Myocardial perfusion abnormalities in chemical warfare patients intoxicated with mustard gas.
BACKGROUND
Mustard agents are of the major chemical agents used during Iran-Iraq war. There are no reports concerning long-term cardiac effects. The aim was to assess the scintigraphic pattern of myocardial perfusion in patients intoxicated with blistering gases.


METHODS
We analyzed myocardial perfusion scans of 22 consecutive intoxicated patients (21 male and 1 female, all < 44 years) and compared results with 14 controls. Only those patients and controls were entered whose 10-year risk of coronary artery disease (Framingham criteria) was <5%. Also only those patients were experimented upon that had currently other confirmed complications of intoxication (respiratory, cutaneous and ocular complications). All patients underwent a 1-day stress and rest protocol using (99m)Tc-MIBI. Images were assessed visually and quantitatively using Cedars Sinai program.


RESULTS
The prevalence of nonhomogeneity of uptake and left and right ventricular enlargement in both visual and quantitative analyses were higher in the mustard exposed patients than unexposed controls. The prevalence of ischemia was higher in the exposed patients (P < 0.05). Cavity to myocardium ratio, as an established and validated measure of ejection fraction, was also significantly lower in the warfare patients than the controls.


CONCLUSIONS
In so far it lies in our knowledge, this is the first report concerning the scintigraphic pattern of myocardial perfusion in mustard intoxicated patients. Based on the results, the pattern of myocardial perfusion in these patients is significantly different from normal controls, which could resemble either coronary artery disease or mild cardiomyopathic changes.
Gholamrezanezhad
Ali
A
Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Shariati hospital Northern Kargar Street, 14114 Tehran, Iran. gholamrezanejhad@razi.tums.ac.ir
Saghari
Mohsen
M
Vakili
Arsalan
A
Mirpour
Sahar
S
Farahani
Mohammad Hossein
MH
D000328:Adult; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D016022:Case-Control Studies; D002618:Chemical Warfare; D002619:Chemical Warfare Agents / Q000633:toxicity*; D003326:Coronary Circulation / Q000187:drug effects; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D009151:Mustard Gas / Q000633:toxicity*; D017202:Myocardial Ischemia / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
D002619:Chemical Warfare Agents; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D009151:Mustard Gas