老年代谢综合征患者高血压临床特点分析

目的分析老年代谢综合征(MS)患者高血压的临床特点。方法回顾性分析2005年行年度体检的老年干部资料,按年龄分为≤70岁、71~80岁、>80岁3组,分析各组MS单一组分及多组分聚集后的临床特点;以有无高血压伴其他代谢异常分为5组,比较各年龄组高血压作为MS单一组分及与其他组分聚集后的临床特点;分析心、脑血管病变及肾功能异常在上述各组中的患病特点。结果本研究人群中,伴存1种以上MS组分异常的超过85%。MS的患病率为32.19%,其中4项代谢指标均异常的占8.16%。MS中最多见的组合是血压、血糖及体重指数(BMI)3项代谢异常,患病率为24.67%。高血压是最常见的代谢异常,占总人数的61.78%,按年龄分组比较后可见其患病率存在明显的增龄趋势。高血压患者中有46.67%可诊断为MS,占MS总人数的89.57%,而非高血压MS者仅占MS总人数的10.43%。单纯高血压只占高血压患者的22.87%。高血压MS组罹患心血管并发症的比例最高(73.52%),其次是高血压伴其他1项代谢异常(72.69%);脑血管病患病率各组间未见显著性差异。高血压MS患者肾功能异常的检出率也明显增加,分别为非高血压非MS、非高血压MS患者的1.69和1.65倍。结论老年人MS的患病率高。高血压在MS中是最常见的异常组分,其患者中约2/3合并有其他代谢异常。MS伴高血压患者心血管病患病率高,肾功能异常的检出率也高。     

Cardiopulmonary pathology among children resident at high altitude in Tintaya, Peru: a cross-sectional study

Symptomatic high-altitude pulmonary hypertension and structural cardiac abnormalities related to high altitude have been reported previously. However, their true prevalence has not been systematically determined. We assessed clinical indicators of cardiovascular health or disease and correlated them with anatomic and physiologic cardiovascular features in preschool and schoolchildren living at 4000 m. We also estimated the prevalence of cardiovascular problems in the population, with emphasis on symptomatic high altitude pulmonary hypertension and structural cardiopathies. Three hundred and twenty-six children residents of Tintaya, Peru, were cross-sectionally studied. Methods included structured interviews, anthropometry and physical examination, arterial oxygen saturation, hemoglobin determination, electrocardiography, and echocardiography. The prevalence of structural cardiac problems was 1.5%, with less than 1% possibly attributable to high altitude. All children with structural cardiac abnormalities were identified by a focused physical exam prior to echocardiography. None were identified by the health interview. No symptomatic high altitude pulmonary hypertension was identified in the absence of underlying structural anomalies. The prevalence of structural cardiac problems was consistent with data from sea level. Active monitoring of the health status of a pediatric population at high altitude is valuable in the timely detection of cardiac abnormalities. Although our study children enjoyed generally excellent health, comparative, longitudinal studies are warranted to determine the incidence of high altitude cardiopulmonary problems and to identify risk factors and early markers for later disorders associated to life at high altitude. Our findings are applicable to children with some degree of high altitude genetic background and high mobility patterns to lower altitudes and living in comparatively good nutritional and socioeconomic conditions.     

Intrathoracic manifestations of sickle cell disease

A retrospective analysis of 50 patients with sickle cell disease was performed. The majority of patients was admitted because of sickle cell crisis, pneumonia or congestive heart failure. Global cardiomegaly, pulmonary vascular engorgement, pneumonia and infiltrative lung parenchymal abnormalities were encountered. Our study shows a very high prevalence of intrathoracic abnormalities in patients afflicted with sickle cell disease.     

脑静脉性血管畸形相邻脑实质异常MRI表现的初步研究

目的探讨脑静脉性血管畸形相邻脑实质异常的MRI表现。资料与方法对29例脑静脉性血管畸形患者的影像资料进行回顾性研究,分析其引流区域相邻脑实质异常的发生率及MRI表现。结果静脉性血管畸形相邻脑实质异常的发生率为48.3%(14/29)。其中伴发海绵状血管瘤的发生率为13.8%(4/29),MRI均可见较明显的"铁环征";静脉畸形引流区域的信号异常发生率为34.5%(10/29),这其中包括白质病变、出血或钙化。结论静脉性血管畸形引流区域脑实质异常的发生率较高,MRI可以明确显示,其病因尚不明确,可能与局部血流动力学的改变有关。     

Prevalence of cardiovascular abnormalities in pilots involved in fatal general aviation airplane accidents

INTRODUCTION: Cardiovascular disease in general and coronary heart disease in particular remains the leading cause of morbidity and mortality in developed countries. Coronary artery disease is of concern in aviation because of its potential to cause sudden in-flight incapacitation. The purpose of this study was to analyze the cardiovascular abnormalities in pilots involved in fatal general aviation airplane accidents. METHOD: A comprehensive review was performed of all cardiovascular abnormalities detected during autopsies conducted on pilots involved in fatal fixed-wing general aviation aircraft accidents in the U.S. from 1996-1999. Data was obtained from the database maintained at Civil Aerospace Medical Institute in Oklahoma City. RESULTS: An analysis of 534 autopsy reports revealed presence of cardiovascular abnormalities in 234 pilots (prevalence rate 43.82%). Coronary artery stenosis had a prevalence rate of 37.64%. There were 41 pilots who had evidence of severe atherosclerosis of the left coronary artery. This was significantly associated with stenosis of the right coronary and circumflex arteries. There was a statistically significant relation between coronary atherosclerosis and advancing age. DISCUSSION: Although the overall prevalence of coronary atherosclerosis is lower than previously reported, evidence of severe atherosclerosis was found in a relatively high percentage of pilots and may be a cause for concern. The findings have implications for aircrew health education and primary prevention programs. There is also a need for more standardized data collection.     

Prevalence of ethmoid sinus abnormalities on brain CT of asymptomatic adults

To evaluate the prevalence of ethmoid sinus abnormalities in adults without clinical history of sinusitis or allergic rhinitis, the brain CT scans of 156 patients were analyzed prospectively. In 17 cases (10.9%) the ethmoid labyrinth showed abnormalities. In most of these cases (88%) the ethmoid disease was localized to four or fewer cells. Men were more often affected than women (ratio, 2.5:1), and the prevalence of abnormalities was fairly similar across age groups.     

Evidence against the use of lumbar spine radiography for low back pain

AIM: To review abnormalities reported on plain radiographic examination of the lumbar spine in patients referred with low back pain by general practitioners. Additionally, we evaluated and stratified the prevalence of these abnormalities by age. Finally, the diagnostic impact of lumbar spine radiography for the diagnosis of degenerative change, fracture, infection and possible tumour, was modelled. MATERIALS AND METHODS: A retrospective review of 2007 radiographic reports of patients referred with low back pain for lumbar spine radiography to a large radiology department was performed. The reports were classified into different diagnostic groups and subsequently stratified according to age. The potential diagnostic impact of lumbar spine radiography was modelled by using the prevalence of conditions studied as pre-test probabilities of disease. RESULTS: The prevalence of reported lumbar spine degeneration increased with age to 71% in patients aged 65-74 years. The overall prevalence of fracture, possible infection, possible tumour was low in our study population: 4, 0.8 and 0.7%, respectively. Fracture and possible infection showed no association with age. Possible tumour was only reported in patients older than 55 years of age. CONCLUSION: Although the prevalence of degenerative changes was high in older patients, the therapeutic consequences of diagnosing this abnormality are minor. The prevalence of possible serious conditions was very low in all age categories, which implies radiation exposure in many patients with no significant lesions.     

Primary tuberculosis in childhood: radiographic manifestations.

The aim of the study was to review the radiologic features of primary tuberculosis in childhood and to determine whether differences in patterns of disease occur among age and ethnic groups. Chest radiographs of 191 children with pediatric primary tuberculosis were reviewed by two observers. Lymphadenopathy, present in 92% of cases, was the most common abnormality identified on the initial chest radiograph and typically involved the hilar and paratracheal regions. Parenchymal abnormalities, identified in 70% of cases, occurred more commonly in the right lung (P less than .001). Children 0-3 years of age had a higher prevalence of lymphadenopathy (P less than .01) and a lower prevalence of parenchymal abnormalities (P less than .001) than older children. A lower prevalence of lymphadenopathy was found in whites than in nonwhites (P less than .02). The radiologic abnormalities often progressed in the initial follow-up. Lymphadenopathy, with or without concomitant parenchymal abnormality, is the radiologic hallmark of primary tuberculosis in childhood. However, distinct age-related and racial differences in presenting patterns of disease exist and should be recognized.     

Brain imaging findings in pediatric patients with sickle cell disease

PURPOSE: To determine prevalence of imaging abnormalities in the brain of children with sickle cell disease (SCD) and to identify clinical and methodological factors that influence prevalence estimate. MATERIALS AND METHODS: Magnetic resonance (MR) imaging and MR angiographic findings for 185 patients with SCD examined at St Jude Children's Research Hospital since 1993 were reviewed. At least two readers independently reviewed images. Standard MR imaging criteria were used to identify lacunae, loss of white matter volume, encephalomalacia, or leukoencephalopathy. Patients were assigned grades to indicate limited or extensive abnormalities. Standard MR angiographic criteria were used to identify arterial tortuosity (limited vasculopathy) and stenosis or occlusion (extensive vasculopathy). Findings were evaluated as a function of patient clinical status (including stroke) and diagnosis. Recent methods (T1- and T2-weighted MR imaging plus fluid-attenuated inversion recovery [FLAIR] at 3-mm section thickness) were compared with older methods (T1- and T2-weighted MR imaging without FLAIR at 5-mm section thickness). RESULTS: At mean age of 10 years, overall prevalence of infarction, ischemia, or atrophy in patients with SCD was 44% (82 of 185), and prevalence of vasculopathy was 55% (102 of 185), without evidence of a significant referral bias. Twenty-six of 27 patients with clinical stroke had abnormal findings at imaging, but even if patients with stroke were excluded, 35% (56 of 158) had a "silent infarction" (MR imaging-visible injury without clinical stroke), and 49% (78 of 158) had abnormal findings at MR angiography. Patients with clinically severe disease had more abnormalities at MR imaging (P <.001) and MR angiography (P <.004) than did patients with milder disease. Severe vasculopathy was more prevalent in patients with hemoglobin SS than in those with hemoglobin SC (P <.001). Recent imaging methods showed more abnormalities than did older methods (P <.01). With newer methods, 43% (29 of 67) of patients had extensive abnormalities, whereas with older methods, 28% (33 of 116) had extensive abnormalities. CONCLUSION: Prevalence of ischemic brain injury in pediatric patients with SCD is substantially higher than was previously reported, in part because of improvements in imaging methods.     

Asymptomatic carotid arterial disease in young patients following neck radiation therapy for Hodgkin lymphoma.

PURPOSE: To determine the prevalence and severity of asymptomatic carotid arterial disease in young patients following neck radiation therapy for Hodgkin lymphoma and to compare the prevalence of carotid arterial disease following radiation therapy alone with that following radiation therapy and chemotherapy. MATERIALS AND METHODS: Forty-two survivors of childhood or early adult Hodgkin lymphoma aged 18-37 years who had undergone radiation therapy more than 5 years earlier underwent carotid arterial ultrasonography. Common carotid intima-media thickness was measured; carotid vessels were assessed for intima-media abnormalities. Results were compared with those from 33 control subjects. RESULTS: Patients had a significantly greater number of abnormal scans than did control subjects (11 [26%] vs one [3%]; P < .01). Ten patients (24%) had intima-media abnormalities that did not cause significant stenosis; one patient had diffuse bilateral intima-media thickening (mean, 1.99 mm) with greater than 70% stenosis of both common carotid arteries. Intima-media thickness was significantly greater in patients (0.51 mm) than in control subjects (0.43 mm; P < .005). The number of abnormalities in patients with radiation therapy plus chemotherapy (six [19%] of 31 patients) did not differ significantly from the number in patients with only radiation therapy (five [45%] of 11 patients; P = .12); there was no significant difference between median intima-media thicknesses (0.50 mm vs 0.51 mm, P > .2). CONCLUSION: Asymptomatic carotid arterial disease occurs frequently in young patients following neck radiation therapy for Hodgkin lymphoma. No difference in prevalence was shown between only radiation therapy and radiation therapy plus chemotherapy.     

MRI and ultrasound detection of asymptomatic thyroid nodules in hyperparathyroidism.

A retrospective MRI and ultrasound (US) study of 50 patients with hyperparathyroidism and no history of thyroid disease was done. The purpose was to compare the sensitivity of both methods in the detection of asymptomatic thyroid nodules, as well as to determine the prevalence of thyroid abnormalities in patients with hyperparathyroidism. All the patients underwent MR and 33 were also studied by high-resolution US. Magnetic resonance imaging was performed on a 1.5 T unit, using T1-(500-700/20) and T2-(2,000/20 and 70) weighted images. Axial sections (5 mm with a 1 mm interval between them) were obtained along the neck. Ultrasonography was performed using a 10 MHz linear array transducer. The prevalence of thyroid nodules was 46% in the 50 patients studied by MR imaging. In the subgroup of patients studied by both methods, US depicted nodules in 48% of patients, and MR depicted nodules in 45%. Magnetic resonance imaging and US detected a high frequency of thyroid nodules in patients with hyperparathyroidism. This high frequency makes the detection of an intrathyroidal parathyroid adenoma problematic.     

Bone scans with one or two new abnormalities in cancer patients with no known metastases: frequency and serial scintigraphic behavior of benign and malignant lesions

Scintigraphic, radiologic, and clinical follow-up findings were reviewed in cases in which bone scans (n = 301) showed one or two new abnormalities in patients with malignancy but no known metastases. Metastatic disease was confirmed for 25 of 231 scans (11%) with one new abnormality and for 17 of 70 scans (24%) with two new abnormalities. The prevalence of metastases was 0.06 to 0.13 for lesions in all regions of the skeleton, except the sternum (three of six) and the pelvis (10 of 32). On follow-up scans, in the absence of an interval change in therapy, 19 of 21 metastases became more intense, whereas most benign abnormalities either remained unchanged (47%) or resolved (41%). Benign lesions in the ribs, extremities, and pelvis generally resolved within 12-24 months, while most benign skull and spine abnormalities were still apparent after 35-58 months of follow-up.     

Meniscal abnormalities in the asymptomatic population at MR imaging

Two hundred eighty meniscal horns in 64 asymptomatic volunteers in the 2nd to 8th decades of life were analyzed for meniscal abnormalities. Grade 1, 2, and 3 changes were present in essentially all decades. There was at least a 25% prevalence of meniscal signal abnormalities as early as the 2nd decade. The prevalence of meniscal abnormalities increased sharply with age. The prevalence of all signal abnormalities correlated with age, grade 2 changes having the highest correlation coefficient (+.88). The correlation coefficient for grades 1 and 3 changes were +.60 and +.71, respectively. The posterior horn of the medial meniscus had a significantly higher (P less than .02) prevalence of abnormalities than did the other meniscal locations. There was no significant correlation between subject weight or sex and meniscal signal. The authors conclude that there is a baseline prevalence of meniscal signal in the asymptomatic population.     

Kashin-Beck disease in children: radiographic findings in the wrist

OBJECTIVE: To characterize the features and prevalence of radiographic abnormalities of the wrist in children with Kashin-Beck disease (KBD) and to determine whether the presence of radiographic abnormalities in the wrist correlates with the severity of KBD. DESIGN AND PATIENTS: Two hundred and eight posteroanterior radiographs of the right hand (including wrist) in children with KBD, ranging in age from 4 to 11 years (mean age 7.7 years), from endemic areas of China were reviewed. Carpal bony margins were evaluated for blurring, thinning, irregularity with and without sclerosis, interruption, depression or destruction. The radiocarpal, intercarpal and carpometacarpal joints were assessed for widening or narrowing. The severity of the disease was graded using the hand criteria from the Chinese Radiographic Criteria of KBD Diagnosis, which classifies the following five types according to the location of the hand involved: I, metaphysis; II, diaphysis; III, I+II; IV, metaphysis and epiphysis; V, II+IV. RESULTS: Of the 208 children, 95 had abnormalities in the hand but not in the wrist; 108 had both hand and wrist abnormalities; only five had abnormal wrist findings without any hand abnormalities. Of the 108 cases with wrist abnormalities, all the carpal bones were involved in 33 cases, of which the hand types were either IV or V. However, any individual carpal bone, or combination of bones, may become involved. The carpal bones most likely to show abnormalities were the capitate and the hamate (93%), followed by the triquetrum (31%), the lunate (9%), the scaphoid (6%), and the trapezoid and the trapezium (5%). The pisiform bones were not evaluated because they cannot be seen on the overlapping posteroanterior radiographs. The most commonly involved carpal joint was the midcarpal joint (42%). CONCLUSIONS: Recognizing carpal abnormalities on radiographs is helpful for the diagnosis of KBD and the evaluation of the severity of the disease. The more severe the KBD, the more likely that the carpal bones will be involved. The capitate and hamate are frequently affected if the disease involves the carpal bones.     

Computed tomography evaluation of the sacroiliac joints in Crohn disease

Computed tomography (CT) was used in a prospective study of the sacroiliac joints in 86 patients with Crohn disease to determine the type and frequency of sacroiliac joint abnormalities present in this population. The CT findings were correlated with review of the clinical history in 64 patients. Computed tomography demonstrated changes of sacroiliitis in 29% of the study group. This high prevalence of sacroiliac joint abnormality was found even in those under 30 years of age. It exceeds the 11–19% previously reported from plain film examination, reflecting the greater sensitivity of CT. In the subgroup of 64 patients studied clinically, 19 (30%) had abnormal sacroiliac joints on CT, but only 2 (3%) reported symptoms related to the sacroiliac joints.     

Evaluation of malposition of the branch pulmonary arteries using cardiovascular computed tomography angiography

Objectives

To analyze 15 cases of malposition of branch pulmonary arteries (MBPA) for the hospital-based prevalence, clinical information, surgical outcome, imaging findings, associated cardiovascular and airway abnormalities on cardiovascular computed tomography angiography (CCTA).

Methods

We retrospectively searched for patients with MBPA from our database consisting of patients referred for CCTA due to known or suspected congenital heart disease and also from all patients receiving chest computed tomography (CT) during the same time period. We analyzed the hospital-based prevalence, image findings, associated cardiovascular anomalies, airway compression, and recorded the clinical information and surgical outcome.

Results

Our study showed 15 patients with MBPA (hospital-based prevalence: 0.33 % among patients with congenital heart disease and 0.06 % in all patients receiving chest CT or CCTA). Classic type was more common than lesser type (67 % versus 33 %). All patients had associated cardiovascular anomalies, including aortic arch abnormalities (80 %) and secondary airway compression (33 %). Surgery was performed in 67 % of cardiovascular anomalies and 60 % of airway stenoses.

Conclusions

MBPA has a hospital-based prevalence of 0.33 % among patients with congenital heart disease and 0.06 % in all patients receiving either chest CT or CCTA. CCTA can delineate the anatomy of MBPA, associated cardiovascular and airway abnormalities for preoperative evaluation.

Key Points

? MBPA has a hospital-based prevalence of 0.33 % among congenital heart disease patients. ? Classic type of MBPA was more common than lesser type. ? All MBPA patients had associated cardiovascular anomalies, 33 % had secondary airway compression. ? CCTA delineates the anatomy of MBPA, associated cardiovascular and airway abnormalities. ? CCTA is beneficial in MBPA for preoperative evaluation and planning.     

Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings

OBJECTIVE: To determine the prevalence and morphologic helical computed tomography (CT) features of peripancreatic vascular abnormalities in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis. MATERIALS AND METHODS: One hundred and fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were retrospectively and independently reviewed by three observers. CT scans were scored using the CT severity index (CTSI): pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CT severity index and the presence of peripancreatic vascular abnormalities was calculated (K-statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using Fisher's exact test. RESULTS: The severity of pancreatitis was graded as mild (n = 59 scans), moderate (n = 82 scans), and severe (n = 18 scans). Venous abnormalities detected included splenic vein (SV) thrombosis (31 scans, 19 patients), superior mesenteric vein (SMV) thrombosis (20 scans, 14 patients), and portal vein (PV) thrombosis (17 scans, 13 patients). Arterial hemorrhage occurred in five patients (6 scans). In our series, no cases of arterial pseudoaneurysm formation were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of major vascular abnormalities was 75.5-79.2 and 86.2-98.8%, respectively. The presence of the vascular abnormalities in correlation with the severity of pancreatitis was variable. CONCLUSION: Vascular abnormalities are relatively common CT findings in association with acute pancreatitis. The CT severity index is insufficiently accurate in predicting some of these complications since no statistically significant correlation between their prevalence and the severity of pancreatitis could be established.     

Prevalence and Spectrum of In Utero Structural Brain Abnormalities in Fetuses with Complex Congenital Heart Disease

BACKGROUND AND PURPOSE:Brain injury is a major complication in neonates with complex congenital heart disease. Preliminary evidence suggests that fetuses with congenital heart disease are at greater risk for brain abnormalities. However, the nature and frequency of these brain abnormalities detected by conventional fetal MR imaging has not been examined prospectively. Our primary objective was to determine the prevalence and spectrum of brain abnormalities detected on conventional clinical MR imaging in fetuses with complex congenital heart disease and, second, to compare the congenital heart disease cohort with a control group of fetuses from healthy pregnancies.MATERIALS AND METHODS:We prospectively recruited pregnant women with a confirmed fetal congenital heart disease diagnosis and healthy volunteers with normal fetal echocardiogram findings who underwent a fetal MR imaging between 18 and 39 weeks gestational age.RESULTS:A total of 338 fetuses (194 controls; 144 with congenital heart disease) were studied at a mean gestational age of 30.61 ± 4.67 weeks. Brain abnormalities were present in 23% of the congenital heart disease group compared with 1.5% in the control group (P < .001). The most common abnormalities in the congenital heart disease group were mild unilateral ventriculomegaly in 12/33 (36.4%) and increased extra-axial spaces in 10/33 (30.3%). Subgroup analyses comparing the type and frequency of brain abnormalities based on cardiac physiology did not reveal significant associations, suggesting that the brain abnormalities were not limited to those with the most severe congenital heart disease.CONCLUSIONS:This is the first large prospective study reporting conventional MR imaging findings in fetuses with congenital heart disease. Our results suggest that brain abnormalities are prevalent but relatively mild antenatally in fetuses with congenital heart disease. The long-term predictive value of these findings awaits further study.

Brain injury is a major complication in neonates with complex congenital heart disease (CHD).^1,2 During the past decade, a growing body of evidence has demonstrated the high prevalence of preoperative brain imaging abnormalities in neonates with CHD, suggesting an antenatal origin in many cases.^3–6 More recently, our group has used quantitative MR imaging to demonstrate a progressive third-trimester deceleration in volumetric brain growth and metabolism in fetuses with CHD,⁷ reduced volumes of gray (cortical and subcortical) and white matter, and significant delays in cortical gyrification and surface area in fetuses with hypoplastic left-heart syndrome (HLHS).⁸ To date, there is only 1 published report of brain findings in fetuses with CHD by using conventional MR imaging.⁹ This retrospective chart review of 53 cases reported a 39% incidence of brain anomalies in fetuses with CHD. Taken together, preliminary evidence suggests that fetuses with CHD are at risk of brain abnormalities, including delayed maturation and brain injury. However, to date, no study has prospectively ascertained the frequency and nature of brain abnormalities by conventional MR imaging in fetuses with CHD. The primary objective of this study was to determine the prevalence and spectrum of brain abnormalities detected on conventional clinical MR imaging in fetuses with complex CHD and, second, to compare the CHD cohort with a control group of fetuses from healthy pregnancies.     

Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging

This study compares quantitative and qualitative information on global and regional left ventricular (LV) function obtained with multidetector-row computed tomography (MDCT) with that obtained with magnetic resonance imaging (MRI) in patients with a high prevalence of LV wall motion abnormalities. Thirty patients (19 male, 63.7+/-15.1 years) with myocardial infarction (n=12), coronary artery disease (n=9), arrhythmogenic right ventricular cardiomyopathy (n=6), and dilation cardiomyopathy (n=3) were included. Segmental LV wall motion (LV-WM) was assessed using a 4-point scale. Wall thickness measurements were calculated in diastolic and systolic short axis images. Two hundred and fifty-two out of 266 (94.7%) normal and 189 out of 214 (88.3%) segments with decreased wall motion were correctly identified by MDCT, yielding a sensitivity of 88% and specificity of 95% for identification of wall motion abnormalities. LV-WM scores were identical in 86.7% of 480 segments (kappa=0.809). MDCT had a tendency to underestimate the degree of wall motion impairment. Interobserver agreement was lower in MDCT (66.5%) than in MRI (89.1%; p<0.01). Normokinetic segments are reliably identified with MDCT. Sensitivity for detection and accurate classification of LV wall motion abnormalities need to be improved. Better temporal resolution of the CT system seems to be the most important factor for enhancing MDCT performance.     

Relation between exercise-induced ventricular arrhythmias and myocardial perfusion abnormalities in patients with intermediate pretest probability of coronary artery disease

The significance of exercise-induced ventricular arrhythmias (VAs) is largely dependent on the clinical characteristics of the studied population. The relation between exercise-induced VAs and myocardial perfusion abnormalities has not yet been evaluated in a homogeneous patient population with intermediate probability of coronary artery disease (CAD). We studied 302 patients (mean age 54+/-9 years, 152 men and 150 women) with intermediate pretest probability of CAD (range=0.25-0.80, mean=0.43+/-0.20) by upright bicycle exercise stress test in conjunction with technetium-99m single-photon emission tomography (SPET) imaging. Exercise-induced VAs (frequent or complex premature ventricular contractions or ventricular tachycardia) occurred in 65 patients (22%). No significant difference was found between patients with and patient without VAs regarding the pretest probability of CAD (0.45+/-0.21 vs 0.43+/-0.20). Patients with exercise-induced VAs had a higher prevalence of perfusion abnormalities (52% vs 26%, P=0.002) and ischaemic electrocardiographic changes (31% vs 16%, P<0.05) compared to patients without VAs. A higher prevalence of perfusion abnormalities in patients with VAs was observed in both men (67% vs 35%, P<0.01) and women (38% vs 16%, P<0.05). However, the positive predictive value of exercise-induced VAs for the presence of myocardial perfusion abnormalities was higher in men than in women (67% vs 38%, P<0.05). The presence of abnormal myocardial perfusion was the only independent predictor of exercise-induced VAs (OR 2.2; 95% CI, 1.2-4.2) by multivariate analysis of clinical and stress test variables. It is concluded that in patients with intermediate pretest probability of CAD, exercise-induced VAs are predictive of a higher prevalence of myocardial perfusion abnormalities in both men and women. However, the positive predictive value of exercise-induced VAs for perfusion abnormalities is higher in men. Because of the underestimation of ischaemia by electrocardiographic changes, exercise-induced VAs should be interpreted as a marker of a higher probability of CAD.