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Scintigraphic characterization of Q wave and non-Q-wave acute myocardial infarction
Authors:J M Wahl  A H Hakki  A S Iskandrian  L Yacone
Affiliation:1. National Center for Environmental Assessment, US Environmental Protection Agency, Washington, DC, USA;2. Dept of Pharmacology and Toxicology, University of Louisville, 2363 Valleta Lane, Louisville, KY, USA;3. Eurofins GfA Lab Service, Hamburg, Germany;4. Environmental and Occupational Health Sciences Program, University of Texas School of Public Health, Dallas, TX, USA;5. Wisconsin Division of Public Health, Bureau of Environmental and Occupational Health, 1 West Wilson Street, Room 145, Madison, WI, USA;6. NCI/NIH, Research Triangle Park, NC, USA;1. National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Centre for Kidney Disease, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China;2. Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China;3. Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden;4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;5. Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;6. Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China;7. Department of Nephrology, Sir Run Shaw Hospital affiliated to Zhejiang University School of Medicine, Zhejiang, Hangzhou, China;8. Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, China;9. Department of Nephrology, Shenzhen Second People''s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China;10. Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China;11. Children''s Hospital of Fudan University, China;12. Renal Department and Institute of Nephrology, Sichuan Provincial People''s Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, China;13. Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China;14. Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China;15. Department of Critical Care Medicine, Maoming People''s Hospital, Guangdong Province, China;p. Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Guangdong, China;q. Huizhou Municipal Central Hospital, Guangdong, China;r. Guizhou Provincial People''s Hospital, Guiyang, China;s. Foshan First People''s Hospital, Guangdong, China;t. The Third Affiliated Hospital of Southern Medical University, China;u. Shunde Hospital, Southern Medical University, The First People''s Hospital of Shunde, Guangdong, China;v. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia;w. Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia;1. Department of Medicine, Division of Infectious Disease, Cornell University of Weill Medical College, New York, NY, USA;2. Department of Healthcare Policy & Research, Cornell University of Weill Medical College, New York, NY, USA;1. Innovative Medicine, Kochi Medical School, Kochi University, Kochi, Japan;2. Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
Abstract:This study examines the scintigraphic features of patients in Killip class I or II after acute myocardial infarction (AMI) with relation to ECG changes. The 41 consecutively studied patients (23 men and 18 women) with first AMI were divided into two groups: group 1 (n = 25) had Q wave AMI, and group 2 (n = 16) had non-Q wave AMI. Rest thallium-201 myocardial scintigrams and radionuclide ventriculograms were obtained 10 days (mean) after AMI. The thallium images were divided into 15 segments in three projections and assessed qualitatively and quantitatively. Fixed perfusion defects were present in at least one segment in 23 patients (92%) in group 1 and in eight patients (50%) in group 2 (p = 0.007). All but one patient in group 1 (4%) and three patients in group 2 (19%) had perfusion defects (fixed or reversible). The number of segments with perfusion defects was 5.6 +/- 2.6 in group 1 and 2.9 +/- 2.3 in group 2 (p = 0.002); the peak creatine kinase was 1280 +/- 880 Units/L in group 1 and 360 +/- 340 Units/L in group 2 (p less than 0.001); the left ventricular ejection fraction was 38 +/- 14% in group 1 vs 43 +/- 15% in group 2 (p = NS). Thus fixed perfusion defects are present in 92% of patients with Q waves and in 50% of patients with no Q waves.
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