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Biomedical subjects

D Poldermans

Publications and source records attributed to D Poldermans.

At least 91 records · Page 5Linked to original sources
PubMed2000

The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities.

AIM: To evaluate the angiographic, myocardial perfusion, and wall motion abnormalities in patients with severe compared with mild worsening of regional function during dobutamine stress echocardiography (DSE) for evaluation of myocardial ischaemia. METHODS: 147 patients with significant coronary artery disease and new or worsening wall motion abnormalities during DSE were enrolled. Left ventricular function was evaluated using a 16 segment/4 grade score model where 1 = normal and 4 = dyskinesis. Simultaneous sestamibi SPECT myocardial perfusion imaging was performed in all patients. RESULTS: Severe worsening of regional function (an increase in wall motion score of two grades or more in >/= 1 segment) was detected in 37 patients, while 110 patients had mild worsening (an increase in wall motion score of no more than one grade in >/= 1 segment). Patients with severe worsening of regional function had more stenotic coronary arteries (2.31 (0.8) v 1.97 (0. 8) (mean (SD)) (p <0.05), a higher prevalence of left anterior descending coronary artery disease (95% v 73%) (p < 0.05), a higher resting wall motion score index (1.71 (0.42) v 1.51 (0.40) (p = 0. 01), and more stress perfusion defects (3.8 (1.5) v 2.8 (1.5) (p < 0.001) compared with patients with mild worsening. Multivariate analysis identified the number of stress perfusion defects (p < 0. 005, chi(2) = 8.8) and the number of ischaemic segments on echocardiography (p < 0.05, chi(2) = 4.3) as independent variables associated with severe worsening of regional function. CONCLUSIONS: The grade of worsening of regional function during DSE predicts the underlying extent of myocardial perfusion abnormalities. The occurrence of severe worsening of regional function is associated with variables known to predict worse prognosis in patients with coronary artery disease.

Aged↗
PubMed1999

The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group.

BACKGROUND: Cardiovascular complications are the most important causes of perioperative morbidity and mortality among patients undergoing major vascular surgery. METHODS: We performed a randomized, multicenter trial to assess the effect of perioperative blockade of beta-adrenergic receptors on the incidence of death from cardiac causes and nonfatal myocardial infarction within 30 days after major vascular surgery in patients at high risk for these events. High-risk patients were identified by the presence of both clinical risk factors and positive results on dobutamine echocardiography. Eligible patients were randomly assigned to receive standard perioperative care or standard care plus perioperative beta-blockade with bisoprolol. RESULTS: A total of 1351 patients were screened, and 846 were found to have one or more cardiac risk factors. Of these 846 patients, 173 had positive results on dobutamine echocardiography. Fifty-nine patients were randomly assigned to receive bisoprolol, and 53 to receive standard care. Fifty-three patients were excluded from randomization because they were already taking a beta-blocker, and eight were excluded because they had extensive wall-motion abnormalities either at rest or during stress testing. Two patients in the bisoprolol group died of cardiac causes (3.4 percent), as compared with nine patients in the standard-care group (17 percent, P=0.02). Nonfatal myocardial infarction occurred in nine patients given standard care only (17 percent) and in none of those given standard care plus bisoprolol (P<0.001). Thus, the primary study end point of death from cardiac causes or nonfatal myocardial infarction occurred in 2 patients in the bisoprolol group (3.4 percent) and 18 patients in the standard-care group (34 percent, P<0.001). CONCLUSIONS: Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

Adrenergic beta-Antagonists↗
PubMed1999

Dobutamine stress echocardiography and technetium-99m-tetrofosmin/fluorine 18-fluorodeoxyglucose single-photon emission computed tomography and influence of resting ejection fraction to assess myocardial viability in patients with severe left ventricular dysfunction and healed myocardial infarction.

The purpose of this study was to compare 2 different techniques--dobutamine-atropine stress echocardiography (DSE) and dual-isotope simultaneous acquisition (technetium-99-m-tetrofosmin/fluorine 18-fluorodeoxyglucose) single-photon emission computed tomography (DISA-SPECT)--for assessment of viable myocardium. One hundred ten patients (mean age 55 +/- 9 years) with left ventricular (LV) dysfunction (mean LV ejection fraction 27 +/- 13%) underwent both DISA-SPECT and DSE. A 16-segment scoring model was adopted for both techniques. Four types of wall motion during DSE were assessed: (1) biphasic, improvement at low dose (10 microg/kg/min) with worsening at high dose; (2) worsening, deterioration without initial improvement; (3) sustained, persistent or late improvement; and (4) no change. Viability criteria were biphasic, worsening, and sustained improvement with DSE. Viability criteria with DISA-SPECT were normal perfusion and metabolism (normal), concordantly mildly reduced perfusion and metabolism (subendocardial scar), or severely reduced perfusion and increased metabolism (mismatch). Myocardium was considered nonviable with DSE in case of unchanged wall motion, or moderate reduction or absence in both technetium-99m-tetrofosmin perfusion and fluorodeoxyglucose uptake with DISA-SPECT. Of 1,756 of 1,760 analyzable LV segments, 1,373 (78%) had severe wall motion abnormalities at baseline (severe hypokinesia, akinesia, or dyskinesia). Of these abnormal segments, 282 (21%) were considered viable during DSE (63 [5%] with biphasic response, 47 [3%] with ischemia, and 172 [13%]) with sustained improvement, whereas 1,091 (79%) were considered nonviable. With DISA-SPECT, 396 (29%) segments were considered viable (312 [23%] with matched perfusion/metabolism and 84 [6%] with mismatch), whereas 977 segments (71%) were considered nonviable. Both techniques showed agreement for viability in 201 segments and 896 were concordantly classified as nonviable. Disagreement was present in 276 segments of which 195 (71%) were nonviable with DSE and viable with DISA-SPECT. Overall agreement between the 2 techniques was 81% (kappa 0.46) in a subgroup of patients with an ejection fraction <25% 78% (kappa 0.39). Thus, DSE and DISA-SPECT show good agreement for assessing viable myocardium not influenced by resting ejection fraction. DSE underestimated the amount of viable tissue compared with DISA-SPECT.

Blood Pressure↗
PubMed1999

Long-term prognostic value of dobutamine-atropine stress echocardiography in 1737 patients with known or suspected coronary artery disease: A single-center experience.

BACKGROUND: The purpose of this study was to assess the long-term value of dobutamine-atropine stress echocardiography (DSE) for prediction of late cardiac events in patients with proven or suspected coronary artery disease. METHODS AND RESULTS: Clinical data and DSE results were analyzed in 1734 consecutive patients undergoing DSE between 1989 and 1997. Seventy-four patients who underwent revascularization within 3 months of DSE and 1 patient lost to follow-up were excluded; the remaining 1659 (median age, 62 years; range, 14 to 99 years) were followed up for 36 months (range, 6 to 96 months). Wall motion abnormalities at rest and the presence and extent of stress-induced wall motion abnormalities (ischemia) were scored for each patient. Cardiac events were related to clinical and ECG data and DSE results. Four hundred twenty-eight cardiac events occurred in 366, documented cardiac death in 108 (total death, 247), nonfatal infarction in 128, and late revascularization in 192 patients. In a multivariable Cox proportional-hazards model, the ratio of documented cardiac death or (re)infarction was increased in the presence of stress-induced ischemia (hazard ratio, 3.3; 95% CI, 2.4 to 4.4) and extensive rest wall motion abnormalities (hazard ratio, 1.9; 95% CI, 1.3 to 2.6). The number of ischemic segments was predictive for late cardiac events. A normal DSE carried a relatively good prognosis, with an annual event rate of cardiac death or infarction of 1.3% over a 5-year period. CONCLUSIONS: In a large group of patients, DSE has an added value for predicting late cardiac events during long-term follow-up, improving the separation between high- risk and very-low-risk patients.

Adolescent↗
PubMed1999

Comparison of native and contrast-enhanced harmonic echocardiography for visualization of left ventricular endocardial border.

Our study was designed to compare the utility of fundamental and second harmonic imaging (SH) for visualization of the left ventricular (LV) endocardial border. SH is a new imaging modality using nonlinear acoustic response, which may provide better endocardial border delineation. Standard apical views were studied in 42 patients using fundamental frequency (FF), SH without contrast (1.6- to 1.8-MHz and 2.1- to 2.5-MHz transmission frequencies), and SH after an intravenous injection of 2.5 g of Levovist. The quality of endocardial delineation in 16 standard segments was scored from 0 to 2. The endocardial visualization index was calculated as a mean of the scores. SH with and without contrast significantly improved LV endocardial border detection (endocardial visualization index 1.25+/-0.53, 1.64+/-0.67, 1.55+/-0.69, and 1.73+/-0.28 for fundamental, lower, and higher frequency harmonic and contrast-harmonic mode, respectively, p <0.005). Improvement was found in all LV segments. The number of invisible segments decreased from 142 (FF) to 54, 112, and 61 (in lower, higher, and contrast SH mode, respectively, p <0.001). Endocardial delineation in the apical segments using SH was optimal after contrast injection. In the basal LV area, contrast-enhanced images were less informative because of signal attenuation. Thus, SH significantly improves visualization of the LV endocardial border. Contrast enhancement with Levovist improves imaging of the apical segments but has no additional advantage in the basal segments. SH emerges as first-line modality for studies of LV function.

Contrast Media↗
PubMed1999

Corneal arcus: indicator for severity of coronary atherosclerosis?

BACKGROUND: The occurrence of a corneal arcus before the age of 60 years has been associated with the presence of atherosclerosis and the occurrence of hypercholesterolemia. The aim of this observational study was to assess the correlation between the presence of a corneal arcus and the severity of coronary artery disease. METHODS: A consecutive group of 200 Caucasian patients aged 40-60 years were studied. All patients were scheduled for diagnostic coronary angiography in a tertiary referral center. RESULTS: The severity of coronary disease was assessed by coronary angiography. A corneal arcus was observed in 38% of the patients. The prevalence of multivessel disease on a coronary angiogram was significantly higher in the group of patients with corneal arcus (p < 0.02). Patients with a corneal arcus compared to patients without a corneal arcus were slightly older (p < 0.05). Corrected for age, patients with an arcus has a relative risk for multivessel disease of 3.3 (CI 1.1-12.1, p < 0.05). CONCLUSION: In Caucasian patients with symptoms of coronary disease, the presence of a corneal arcus below 60 years of age indicates a high risk for multivessel coronary atherosclerosis.

Adult↗
PubMed1999

Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography.

OBJECTIVES: This study was designed to address, in patients with severe ischemic left ventricular dysfunction, whether dobutamine stress echocardiography (DSE) can predict improvement of left ventricular ejection fraction (LVEF), functional status and long-term prognosis after revascularization. BACKGROUND: Dobutamine stress echocardiography can predict improvement of wall motion after revascularization. The relation between viability, improvement of function, improvement of heart failure symptoms and long-term prognosis has not been studied. METHODS: We studied 68 patients with DSE before revascularization; 62 patients underwent resting echocardiography/radionuclide ventriculography before and three months after revascularization. Long-term follow-up data (New York Heart Association [NYHA] functional class, Canadian Cardiovascular Society [CCS] classification and events) were acquired up to two years. RESULTS: Patients with > or =4 viable segments on DSE (group A, n = 22) improved in LVEF at three months (from 27+/-6% to 33+/-7%, p < 0.01), in NYHA functional class (from 3.2+/-0.7 to 1.6+/-0.5, p < 0.01) and in CCS classification (from 2.9+/-0.3 to 1.2+/-0.4, p < 0.01); in patients with <4 viable segments (group B, n = 40) LVEF and NYHA functional class did not improve, whereas CCS classification improved significantly (from 3.0+/-0.8 to 1.3+/-0.5, p < 0.01). A higher event rate was observed at long-term follow-up in group B versus group A (47% vs. 17%, p < 0.05). CONCLUSIONS: Patients with substantial viability on DSE demonstrated improvement in LVEF and NYHA functional class after revascularization; viability was also associated with a favorable prognosis after revascularization.

Aged↗
PubMed1999

Stroke volume changes during dobutamine-atropine stress echocardiography: the influence of heart rate and ischaemia.

BACKGROUND: A decrease in stroke volume during dobutamine-atropine stress echocardiography heralds ischaemia and possible hypotension. Hypotension results from worsening of LV-function (as a result of ischaemia) left ventricular outflow tract obstruction or hypovolemia, while an increase of stroke volume indicates the preservation of myocardial contractile reserve. OBJECTIVE: To assess stroke volume changes during dobutamine stress echocardiography in relation to heart rate and occurrence of ischaemia and to validate a new automated cardiac output measurement device. METHODS: In fifty patients, the stroke volume was assessed using the echocardiographic biplane discs method during a stress echocardiography. These data were reference values for the validation of a new automated cardiac output measurement using the first method as a reference. RESULTS: Stroke volume measured by the biplane discs method and automated cardiac output device decreased from rest to peak stress, respectively, from 54+/-16 to 34+/-9 (63%) ml and 63+/-17 to 38+/-15 (60%) ml (p < 0.001). Stroke volume decreased with increased heart rate and stress-induced ischaemia when assessed by the biplane discs method, but with the automated device it decreased only with increased heart rate. CONCLUSIONS: Both increased heart rate and myocardial ischaemia during dobutamine stress echocardiography cause a reduction of stroke volume. However, the automated device did not detect the effects of stress-induced ischaemia on stroke volume. It appears that the biplane discs method is more sensitive for evaluating the effect of ischaemia.

Adrenergic beta-Agonists↗
PubMed1999

Cardiac evaluation in hypotension-prone and hypotension-resistant hemodialysis patients.

BACKGROUND: Hypotension during hemodialysis occurs frequently, but the precise mechanism remains unclear. In this study, the presence of myocardial ischemia and myocardial contractile reserve during infusions of the beta-adrenergic receptor agonist dobutamine was assessed by means of dobutamine-atropine stress echocardiography (DSE) in hypotension-prone (HP) and hypotension-resistant (HR) hemodialysis patients. METHODS: Eighteen HP patients (age 53 +/- 6 years) were compared with 18 HR patients (age 53 +/- 3 years), matched with respect to the duration of hemodialysis and cardiovascular history. New wall abnormalities during dobutamine stress reflect the presence of myocardial ischemia, whereas the increase in stroke index and cardiac index reflects myocardial contractile reserve. RESULTS: Wall motion score at rest (1.42 +/- 0.53 vs. 1.44 +/- 0.57) and dobutamine-induced new wall motion abnormalities (4 vs. 3 patients) between HP and HR patients were similar, but responses of cardiac index, stroke index, and systolic blood pressure to do butamine between the two groups were different. Not withstanding a similar cardiac index at rest (2.4 +/- 1.1 liter/min/m2 in HP and 2.8 +/- 1.2 liter/min/m2 in HR patients), dobutamine-induced increments in the cardiac index were considerably smaller in the former (0.8 +/- 1.3 liter/min/m2) than in the latter patients (2.3 +/- 1.6 liter/min/m2, P = 0.002), predominantly because of a progressive decrease in the stroke index in the HP patients. CONCLUSION: Impaired myocardial contractile reserve rather than ischemia is predominant in HP patients. This impaired myocardial contractile reserve may play a role in the development of hemodialysis-induced hypotension.

Adult↗
PubMed1999

Prediction of improvement of regional left ventricular function after revascularization using different perfusion-metabolism criteria.

UNLABELLED: Increased myocardial uptake of 18F-fluorodeoxyglucose (FDG) in regions with perfusion defects (perfusion-FDG mismatch) has been shown to predict functional recovery after revascularization; conversely, a concordant decrease in perfusion and FDG uptake (perfusion-FDG match) represents scar tissue (varying from subendocardial to transmural scar) that will not improve in contractile function after revascularization. Several recent studies have used a mild reduction in perfusion or FDG uptake (or both) as an indicator of viable tissue. To our knowledge, this criterion has not been validated against functional outcome after revascularization. This study aimed to compare the predictive value for functional recovery of these different perfusion-metabolism criteria. METHODS: Forty-two patients referred for revascularization were studied with early resting 201Tl SPECT (to evaluate perfusion) and FDG SPECT. Contractile function was evaluated before and 3-4 mo after revascularization using two-dimensional echocardiography. Angiography was not repeated. RESULTS: Two hundred six dysfunctional segments were identified; functional recovery occurred in 71 segments. The 206 dysfunctional segments were divided into five groups: group I, segments (n = 37) with normal perfusion; group II, segments (n = 69) with a mild reduction in perfusion (> or =60% of normal 201Tl uptake) without increased FDG uptake (mild match); group III, segments (n = 29) with a mild reduction in perfusion and increased FDG uptake (mild mismatch); group IV, segments (n = 46) with a more severe reduction in perfusion (<60% of normal 201Tl uptake) without increased FDG uptake (severe match); and group V, segments (n = 25) with a 201Tl activity < 60% and increased FDG uptake (severe mismatch). The mean wall motion score improved significantly in groups I, III and V but not in groups II and IV. Improvement of function was observed in 76% of group I segments, in 69% of group III segments and in 68% of group V segments. In contrast, only 13% of group II segments and 7% of group IV segments improved after revascularization. CONCLUSION: The results indicate that normal perfusion and mismatch patterns (either mild or severe) are predictive of functional recovery, whereas match patterns (either mild or severe) are predictive of absence of recovery. Match patterns are likely to represent different degrees of scar tissue, ranging from subendocardial to transmural scars. To identify segments with a high likelihood of improvement of function after revascularization, integration of information on perfusion and FDG uptake appears mandatory.

Angioplasty, Balloon, Coronary↗
PubMed1998

Optimal criteria for the diagnosis of coronary artery disease by dobutamine stress echocardiography.

The diagnosis of coronary artery disease (CAD) on the basis of inducible ischemia in > or = 2, rather than 1, segments was suggested to improve specificity of dobutamine stress echocardiography (DSE). However, the impact of using these criteria on the sensitivity and accuracy of DSE was not studied. We studied the accuracy of DSE (up to 40 microg/kg/min) for the diagnosis of CAD in 290 patients with suspected myocardial ischemia using the criteria of > or = 1 and > or = 2 ischemic segments. Ischemia was defined as new or worsening wall motion abnormalities using a 16-segment model. Among the 85 patients without previous myocardial infarction, significant CAD was detected in 51 (60%). Sensitivity, specificity, and accuracy of DSE using > or = 1 ischemic segment were 73%, 85%, and 78%, respectively. Those using > or = 2 segments were 67%, 94%, and 78%, respectively (p = NS). Regional specificity improved by using > or = 2 segments (91% vs 96%, p <0.05) at the expense of an equivalent reduction in regional sensitivity (60% vs 44%, p <0.05), whereas the regional accuracy was similar (80% vs 79% for > or = 1 and > or = 2 segments, respectively). In the 205 patients with previous myocardial infarction, the criterion of ischemia in > or = 1 segment had a higher sensitivity and accuracy for overall diagnosis of CAD (75% vs 64%, p <0.05; 77% vs 68%, p <0.05), infarct-related CAD (64% vs 47%, p <0.005; 70% vs 57%, p <0.01), and remote CAD (74% vs 57%, p <0.005; 78% vs 69%, p <0.05) than the criterion of > or = 2 segments, respectively. It is concluded that in patients without previous myocardial infarction, the use of > or = 2 ischemic segments by DSE for the diagnosis of CAD does not improve the accuracy of DSE compared with the criterion of > or = 1 ischemic segment. Conversely, in patients with previous infarction the use of > or = 2 segments reduces the overall and regional sensitivity and accuracy without a significant improvement in specificity.

Cardiotonic Agents↗
PubMed1998

Usefulness of pulse-wave Doppler tissue sampling and dobutamine stress echocardiography for the diagnosis of right coronary artery narrowing.

To study the feasibility and diagnostic accuracy of right coronary artery (RCA) narrowing by right ventricular (RV) pulse-wave Doppler tissue sampling during dobutamine stress echocardiography (DSE), 30 patients (mean age 55 +/- 9.5 years, 26 men) with suspected coronary artery disease underwent DSE (up to 40 microg/kg/min with additional atropine during submaximum heart rate responses). Pulse-wave Doppler tissue sampling of RV free walls close to the tricuspid annulus was performed in the apical 4-chamber view. The maximum velocity during the ejection phase, early, and late diastole was measured. Data from 5 consecutive beats were averaged. The measurements were repeated at rest, at low dose (10 microg/kg/min), and at peak dobutamine stress. The results were evaluated for the prediction of significant proximal or medium RCA narrowing (> or = 50% diameter stenosis, assessed by quantitative coronary angiography within the previous 3 months). A progressive increase of the ejection phase velocity (> 25% between 10 microg/kg/min and peak stress) was predictive of a normal RCA, whereas a blunted increase and/or decrease (< 25% of increase) was predictive of significant RCA narrowing: sensitivity (95% confidence intervals): 82% (68 to 96), specificity: 78% (67 to 93), positive predictive value: 69% (52 to 86), negative predictive value: 88% (75 to 100), accuracy: 79% (65 to 94). Pulse-wave Doppler tissue sampling provided analyzable data in 100%, whereas the visual assessment of gray-scale images was possible only in 90%. Thus, in patients with suspected RCA narrowing, pulse-wave Doppler tissue sampling during DSE was able to diagnose significant RCA narrowing.

Cardiotonic Agents↗
PubMed1998

[Myocardial tissue vitality: clinical relevance, pathophysiology and identification].

Heart failure is an increasing clinical problem because of the rising frequency of admissions and the high mortality. Excellent long-term results are obtained with heart transplantation, whereas the long-term prognosis is poor when patients are treated medically. It has recently been demonstrated that, in patients with depressed left ventricular (LV) function, revascularization may be an alternative form of therapy, since improvement of LV function, which is an important prognostic factor, may occur after coronary revascularization. Recovery of LV function after revascularization may occur in patients with dysfunctional but viable myocardium, whereas no recovery can be expected in patients with scar tissue. Improvement of LV function after revascularization can be explained on the basis of the concept of myocardial tissue vitality': chronically ischaemic myocardium temporarily loses the facility to contract, but the contraction is regained after revascularization (once the ischaemia is eliminated). For the selection of patients who may profit by a revascularization procedure, techniques have been developed for the identification of dysfunctional but viable tissue. The myocardial glucose metabolism can be visualized by administration of 18F desoxyglucose (FDG) and imaging by positron emission tomography or 'single photon emission computer tomography'. Vital tissue shows diminished perfusion with intact glucose metabolism (FDG perfusion mismatch); a vital tissue shows diminished perfusion without glucose metabolism (FDG perfusion match). Scintigraphy of the membrane of the myocardial cell can also be investigated using 201Tl scintigraphy. Reserve contractility of the myocardium can be visualized by echocardiography during administration of dobutamine.

Coronary Circulation↗
PubMed1998

Early recovery of wall motion abnormalities after recanalization of chronic totally occluded coronary arteries: a dobutamine echocardiographic, prospective, single-center experience.

BACKGROUND: Patients with symptomatic myocardial ischemia from a chronic totally occluded coronary (TOC) artery are usually referred for coronary artery bypass surgery. Because guide wire technology has improved considerably in recent years, percutaneous coronary angioplasty has become a useful technique in opening chronic TOC arteries. We evaluated the early functional results of successful percutaneous recanalization by performing dobutamine stress echocardiography (DSE). METHODS: Fifteen patients with a chronic TOC artery who underwent a successful recanalization were prospectively studied. Each patient had a DSE within 24 hours before and 48 hours after the procedure. Wall motion was scored according to a 16-segment/5-point model. A clinical and angiographic follow-up of 6 months was obtained. RESULTS: The wall motion score index at rest improved from 1.26+/-0.23 before to 1.22+/-0.21 after the procedure (P < .05). Of those 10 segments that improved at rest, 7 were collateral recipients and 3 were collateral donors. The number of ischemic segments decreased from 46 before to 4 after the procedure (P < .0001). Wall motion score index at peak stress improved from 1.34+/-0.20 before to 1.15+/-0.12 after the procedure (P < .05). DSE was positive for ischemia in 15 patients before and 2 patients after the procedure (P < .0001). Angina was present in 12 patients before and in 2 patients after recanalization (P < .0001). Two patients (13%) had angiographic reocclusion and 5(33%) restenosis after 6 months of follow-up. CONCLUSIONS: Successful percutaneous recanalization of chronic TOC artery results in an early improvement of both clinical status and resting or stress-induced wall motion abnormalities, as detected by DSE.

Adult↗
PubMed1998

Tissue Doppler imaging and the quantification of myocardial function.

Tissue Doppler imaging (TDI) has recently been introduced in clinical echocardiography. Most widely used are tissue velocity maps, in which the velocity of moving tissue is calculated relative to the transducer from the Doppler shift and displayed as colour-encoded velocity maps in either M-mode or two-dimensional image formats (Doppler velocity mode). This allows detection and quantification of dyssynergic areas of the myocardium. Additionally, the velocities may be studied with pulsed wave-tissue Doppler sampling (PW-TDS) which displays the velocity of a selected myocardial region versus time with high temporal resolution. Less often used, are tissue acceleration maps which display acceleration or velocity change of subsequent frames as different colours (Doppler acceleration mode). These maps may find application in clinical electrophysiology. Another TDI modality is tissue energy imaging, which is based on the integration of the power spectrum of the Doppler signals from the tissue. This technique provides maps of Doppler energy which are represented as colour brightness. Such maps offer potential for the study of myocardial perfusion. TDI modalities have promise to become clinically useful for quantifying myocardial function.

Animals↗
PubMed1998

Safety and utility of atropine addition during dobutamine stress echocardiography for the assessment of viable myocardium in patients with severe left ventricular dysfunction.

OBJECTIVE: To assess the feasibility safety and side effects of the addition of atropine to dobutamine stress echocardiography for the detection of viable myocardium in patients with left ventricular dysfunction (ejection fraction < or = 35%) prior to coronary revascularization. BACKGROUND: The assessment of viable and/or ischaemic myocardium has high prognostic value as regards improvement of function and survival after coronary revascularization. The addition of atropine to dobutamine during echocardiographic testing for the presence of viable myocardium is not common practice. Consequently, no data exist on the safety and additional diagnostic value of this practice. METHODS: Two hundred patients with left ventricular ejection fraction < or = 35% were studied. RESULTS: Test end-points were: target heart rate in 164 (82%) of the patients, severe angina in 18 (9%), maximum dobutamine-atropine dose in six (3%), severe ST segment changes in five (2%), cardiac arrhythmias in four (2%), and hypotension in three (1%). Viability could be assessed echocardiogaphically in 105/200 (53%) from a biphasic response (improvement of wall motion with low dose dobutamine and worsening with high dose), in 93 from ischaemia and in 12 from sustained or late improvements. In 36/105 (34%) patients, ischaemic myocardium could only be assessed after the addition of atropine. Cardiac arrhythmias occurred in 11/200 (6%) and hypotension (decrease of systolic blood pressure >30 mmHg) in 21/200 (11%). Neither the use of atropine nor the induction of ischaemia were associated with an increased incidence of cardiac arrhythmias or hypotension. CONCLUSIONS: In a large group of patients with severe left ventricular dysfunction, dobutamine stress echocardiography is feasible and safe in 186/200 (93%); the addition of atropine was necessary in 34% to assess myocardial viability. Hypotension and cardiac arrhythmias were the most frequent side effects, but were not related to the induction of ischaemia or addition of atropine.

Adult↗
PubMed1998

Safety and feasibility of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients unable to perform an exercise stress test.

OBJECTIVE: Dobutamine stress testing is increasingly used for the diagnosis and functional evaluation of coronary artery disease. However, little is known about the safety and feasibility of this stress modality in diabetic patients. RESEARCH DESIGN AND METHODS: We studied the impact of diabetes on hemodynamic profile and on the safety and feasibility of dobutamine (up to 40 microg x kg(-1) x min(-1)) and atropine (up to 1 mg) stress echocardiography for the diagnosis of coronary artery disease in 1,446 consecutive patients (aged 60+/-12 years, 962 men) with limited exercise capacity and suspected myocardial ischemia. Of these, 184 patients were known to have IDDM or NIDDM. The test was considered feasible when 85% of the maximal heart rate and/or an ischemic end point (new or worsened wall motion abnormalities, ST segment depression, or angina) was achieved. RESULTS: No myocardial infarction or death occurred during the test. There was no significant difference between diabetic and nondiabetic patients with regard to heart rate increase during dobutamine stress echocardiography (58+/-25 vs. 61+/-24 beats/min), peak rate pressure product (18,400+/-3,135 vs. 18,048+/-4454), or the prevalence of hypotension (systolic blood pressure drop of >40 mmHg) (7 vs. 5%), ventricular tachycardia (5.4 vs. 4.5%), and supraventricular tachycardia (3 vs. 4%) during the test. Dobutamine stress echocardiography was feasible in 92% of the diabetic patients and in 90% of the nondiabetic patients. Coronary angiography was performed in 55 diabetic and 240 nondiabetic patients. Sensitivity, specificity, and accuracy of dobutamine stress echocardiography for the diagnosis of coronary artery disease in diabetic patients were 81, 85, and 82%. Those in nondiabetic patients were 74, 87, and 77%, respectively (NS). CONCLUSIONS: Dobutamine stress echocardiography is a feasible method for the diagnosis of coronary artery disease in patients with limited exercise capacity with a comparable safety, feasibility, and accuracy in diabetic and nondiabetic patients.

Aged↗