Phenylalkyl 1,2-diamines as sigma receptor ligands: The discovery of novel anti-depressant agents

This article focuses on the study of phenylalkyl 1,2-diamines as sigma-receptor ligands for the discovery of antidepressant agents. We synthesized N-chain substituted phenylalkyl 1,2-diamine derivatives. Phenylalkyl 1,2-diamines are one of the most important class of therapeutical medicines useful in managing central nervous system diseases and have been used mainly to treat obesity, narcolepsy, minimal brain dysfunction, and mild depression. In the present study, we found that phenylalkyl 1,2-diamine and amide compounds were strongly bound to the sigma-receptors and showed a potent activity of mice forced swimming test. Our article, after briefly outlining the background and nature of sigma-receptor ligands, explores the antidepressant activity of phenylalkyl 1,2-diamines.

Hepatic corticosteroid-binding globulin (CBG) messenger RNA expression and plasma CBG concentrations in young pigs in response to heat and social stress1,2

Plasma cortisol, porcine corticosteroid-binding globulin (pCBG), hepatic CBG expression, and other physiological and behavioral measures of stress were studied in pigs in response to elevated temperature in conjunction with establishing a social hierarchy. Twenty-four crossbred pigs were weaned at 25 d of age (three or six pigs from six sows) and housed in littermate groups at 23 +/- 2 degrees C. At 57 d of age (d 0), animals were weighed and placed under general anesthesia for collection of blood (10 mL) and liver (approximately 100 mg) samples. On d 1, three unacquainted pigs of similar BW (23 +/- 1 kg) from different litters were allotted to each of eight nursery pens within two environmentally controlled rooms (12 pigs per room). From d 1 to 7, one room was maintained at 23 +/- 2 degrees C (CON) and the other at 33 +/- 2 degrees C (HEAT). Both rooms were kept at 23 +/- 2 degrees C from d 8 to 14. Animals were videotaped for 72 h beginning on d 1 and 8 to document behavioral changes in response to room temperature. The social hierarchy of pigs within each pen was based on fight activity recorded on d 1 to 3. Blood and liver tissue were collected again on d 7 and 14. The ADG for HEAT pigs increased (P < 0.05) over d 8 to 14 compared with d 1 to 7. In contrast to CON pigs, HEAT pigs displayed increased (P < 0.01) drinking but decreased feeding and lying in contact with other pigs from d 1 to 3, and similar drinking and feeding but increased (P < 0.01) lying with contact behaviors from d 8 to 10. With the exception of subordinate pigs exhibiting less (P < 0.05) frequent standing/walking behavior than the dominant or intermediate pigs on d 1 to 3, frequency of behaviors for both recorded time periods did not differ among pigs due to social status, regardless of treatment. The concentration of plasma haptoglobin in HEAT pigs on d 7 compared with d 0 increased (467 vs. 763 mg/L; P < 0.05), whereas cortisol and pCBG decreased (274 vs. 235 nmol/L and 11.4 vs. 9.9 mg/L, respectively; P < 0.05) as a result of treatment. The free cortisol index (total cortisol/pCBG) was greater (P < 0.05) in HEAT pigs on d 14 than on d 0 or 7. Hepatic CBG mRNA level was not affected by treatment. On d 14, HEAT pigs had plasma cortisol, pCBG, and haptoglobin concentrations similar to those of CON pigs. These results indicate that measured behavioral and physiological responses were not related to social status, and decreased circulating levels of cortisol and pCBG in pigs following a 7-d exposure to elevated temperature may not be determined by hepatic CBG mRNA expression.

Which types of stent, uncovered or covered, should be used in gastric outlet obstructions?

BACKGROUND

Self-expandable metallic stents (SEMS) have been widely used in inoperable malignant gastric outlet obstructions, but stent obstructions caused by tumor ingrowth and migration are a major problem of SEMS. The aims of this study were to assess the rate of stent restenosis, to identify lesion characteristics related to early restenosis by tumor ingrowth, and, in particular, to find suitable patient groups for uncovered or covered stents at first implantation.

METHODS

Forty-nine patients were reviewed: stomach cancer in 34 patients, primary duodenal cancer in 3 patients, pancreatic cancer in 5 patients, and common bile duct cancer in 7 patients. In principle, uncovered stents were initially placed at the time when obstruction symptoms occurred and the endoscope would not pass through. Stent obstruction due to tumor ingrowth within 4 weeks after the first stent implantation was regarded as early stent restenosis.

RESULTS

Technical success was seen in 49/49 patients (100%). Migration did not occur. Stent obstructions caused by tumor overgrowth were found in 2/49 patients (4.1%) after 1 month. Stent obstructions caused by tumor ingrowth occurred in 14/49 patients (28.5%), and 7 of them (14.3%) were found to have early restenosis. The only statistically significant factor for early restenosis was stenosis site, and early restenosis was more frequent in the postoperative anastomosis site in the current study; a) 2/18 antropyloric obstructions (11.1%), b) 1/15 pyloric and duodenal bulb obstructions (6.7%), c) 0/10 duodenal second portion obstructions (0%), and d) 4/6 postoperative anastomosis site obstructions (66.7) (P < 0.05, 95% CI 0.003-0.005).

CONCLUSIONS

Uncovered stents are technically feasible and effective for most malignant gastric outlet obstructions. However, because of frequent early restenosis among patients with postoperative anastomosis site obstructions, the placement of covered or simultaneous dual stents to prevent early restenosis should be considered when stenting postoperative anastomosis site obstructions.

Partial nucleotide sequence of the porcine corticosteroid-binding globulin (CBG) cDNA and specification of CBG expression sites in postnatal pigs

The purpose of this study was to develop a porcine CBG cDNA probe in order to examine the porcine CBG mRNA expression in major tissues from the postnatal pig. The reverse transcriptase-polymerase chain reaction (RT-PCR) was conducted to develop the porcine CBG cDNA probe using total RNA extracted from liver of 40-day-old pig. The RT-PCR product was subcloned into the pGEM vector (Promega, Madison, WI) and subjected to restriction enzyme treatments and DNA sequencing. Northern blot analysis was conducted using total RNA extracted from samples (approximately 200 mg) of liver, lung, kidney, and whole adrenal tissue that were collected from pigs on day 3 (n = 2) or day 40 (n = 2) postpartum. A 500 bp partial porcine CBG cDNA encoded 166 amino acids and had 83, 78, and 77% homology to a 494-nucleotide sequence of CBG from sheep, human, and rabbit, respectively. The deduced peptide sequence of the partial porcine CBG showed 77, 62, 60, and 51% homology to sheep, human, rabbit, and rat CBG sequences, respectively. An approximately 1.53 kb CBG mRNA was detected only in the liver tissue. In conclusion, the development of a partial CBG cDNA for swine makes it possible to study the ontogeny and the regulation of CBG synthesis at the molecular level and, based on tissues examined in this study, the liver appears to be the primary source of CBG biosynthesis in the postnatal pig.

Life on carbon monoxide: X-ray structure of Rhodospirillum rubrum Ni-Fe-S carbon monoxide dehydrogenase

A crystal structure of the anaerobic Ni-Fe-S carbon monoxide dehydrogenase (CODH) from Rhodospirillum rubrum has been determined to 2.8-A resolution. The CODH family, for which the R. rubrum enzyme is the prototype, catalyzes the biological oxidation of CO at an unusual Ni-Fe-S cluster called the C-cluster. The Ni-Fe-S C-cluster contains a mononuclear site and a four-metal cubane. Surprisingly, anomalous dispersion data suggest that the mononuclear site contains Fe and not Ni, and the four-metal cubane has the form [NiFe(3)S(4)] and not [Fe(4)S(4)]. The mononuclear site and the four-metal cluster are bridged by means of Cys(531) and one of the sulfides of the cube. CODH is organized as a dimer with a previously unidentified [Fe(4)S(4)] cluster bridging the two subunits. Each monomer is comprised of three domains: a helical domain at the N terminus, an alpha/beta (Rossmann-like) domain in the middle, and an alpha/beta (Rossmann-like) domain at the C terminus. The helical domain contributes ligands to the bridging [Fe(4)S(4)] cluster and another [Fe(4)S(4)] cluster, the B-cluster, which is involved in electron transfer. The two Rossmann domains contribute ligands to the active site C-cluster. This x-ray structure provides insight into the mechanism of biological CO oxidation and has broader significance for the roles of Ni and Fe in biological systems.

Redox-dependent activation of CO dehydrogenase from Rhodospirillum rubrum

Studies of initial activities of carbon monoxide dehydrogenase (CODH) from Rhodospirillum rubrum show that CODH is mostly inactive at redox potentials higher than -300 mV. Initial activities measured at a wide range of redox potentials (0--500 mV) fit a function corresponding to the Nernst equation with a midpoint potential of -316 mV. Previously, extensive EPR studies of CODH have suggested that CODH has three distinct redox states: (i) a spin-coupled state at -60 to -300 mV that gives rise to an EPR signal termed C(red1); (ii) uncoupled states at <-320 mV in the absence of CO(2) referred to as C(unc); and (iii) another spin-coupled state at <-320 mV in the presence of CO(2) that gives rise to an EPR signal termed C(red2B). Because there is no initial CODH activity at potentials that give rise to C(red1), the state (C(red1)) is not involved in the catalytic mechanism of this enzyme. At potentials more positive than -380 mV, CODH recovers its full activity over time when incubated with CO. This reductant-dependent conversion of CODH from an inactive to an active form is referred to hereafter as "autocatalysis." Analyses of the autocatalytic activation process of CODH suggest that the autocatalysis is initiated by a small fraction of activated CODH; the small fraction of active CODH catalyzes CO oxidation and consequently lowers the redox potential of the assay system. This process is accelerated with time because of accumulation of the active enzyme.

Redox-dependent CO2 reduction activity of CO dehydrogenase from Rhodospirillum rubrum

Carbon monoxide dehydrogenase (CODH) from Rhodospirillum rubrum catalyzes both the oxidation of CO and the reduction of CO(2). Studies of the redox dependence of CO(2) reduction by R. rubrum CODH show that (1) CODH is unable to catalyze CO(2) reduction at potentials greater than -300 mV; (2) the maximum activity is observed at potentials less than -480 mV; and (3) the midpoint potential (E(m)) of the transition from minimum to maximum CO(2) reduction activity occurs at approximately -339 mV. These results indicate that the C(red1) state of R. rubrum CODH (E(m) = -110 mV; g(zyx)() = 2.03, 1.88, 1.71) is not competent to reduce CO(2). Nernst analyses suggest that the reduction of CODH from the C(red1) state to the CO(2)-reducing form (C(unc), g(zyx)() = 2.04, 1.93, 1.89; E < approximately -300 mV) of the enzyme is a one-electron process. For the entire redox range, viologens stimulate CO(2) reduction by CODH more than 50-fold, and it is proposed that viologens accelerate the redox equilibration of redox buffers and [Fe(4)S(4)](B) during catalysis.

Evidence for a ligand CO that is required for catalytic activity of CO dehydrogenase from Rhodospirillum rubrum

Radiolabeling studies support the existence of a nonsubstrate CO ligand (CO(L)) to the Fe atom of the proposed [FeNi] cluster of carbon monoxide dehydrogenase (CODH) from Rhodospirillum rubrum. Purified CODH has variable amounts of CO(L) dissociated depending on the extent of handling of the proteins. This dissociated CO(L) can be restored by incubation of CODH with CO, resulting in a 30-40% increase in initial activity relative to as-isolated purified CODH. A similar amount of CO(L) binding is observed when as-isolated purified CODH is incubated with (14)CO: approximately 0.33 mol of CO binds per 1 mol of CODH. Approximately 1 mol of CO was released from CO-preincubated CODH upon denaturation of the protein. No CO could be detected upon denaturation of CODH that had been incubated with cyanide. CO(L) binds to both Ni-containing and Ni-deficient CODH, indicating that CO(L) is liganded to the Fe atom of the proposed [FeNi] center. Furthermore, the Ni in the CO(L)-deficient CODH can be removed by treatment with a Ni-specific chelator, dimethylglyoxime. CO preincubation protects the dimethylglyoxime-labile Ni, indicating that CO(L) is also involved in the stability of Ni in the proposed [FeNi] center.

Long-term outcome of patients with intermediate-risk exercise electrocardiograms who do not have myocardial perfusion defects on radionuclide imaging

BACKGROUND

The appropriate management of patients with intermediate-risk Duke treadmill scores is not established. The purpose of this study was to determine the long-term risk of subsequent cardiovascular events in patients with an intermediate-risk treadmill score who do not have myocardial perfusion defects on radionuclide imaging.

METHODS AND RESULTS

The existing databases of the nuclear cardiology laboratories of 4 academic institutions were searched retrospectively. A total of 4649 patients were identified who had intermediate-risk Duke treadmill scores (-10 to 4), normal or near-normal exercise single photon-emission computed tomographic myocardial perfusion images using either thallium-201 or technetium-99m sestamibi, and no previous coronary revascularization. Follow-up was 95% complete. Cardiovascular survival was 99.8% at 1 year, 99.0% at 5 years, and 98.5% at 7 years. Cardiac survival free of myocardial infarction was similarly high at 96.6% at 7 years. Cardiac survival free of myocardial infarction or revascularization was 87.1% at 7 years. Near-normal scans and cardiac enlargement were independent predictors of time to cardiac death. Seven-year cardiac survival was still high at 97.0% in the 357 patients with near-normal scans and normal cardiac size and somewhat lower, at 89.0%, in the 167 patients with cardiac enlargement.

CONCLUSIONS

Patients with an intermediate-risk treadmill score but with normal or near-normal exercise myocardial perfusion images and normal cardiac sizes are at low risk for subsequent cardiac death and can be safely managed medically until their symptoms warrant revascularization. The appropriate management of patients with cardiac enlargement will remain a matter of clinical judgment.

Comparison of dobutamine echocardiography, dobutamine sestamibi, and rest-redistribution thallium-201 single-photon emission computed tomography for determining contractile reserve and myocardial ischemia in ischemic cardiomyopathy

Both dobutamine stress echocardiography (DSE) and myocardial perfusion scintigraphy are used to assess myocardial viability. Few studies have compared the data on myocardial viability and ischemia by low and peak dose DSE and myocardial perfusion imaging in the same patients. Fifty-four patients (45 men and 9 women aged 65 +/- 9 years) with ischemic cardiomyopathy (mean ejection fraction 24 +/- 9%) underwent rest 4-hour redistribution thallium-201 single-photon emission computed tomography (SPECT), low and peak dose DSE, and dobutamine sestamibi SPECT. A total of 864 segments were analyzed (16 segments/patient). Wall motion abnormality was present in 796 segments (92%), and contractile reserve during dobutamine infusion was seen in 400 of these segments (50%). Contractile reserve was seen in 331 of 509 hypokinetic segments (65%) and 69 of 287 akinetic/dyskinetic segments (24%) (p <0.001). Contractile reserve was more frequent in segments with normal thallium uptake (64%), reversible thallium defects (42%), or mild to moderate fixed thallium defects (48%) than severely fixed defects (22%) (p <0.05 each). Concordant information about viability by thallium imaging and DSE was obtained in 62% of segments. Dobutamine sestamibi ischemia was seen in 518 of 796 segments (65%) compared with 265 segments (33%) by DSE (p <0.001). Scintigraphic ischemia was noted in 126 of 195 segments (65%) demonstrating biphasic response, 129 of 205 segments (63%) showing sustained improvement, 42 of 70 segments (60%) deteriorating during dobutamine infusion, and 221 of 326 (68%) demonstrating no change (p = NS). Thus, in patients with ischemic cardiomyopathy, contractile reserve is more frequent in hypokinetic segments than akinetic/dyskinetic segments. The number of segments with normal or near-normal thallium uptake or with scintigraphic ischemia is significantly greater than the number of those capable of increasing contractile function or demonstrating an ischemic response during dobutamine echocardiography.

Impact of stress single-photon emission computed tomography perfusion imaging on downstream resource utilization

This study shows that in patients with intermediate pretest probability of coronary artery disease stress single-photon emission computed tomography perfusion imaging decreases the rate of coronary angiography and coronary revascularization and is economically a superior strategy to routine coronary angiography.

Comparison of the prognostic value of qualitative versus quantitative stress tomographic perfusion imaging

This study compared qualitative assessment of exercise thallium imaging to quantitative assessment in predicting outcome in 713 patients with 78% prevalence of coronary artery disease by coronary angiography; during a mean follow-up of 52 months, there were 106 hard cardiac events (death or nonfatal myocardial infarction). The qualitative method provided important prognostic information; however, unlike the quantitative technique, less patients were assigned to either the low- or high-risk group and proportionally more patients into the intermediate-risk group, which may limit the clinical usefulness of the technique.

Regulation of 2-carboxy-D-arabinitol 1-phosphate phosphatase: activation by glutathione and interaction with thiol reagents

2-Carboxy-D-arabinitol 1-phosphate (CA1P) phosphatase de- grades CA1P, an inhibitor associated with the regulation of ribulose bisphosphate carboxylase/oxygenase in numerous plant species. CA1P phosphatase purified from Phaseolus vulgaris was partially inactivated by oxidizing conditions during dialysis in air-equilibrated buffer. Phosphatase activity could then be stimulated 1.3-fold by dithiothreitol and also by addition of reduced thioredoxin from Escherichia coli. These effects were enhanced synergistically by the positive effector, fructose 1, 6-bisphosphate (FBP). Most notably, CA1P phosphatase activity was stimulated up to 35-fold by glutathione, and was sensitive to the ratio of reduced (GSH) to oxidized (GSSG) forms. At concentrations of glutathione approximating measured levels in chloroplasts of P. vulgaris (5 mM total S), CA1P phosphatase exhibited >20-fold stimulation by a change in the redox status of glutathione from 60 to 100% GSH. This stimulation was augmented further by reduced E. coli thioredoxin. In contrast, FBP, which activates CA1P phosphatase under reducing conditions, was strongly inhibitory in the presence of GSSG. We propose that glutathione may have an appreciable role in the light/dark regulation of CA1P phosphatase in vivo. A model for the reversible activation of CA1P phosphatase by GSH was derived based upon the various responses of the enzyme's activity to a range of thiol reagents including N-ethylmaleimide, 5, 5'-dithiobis-(2-nitrobenzoic acid) and arsenite. These data indicate that the bean enzyme contains two physically distinct sets of thiol groups that are critical to its redox regulation.

Predictors of outcome of medically treated patients with left main/three-vessel coronary artery disease by coronary angiography

This study examined the prognostic value of single-photon emission computed tomography in angiographically high-risk patients with left main and/or 3-vessel coronary artery disease who were treated medically. Multivariable Cox survival analysis revealed the single-photon emission computed tomography score (based on size of perfusion abnormality, multivessel abnormality, left ventricular dilation, and lung uptake) as the only independent predictor of outcome.

Comparison of the polar maps method and the summed stress score for predicting outcome in medically treated patients with coronary artery disease

This study showed that quantitative analysis of SPECT perfusion images provide comparable prognostic information to summed stress score in medically treated patients with coronary artery disease.

Fasting and nonfasting iodine-123-idophenylpentadecanoic acid myocardial SPECT imaging in coronary artery disease

Iodine-123-labeled idophenylpentadecanoic acid (IPPA) metabolic imaging has been shown to be clinically useful for the identification of myocardial viability in patients with coronary artery disease and left ventricular dysfunction. Imaging is usually performed under fasting conditions since nonfasting conditions may affect myocardial uptake of 123I-IPPA. The purpose of this study was to examine the impact of dietary condition on 123I-IPPA metabolic imaging.

METHODS

Forty patients with stable coronary artery disease underwent, in randomized order and on separate days, 123I-IPPA SPECT myocardial imaging under fasting and nonfasting conditions. Patients were injected with 123I-IPPA (4-5 mCi) at rest with imaging performed at 4 (initial) and 30 (delay) min. For each image (initial and delay images), 10 segments were analyzed by three experienced observers without knowledge of patient identity or dietary condition using a 5-point grading system (O = no uptake to 4 = normal uptake). A summed global score was obtained for each image by adding the scores for all 10 segments. Image quality was assessed using a 3-point grading system.

RESULTS

Visual agreement for normal and abnormal segments between fasting and nonfasting conditions was 82% (kappa = 0.63). There were no significant differences in the summed global scores for both conditions. Image quality was equivalent for both conditions in 65% of cases and superior under the nonfasting condition in 25% of cases.

CONCLUSION

Image quality as well as the presence, location and severity of defects are similar under fasting and nonfasting conditions with 123I-IPPA. Therefore, fasting is not necessary before 123I-IPPA SPECT imaging for the assessment of myocardial viability.

Impact of exercise single-photon emission computed tomographic imaging on appropriateness of coronary revascularization

This study examined the predictors of early coronary revascularization in 816 patients with chest pain syndromes who had coronary artery disease by angiography and exercise single-photon emission computed tomography (SPECT) thallium imaging. Multivariate analysis of clinical, stress, nuclear, and catheterization variables revealed the presence of SPECT reversibility as the most powerful predictor (chi-square = 43) of early revascularization.

Correlation between hemodynamic changes and tomographic sestamibi imaging during dipyridamole-induced coronary hyperemia

OBJECTIVES

The purposes of this study were to examine the effects of dipyridamole infusion on hemodynamic variables and to compare these changes with myocardial perfusion.

BACKGROUND

Dipyridamole stress testing with myocardial perfusion imaging is widely used in the assessment of patients with known or suspected coronary artery disease (CAD). Few studies, however, have correlated the hemodynamic effects of dipyridamole using invasive monitoring with perfusion patterns in patients with chest pain syndromes.

METHODS

Hemodynamic measurements were made in the cardiac catheterization laboratory with a Swan-Ganz thermodilution catheter before, during and after infusion of dipyridamole (142 microg/kg body weight per min for 4 min). Technetium-99m sestamibi was injected 3 min after the completion of the infusion.

RESULTS

There were 20 patients with and 6 without CAD, as demonstrated by angiography. Compared with baseline values, dipyridamole resulted in an increase in pulmonary capillary wedge pressure (54 +/- 78% vs. 32 +/- 26%, p = NS), cardiac index (36 +/- 21% vs. 40 +/- 18%, p = NS) and stroke volume index (16 +/- 18% vs. 40 +/- 18%, p = NS) and a decrease in systemic vascular resistance (22 +/- 13% vs. 24 +/- 11%, p = NS), aortic pressure (2 +/- 9% vs. 0 +/- 6%, p = NS) and pulmonary vascular resistance (19 +/- 25% vs. 11 +/- 32%, p = NS) in patients with and without CAD. The peak effect of dipyridamole on heart rate, systemic vascular resistance and pulmonary capillary wedge pressure was evident at 3 min after infusion in 70% of patients. Aminophylline, given to 20 patients, improved hemodynamic variables within 2 min. The single-photon emission computed tomographic sestamibi images were normal in the 6 patients without and abnormal in the 18 patients with CAD.

CONCLUSIONS

Dipyridamole-induced coronary hyperemia produces mild hemodynamic changes in patients with and without CAD; these changes are at or near peak effect at 3 min after infusion and are rapidly reversed by aminophylline.

Utility of stress single-photon emission computed tomography (SPECT) perfusion imaging in predicting outcome after coronary artery bypass grafting

Previous studies have examined the predictors of outcome in medically treated patients with coronary artery disease (CAD). There is limited information on predictors of outcome after coronary artery bypass grafting (CABG). This study examined the predictors of outcome of 255 patients with CAD, at a mean time of 5 years after CABG for angina pectoris. The 255 patients underwent coronary angiography and stress single-photon emission computed tomography (SPECT) myocardial perfusion imaging after CABG. During a mean follow-up of 41 +/- 28 months after stress testing, there were 34 hard events (24 cardiac deaths and 10 nonfatal myocardial infarctions). The hemodynamics during stress testing, and age and gender were not predictors of events. The SPECT variables of multivessel perfusion abnormality, perfusion deficit size, and increased lung thallium uptake were predictors of death and total events by uni- and multivariate survival analysis. There were 14 events in 45 patients (31%) with multivessel abnormality and increased lung thallium uptake, 14 events in 101 patients (14%) with either multivessel abnormality or increased lung uptake, and 6 events in 109 patients (6%) with neither of these 2 variables (p = 0.0001). The annual mortality and total event rates were 7.5% and 9.5% with both variables, 3.4% and 4.3% with either variable, and 0.6% and 1.7% with neither of the variables (p = 0.01). Thus, stress SPECT perfusion imaging is useful to stratify patients after CABG into low, intermediate, and high risk groups for future cardiac events.

Prognostic value of stress myocardial perfusion single photon emission computed tomography imaging in patients with left ventricular bundle branch block

BACKGROUND

Left bundle branch block (LBBB) may occur with or without structural heart disease. In patients with coronary artery disease the presence of LBBB is associated with an increased risk of cardiovascular events.

METHODS AND RESULTS

This study examined the outcome of 293 medically treated patients with LBBB and symptoms who were undergoing stress thallium-201 single photon emission computed tomography imaging. One hundred seventy-three men and 120 women with an age range of 67 +/- 9 years and a pretest probability of coronary artery disease of 77% +/- 28% were studied. During a mean follow-up of 33 months 58 hard cardiac events (death or nonfatal myocardial infarction) and 112 total events (hard events, coronary angioplasty, coronary bypass surgery, or cardiac transplantation) occurred. Univariate and multivariate Cox survival analysis with clinical, stress, hemodynamic, and single photon emission computed tomography variables identified the perfusion defect size (chi square = 27, p = 0.0001) and increased lung thallium uptake as the most important independent predictors of hard or total cardiac events. The hard event-free survival rate was 91% in patients with no or small defects (<15% of left ventricular myocardium) and 72% in patients with large defects (p = 0.0001, RR = 3.2, 95% CI 1.7 to 5.9). The total event-free survival rate was 81% in patients with small defects and 48% in patients with large defects (p = 0.0001, RR = 2.7, 95% CI 1.9 to 4.0). The total event rate was 54% in patients with large perfusion defects and increased lung uptake and 17% in patients with no or small abnormality and normal lung thallium uptake (p = 0.0001).

CONCLUSION

Single photon emission computed tomography perfusion imaging is useful in predicting outcome in patients with LBBB and intermediate pretest probability of coronary artery disease. The size of perfusion abnormality and lung thallium uptake stratified patients into high and low risk groups with a threefold difference in hard and total cardiac events.

Effect of Ca2+ channel blockers, external Ca2+ and phospholipase A2 inhibitors on t-butylhydroperoxide-induced lipid peroxidation and toxicity in rat liver slices

OBJECTIVES

This study was undertaken to examine the effect of oxidant on lipid peroxidation and lethal cell injury in rat liver slices.

METHODS

t-Butylhydroperoxide (t-BHP) was employed as a model of an oxidant. The lipid peroxidation and lethal cell injury were estimated by measuring the formation of malondialdehyde (MDA) and lactate dehydrogenase (LDH) release, respectively.

RESULTS

t-BHP increased lipid peroxidation and LDH release in a dose-dependent manner over concentrations of 0.5-10 mM. t-BHP-induced lipid peroxidation was completely prevented by an antioxidant, N,N-diphenyl-p-phenylenediamine (DPPD), but LDH release was partially decreased. Both t-BHP-induced lipid peroxidation and LDH release were significantly protected by iron chelator, deferoxamine, sulfhydryl reducing agent, dithiothreitol and glutathione. Ca2+ channel blockers, verapamil, diltiazem and nifedipine exerted a significant protective effect against t-BHP-induced lipid peroxidation and LDH release. By contrast, addition of external Ca2+ chelator, ethylene glycol bis(b-aminoethyl ether)-N,N-tetraacetic acid (EGTA) did not alter t-BHP-induced lipid peroxidation, whereas t-BHP-induced lethal cell injury was significantly prevented. Phospholipase A2 (PLA2) inhibitors, mepacrine and butacaine produced a partial protective effect.

CONCLUSIONS

These results suggest that t-BHP induces cell injury by lipid peroxidation-dependent and -independent mechanisms which can be partially prevented by Ca2+ channel blockers and PLA2 inhibitors.

Exercise-rest same-day SPECT sestamibi imaging to detect coronary artery disease

This study examined the results of exercise-rest same-day SPECT protocol in 193 patients, of whom 132 had coronary artery disease (CAD) by angiography (> or = 50% diameter stenosis), and 61 had a low pretest probability of CAD.

METHODS

The rest study was combined with first-pass radionuclide angiography using the multicrystal gamma camera in 72 patients.

RESULTS

The sensitivity of SPECT was 76% (25/33 patients) in patients with one-vessel, 84% in patients with two-vessel (38/45) and 98% in patients with three-vessel CAD (53/54) (P = 0.01 versus one- or two-vessel CAD). The sensitivity of SPECT in patients with CAD was higher than ST depression (88% versus 28%, P = 0.001). The exercise was submaximal in 53 patients (40%). The perfusion defects were reversible (complete or partial) in 80 patients and fixed in 36 patients. The left ventricular ejection fraction was 50 +/- 12% in patients with reversible defects (n = 44) and 39 +/- 9% in patients with fixed defects (n:19) (P = 0.0004). The normalcy rate in subjects with a low pretest probability of CAD was 95% (53 of 61 subjects).

CONCLUSION

The exercise-rest same-day sestamibi protocol provides high diagnostic accuracy for CAD detection. The protocol may eliminate the need for rest studies in patients with normal exercise images, help improve laboratory throughput and lower costs.

Prediction of outcome of patients with life-threatening ventricular arrhythmias treated with automatic implantable cardioverter-defibrillators using SPECT perfusion imaging

BACKGROUND

In the present study, we examined the predictors of outcome of 103 patients with coronary artery disease and left ventricular dysfunction who had life-threatening ventricular arrhythmias and were treated with implantable cardioverter-defibrillators with the use of single-photon emission computed tomography (SPECT).

METHODS AND RESULTS

During a mean follow-up of 29 months, there were 29 cardiac deaths. In comparison with patients who died, survivors had less diabetes mellitus (45% versus 19%, P < .007), higher left ventricular ejection fraction (23 +/- 9% versus 27 +/- 11%, P = .04), and fewer perfusion defects as determined with stress SPECT (15 +/- 5 versus 12 +/- 5, P < .004). Most of the perfusion defects were fixed, indicative of scarring; the extent of reversible defects did not differ (2 +/- 3 in survivors and 3 +/- 4 in nonsurvivors). Multivariate Cox survival analysis identified the number of fixed defects as the only independent predictor of death (chi 2 = 10, P = .002). There were six deaths among 42 patients (14%) with < 8 fixed defects compared with 23 deaths among 61 patients (38%) with > or = 8 defects (P = .005). The 4-year survival was better in patients with < 8 segmental fixed defects than in those with > or = 8 fixed defects (80% versus 36%) (chi 2 = 8, P = .005).

CONCLUSIONS

The myocardial perfusion pattern is an important determinant of outcome in patients with life-threatening ventricular arrhythmias who are treated with a implantable cardioverter-defibrillator. The extent of scarring separates patients into high- and low-risk groups with a 2.7-fold difference in death rate.

Myocardial viability: methods of assessment and clinical relevance

Myocardial hibernation is hypoperfused dysfunctional myocardium that has the potential to recover function after coronary revascularization. Although recovery of regional function after revascularization is the gold standard for assessing the diagnostic accuracy of various techniques, improvements of EF, symptoms, and survival are fundamental end points. Despite important differences in the markers of viability by positron-emission tomography, single-photon emission tomography, two-dimensional echocardiography, and magnetic resonance imaging, their positive and negative predictive values in nonrandomized studies are fairly comparable. Assessment of myocardial viability may be clinically important in many patients but especially in those with EF < 30% and congestive heart failure. The degree of improvement in EF after coronary revascularization depends on the extent of hibernation, the suitability of coronary structure for revascularization, the lack of perioperative infarction, the completeness of revascularization, and the long-term patency of grafts.

Dynamic planar myocardial perfusion imaging in patients with one-vessel disease with intracoronary injection of technetium 99m teboroxime during papaverine-induced coronary hyperemia

This study examined the imaging results and kinetics of technetium 99m teboroxime after its intracoronary injection during papaverine-induced coronary hyperemia in patients with one-vessel disease before and after coronary angioplasty. Thirteen patients with > or = 90% diameter stenosis of either the left anterior descending or the left circumflex coronary artery were included. Two patients were excluded because of ventricular tachycardia during papaverine injection in one patient and unsuccessful angioplasty in the second patient. One mCi of technetium 99m teboroxime was injected into the left main coronary artery during coronary hyperemia induced by intracoronary injection of papaverine. Dynamic acquisition in a frame mode (20 sec/frame) was performed for 5 minutes in the left anterior oblique projection with a multicrystal gamma camera before and after successful angioplasty. Ischemic:normal count ratio increased from 0.75 +/- 0.4 before to 1.00 +/- 0.50 after angioplasty (p < 0.1). The T 1/2 of teboroxime was 6.5 +/- 1.5 min in the normal zone and 7.2 +/- 1.9 min in the ischemic zone (p, NS). Perfusion defects were visible in the territory of the stenosed coronary artery in 9 of 11 patients before angioplasty and in 7 of 11 patients after angioplasty. The image quality was excellent in all studies. Thus this study shows that performing dynamic imaging with intracoronary injection of technetium 99m teboroxime is feasible. This technique may be useful to study the impact of angioplasty on coronary flow and tracer kinetics.

Comparison of left ventricular performance in healthy young women and men during exercise

BACKGROUND

Previous studies show sex-related differences in left ventricular (LV) response to exercise. It is not clear, however, whether these differences are also seen in younger healthy subjects.

METHODS AND RESULTS

This study examined the changes in LV performance during dynamic upright exercise in 11 healthy men and 19 healthy young women according to the Bruce protocol and an individualized ramp protocol. There were no significant differences between the two protocols for either men or women in heart rate, blood pressure, LV ejection fraction (EF) (measured by ambulatory nuclear detector), and measured oxygen consumption. The peak oxygen consumption was higher in men than in women (44 +/- 13 vs 36 +/- 9 ml/kg/min; p < 0.05), but the peak heart rate, systolic blood pressure, and EF were similar. The change in EF (from rest to exercise) was 19% +/- 8% in men and 19% +/- 11% in women with the Bruce protocol (difference not significant) and 26% +/- 9% in men and 19% +/- 6% in women with the ramp protocol (difference not significant). At peak exercise, both men and women showed an increase in end-diastolic volume (29% +/- 14% vs 23% +/- 11%; difference not significant) and a decrease in end-systolic volume (41% +/- 15% vs 43% +/- 21%) (difference not significant). The increase in cardiac output during exercise was due to an increase in heart rate and stroke volume in both men and women. At submaximal exercise, however, the decrease in end-systolic volume was less in women than in men (p < 0.05).

CONCLUSIONS

There are no sex-related differences in compensatory mechanism during dynamic exercise in healthy subjects. The changes in contractility and LV volume are not affected by the exercise protocol.

Prognostic value of simultaneous perfusion and function assessment using technetium-99m sestamibi

This study examines the prognostic value of simultaneous perfusion and function assessment in 412 patients. The exercise perfusion pattern was a stronger predictor of events (mostly acute nonfatal myocardial infarcts) than resting ejection fraction.

Early postoperative rise in defibrillation threshold in patients with nonthoracotomy defibrillation lead systems: attenuation with biphasic shock waveforms

INTRODUCTION

In patients with non-thoracotomy defibrillation lead (NTL) systems coupled with monophasic shock waveforms, the defibrillation threshold (DFT) rises early after implantation. There is little information regarding features predictive of the DFT rise, or DFT changes early after implantation of NTL systems coupled with biphasic shock waveforms.

METHODS AND RESULTS

DFT measurements were performed serially at implantation, prior to hospital discharge (mean 4 +/- 3 days), and at follow-up (mean 49 +/- 22 days) in 146 patients with an NTL system. Factors were assessed for association with a "clinically important" early postimplantation DFT rise, defined as a rise of > or = 2 energy steps (2 to 4 J per step; > or = 5 J total). A clinically important early postimplantation DFT rise occurred in 48 patients (33%). Univariate predictors of the rise included the monophasic shock waveform, the Medtronic Transvene lead system, the presence of a subcutaneous defibrillation patch, and the number of shocks delivered during the implantation procedure. However, the only independent predictor of a clinically important DFT rise was the monophasic shock waveform (F = 18, P < 0.001). For the monophasic patient group (n = 79), the incidence of a DFT rise was 53% (n = 42). For the biphasic patient group (n = 67), the incidence of a DFT rise was 9% (n = 6). The clinical characteristics of the monophasic and biphasic groups were not significantly different, nor were their DFTs at implantation. Among a subgroup of 18 consecutive patients who underwent serial DFT testing utilizing both monophasic and biphasic waveforms, the incidence of a clinically important DFT rise with monophasic (n = 9,50%) was higher than with biphasic shocks (n = 3,17%; P = 0.05).

CONCLUSION

NTL systems coupled with biphasic shock waveforms have an attenuated incidence of a clinically important DFT rise early after implantation, relative to patients with NTL systems coupled to monophasic waveforms.

Prognostic value of tomographic rest-redistribution thallium 201 imaging in medically treated patients with coronary artery disease and left ventricular dysfunction

BACKGROUND

Previous studies show that rest-redistribution thallium imaging is useful in the assessment of myocardial viability. The impact of such studies on patient outcome is not well defined. This study examined the prognostic value of tomographic rest-redistribution 201T1 imaging in 81 medically treated patients with coronary artery disease and left ventricular dysfunction.

METHODS AND RESULTS

Rest-redistribution single-photon emission computed tomographic images were obtained and analyzed quantitatively. The segmental thallium uptake (20 segments per patient) was interpreted as normal, reversible defect, mild to moderate fixed defect, or severe fixed defect. The thallium images were abnormal in 80 patients, with no redistribution (no ischemia) in 43 patients and redistribution (ischemia) in 38 patients. The left ventricular ejection fraction was 27% +/- 8% in patients with no redistribution and 26% +/- 7% in patients with redistribution (difference not significant). In patients with no ischemia, there were 7 +/- 5 severe fixed defects and 5 +/- 4 mild to moderate fixed defects per patient. In patients with ischemia there were 7 +/- 4 reversible defects, 3 +/- 3 mild to moderate fixed defects, and 5 +/- 4 severe fixed defects per patient. The number of any abnormal segments was 11 +/- 5 in patients with no ischemia and 14 +/- 4 in patients with ischemia (p = 0.03). During a mean follow-up of 31 +/- 24 months, there were 11 cardiac deaths in patients with no ischemia (26%) and 22 in patients with ischemia (58%); the survival rate was worse in patients with than without ischemia (p < 0.05). Multivariate Cox survival analysis on important clinical, angiographic, and thallium variables showed that the presence of redistribution was an independent predictor of death (x2 = 5; p = 0.03).

CONCLUSIONS

Patients with left ventricular dysfunction and redistribution on rest thallium imaging, a marker of hibernating myocardium, have a higher mortality rate with medical therapy than do patients with a comparable degree of left ventricular dysfunction but with fixed defects only. Thus observations similar to those made with positron emission tomography can be made in a much more straightforward, simple, and probably cost-effective manner with single-photon emission computed tomography.

Prediction of improvement in left ventricular function with iodine-123-IPPA after coronary revascularization

Iodine-123-phenylpentadecanoic acid (IPPA) is a synthetic fatty acid suitable for myocardial imaging. This study is the result of a Phase I/II trial to evaluate IPPA's ability to predict functional recovery in patients undergoing coronary revascularization.

METHODS

Twenty-three patients with documented coronary disease underwent sequential SPECT imaging with IPPA before and radionuclide ventriculography both before and 8 wk after revascularization. Software was developed to evaluate myocardial IPPA metabolism and to determine the fraction of the left ventricle with intermediate metabolism.

RESULTS

There was a significant correlation between initial IPPA uptake and final LVEF. The fractional area of the left ventricle demonstrating IPPA metabolism in the intermediate metabolic range was significantly higher in patients who demonstrated a 5% or greater increase in EF after revascularization (0.90 +/- 0.08 versus 0.78 +/- 0.17, p = 0.04). When only the patients who received complete revascularization were evaluated, there was a more significant difference (improved 0.92 +/- 0.05 versus 0.74 +/- 0.17, p = 0.011). Taking a lower limit of 1 s.d. from the mean, (87%) the six patients who had > or = 5% increase in LVEF after revascularization had more than 87% of the left ventricle in the intermediate metabolic range, whereas seven of ten patients whose change in LVEF was < 5% had less than 87% in the intermediate metabolic range (p = 0.011).

CONCLUSION

In this initial experience, the amount of myocardium in the intermediate metabolic range is associated with improvement in LVEF after revascularization, especially in patients receiving complete revascularization.

Use of a tantalum-178 generator and a multiwire gamma camera to study the effect of the Mueller maneuver on left ventricular performance: comparison to hemodynamics and single photon emission computed tomography perfusion patterns

During the Mueller maneuver, there is a decrease in intrathoracic pressure and an increase in transmural left ventricular pressure. The changes in loading conditions cause transient left ventricular dysfunction. This study examined the effects of the Mueller maneuver on left ventricular performance using tantalum (Ta)-178 (half-life 9.3 min) and a multiwire gamma camera. First-pass radionuclide angiograms were obtained at baseline and during Mueller maneuver in 41 patients aged 58 +/- 10 years. In 34 patients, stress single photon emission computed tomography (SPECT) myocardial perfusion imaging with thallium-201 or sestamibi was also performed. Hemodynamic measurements during the Mueller maneuver (n = 10) showed a decrease in systemic pressure (139 +/- 25 mm Hg vs 123 +/- 24 mm Hg, p < 0.001) and pulmonary artery pressure (24 +/- 6 mm Hg vs 14 +/- 12 mm Hg, p = 0.01) and an increase in heart rate (67 +/- 10 bpm vs 75 +/- 14 beats/min, p = 0.001). Among the 34 patients who had perfusion imaging, the left ventricular ejection fraction remained unchanged or increased in 17 patients (group 1) (48% +/- 19% vs 49% +/- 21%, p not significant) and decreased (> or = 5%) in 17 patients (group 2) (55% +/- 13% vs 40% +/- 16%, p = 0.001). The stress SPECT images showed no or only fixed defects in 11 (65%) patients in group 1 and 3 (18%) patients in group 2 (p = 0.02), and reversible defects in 6 (35%) patients in group 1 and 14 (82%) patients in group 2 (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Implications of increased lung thallium uptake during exercise single photon emission computed tomography imaging

Increased lung thallium uptake during exercise is an important marker of patients who are at high risk and have CAD; however, most previous studies were done with planar imaging, and therefore it is unclear whether this conclusion is also true with SPECT imaging. This study examined the lung thallium uptake during exercise SPECT imaging in 1031 patients who also underwent coronary angiography. The lung thallium uptake was increased in 309 patients (group 1) and normal in 722 patients (group 2). Compared with patients in group 2, those in group 1 had more ST segment depression (44% vs 28%, p = 0.01), previous Q-wave myocardial infarction (28% vs 17%, p = 0.0001), larger perfusion defects (24% +/- 11% vs 10% +/- 11%, p = 0.0001), and multivessel CAD by angiography (75% vs 47%, p = 0.0001). Multivariate discriminant analysis identified left ventricular dilation, reversible defects, the size of perfusion abnormality, and the extent of CAD as independent predictors of increased lung thallium uptake. Increased lung thallium uptake was more common in men than women regardless of the extent of CAD: 26% versus 11% in patients with one-vessel, 38% versus 18% in patients with two-vessel, and 51% versus 31% in patients with three-vessel disease (p < 0.001 each). Thus increased lung thallium uptake by SPECT identifies patients with more severe anatomic and functional evidence of CAD. The sex-related difference suggests the need for a sex-specific normal file for quantitative analysis.

Spectroscopic analysis of Tm(3+) in PbO-Bi(2)O(3)-Ga(2)O(3) glass

Tm(3+)-doped heavy metal oxide glasses in the PbO-Bi(2)O(3)-Ga(2)O(3) system were prepared, and their emission characteristics were examined. Three emission bands at the infrared wavelength region were observed, at 1.46, 1.79, and 2.36 µm, which are associated with the (3)H(4) ? (3)F(4), (3)F(4) ? (3)H(6), and (3)H(4) ? (3)H(5), transitions, respectively. Measured fluorescence lifetimes for the first two transitions were 0.160 and 1.035 ms, respectively. Oscillator strengths and intensity parameters suggest that the ionicity of Tm-Obonds in the glass is higher when compared with those in other oxide glass hosts. Higher radiative transition probabilities of the three infrared emissions than those calculated for other glasses appear to provide potentials for future laser applications.