- Email: [email protected]
Abnormal myocardial I-123-MIBG uptake in patients with acquired long QT syndrome (LQTS)
S 112
Abstracts Wednesday afternoon, April 9, 1997
99,7
99.9
R I G H T ATRIAL SESTAMIBI UPTAKE IN PATIENTS WITH PAROXYSMAL SUPRAVENTRICULAR ARRHYTHMIAS C.Marcassa, M.Galli, R.Campini, F.Fringuelli. S. Maugeri Foundation IRCCS, Veruno, Italy.
EVALUATION OF WOLFF- PARKINSON-WHITE (WPW) PATIENTS BEFORE AND AFTER RADIOFREQUENCY (RF) ABLATION OF ACCESSORY PATHWAYS. L. Bontemps, H. Ben Brahim. T. Kralem, P. Chevalier, G. Kirkorian, P. Touboul, R. Itti. Cardiovascular Hospital, Lyon, France.
Paroxysmal supraventricular tachiarrhythmias (PSVA: supraventricular tachicardia and, occasionally, atrial fibrillation), have been observed in patients with no organic heart disease. In a consecutive cohort of 216 patients referred for a stress-rest sestamibi SPECT for the evaluation of suspected or known C A D and without signs of cardiac disease, other than CAD, at clinical and t r a n s t h o r a c i c 2 D - E C H O , history of P S V A was documented in 14 (6%) patients. A clear right atrial sestamibi uptake was observed in 20/216 patients (9%). At ECG-gated images, the right atrial tracer uptake was diffuse in 12 patients (60%) and localized in the remaining 8 (40%), Out of 20 patients with abnormal right atrial uptake, 10 (50%) had history of P S V A (atrial fibrillation in 7 patients, SV tachicardia in 3 patients); the right atrial uptake was diffuse in 7/10. Conversely, out of 202 patients without PSVA, only 10 (5%) had right atrial sestamibi uptake (p<0.001) (RR for PSVA of right atrial tracer uptake =24.5, (21 6.5-91.9). Some structural abnormality of the atrial wall (otherwise undetected at conventional noninvasive screening) may be responsible for the unusual right atrial tracer uptake. Such structural abnormalities may be the trigger, in some cases, of "lone" supraventricular arrhythmias.
W E
D N E
S D A Y P M A P R I
L 9
Journal of Nuclear Cardiology January/February 1997, Part 2
In order to demonstrate the effects of radiofmqueacy (RF) ablation of accessory pathways in WPW patients (pts) on the left (LV) and fight (RV) ejection fractions (EF) and on Fourier phase variables, a group of 40 consecutive patients has been evaluated before and after RF. According to electrophyslology, the patients have been classified into : right sidedWPW = 13 pts and left sided WPW = 27 pts. From gated blood pool SPECT, perfumed shortly before and after RF, left a~l fight ejection fractions have been measured as well as mean phases (MP, expressed in degrees) and phase standaxd deviations (PSD). LVEF RVEF left WPW before RF afterRF fight WPW before RF afterRF
LVMP
RVMP LVPSD RVPSD
62+/-8 36+/-7 141+/-17 144+/-19 13+/-3 21+/-9 64+/-7 38+•-9 143+/-15 141+1-14 13+/-2 21+/-8 60+/-8 36+/-10 145+/-21 132+/-18 15+/-6 27+/-12 59+1-8 40+/-9 144+/-18 143+/-12 12+/-3 19+/-4
Results indicate that RF preserves or slightly improves cardiac function, in right sided WPW, phase analysis clearly demonslrates the disappearance of preexcitation associated with a significant reduction of phase dispersion, ie conlraction heterogeneity. In left WPW, the phase differences are smaller, specially in postero-iateral locations of the pathways, and pre and post RF changes are more difficult to quantify.
99.8
99.10
MENTAL-STRESS INDUCED LEFT VENTRICULAR DYSFUNCTION: REPRODUCIBILITYWITH DIFFERENT MENTAL STRESSORS Diwakar dain, Matthew Burg, Robert Soufer, Barry L Zaret. Yale University, New Haven CT
A B N O R M A L M Y O C A R D I A L 1-123-MIBG U P T A K E IN PATIENTS
Mental Stress (MS) provokes myocardial ischemia in patients (pts) with coronary artery disease (CAD). A number of different tasks are used to induce MS. The relative potency, reproducibility & agreement between different MS tasks are not known. Twenty CAD pts with exercise induced ischemia underwent a battery of MS tests [Mental Arithmetic (MA), Color Stoop test (CS) and Anger Recall (AR)] while undergoing continuous ambulatory left ventricular (LV) function monitoring. Ten Lotsdeveloped LV Dysfunction (Dys) (_>5%fall in LVEF) with _>1stressor(s). These 10 pts underwent second MS 4-8 weeks later with no change in medication or clinical status. The frequency of LV Dys on the first (#1) and second occasion (#2), reproducibility of the responses and increase in HR (AHR) and systolic blood pressure (ASBP) in these 10 patients were: MA LVDys#1 70% LVDys#2 60% Reproducibility 50%
CS62% 75% 62%
AR ;:1test AHR ASBP 90% 100% +7+5 +27+10 80% 90% +7±4 +24__.10 90% 90%
In CAD pts with MS induced LV Dys, AR produces LV Dys with highest frequency (90%) & is most reproducible (90%). MA & CS induce LV Dys less frequently and are less reproducible. Overall, on retesting 90% of the pts had reproducible response with at least I stressor. HR and SBP changes were not different between two studies. Response to repeat MA & CS may be influenced by conditioning. In contrast, response to AR remains highly reproducible since it uses a different kind of life situation to elicit anger. Protocols evaluating treatment effects should employ either AR alone or a battery of MS tasks.
WITH ACQUIRED LONG QT SYNDROME (LQTS). L. Bontemps, P. Chevalier, A. Dacosta, E. Bonnefoy, G. Kirkorian, P. Touboul, R. Itti. Cardiovascular Hospital, Lyon, France. Acquired LQTS may be a variant of inherited LQTS, and therefore could be associated with cardiac sympathetic innervation disorders, as it has been previously demonstrated in congenital LQTS, using non invasive imaging. The purpose of this study was to evaluate semiquantitatively the pattern of myocardial uptake of 1-123-MIBG in a group of patients with acquired LQTS. After exclusion of coronary artery disease using coronary angiography or thallium stress sciatigrnphy, seven patients (aged 70 +1'- 8 years) have been selected for planar MIBG scintigmphy acquired in anterior projection four hours after tracer injection. Five healthy volunteers were the reference. Regional MIBG uptake was expressed in counts per pixel in several regions of interest and heart/mediastinal ratios w~e calculated for the most active part of the myocardium (A1), the less active region in cases where a localizeddefect was present (A2) and the total left ventricular area (A3). Compared to normals, the results are : AI A2 A3
1.53 +/- 0.23 1.30 +I- 0.10 1.39 +/- 0.15
vs
1.97 +/- 0.24
(p < 0,05)
vs
1.98 +/- 0.17
(p < 0.05)
From these results it can be considered that an abnormal cardiac sympathetic innervation can be documented in patients with acquired LQTS on the basis of 1-123-MIBG seintigraphy.
Abstracts Wednesday afternoon, April 9, 1997
99,7
99.9
R I G H T ATRIAL SESTAMIBI UPTAKE IN PATIENTS WITH PAROXYSMAL SUPRAVENTRICULAR ARRHYTHMIAS C.Marcassa, M.Galli, R.Campini, F.Fringuelli. S. Maugeri Foundation IRCCS, Veruno, Italy.
EVALUATION OF WOLFF- PARKINSON-WHITE (WPW) PATIENTS BEFORE AND AFTER RADIOFREQUENCY (RF) ABLATION OF ACCESSORY PATHWAYS. L. Bontemps, H. Ben Brahim. T. Kralem, P. Chevalier, G. Kirkorian, P. Touboul, R. Itti. Cardiovascular Hospital, Lyon, France.
Paroxysmal supraventricular tachiarrhythmias (PSVA: supraventricular tachicardia and, occasionally, atrial fibrillation), have been observed in patients with no organic heart disease. In a consecutive cohort of 216 patients referred for a stress-rest sestamibi SPECT for the evaluation of suspected or known C A D and without signs of cardiac disease, other than CAD, at clinical and t r a n s t h o r a c i c 2 D - E C H O , history of P S V A was documented in 14 (6%) patients. A clear right atrial sestamibi uptake was observed in 20/216 patients (9%). At ECG-gated images, the right atrial tracer uptake was diffuse in 12 patients (60%) and localized in the remaining 8 (40%), Out of 20 patients with abnormal right atrial uptake, 10 (50%) had history of P S V A (atrial fibrillation in 7 patients, SV tachicardia in 3 patients); the right atrial uptake was diffuse in 7/10. Conversely, out of 202 patients without PSVA, only 10 (5%) had right atrial sestamibi uptake (p<0.001) (RR for PSVA of right atrial tracer uptake =24.5, (21 6.5-91.9). Some structural abnormality of the atrial wall (otherwise undetected at conventional noninvasive screening) may be responsible for the unusual right atrial tracer uptake. Such structural abnormalities may be the trigger, in some cases, of "lone" supraventricular arrhythmias.
W E
D N E
S D A Y P M A P R I
L 9
Journal of Nuclear Cardiology January/February 1997, Part 2
In order to demonstrate the effects of radiofmqueacy (RF) ablation of accessory pathways in WPW patients (pts) on the left (LV) and fight (RV) ejection fractions (EF) and on Fourier phase variables, a group of 40 consecutive patients has been evaluated before and after RF. According to electrophyslology, the patients have been classified into : right sidedWPW = 13 pts and left sided WPW = 27 pts. From gated blood pool SPECT, perfumed shortly before and after RF, left a~l fight ejection fractions have been measured as well as mean phases (MP, expressed in degrees) and phase standaxd deviations (PSD). LVEF RVEF left WPW before RF afterRF fight WPW before RF afterRF
LVMP
RVMP LVPSD RVPSD
62+/-8 36+/-7 141+/-17 144+/-19 13+/-3 21+/-9 64+/-7 38+•-9 143+/-15 141+1-14 13+/-2 21+/-8 60+/-8 36+/-10 145+/-21 132+/-18 15+/-6 27+/-12 59+1-8 40+/-9 144+/-18 143+/-12 12+/-3 19+/-4
Results indicate that RF preserves or slightly improves cardiac function, in right sided WPW, phase analysis clearly demonslrates the disappearance of preexcitation associated with a significant reduction of phase dispersion, ie conlraction heterogeneity. In left WPW, the phase differences are smaller, specially in postero-iateral locations of the pathways, and pre and post RF changes are more difficult to quantify.
99.8
99.10
MENTAL-STRESS INDUCED LEFT VENTRICULAR DYSFUNCTION: REPRODUCIBILITYWITH DIFFERENT MENTAL STRESSORS Diwakar dain, Matthew Burg, Robert Soufer, Barry L Zaret. Yale University, New Haven CT
A B N O R M A L M Y O C A R D I A L 1-123-MIBG U P T A K E IN PATIENTS
Mental Stress (MS) provokes myocardial ischemia in patients (pts) with coronary artery disease (CAD). A number of different tasks are used to induce MS. The relative potency, reproducibility & agreement between different MS tasks are not known. Twenty CAD pts with exercise induced ischemia underwent a battery of MS tests [Mental Arithmetic (MA), Color Stoop test (CS) and Anger Recall (AR)] while undergoing continuous ambulatory left ventricular (LV) function monitoring. Ten Lotsdeveloped LV Dysfunction (Dys) (_>5%fall in LVEF) with _>1stressor(s). These 10 pts underwent second MS 4-8 weeks later with no change in medication or clinical status. The frequency of LV Dys on the first (#1) and second occasion (#2), reproducibility of the responses and increase in HR (AHR) and systolic blood pressure (ASBP) in these 10 patients were: MA LVDys#1 70% LVDys#2 60% Reproducibility 50%
CS62% 75% 62%
AR ;:1test AHR ASBP 90% 100% +7+5 +27+10 80% 90% +7±4 +24__.10 90% 90%
In CAD pts with MS induced LV Dys, AR produces LV Dys with highest frequency (90%) & is most reproducible (90%). MA & CS induce LV Dys less frequently and are less reproducible. Overall, on retesting 90% of the pts had reproducible response with at least I stressor. HR and SBP changes were not different between two studies. Response to repeat MA & CS may be influenced by conditioning. In contrast, response to AR remains highly reproducible since it uses a different kind of life situation to elicit anger. Protocols evaluating treatment effects should employ either AR alone or a battery of MS tasks.
WITH ACQUIRED LONG QT SYNDROME (LQTS). L. Bontemps, P. Chevalier, A. Dacosta, E. Bonnefoy, G. Kirkorian, P. Touboul, R. Itti. Cardiovascular Hospital, Lyon, France. Acquired LQTS may be a variant of inherited LQTS, and therefore could be associated with cardiac sympathetic innervation disorders, as it has been previously demonstrated in congenital LQTS, using non invasive imaging. The purpose of this study was to evaluate semiquantitatively the pattern of myocardial uptake of 1-123-MIBG in a group of patients with acquired LQTS. After exclusion of coronary artery disease using coronary angiography or thallium stress sciatigrnphy, seven patients (aged 70 +1'- 8 years) have been selected for planar MIBG scintigmphy acquired in anterior projection four hours after tracer injection. Five healthy volunteers were the reference. Regional MIBG uptake was expressed in counts per pixel in several regions of interest and heart/mediastinal ratios w~e calculated for the most active part of the myocardium (A1), the less active region in cases where a localizeddefect was present (A2) and the total left ventricular area (A3). Compared to normals, the results are : AI A2 A3
1.53 +/- 0.23 1.30 +I- 0.10 1.39 +/- 0.15
vs
1.97 +/- 0.24
(p < 0,05)
vs
1.98 +/- 0.17
(p < 0.05)
From these results it can be considered that an abnormal cardiac sympathetic innervation can be documented in patients with acquired LQTS on the basis of 1-123-MIBG seintigraphy.