4.
Huikuri HV, Castellanos A, Myerburg R. Sudden death due to cardiac arryth-
mias. N Engl J Med 2001;345:1473–1482.
5.
Tapanainen J, Still A-M, Airaksinen J, Huikuri H. Prognostic signifigance of
risk stratifiers of mortality, including T wave alternans, after acute myocardial
infarction. J Cardiovasc Electrophysiol 2001;12:645–652.
6.
Airaksinen KE, Tahvanainen KU, Eckberg DL, Niemela¨ MJ, Ylitalo A,
Huikuri HV. Arterial baroreflex impairment in patients during acute coronary
occlusion. J Am Coll Cardiol 1998;32:1641–1647.
7.
Loimaala A, Sievanen H, Laukkanen R, Parkka J, Vuori I, Huikuri HV.
Accuracy of a novel real time microprocessor QRS detector for heart rate
variability assessment. Clin physiol 1999;19:84–88.
8.
Huikuri HV, Valkama JO, Airaksinen KEJ, Seppanen T, Kessler KM,
Takkunen JT, Myerburg RJ. Frequency domain measures of heart rate variability
before the onset of nonsustained and sustained ventricular tachycardia in patients
with coronary artery disease. Circulation 1993;87:1120–1128.
9.
Task Force of the European Society of Cardiology and the North American
Society of Pacing and Electrophysiology. Heart rate variability: standards of
measurements, physiological interpretation, and clinical use. Circulation 1996;
93:1043–1065.
10.
Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, Do D,
Myers J. Heart rate recovery: validation and methodologic issues. J Am Coll
Cardiol 2001;38:1980–1987.
11.
Watanabe J, Thamilarasan M, Blackstone EH, Thomas JD, Lauer MS. Heart
rate recovery immediately after treadmill exercise and left ventricular systolic
dysfunction as predictors of mortality. Circulation 2001;104:1911–1916.
12.
Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate
recovery immediately after exercise as a predictor of mortality. N Engl J Med
1999;341:1351–1357.
13.
Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after
submaximal exercise testing as a predictor of mortality in a cardiovascular
healthy cohort. Ann Intern Med 2000;132:552–555.
14.
Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Layer MS. Heart rate
recovery and treadmill exercise score as predictors of mortality in patient referred
for exercise ECG. JAMA 2000;284:1392–1398.
15.
Niemela¨ MJ, Airaksinen KEJ, Huikuri HV. Effect of beta-blockade on heart
rate variability and mortality after myocardial infarction. Circulation 1992;85:
164–171.
16.
Mortara A, La Rovere MT, Pinna GD, Maestri R, Capomolla S, Cobelli F.
Nonselective beta-adrenergic blocking agent, carvedilol, improves arterial
baroreflex gain and heart rate variability in patients with stable chronic heart
failure. J Am Coll Cardiol 2000;36:1612–1618.
17.
Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality
among high-risk and low-risk patients after myocardial infarction. N Engl J Med
1998;339:489–497.
18.
BHAT Investigators. A randomized trial of propranolol in patients with acute
myocardial infarction. I. Mortality results. JAMA 1982;247:1707–1714.
19.
Packer M, Bristow MR, Cohn J, Colucci WS, Fowler MB, Gilbert EM,
Shusterman NH. The effect of carvedilol on morbidity and mortality in patients
with chronic heart failure. U. S. Carvedilol Heart Failure Study Group. N Engl
J Med 1996;334:1349–1355.
20.
MERIT-HF Study Group. Effect of metoprolol CR/XL in chronic heart
failure: Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart
Failure. Lancet 1999;353:2001–2007.
Composition of Coronary Atherosclerotic Plaques in
Patients With Acute Myocardial Infarction and Stable
Angina Pectoris Determined by Contrast-Enhanced
Multislice Computed Tomography
Alexander W. Leber,
MD
, Andreas Knez,
MD
, Carl W. White,
MD
,
Alexander Becker,
MD
, Franz von Ziegler, Olaf Muehling,
MD
, Christoph Becker,
MD
,
Maximilian Reiser,
MD
, Gerhard Steinbeck,
MD
, and Peter Boekstegers,
MD
M
ultislice computed tomography (CT) allows for
noninvasive detection and quantification of cor-
onary calcium.
1
Recently, it has been demonstrated
that after the intravenous administration of a contrast
agent, noncalcified plaques can also be detected, and
that the CT attenuation correlates well with the plaque
echogenity of intravascular ultrasound.
2
This method
has the potential to provide noninvasive information
about coronary plaque composition and total plaque
burden. Currently, multislice CT-derived data on the
composition of coronary lesions in the entire coronary
system in patients with different syndromes of coro-
nary artery disease are still lacking. In the present
study, we examined whether multislice CT allows
determination of differences of plaque burden and
plaque composition in patients with acute myocardial
infarction (AMI) and stable angina pectoris (SAP).
•••
We included 40 patients who were referred to our
institution for coronary angiography because of an AMI
or typical SAP. The AMI group (group I) consisted of 21
patients who had an AMI as their first presentation of
coronary artery disease within 14 Ϯ 5 days of a multi-
slice CT scan. All patients had ST-segment elevation
infarction. No patient had prior SAP or evidence of
myocardial ischemia. Systemic thrombolysis was pe-
formed in 18 patients. Three patients were treated with
aspirin and heparin only. At the time of referral to our
institution, all patients were stable and symptom free.
Group II consisted of 19 patients with SAP who were
referred to our hospital for coronary angiography due to
typical SAP. These patients fullfilled all of the following
criteria: no history of coronary artery disease; abnormal
functional test for ischemia; duration of symptoms for
Ͼ2 months with no change in intensity and character of
symptoms; and no changes on the electrocardigram
proving myocardial scarring. All contrast-enhanced CT
scans were screened for a myocardial scar. The average
duration of angina in the SAP group was 5 Ϯ 2 months.
Patients with atrial fibrillation, renal insufficiency, and an
impaired ejection fraction (Ͻ60%) were excluded from
this study. The study was approved by the local ethics
committee and all patients gave informed consent to the
investigation. The clinical characteristics and parameters
for both groups are given in Table 1.
Catheterization was performed by the transfemoral
From the Department of Cardiology and Institute for Diagnostic Radi-
ology, Klinikum Grosshadern, University of Munich, Munich, Ger-
many; and Division of Cardiology, University of Minnesota, Minneap-
olis, Minnesota. Dr. Leber’s address is: University of Munich, Klinikum
Grosshadern, Medizinische Klinik I, Marchioninistraße 15, 81377
Mu¨nchen, Germany. E-mail: aleber@helios.med.uni-muenchen.de.
Manuscript received September 24, 2002; revised manuscript re-
ceived and accepted November 11, 2002.
714
©2003 by Excerpta Medica, Inc. All rights reserved. 0002-9149/03/$–see front matter
The American Journal of Cardiology Vol. 91 March 15, 2003 doi:10.1016/S0002-9149(02)03411-2