Quantitative Interpretation of Coronary Arteriogram based on Pujadas' Description Kai Tsuiki 1 , Yoshihiko Watanabe 1 , Kimio Saito 1 , Makio Hayasaka 1 , Isao Kubota 1 , Masaki Oguma 1 , Hitomi Suzuki 1 , Ikuro Ohta 1 , Shoji Yasui 1 1The First Department of Internal Medicine, Yamagata University School of Medicine pp.771-778
Published Date 1981/7/15
DOI https://doi.org/10.11477/mf.1404203811
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We proposed a method in which coronary arteriogram can be interpreted in order to deter-mine the severity of coronary artery disease and the functional impairment of regional coronary perfusion in a quantitative sense. Original descrip-tion of Pujadas was so arranged that the severity of each stenosis was assessed by grading from 0 through 5; not only the percentage of narrowing of the lumen diameter, but also the length of each stenosis were taken into account. This grading implies the functional status of coronary perfusion impairment, such that grade 3 is the stenosis that disturbs coronary flow only when a metabolic need requires an increase in the flow through coronary bed, and that a grade more than 3 is the stenosis that disturbs coronary flow even at rest. Pujadas score was defined as a sum of the grade numbers assigned in coronary arterial tree in each patient, asweighted by the dominance determined by the pattern of coronary artery distribution. Pujadas score thus determined was compared with the findings of i) thallium-201 myocardial stress scintigram, ii) treadmill exercise induced changes in body surface ECG map, and iii) left ventri-cular function at rest, in 30 patients with ische-mic heart disease including 11 with old myo-cadial infarction (OMI), and 19 with exertional angina pectoris. All these patients underwent cardiac catheterization and were proved to have significant coronary artery disease.

Myocardial thallium uptake counts were compar-ed on the scintigrams recorded immediately after (0) and 3 hours after (3) the end of ergometer stress test with each other, and washout index (WI) was calculated as counts of (0) divided by those of (3) in each region of interest (ROI). Redistribution index (RDI) was defined as the WI at a ROI divided by the WI at normal region. The area was calculated on body surface ECG map where ST segment was depressed (>=0.lmV) at the end of treadmill exercise test, compared with the ST level before exercise as a reference level. Left ventricular volume was calculated according to Chapman's method on biplanar 35 mm cine films and ejection fraction (EF) was calculated.

Copyright © 1981, Igaku-Shoin Ltd. All rights reserved.


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