Cardiovascular events remain one of the most frequent causes of mortality and morbidity worldwide. The majority of cardiac events occur in individuals without known coronary artery disease (CAD) and in low- to intermediate-risk subjects. Thus, the development of improved preventive strategies may substantially benefit from the identification, among apparently intermediate-risk subjects, of those who have a high probability for developing future cardiac events. Cardiac computed tomography and myocardial perfusion scintigraphy (MPS) by single photon emission computed tomography may play a role in this setting. In fact, absence of coronary calcium in cardiac computed tomography and inducible ischaemia in MPS are associated with a very low rate of major cardiac events in the next 3-5 years. Based on current evidence, the evaluation of coronary calcium in primary prevention subjects should be considered in patients classified as intermediate-risk based on traditional risk factors, since high calcium scores identify subjects at high-risk who may benefit from aggressive secondary prevention strategies. In addition, calcium scoring should be considered for asymptomatic type 2 diabetic patients without known CAD to select those in whom further functional testing by MPS or other stress imaging techniques may be considered to identify patients with significant inducible ischaemia. From available data, the use of MPS as first line testing modality for risk stratification is not recommended in any category of primary prevention subjects with the possible exception of first-degree relatives of patients with premature CAD in whom MPS may be considered. However, the Working Group recognizes that neither the use of computed tomography for calcium imaging nor of MPS have been proven to significantly improve clinical outcomes of primary prevention subjects in prospective controlled studies. This information would be crucial to adequately define the role of imaging approaches in cardiovascular preventive strategies.

Forty-five patients with suspected acute myocardial infarction were examined with magnetic resonance (MR) imaging before and serially up to 30 minutes after intravenous injection of gadolinium diethylenetriaminepentaacetic acid (DTPA), 0.1 mmol/kg of body weight. Coronary angiography after thrombolytic therapy was performed in all patients to assess reperfusion. Intensity ratios between both reperfused and nonreperfused infarcted areas and normal myocardium increased significantly up to 15-20 minutes after administration of Gd-DTPA and were still elevated 30 minutes after injection (P less than .0001). In accordance with the findings in experimental studies, four distribution patterns of infarct enhancement were observed. The overlap in enhancement patterns and similar maximal intensity ratios after Gd-DTPA administration for both reperfused and nonreperfused infarcts preclude a reliable differentiation on the basis of these factors alone. Significant enhancement of both reperfused and nonreperfused infarcts allows adequate infarct imaging up to at least 30 minutes after administration of Gd-DTPA.

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Summary:Several studies have pointed out that L-selectin on CD34-positive cells plays a role in haematopoietic reconstitution after peripheral blood stem cell (PBSC) transplantation. Since it is known that a decrease in L-selectin expression in lymphocytes and granulocytes can be induced by a variety of stress situations, we have investigated in this study whether the freeze-thawing procedure, used in PBSC transplantation, would affect L-selectin expression on CD34 + stem cells.

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