LETTERS
TO
THE
EDITOR
The final point reflects a question of nomenclature. The postextrasystolic heat phenomenon is synonymous with the Brockenbrough phenomenon and is defined as a decrease in the arterial pulse pressure in the sinus beat following an extrasysto1e.l Thus, it is an abnormal finding that has been said to be relatively specific for idiopathic hypertorphic subaortic stenosis, but which we have found in patients with cavity obliteration who do not have other evidence of idiopathic hypertrophic subaortic stenosis. Albert E. Raizner, MD, FACC Robert A. Chahine, MD, FACC Tetsuo Ishimori, MD Mahir Awdeh, MD Cardiology Section Baylor College of Medicine Houston, Texas
diagnosing this process are relatively nonspecific. Endomyocardial biopsy, the current procedure of choice for definitive diagnosis, is an invasive procedure with some risk. Therefore, leukocytic scintigraphy might be a useful addition to the diagnostic tools for managing patients after cardiac transplantation. Richard F. Gillum, MD Laboratory of Physical Hygiene School of Public Health Minneapolis, Minnesota Reference 1. w0in a, hn8d
8A, lhako *
emit canhe myocardlun
oi al: lmaglng of the
with l%dhim&b&d
inflammatory response in is& ldwytas. Am J Cardiol40:195-199.
1977
Reference herodynamic tedwk 1. Broc&~EC,Br-akfE.MamvrML:A of hypwtrophic subaortic stenosis. Circulation 23~199-194. 1961
LEUKOCYTIC
for Uw detection
SClNTlORAPHY AFTER CARDIAC TRANSPLANTATlON
Weiss et al.l recently reported a technique for imaging of the inflammatory response in ischemic myocardium with rlrindium-labeled leukocytes. They suggest that, in addition to detection of myocardial infarction, this technique may prove useful in detecting bacterial endocarditis, myocarditis and pericarditis. Another potentially useful application they did not mention might be detection of acute rejection in patients with a cardiac transplant. Current noninvasive techniques for
528
S8ptember 1978
REPLY
We concur that scintigraphy with labeled leukocytes, and for that matter other cell types, may be useful in evaluating possible rejection among patients with a cardiac transplant. As we indicated in our paper, the technique was developed not only to evaluate ischemic myocardium, but also to provide a new tool for assessing cell responses within the heart to a variety of pathophysiologic conditions. The one Gillum suggests is indeed attractive and appears to merit objective evaluation in experimental animals and possibly in man.
The American Journal of CARWOLOQY Volume 42
Burton E. Sobel. MD, FACC Cardiovascular Division Washington University School of Medicine Saint Louis, Missouri
TO
THE
EDITOR
The final point reflects a question of nomenclature. The postextrasystolic heat phenomenon is synonymous with the Brockenbrough phenomenon and is defined as a decrease in the arterial pulse pressure in the sinus beat following an extrasysto1e.l Thus, it is an abnormal finding that has been said to be relatively specific for idiopathic hypertorphic subaortic stenosis, but which we have found in patients with cavity obliteration who do not have other evidence of idiopathic hypertrophic subaortic stenosis. Albert E. Raizner, MD, FACC Robert A. Chahine, MD, FACC Tetsuo Ishimori, MD Mahir Awdeh, MD Cardiology Section Baylor College of Medicine Houston, Texas
diagnosing this process are relatively nonspecific. Endomyocardial biopsy, the current procedure of choice for definitive diagnosis, is an invasive procedure with some risk. Therefore, leukocytic scintigraphy might be a useful addition to the diagnostic tools for managing patients after cardiac transplantation. Richard F. Gillum, MD Laboratory of Physical Hygiene School of Public Health Minneapolis, Minnesota Reference 1. w0in a, hn8d
8A, lhako *
emit canhe myocardlun
oi al: lmaglng of the
with l%dhim&b&d
inflammatory response in is& ldwytas. Am J Cardiol40:195-199.
1977
Reference herodynamic tedwk 1. Broc&~EC,Br-akfE.MamvrML:A of hypwtrophic subaortic stenosis. Circulation 23~199-194. 1961
LEUKOCYTIC
for Uw detection
SClNTlORAPHY AFTER CARDIAC TRANSPLANTATlON
Weiss et al.l recently reported a technique for imaging of the inflammatory response in ischemic myocardium with rlrindium-labeled leukocytes. They suggest that, in addition to detection of myocardial infarction, this technique may prove useful in detecting bacterial endocarditis, myocarditis and pericarditis. Another potentially useful application they did not mention might be detection of acute rejection in patients with a cardiac transplant. Current noninvasive techniques for
528
S8ptember 1978
REPLY
We concur that scintigraphy with labeled leukocytes, and for that matter other cell types, may be useful in evaluating possible rejection among patients with a cardiac transplant. As we indicated in our paper, the technique was developed not only to evaluate ischemic myocardium, but also to provide a new tool for assessing cell responses within the heart to a variety of pathophysiologic conditions. The one Gillum suggests is indeed attractive and appears to merit objective evaluation in experimental animals and possibly in man.
The American Journal of CARWOLOQY Volume 42
Burton E. Sobel. MD, FACC Cardiovascular Division Washington University School of Medicine Saint Louis, Missouri
