced operators in the diagnosis of coronary artery disease (CAD) or stenosed arteries in patients having intermediate or high pretest likelihood. MATERIALS AND METHODS: Rest/dipyridamole stress gated attenuation-corrected SPECT was performed in 81 patients (M:F=48:33, 62+/-8.6 years old, of high (n=38) or intermediate (n=43) pre-test likelihood for CAD, 1 vessel; 14, 2 vessel; 19, 3 vessel disease; 31, normal; 17). Two experienced and one novice physicians graded 1 (normal) to 5 (definitely abnormal) for each artery 1) by conventional rest Tl-201/stress Tc-99m-MIBI SPECT, 2) 1) plus viewing gated SPECT (+gated) and 3) 2) plus attenuation-corrected SPECT (+AC gated). Areas under curves (AUC) of receiver operating characteristic (ROC) curves were compared. RESULTS: AUC was greater in patients with high likelihood than intermediate likelihood. Novice physician performed better in diagnosing RCA stenosis (AUC: 0.53 for usual, 0.58 for +gated, and 0.66 for +AC gated) in patients with intermediate likelihood. AUC was not different for the diagnosis of CAD and LAD or LCx. Performance of experienced physicians was not different regardless of pre-test likelihood. Novice operator's specificity increased from 53% to 73% for CAD, and 62% to 89% (p<0.05) for RCA in patients with intermediate likelihood. CONCLUSION: We conclude that gated attenuation-corrected SPECT was helpful only for novice physician to diagnose RCA stenosis by increasing specificity in patients with intermediate likelihood. Even for inexperienced physician, these methods were not helpful in patients with high pre-test likelihood or for LAD or LCX.
Area Under Curve ; Arteries ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Humans ; ROC Curve ; Sensitivity and Specificity ; Tomography, Emission-Computed, Single-Photon*

We studied to investigate the predictive values of gated SPECT for the improvement of wall motion after bypass surgery. As we compared postoperative SPECT with preoperative ones, we defined viability as wall motion improvement. We performed rest T1-20l/stress Tc-99m-MIBI gated SPECT in 25 patients before and 3 months after bypass surgery. Myocardial wall motion was graded as normal, hypokinesia, a kinesia, and dyskinesia by pair-wise visual analysis of gated pre and postoperative SPECT's on the same monitor wall motion abnormalities before operation, 69 (75%) improved and 23 did not. Before operation, we could find segments with good systolic thickenining 64 segments among total 92. Thickening of the remaining 28 was poor. Wall motion improved postoperatively in 45 segments (70%) among 64 with good thickening, Twenty four(86%) among 28 segments with poor thickening had also improved. We grouped segments into mild(hypokinetic) and severe(akinetic/dyskinetic) ones. Among 33 segments with severe motion abnormalities, 14 had good thickening and 19 did not. Nine(60%) improved out of 14 segments having severe abnormality with good thickening. However, 16(84%) segments out of 19 having severe abnormality with poor thickening also improved. Neither degree of perfusion decrease nor severity of wall motion abnormalities could explain the high rate of false negatives. In conclusion, as we defined viability as wall motion improvement by comparing pre and postoperative SPECT, systolic thickening observed by gated Tc-99m-MIBI SPECT in myocardial segments with wall motion abnormalities predicted wall motion improvement after bypass surgery. However, poor thickening could not be referred as evidence of nonviable myocardium both in mild and severe contractile dysfunction, so that we might need stimulation study such as dobutamine echocardiography or dobutamine gated SPECT.
Coronary Artery Disease* ; Coronary Vessels* ; Dobutamine ; Dyskinesias ; Echocardiography ; Humans ; Hypokinesia ; Myocardium ; Perfusion* ; Tomography, Emission-Computed, Single-Photon*

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Tomography, Emission-Computed, Single-Photon*

A Clinical observation was made on five patients with ruptured aortic sinus of Valsalva who visited Seoul National university hospital during the period of May, 1975~Jan., 1980. 1. Age distribution was from 19 to 32 years and four patients were male and the rest one case was female. 2. Chief complaints on admission were dyspnea in 3 cases and chest pain in 2 cases. Onset of symptoms was abrupt in 4 cases. 3. Continuous murmur was heard at third and fourth intercostal space along left sternal border with thrill in all cases. 4. Cardiac catheterization and aortography showed regurgitant flow from aorta to right ventricle in all cases. 5. Operation was done successfully in 3 cases, of which aortic insufficiency was persistent in one case.
Age Distribution ; Aorta ; Aortography ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Dyspnea ; Female ; Heart Ventricles ; Humans ; Male ; Seoul ; Sinus of Valsalva*

We report a case of coronary arteriovenous fistula in a female adult confirmed by aortography. The fistulous communication was between right coronary artery and right ventricle. This is the first case report of adult patient with coronary arteriovenous fistula in Korea.
Adult ; Aortography ; Arteriovenous Fistula* ; Coronary Vessels ; Female ; Heart Ventricles ; Humans ; Korea

The force-interval relationship of cardiac muscle has been known as not only a fundamental manifestation of beat-to-beat kinetics of intracellular activator calcium which control contractile response but also a potential clinical tool for evaluating cardiac contracile function. In this study were evaluated the force-interval relationship of intact canine left ventricle through mechanical restitution curves by plotting contrctile responses to varying steady state, extrasystolic and postextrasystolic intervals, and compared the force-interval relationships of intact canine left and right ventricles quantitatively. Effects of localized myocardial ischemia on the left ventricular force-interval relationship and relaxtion function were also evaluated 30 minutes after ligating proximal left anterior descending coronary artery through observing contractile and relaxtion responses to various intervals. 1) Mechanical restitution curve of left ventricle showed that left ventricular dp/dt max responses rose stiffly until plateau level with increasing postextrasystolic intervals, then declined with further increment of postextrasystolic intervals. 2) Mechanical restitution curve of left ventricle shifted leftward and upward with shortening of steady state and extrasystolic intervals, which suggest intracellular calcium kinetics during electrical diastole may operate as a mechanism of the force-interval relationship. 3) Steady state contractile responses remained unchanged but maximal contractile responses increased significantly or contractile reserve in intact left ventricle. 4) Normalized force-interval relationships of left and right ventricle were similar quantitatively, which suggest the force-interval relationship is independent of structural factors in intact canine heart. 5) Occlusion of coronary artery lowered absolute values of left ventricular dp/dt max responses to varying postextrasystolic intervals, but didn't show significant changes of normalized dp/dt max responses, which suggest force-interval relationship be also present in spite of localized myocardial ischemia. 6) Responses of normalized left ventricular dp/dt min to varying postextrasystolic intervals were similar to those of normalized dp/dt max but reduced after coronary artery occlusion in the range above 100% dp/dt max response, which may be used for the detection and evaluation of deranged myocardial relaxation in the left ventricle with localized myocardial ischemia.
Calcium ; Coronary Vessels ; Diastole ; Heart ; Heart Ventricles ; Kinetics ; Myocardial Ischemia ; Myocardium ; Relaxation ; Ventricular Function, Left*

Pentoxifylline (Trental(R)) is a drug which blocks pathophysiologic process of cerebrovascular disease by inhibiting platelet aggregation, improving cerebral microcirculation preventing development of cerebral edema. In an attempt to evaluate the effect of pentoxifylline for the treatment of 25 patients (male 17 cases, female 8 cases) with cerebrovasculaar disease, we administered pentoxifylline 600mg daily in devided dosage for 1 to 7 months. Most of them were patients with cerebral thrombosis (52%), cerebral embolism (24%), cerebral hemorrhage (12%) and transient ischemic attack (12%). Clinical effects were evaluated at least 1 month later by the criteria using scoring method of serverity of symptoms. In summary, definite effect was found in 15 cases (60%), mild effect in 6 cases (24%) and no efect or aggravation in 4 cases (16%), especially in patients with cerebral hemorrhage. During treatment there was no significant side effect except mild elevation of serum creatinine in one case who was associated with chronic renal failure.
Brain Edema ; Cerebral Hemorrhage ; Creatinine ; Female ; Humans ; Intracranial Embolism ; Intracranial Thrombosis ; Ischemic Attack, Transient ; Kidney Failure, Chronic ; Microcirculation ; Pentoxifylline* ; Platelet Aggregation ; Research Design