Page 1: Importance of radionuclide exercise ventriculography in patients with myasthenia gravis

Euro-Myasthenia III

3.15 IMPORTANCE OF RADIONUCLIDE EXE~CISlf y'"TR;RzyHY IN PATIENTS WITH MYASTJBNIA GRAVIS. V. , S. Apostolski. D. LavrniB, A. Vidakovio and N: Korarevid. Department of Neurology WCC, Dr SubotiCa 6, 11000 Belgrade, YU.

Many authors have published details about the cardiac changes associated with myasthenia gravis (MG). Thus, we have analysed the cardiac function in 25 patients with MG, 17 females and 8 males (mean age = 35 years), and in 10 healthy controls. They were subjected to physical heart examination, standard ECC and radionuclide exercise ventriculography. Of these 25 patients with MG, the ocular form was detected in 3 (12%) without undergoing a thvmectomy. The others had generalized MG and underwent thymectomy. Two patients had thymoma and 20 thymus hyperplasia. Only in two patients we found cardiac muscle antibodies. ECG at rest in all of these patients was normal. The most common finding during exercise was Q-T prolongation seen in 12 (48%) patients. Q-T intervals were corrected according to the heart rate per minute. Only One patient had arrhythmia and two showed nonspecific T wave shanges. Using radionuclide ventriculography at rest and during exercise we found the decrease in global ejection fraction (EF) after exercise in 10 (40%) patients, more frequently in those with Q-T prolongation. We also analysed other parameters such as peak ejection rate (PER), time to peak ejection rate (TPER), peak filling rate (PER) and time to peak filling rate (TPFR). The most sensitive parameter was TPFR. We found increased TPFR in 8 (32%) patients. Our findings suggest a causal relationship between MG and heart disease, (Supported by the Research fund of Serbia)


A. Hendrich, G. Hertel, Hospital Moabit, Department of Neurology, W-1000 Berlin, Turmstr. 21 and I. Schmehl, R. Zschenderlein, Department of Neurology of the Humbold-University (Charite), O-1040 Berlin, Schumannstr. 20/21.

HLA typing "as performed on 46 patients with generalized myasthenia gravis from the North-East German area (52 to 53 Northern latitude). The data of 230 unrelated patients without autoimmune diseases from the same laboratory were available as controls. The results were compared with similar investigations (PIRSRANEN 1976, COMPSTON 1980, GROSSE-WILDE et al, 1983) in relation to age of onset, sex and thymus pathology. In the group of patients with the age of onset under 40 years and without thymoma (24 of 46 patients, mean age of onset is 25.4 years), Al, B8 and DR3 are increased significantly (p 10.05 to p tO.O1) as compared with the controls, whereas in comparison with the group with the age of onset over 40 years (17 of 46, mean age of onset is 56 years), they were increased with different significance (p to.05 to p ~0.01). Patients with Al and B8 have a significantly earlier onset than patients without Al and B8. In the group with the onset of the disease over 40 years, 818 seems to be frequently increased compared with controls (p 0.01). In this group, A3 is increased compared with the group with the age of onset under 40 years. The presence of DR2, B7 and A3 indicate a later beginning of the disease. Previous studies are confirmed by the results of our epidemiologically well defined group of patients.


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