Nuklearmedizin 1993; 32(03): 120-127
DOI: 10.1055/s-0038-1629653
Originalarbeiten
Schattauer GmbH

Early and Late Effects of rt-PA vs Placebo on Left Ventricular Function Measured by Nuclear Ventriculography

L. Mortelmans
1   From the Department of Nuclear Medicine
,
I. Scheys
2   The Department of Epidemiology, Biostatistical Centre
,
T. Brzostek
3   The Department of Cardiology, and
,
E. Lesaffre
2   The Department of Epidemiology, Biostatistical Centre
,
M. De Roo
1   From the Department of Nuclear Medicine
,
M. Verstraete
4   The Centre for Thrombosis and Vascular Research, University Hospital Leuven, Belgium
,
H. De Geest
3   The Department of Cardiology, and
,
F. Van de Werf
3   The Department of Cardiology, and
› Institutsangaben
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Publikationsverlauf

Received: 21. Juli 1992

13. November 1992

Publikationsdatum:
03. Februar 2018 (online)

Summary

The aim of the study was the functional re-evaluation of 296 patients 12 to 18 months after a double-blind trial evaluating the effect of tissue plasminogen activator (rt-PA) versus placebo given within 5 h of onset of symptoms caused by an acute myocardial infarction. All patients underwent rest-stress radionuclide angiography (Egna). For each exercise level the global left ventricular ejection fraction (LVEF) was calculated together with an estimate of regional wall motion abnormalities (RWMA). A clear difference of the total workload and the peak workload was found between both therapeutic groups. Discriminant analysis evaluating four parameters (LVEF at peak exercise and at the endpoint and the workload at those levels) revealed a beneficial therapeutic effect. The RWM at rest showed only a difference in the apico-inferior region. There were less wall motion abnormalities in the treated group. Radionuclide analysis demonstrated a larger functional capacity and a better coordination of myocardial contractility during stress RNA one year after thrombolytic therapy. At rest, no major differences were found between the hospital stage and the follow-up in both therapeutic groups one year later.

Zusammenfassung

Ziel der Studie war die Bewertung der Ventrikelfunktion bei 296 Patienten 12 bis 18 Monate nach dem Doppelblindeinsatz von RTPA im Vergleich zu Plazebo, verabreicht innerhalb von 5 h nach Auftreten eines akuten Myokardinfarkts. Die Äquilibrium-Radionuklid-Ventrikulographie (ÄRNV) wurde in Ruhe sowie nach Belastung durchgeführt. Für jede Belastungsstufe wurden die globale linksventrikuläre Auswurffraktion (GAF) berechnet und Veränderungen der regionalen Wandbewegung (RWB) untersucht. Beide Gruppen unterschieden sich deutlich in bezug auf sowohl die Gesamt- als auch die Spitzenbelastung. Eine Diskriminanzanalyse für maximale GAF und GAF am Endpunkt zusammen mit der Belastung erbrachte in der RTPA-Gruppe eine bessere globale Ventrikelfunktion. Für RWB in Ruhe ergaben sich Differenzen für das apiko-inferiore Segment. In der RTPA-Gruppe waren weniger Wandbewegungsstörungen zu beobachten. Mittels der Belastungs-ÄRNV konnte gezeigt werden, daß ein Jahr nach der thrombolytischen Therapie eine größere Funktionsreserve und eine bessere myokardiale Kontraktilität im Vergleich zum Plazebo vorhanden war. Bei Untersuchungen in Ruhe ergaben sich keine Unterschiede zwischen der Postinfarktperiode und der Kontrolle nach einem Jahr.

 
  • LITERATUR

  • 1 American Psychiatric Association: Diagnostic and statistical manual of mental disorders DSM-IIIR (third edition). Washington: 1987
  • 2 Büll U, Braun H, Ferbert A. et al. Combined SPECT imaging of regional cerebral blood flow (99mTc-hexarnethyl-propylene- amine oxime, HMPAO) and blood volume (99mTc-RBC) to assess regional cerebral perfusion reserve in patients with cerebrovascular disease. Nucl-Med 1988; 27: 51-6.
  • 3 Büll U, Costa DC, Kirsch G. et al. The investigation of dementia with single photon emission tomography. Nucl Med Commun 1990; 11: 823-41.
  • 4 Deisenhammer E, Reisecker F, Leblhuber F. et al. Single-Photon-Emissions-Compu- tertomographie bei der Differentialdiagnose der Demenz. Dtsch Med Wschr 1989; 114: 1639-44.
  • 5 Delcourt K, Binon JP, Detourtchaninoff M, Jacquy J. Abnormalities of left to right regional cerebral blood flow in depressed patients. Eur J Nucl Med 1988; 14: 309.
  • 6 Devous MD, Stokely EM, Bonte FJ. Quantitative imaging of regional cerebral blood flow in man by dynamic single photon tomography. In: Holman BL. eds. Radionuclide imaging of the brain. London: Churchill-Livingston; 1985: 135-62.
  • 7 Domper M, Arbizu J, Garcia MJ. et al. Semiquantitative analysis of brain SPECT. Evaluation of different indexes in Alzheimer’s disease. Eur J Nucl Med 1991; 18: 597.
  • 8 Ebert D, Feistel H, Barocka A. Effects of sleep deprivation on the limbic system and the frontal lobes in affective disorders: a study with Tc-99m-HMPAO SPECT. Psy- chiat Res Neuroimaging 1991; 40: 247-51.
  • 9 Fazekas F, Alavi A, Chawluk JB. et al. Comparison of CT, MR, and PET in Alzheimer’s dementia and normal aging. J Nucl Med 1989; 30: 1607-15.
  • 10 Folstein MF, Folstein SE, McHugh PR. “Mini Mental State” A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975; 12: 189-98.
  • 11 Foster NL, Chase TN, Fedio P. et al. Alzheimer’s disease: focal cortical changes shown by positron emission tomography. Neurology 1983; 33: 961-5.
  • 12 Fukuyama H, Harada K, Yamauchi H. et al. Coronal reconstruction images of glucose metabolism in Alzheimer’s disease. J Neurol Sei 1991; 106: 128-34.
  • 13 Gemmell HG, Sharp PF, Besson JAO. et al. Differential diagnosis in dementia using the cerebral blood flow agent 99mTc HM-PAO. A SPECT study. J Comput Assist Tomogr 1987; 11: 398-402.
  • 14 Grünwald F, Zierz S, Broich K. et al. HMPAO-SPECT imaging resembling Alzheimer-type dementia in mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). J Nucl Med 1990; 31: 1740-2.
  • 15 Grünwald F, Broich K, Hartmann A. et al. Nuklearmedizinische Diagnostik der Demenz vom Alzheimer-Typ. Dtsch Med Wschr 1988; 113: 208-12.
  • 16 Habert MO, Spampinato U, Mas JL. et al. A comparative technetium 99m hexamethyl- propylene amine oxime SPET study in different types of dementia. Eur J Nucl Med 1991; 18: 3-11.
  • 17 Hachinski VC, Iliff LD, Chiak E. et al. Cerebral blood flow in dementia. Arch Neurol 1975; 32: 632-7.
  • 18 Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiat 1960; 23: 56-62.
  • 19 Hoffmann JM, Hanson MW, Earl NL, Coleman RE. Beware the classic FDG-PET pattern of Alzheimer’s disease. J Nucl Med 1990; 31: 740.
  • 20 Holman BL, Johnson KA, Gerada B, Carvalho PA, Satlin A. The scintigraphic appearance of Alzheimer’s disease: a prospective study using technetium-99m-HMPAO SPECT. J Nucl Med 1992; 33: 181-5.
  • 21 Horn R, Broich K, Grünwald F, Möller HJ. HMPAO-SPECT findings in various states of dementia of Alzheimer’s disease. Clin Neuropharm 1992; 15 (Suppl. 01) 471B.
  • 22 Horn R, Erkwoh R, Broich K. et al. Contribution of HM-PAO-SPECT and 133Xe- rCBF to the differential diagnosis of dementia as experienced in clinical practice. In Hartmann A, Kuschinsky W, Hoyer S. eds. Cerebral ischemia and dementia. Berlin – Heidelberg: Springer; 1991: 316-21.
  • 23 Hurwitz TA, Ammann W, Chu D. et al. Single photon emission computed tomography using 99mTc-HM-PAO in the routine evaluation of Alzheimer’s disease. Can J Neurol Sei 1991; 18: 59-62.
  • 24 Jobst KA, Smith AD, Shepstone BJ. et al. Ante mortem diagnosis of Alzheimer’s disease using a combination of CT scan and SPET scan measures: a study with post mortem confirmation. Eur J Nucl Med 1992; 19: 616.
  • 25 Klemm E, Grünwald F, Overbeck B. et al. HMPAO-SPECT in schizophrenia and depression. J Nucl Med 1992; 33: 972.
  • 26 Kuhs H. Depression und Demenz. Dtsch Ärztebl 1992; 89: 1585-8.
  • 27 Kurz A, Haupt M, Romero B. et al. Kognitive Störungen bei Depression oder beginnende Alzheimersche Krankheit? Ein Beitrag zur Differentialdiagnose. Z Geronto- psychol Psychiat 1991; 04: 35-40.
  • 28 Kuwabara Y, Ichiya Y, Otsuka M. et al. Differential diagnosis of bilateral parietal abnormalities in 1-123 IMPF SPECT imaging. Clin Nucl Med 1990; 15: 893-9.
  • 29 Loewenstein DA, Barker WW, Chang J. et al. Predominant left hemisphere metabolic dysfunction in dementia. Arch Neurol 1989; 46: 146-52.
  • 30 Mignecq O, Darcourt J, Aubin V. et al. Major role of right temporal lobe (RT) involvement in Alzheimer type dementia (ATD). Eur J Nucl Med 1991; 18: 570.
  • 31 Miller BL, Lesser IM, Mena I. et al. Regional cerebral blood flow in late-life-onset psychosis. Neuropsychiat Neuropsychol Behav Neurol 1992; 05: 132-7.
  • 32 Miller BL, Mena I, Daly J. et al. Temporalparietal hypoperfusion studied with singlephoton emission computerized tomography in conditions other than Alzheimer’s disease. Dementia 1990; 01: 41-5.
  • 33 O’Connell RA, van Heertum RL, Billick SB. et al. Single photon emission computed tomography (SPECT) with 123I-IMP in the differential diagnosis of psychiatric disorders. J Neuropsych 1989; 01: 145-53.
  • 34 O’Connell RA, van Heertum RL, Holt AR. et al. Single photon emission computed tomography (SPECT) in psychiatry. Clin Nucl Med 1987; 12 (Suppl. 13) 9.
  • 35 Okazaki Y, Hashikawa K, Tanabe H. et al. Significance of measurement of hippocampal blood flow in the diagnosis of Alzheimer disease: survey by means of SPECT images longitudinally parallel to the hippocampus. J Nucl Med 1992; 33: 940.
  • 36 Perani D, DiPiero V, Vallar G. et al. Tech- netium-99m-HM-PAO-SPECT study of regional cerebral perfusion in early Alzheimer’s disease. J Nucl Med 1988; 29: 1507-14.
  • 37 Podreka I, Suess E, Brücke T. et al. SPECT- Untersuchungen mit 99mTc-Hexamethyl- Propylen-Amin-Oxim (99mTc-HMPAO) beim Parkinson-Syndrom und bei Demenz. Nucl-Med 1987; 26: 96-9.
  • 38 Prohovnik G, Alexander E, Tatemichi TK, Mayeux R. Exploring the nature of the parietotemporal perfusion deficit in Alzheimer’s disease. J Cereb Blood Flow Metab 1991; (Suppl. 02) 11: 179.
  • 39 Rush AJ, Schlesser MA, Stokely EM. et al. Cerebral blood flow in depression and mania. Psychopharmacol Bull 1982; 18: 6-8.
  • 40 Van Heertum RL, O’Connell RA. The evaluation of psychiatric diseases with IMP cerebral SPECT imaging. Adv Function Neuroimaging 1988; 01: 4-11.
  • 41 Weinstein HC, van Gool WA, Hijdra A, van Royen EA. Effect of cerebral atrophy on semiquantitative analysis of SPECT in Alzheimer’s disease. Eur J Nucl Med 1990; 16: 523.
  • 42 Wellman HN, Kapuscinski A, Mock BH. et al. Clinical application of single-photon- emission computed tomography studies in dementia. Am J Physiol Imag 1988; 03: 61-2.
  • 43 Yazici K, Kapucu LÖ, Erbas B. et al. A preliminary report of a study on regional cerebral blood flow changes in major depressive patients using 99mTc-HMPAO/ SPECT. Eur J Nucl Med 1991; 18: 611.
  • 44 Yessavage JA, Brink TL, Rose TL. et al. Development and validation of a new geriatric depression rating scale: preliminary report. J Psychiat Res 1983; 17: 37-49.
  • 45 Zimmer R, Lauter H. Zum Problem der depressiven Pseudodemenz. Z Gerontol 1984; 17: 109-12.
  • 46 Zimmer R, Rädler T, Schmauss F, Gebhardt U. Die diagnostische Relevanz der Hirndurchblutungsmessung mittels HMPAO-SPECT bei der Alzheimerschen Krankheit. Fortschr Neurol Psychiat 1992; 60 (Suppl. 02) 231-2.