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Biomedical subjects

J D Kasprzak

Publications and source records attributed to J D Kasprzak.

At least 19 recordsLinked to original sources
PubMed2003

Arterial dysfunction in syndrome X: results of arterial reactivity and pulse wave propagation tests.

OBJECTIVE: To assess arterial distensibility using pulse wave velocity (PWV) measurements and its relation with endothelium dependent vasodilatation (EDV) in patients with cardiological syndrome X. METHODS: The study group consisted of 92 patients: 52 with syndrome X (34 women, 18 men, mean (SD) age 45 (3) years) and 40 healthy volunteer controls (27 women, 13 men, mean (SD) age 41 (2) years) without risk factors of atherosclerosis and with negative ECG exercise test and normal proximal coronaries on transoesophageal echocardiography. Patients with arterial hypertension, diabetes mellitus, valvar disease, or cardiomyopathy were excluded. PWV measured by a Complior Colson device was calculated for each patient. EDV was assessed from two dimensional Doppler measurement using an Acuson Sequoia with 8 MHz linear transducer at rest, during postischaemic reactive hyperaemia, and after an oral dose of 400 micro g of glyceryl trinitrate. RESULTS: PWV was significantly higher in patients with syndrome X than in healthy subjects (9.3 (0.7) m/s v 8.2 (0.9) m/s, respectively, p < 0.001). Baseline brachial artery diameter was similar in the syndrome X and control groups (4.0 (0.6) mm v 4.08 (0.64) mm, NS). EDV was impaired in patients with syndrome X compared with controls (6.6 (3.0)% v 11.1 (3.9)%, p < 0.001). Endothelium independent vasodilatation was similar in both groups. In patients with syndrome X there was a positive correlation between PWV and the degree of EDV (r = 0.864, p < 0.001). The cut off value for PWV was 8.5 m/s, with a sensitivity of 62% and a specificity of 91%. CONCLUSIONS: EDV but not glyceryl trinitrate induced vasodilatation is decreased in patients with syndrome X. There is a strong correlation between PWV and the degree of endothelial dysfunction of peripheral arteries in patients with syndrome X. PWV assessment may be useful to identify abnormal vascular physiology in these patients.

Adult↗
PubMed2001

Usefulness of power Doppler contrast echocardiography to identify reperfusion after acute myocardial infarction.

Microvascular integrity, as seen by myocardial contrast echocardiography (MCE), assesses whether myocardium has been successfully reperfused after an acute myocardial infarction. Until now this has been demonstrated only with intracoronary injection of an ultrasound contrast agent. Power Doppler imaging is a recently developed myocardial contrast echocardiographic method that counts the contrast microbubbles destroyed by ultrasounds and displays this number in color. This study sought to evaluate whether power Doppler MCE is able to visualize myocardial reperfusion during intravenous contrast injection. Thirty patients were evaluated 2 days after their first myocardial infarction during intravenous infusion of perfluorocarbon-exposed sonicated dextrose albumin (PESDA). Coronary artery angiography and single-photon emission computed tomography (SPECT) were used as reference techniques. A 16-segment left ventricular model was used to relate perfusion to coronary artery territories. Sensitivity and specificity of power Doppler MCE for segments supplied by infarct-related arteries were 82% and 95%, respectively. Accuracy of power Doppler MCE and SPECT were similar (90% vs 92% on segmental basis and 98% vs 98% on coronary artery territory basis). Two-dimensional echocardiography was repeated after 6 weeks. Segments recovering wall motion after 6 weeks were defined as stunning myocardium. Dysfunctional but perfused myocardium at day 2 after the infarction showed a better late recovery of wall motion compared with dysfunctional but nonperfused myocardium (p <0.001). In conclusion, harmonic power Doppler imaging is a sensitive and specific method for the identification of myocardial reperfusion early after myocardial infarction. It yields prognostic information for late recovery of ventricular function differentiating stunning (dysfunctional but perfused) from necrotic myocardium (dysfunctional and nonperfused).

Adult↗
PubMed2001

Symptomatic atrial pacemaker lead thrombosis: detection by echocardiography and successful surgical treatment.

Formation of thrombi on a permanent pacemaker lead is a rare complication of pacing. However, because of its serious outcome it should be suspected in a patient who reveals right-sided heart failure, dyspnea, or syncope. An early decision to perform an echocardiographic examination, followed by surgical or thrombolytic treatment can solve this clinical problem. In a 69-year-old woman with increasing signs of congestive heart failure, echocardiography revealed a mobile mass in the right atrium attached to the pacemaker lead. Because of threatened symptoms and large dimensions of the mass, urgent surgical removal of the endocardial lead was successfully performed.

Aged↗
PubMed2000

A fast rotating scanning unit for real-time three-dimensional echo data acquisition.

Most three-dimensional (3-D) echocardiography (3-DE) systems today are based on off-line methods where a large number of cross-sectional 2-D scans have to be acquired sequentially before a 3-D image can be reconstructed. Because acquisition is done step-by-step based on ECG triggering plus respiratory gating, this introduces motion artefacts and takes significant acquisition time. Another 3-D approach is based on 2-D transducers and parallel beam-forming. Such a system is very complex. In this manuscript, a fast continuously-rotating scanning unit, based on a 64-element phased-array transducer, is described. Typical rotation speed of the 3-D unit is 8 rotations per s. Therefore, 16 3-D volume datasets can be acquired per s in real-time. The first clinical examples as acquired with this probe are presented.

Artifacts↗
PubMed2000

Safety and prognostic value of early dobutamine-atropine stress echocardiography in patients with spontaneous chest pain and a non-diagnostic electrocardiogram.

AIMS: To risk stratify and shorten hospital stay in patients with spontaneous (resting) chest pain and a non-diagnostic electrocardiogram (ECG). METHODS AND RESULTS: The study comprised 102 patients (mean age 58+/-12 years, 67 men) with spontaneous chest pain and a non-diagnostic ECG. Forty-three patients had suspected coronary artery disease and 59 had known (but of unknown actual significance) coronary artery disease. All patients underwent serial creatine kinase enzyme measurements, continuous ECG monitoring for at least 12 h and early dobutamine-atropine stress echocardiography in patients with negative creatine kinase enzymes and normal findings at ECG monitoring. Dobutamine-atropine stress echocardiography was considered positive in patients with new or worsening wall thickening abnormalities. Patients with negative dobutamine-atropine stress echocardiography were discharged after the test. In-hospital and 6 month follow-up events noted were cardiac death, non-fatal myocardial infarction, unstable angina, and coronary artery bypass surgery or angioplasty. Thirteen patients had evidence of evolving myocardial infarction by elevated creatine kinase enzymes, or unstable angina by ECG monitoring. In the remaining 89 patients, dobutamine-atropine stress echocardiography was performed after a median observation period of 31 h (range 12-68 h). During dobutamine-atropine stress echocardiography no serious complications (death, non-fatal myocardial infarction, sustained ventricular tachycardia or ventricular fibrillation) occurred. Dobutamine-atropine stress echocardiography results were of poor quality in three, non-diagnostic in six, negative in 44 and positive in 36 patients. In the 80 patients with diagnostic dobutamine-atropine stress echocardiography, variables associated with in-hospital events (n=7) were history of exertional angina (P<0. 005), chest pain score (P<0.005), stress-induced angina (P<0.001) and positive dobutamine-atropine stress echocardiography (P<0.005). Variables associated with follow-up events (n=11) were history of exertional angina (P<0.05), chest pain score (P<0.001), stress-induced angina (P<0.01) and positive dobutamine-atropine stress echocardiography (P<0.01). At multivariate analysis the only significant predictor of events was positive dobutamine-atropine stress echocardiography (P<0.01). CONCLUSION: Early dobutamine-atropine stress echocardiography may safely distinguish between low- and high-risk subsets for subsequent cardiac events in patients with spontaneous chest pain and a non-diagnostic ECG.

Atropine↗
PubMed2000

Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study.

BACKGROUND: Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. METHODS AND RESULTS: Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis >/=50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration >/=160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%). CONCLUSIONS: Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram.

Adult↗
PubMed2000

Optimal rotational interval for 3-dimensional echocardiography data acquisition for rapid and accurate measurement of left ventricular function.

BACKGROUND: Prolonged 3-dimensional echocardiography (3DE) acquisition time currently limits its routine use for calculating left ventricular volume (LVV) and ejection fraction (EF). Our goal was to reduce the acquisition time by defining the largest rotational acquisition interval that still allows 3DE reconstruction for accurate and reproducible LVV and EF calculation. METHODS: Twenty-one subjects underwent magnetic resonance imaging and precordial 3DE with 2 degrees acquisition intervals. Images were processed to result in data sets containing images at 2 degrees, 4 degrees, 8 degrees, 16 degrees, 32 degrees, and 64 degrees intervals by excluding images in between. With use of the paraplane feature, 8 equidistant short-axis slices were generated from each data set. The suitability of these short-axis slices for manual endocardial tracing was scored visually by 4 independent experienced observers. The LVV and EF were calculated by using Simpson's rule from 3DE data sets with 2 degrees, 8 degrees, and 16 degrees intervals, and the results were compared with values obtained from magnetic resonance imaging. The probability of 3DE to detect LVV and EF differences was calculated. RESULTS: All patients were in sinus rhythm with a mean heart rate of 72 bpm (SD + or - 12). The LV short-axis images obtained with 16 degrees rotational scanning intervals allowed LV endocardial tracing in all subjects. Good correlation, close limits of agreement, and nonsignificant differences were found between values of LVV and EF calculated with 3DE at 2 degrees, 8 degrees, and 16 degrees rotational intervals and those obtained with magnetic resonance imaging. At steps of 16 degrees, 3DE had excellent correlation (r = 98, 99, and 99), close limits of agreement (+ or - 38, + or - 28.6, and + or - 4.8), and nonsignificant differences (P =.5,.8, and.2) with values obtained from magnetic resonance imaging for calculating end-diastolic LVV, end-systolic LVV, and EF, respectively. Three-dimensional echocardiography with use of 16 degrees rotational intervals could detect 15-mL differences in end-diastolic volume with a probability of 95%, 11-mL differences in end-systolic volume with a probability of 92%, and 0.02 differences in EF with a probability of 95%. CONCLUSIONS: The 3DE data sets reconstructed with images selected at 16 degrees intervals from data sets obtained at 2 degrees precordial rotational acquisition intervals allowed the generation of LV short-axis images with adequate quality for endocardial border tracing. Therefore precordial acquisition at 16 degrees intervals would be sufficient for the reconstruction of 3DE data sets for LV function measurement. This would reduce the acquisition time while maintaining enough accuracy for clinical decision making and would thus make 3DE more practical as a routine method.

Adult↗
PubMed2000

Definition of flow parameters in proximal nonstenotic coronary arteries using transesophageal Doppler echocardiography.

Transesophageal echocardiography (TEE) enables the visualization of proximal coronary arteries. We investigated the feasibility of coronary flow evaluation using TEE, as well as to define flow parameters found in normal proximal coronary arteries. The subgroups of patients with normal proximal segments of coronary arteries were selected from the cohort of 210 patients undergoing routine coronary angiography. The left main coronary artery (LMCA), proximal segment of left anterior descending coronary artery (LAD), left circumflex artery (LCx), and right coronary artery (RCA) were analyzed separately in 147, 64, 53, and 70 patients, respectively. Proximal coronary arteries were evaluated in the transverse plane using a 5-MHz TEE probe, and the flow in normal arteries was registered using pulsed-wave Doppler. The registration of flow with pulsed-wave Doppler was feasible in 88% of studies for the LMCA, 85% for the LAD, 58% for the LCx, and 65% for the RCA. Normal flow was laminar with distinct phasic character (diastolic predominance). Mean +/- SD values of peak coronary flow velocity were (systole/diastole) for the LMCA, 36 +/- 11/71 +/- 19 cm/sec; the LAD, 31 +/- 9/67 +/- 19 cm/sec; the LCx, 36 +/- 13/75 +/- 24 cm/sec; and the RCA, 25 +/- 8/39 +/- 12 cm/sec. Peak diastolic coronary flow velocity was most significantly correlated with heart rate. Doppler evaluation of proximal coronary flow is feasible using TEE in the majority of patients. The knowledge of normal flow values, which is different for the left and the right coronary artery, provides the background for proper interpretation of flow in diseased coronary arteries.

Adolescent↗
PubMed2000

Studies of cardiac function and myocardial tissue characterization.

The heart can be studied using ultrasound techniques. The shape of the heart, its chambers, wall thicknesses, wall tissue characteristics as well as motion of walls and valve leaflets are all diagnostic information. In addition, the blood velocity and its timing within the cardiac cycle is an important diagnostic tool. In the present paper focus will be limited to the analysis of the left ventricular function as observed with two-dimensional and three-dimensional echocardiography and the characteristics of backscattered ultrasound information from the left ventricular chamber wall. Function of the heart is often studied by observation of local wall motion or comparison of chamber volume in maximum and minimum shapes during the cardiac cycle (ejection fraction). Integrated backscatter from the wall is described in examples of cardiac transplantation and hypertrophy. Study of cyclic variation of frequency-dependent attenuation and integrated backscatter indicates that these are independent parameters.

Animals↗
PubMed2000

[Which medical treatment can minimize late complications after pharmacologic treatment of unstable angina?].

UNLABELLED: Current pharmacological treatment of unstable coronary diseases has significantly reduced the rate of early and late complications. Aim of this study was to investigate the impact of in-hospital and ambulatory treatment on the occurrence of late complications in patients with unstable angina treated conservatively. The study group consisted of consecutive 79 patients hospitalized in our Department on the turn of years 1998-1999 (48 men--age 62 +/- 11 years), followed up by at least 1 year. We analyzed the administered agents on the first day of hospitalization: acetylsalicylic acid, heparin, nitroglycerin, beta-adrenergic agents, calcium channels blockers, statins and ACE inhibitors, as well these drugs prescribed for ambulatory management. At least one complication (recurrent hospitalization due to coronary artery disease, unstable angina pectoris, myocardial infarction, need for revascularization or death) occurred in 57 patients (72%) in a follow-up of 16 +/- 3 months. The following drugs significantly reduced rate of late complications (OR--odds ratio, CI--confidence interval, p--significance level):--intravenous heparin during hospitalization: OR = 0.22; CI = 0.12-0.42; p = 0.007;--acetylsalicylic acid administration during hospitalization: OR = 0.42; CI = 0.22-0.77; p = 0.03;--acetylsalicylic acid prescribed for ambulatory treatment: OR = 0.24; CI = 0.13-0.46; p = 0.05. CONCLUSIONS: Heparin and acetylsalicylic acid treatment seems to reduce the number of late complications in patients treated conservatively for the episode of unstable angina.

Adrenergic beta-Antagonists↗
PubMed1999

Usefulness of three-dimensional transesophageal echocardiographic imaging for evaluating narrowing in the coronary arteries.

Coronary artery (CA) imaging has relied on invasive techniques for diagnosing stenotic lesions. Two-dimensional techniques are limited in obtaining optimal longitudinal views of all segments of the CA because of their spatial orientations. Three-dimensional echocardiography (3DE) may produce any desired cross-sectional views and reconstruct 3-dimensional images from a volumetric data set. Its role in CA imaging has not been fully explored. The aim of this study was to evaluate the potential of 3DE in visualizing CAs and in assessing the severity of stenosis. We performed transesophageal 3DE in 46 patients. Images were collected sequentially with the transducer rotated through 180 degrees. From the 3DE data sets of all 46 patients, cross-sectional views and 3-dimensional images of CAs were reconstructed. For segment-by-segment comparison between CA angiography and 3DE in semiquantitative analysis of coronary stenosis, 5 segments were defined for the proximal CA tree in 20 patients who underwent both procedures. The left main, anterior descending, circumflex, and right CAs were visualized from 3DE in 100%, 100%, 98%, and 72%. The available lengths of these segments from 3DE were 12+/-4 mm (range 4 to 22), 15+/-6 mm (range 6 to 36), 30+/-12 mm (range 13 to 60), and 18+/-9 mm (range 6 to 36), respectively. Comparison between 3DE and CA angiography in semiquantitative estimation of CA stenosis resulted in complete agreement in 83% of the segments (kappa value = 0.7). The sensitivity and specificity of 3DE in detecting significant stenosis (> or =50%) were 84% and 97%. In conclusion, transesophageal 3DE allows imaging of the proximal CA, detection of stenotic lesions, and estimation of the severity of stenosis.

Coronary Angiography↗
PubMed1999

Potentials and limitations of the Valsalva maneuver as a method of differentiating between normal and pseudonormal left ventricular filling patterns.

Pseudonormalization of the left ventricular (LV) filling pattern complicates the Doppler echocardiographic assessment of LV diastolic function in patients with heart failure. The Valsalva maneuver is recommended as a method of differentiating between normal and pseudonormal LV filling patterns. However, neither a standardized Valsalva maneuver nor a healthy control population has been studied so far. Therefore, we studied changes in mitral flow velocities in response to a standardized Valsolva maneuver in 55 heart failure patients with LV systolic dysfunction and 35 control subjects. The study subjects were instructed to elevate their intrathoracic airway pressure to 40 mm Hg for 10 seconds. Doppler mitral flow velocities were recorded at rest and during the Valsalva maneuver. All study subjects had comparable decreases in early mitral flow velocity, but mitral flow velocity at atrial contraction increased rather than decreased in patients with a restrictive LV filling pattern. This markedly abnormal response might be useful in detecting elevated filling pressures and pseudonormal filling patterns. Furthermore, in all but 2 patients and all control subjects with an E/A ratio between 1 and 2, inversion of the E/A ratio occurred. This proves that, in contrast to previous beliefs, inversion of the E/A ratio does not differentiate between normal and pseudonormal LV filling patterns.

Blood Flow Velocity↗
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

Paraplane analysis from precordial three-dimensional echocardiographic data sets for rapid and accurate quantification of left ventricular volume and function: a comparison with magnetic resonance imaging.

OBJECTIVES: Three-dimensional echocardiography (3DE) calculates left ventricular volumes (LVV) and ejection fraction (EF) without geometric assumptions, but prolonged analysis time limits its routine use. This study was designed to validate a modified 3DE method for rapid and accurate LVV and EF calculation compared with magnetic resonance imaging (MRI). METHODS: Forty subjects included 15 normal volunteers (group A) and 25 patients with segmental wall motion abnormalities and global hypokinesis caused by ischemic heart disease (group B) who underwent 3DE with precordial rotational acquisition technique (2-degree interval with electrocardiographic and respiratory gating) and MRI at 0.5 T, electrocardiogram (ECG)-triggered multislice multiphase T1-weighted fast field echo. End-diastolic and end-systolic LVV and EF were calculated from both techniques with Simpson's rule by manual endocardial tracing of equidistant parallel left ventricular short-axis slices. Slicing from the 3DE data sets were done by both 2.9-mm slice thickness (method 3DE-A) and by 8 equidistant short-axis slices (method 3DE-B); for MRI analysis, 9-mm slice thickness was used. RESULTS: Analysis time required for manual endocardial tracing of end-diastolic and end-systolic short-axis slices was 10 minutes for the 3DE-B method compared with 40 minutes by the 3DE-A method. For all 40 subjects the mean +/- SD of end-diastolic LVV (mL) were 181 +/- 76, 179 +/- 73, and 182 +/- 76; for end-systolic LVV (mL), 120 +/- 76, 120 +/- 75, and 122 +/- 77; and for EF (%), 39 +/- 18, 38 +/- 18, and 38 +/- 18 for MRI, 3DE-A, and 3DE-B methods, respectively. The differences between 3DE-A and 3DE-B with MRI for calculating end-diastolic and end-systolic LVV and EF were not significant for the whole group of subjects as well as for the subgroups. The 3DE-B method had excellent correlation and close limits of agreement with MRI for calculating end-diastolic and end-systolic LVV and EF: r = 0.98 (-1.3 +/- 26.6), 0.99 (-1.6 +/- 21. 2), and 0.99 (0.2 +/- 5.2), respectively. The correlation between 3DE-A and MRI were r = 0.97, 0.98, and 0.98, and the limits of agreement were -1.4 +/- 36, -0.6 +/- 26, and 0.6 +/- 8 for calculating end-diastolic and end-systolic LVV and EF, respectively. In addition, excellent correlation and close limits of agreement between 3DE-A and 3DE-B with MRI for LVV and EF calculation was also found for the subgroups. Intraobserver and interobserver variability (SEE) of MRI for calculating end-diastolic and end-systolic LVV and EF were 6.3, 4.7, and 2.1; and 13.6, 11.5, and 4.7; respectively, whereas that for 3DE-B were 3.1, 4.4, and 2.2; and 6.2, 3.8, and 3. 6; respectively. Comparable observer variability was also found for the A and B subgroups. CONCLUSIONS: The 3DE-A and 3DE-B methods have excellent correlation and close limits of agreement with MRI for calculating LVV and EF in both normal subjects and cardiac patients. The 3DE-B method by paraplane analysis with 8 equidistant short-axis slices has observer variability similar to MRI and reduces the 3DE analysis time to 10 minutes, therefore offering a rapid, reproducible, and accurate method for LVV and EF calculation.

Adult↗
PubMed1999

Appropriate 3-dimensional echocardiography data acquisition interval for left ventricular volume quantification: implications for clinical application.

UNLABELLED: Volume-rendered 3-dimensional echocardiography (3DE) acquired with small imaging intervals has been validated for accurate left ventricular (LV) volume measurement. However, its clinical application is often impeded by the lengthy acquisition time. The aim of this study was to examine the accuracy of LV volume measurement from 3DE data acquired at different intervals. METHODS: Transthoracic 3DE LV data sets were acquired at intervals of 2 degrees, 6 degrees, 9 degrees, 12 degrees, 15 degrees, 18 degrees, and 20 degrees in 10 human subjects with various cardiac shapes and function. The LV end-diastolic volume and end-systolic volume were measured from each 3DE data set with the "summation of disks" method. Interobserver and intraobserver variability were also examined. Measurements obtained from data acquired at 2 degrees intervals were used as references for comparison. RESULTS: From 10 subjects a total of 70 3DE data sets were obtained. Data acquisition time decreased from 189 +/- 143 seconds at intervals of 2 degrees to 19 +/- 6 minutes at 20 degrees. No statistically significant difference was found among the measurements derived from data obtained at various intervals. Excellent agreement was obtained between interobserver and intraobserver measurements. CONCLUSION: Data acquired at 12 degrees and 15 degrees intervals remained accurate for LV volume measurement and saved over 80% of time in comparison with data acquired at 2 degrees intervals. A further increase in imaging intervals tended to underestimate LV volumes without significant acceleration of the procedure.

Adult↗
PubMed1999

Echocardiographic studies of dobutamine-induced ST-segment elevation before and after coronary artery bypass grafting in patients with old Q-wave myocardial infarction.

There is a controversy regarding the functional significance of stress-induced ST-segment elevation (STE) in Q leads. However, the effect of revascularization on the induction of STE was not investigated. We studied 35 patients with old Q-wave myocardial infarction who underwent coronary artery bypass grafting (CABG) of the infarct-related artery with dobutamine (up to 40 microg/kg per minute) stress echocardiography before and 3 months after CABG. Ischemia was defined as new or worsened wall motion abnormalities. Functional recovery was defined as a reduction of regional wall motion score of 1 or more in 2 or more segments from the pre-CABG to post-CABG resting echocardiogram with the use of the 16-segment/5-grade score model. STE (>/=0.1 mV J-point elevation lasting 80 ms in >/=2 Q leads) occurred in 20 (57%) patients. There was no significant difference between patients with and those without STE before CABG with regard to the prevalence of peri-infarction ischemia (85% vs 80%) or index of improvement of regional function after CABG (0.26 +/- 0.26 vs 0.29 +/- 0.33). STE was reinduced to the same level in 4 patients after CABG, whereas 16 patients showed absent reinduction (8 patients) or reduced level (8 patients) of STE. Functional changes associated with absent reinduction or less STE after CABG were absence of reinduction of regional ischemia in 13 patients, improvement of resting regional function in 5 patients, and resection of scarred segments in 4 patients. Among the 4 patients with persistent dobutamine-induced STE, 1 patient had persistent ischemia and 2 showed worsening of resting regional function. Although dobutamine-induced STE in patients with old Q-wave infarction referred for CABG cannot identify patients with a higher prevalence of ischemia, the lack of reinduction of this pattern after CABG correlates with absent reinduction of ischemia in most of patients.

Cardiotonic Agents↗
PubMed1999

Contrast-enhanced echocardiography: review and current role.

Contrast echocardiography has developed rapidly in the past decade. With the advent of more stable contrast agents and new ultrasound imaging techniques such as second harmonic imaging and transient response imaging, contrast echocardiography has evolved to a promising non-invasive perfusion technique. Myocardial contrast echocardiography is evolving from a qualitative to a quantitative technique, and from an intra-arterial to an intravenous approach. Assessment and quantification of myocardial perfusion in acute myocardial infarction, detection and evaluation of coronary artery disease and enhancement of endocardial border for improved definition of cardiac function are examples of novel applications of contrast echocardiography being developed.

Albumins↗