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Biomedical subjects

Roxy Senior

Publications and source records attributed to Roxy Senior.

At least 19 recordsLinked to original sources
PubMed2007

Clinical and economic impact of stress echocardiography compared with exercise electrocardiography in patients with suspected acute coronary syndrome but negative troponin: a prospective randomized controlled study.

AIMS: Patients attending hospital with suspected acute coronary syndrome (ACS), non-diagnostic electrocardiogram (ECG), and negative troponin present a diagnostic dilemma for admitting physicians. We sought to determine the clinical and economic impact of stress echocardiography (SEcho) when compared with exercise ECG (ExECG) in the assessment of these patients. METHODS AND RESULTS: Following pre-test assessment by (Thrombolysis in Myocardial Infarction) TIMI score, patients were randomized to ExECG (n=218) or SEcho (n=215). Subsequently, low-risk patients were discharged; those considered high risk were referred for coronary angiography. Patients were followed-up for cardiac events and a cost-analysis performed. SEcho was superior to ExECG in stratifying patients as low risk (77 vs. 33%, respectively, P<0.0001) with no difference in cardiac event rate (5 vs. 3%, respectively). SEcho classified fewer patients as intermediate risk (3 vs. 39%, respectively, P<0.0001) and fewer patients required further tests when compared with ExECG (3 vs. 47%, respectively, P<0.0001). Costs for detection of coronary artery disease were significantly less in patients undergoing SEcho (pound366.63 vs. pound515.48, P=0.004). CONCLUSION: SEcho is superior to ExECG in the risk stratification of patients with suspected ACS but negative troponin. SEcho resulted in less diagnostic uncertainty, fewer referrals for further investigation, and hence, a significant cost benefit over ExECG.

Aged↗
PubMed2006

Myocardial contrast echocardiography evolving as a clinically feasible technique for accurate, rapid, and safe assessment of myocardial perfusion: the evidence so far.

Intravenous myocardial contrast echocardiography (MCE) is a recently developed technique for assessment of myocardial perfusion. Up to now, many studies have demonstrated that the sensitivity and specificity of qualitative assessment of myocardial perfusion by MCE in patients with acute and chronic ischemic heart disease are comparable with other techniques such as cardiac scintigraphy and dobutamine stress echocardiography. Furthermore, quantitative parameters of myocardial perfusion derived from MCE correlate well with the current clinical standard for this purpose, positron emission tomography. Myocardial contrast echocardiography provides a promising and valuable tool for assessment of myocardial perfusion. Although MCE has been primarily performed for medical research, its implementation in routine clinical care is evolving. This article is intended to give an overview of the current status of MCE.

Acute Disease↗
PubMed2006

Value of primary care electrocardiography for the prediction of left ventricular systolic dysfunction in patients with suspected heart failure.

To compare electrocardiogram (ECG) with measurement of N-terminal pro-B-type natriuretic peptides (NTproBNP) as the General Practitioner's (GP) initial test for suspected heart failure patients from the community. We prospectively studied 137 suspected heart failure patients who underwent ECG and NTproBNP estimation; were referred from primary care to a specialist unit for echocardiography. We demonstrated that sensitivity of ECG interpreted by GP was significantly lower than both by ECG interpreted by Hospital Physician (HP) and NTproBNP estimation for the detection of left ventricular systolic dysfunction (LVSD). Therefore, measurement of NTproBNP is a better investigation in primary care than ECG for the detection of significant LVSD.

Aged↗
PubMed2006

Comparison between myocardial contrast echocardiography and single-photon emission computed tomography for predicting transmurality of acute myocardial infarction.

Contrast-enhanced cardiovascular magnetic resonance imaging (CMR) has been shown to accurately assess transmural extent of infarction, which is an excellent predictor of long-term improvement in contractile function. We assessed the relative accuracy of myocardial contrast echocardiography (MCE) and single-photon emission computed tomography (SPECT) to predict transmural extent of infarction after acute myocardial infarction. MCE, SPECT, and CMR were performed in 40 patients with acute myocardial infarction 7 to 10 days after thrombolysis. CMR was used to divide the transmural extent of infarction into 5 groups: 0%, 1% to 25%, 26% to 50%, 51% to 75%, and 76% to 100% in dysfunctional segments. MCE and SPECT were compared with assessment grades of transmural extent of infarction. There was a significant relation (p<0.0001) between decreasing contrast intensity as assessed qualitatively by MCE and increasing transmural extent of infarction on CMR as was the case for SPECT. The accuracy of MCE (77%) to predict>50% transmural extent of infarction (nonviable myocardium) was significantly (p=0.02) superior to that of SPECT (70%). Absence of uptake on MCE and SPECT virtually ruled out 25% transmural extent of infarction (84% vs 76%, p=0.03). MCE and SPECT correlate well with the transmural extent of infarction. However, MCE is significantly more accurate in predicting >50% of the transmural extent of infarction and more sensitive in identifying <or=25% of the transmural extent of infarction than SPECT.

Cohort Studies↗
PubMed2006

Diagnostic and imaging considerations: role of viability.

Left ventricular systolic dysfunction is a recognised feature of heart failure. In developed nations, the leading cause of left ventricular systolic dysfunction is coronary artery disease. Revascularisation is a treatment strategy for patients with predominant symptoms of heart failure and significant left ventricular dysfunction. Presence or absence of myocardial viability has been shown to affect outcome after revascularisation. There are various techniques to assess myocardial viability. However, limitations of current literature, lack of completed randomised trials and high peri-procedural trials create significant uncertainty about the optimal strategy. This review focuses on the role of non-invasive testing for myocardial viability in patients with left ventricular systolic dysfunction and heart failure and also outlines the pros and cons of each technique.

Diagnostic Imaging↗
PubMed2006

Contrast echocardiography versus gated single photon emission computed tomography for the assessment of parameters of left ventricular remodeling after acute myocardial infarction.

BACKGROUND: Assessment of parameters of left ventricular (LV) remodeling after acute myocardial infarction (AMI) has both therapeutic and prognostic implication. Contrast echocardiography (CE) has the advantage of simultaneously assessing myocardial perfusion and LV remodeling. We aimed to evaluate the accuracy of CE to assess LV remodeling after AMI compared with technetium-99m sestamibi gated single photon emission computed tomography (SPECT). METHODS: Accordingly, 36 consecutive patients underwent gated SPECT, CE, and cardiovascular magnetic resonance imaging (CMR) 7 to 10 days after AMI. LV ejection fraction (LVEF), and LV end-systolic and end-diastolic volumes were assessed. RESULTS: Absolute differences for LVEF and LV end-diastolic volume between CMR and CE were significantly smaller than that between CMR and SPECT. CE estimate of LVEF more accurately classified patients into LVEF less than 35%, 35% to 45%, and greater than 45% (agreement = 83%, kappa = 0.66 with CMR) compared with SPECT (agreement = 61%, kappa = 0.36 with CMR). CONCLUSION: CE is more accurate than gated SPECT for the estimation of LV remodeling after AMI.

Echocardiography↗
PubMed2006

Detection of residual infarct-related coronary artery stenosis and multivessel disease after thrombolysis: comparison between myocardial contrast echocardiography and single photon emission computed tomography.

BACKGROUND: Detection of residual infarct-related artery (IRA) stenosis and multivessel disease (MVD) after thrombolysis has important therapeutic and prognostic implications. Technetium 99m sestamibi single photon emission computed tomography (SPECT) is used for detection of flow-limiting coronary artery disease (CAD). Myocardial contrast echocardiography (MCE) is a new technique developed to assess CAD. We aimed to compare the relative accuracy of vasodilator stress MCE and SPECT for detection of IRA stenosis and MVD after acute myocardial infarction. METHODS: Accordingly, 72 patients underwent simultaneous MCE and SPECT 7 +/- 2 days after thromobolysis. Coronary angiography was performed in all patients. RESULTS: Of the 72 patients, 60 demonstrated significant myocardial viability of which 55 (92%) showed significant IRA stenosis (> 50%). MVD was present in 30 (42%) of the 72 patients. MCE was more accurate than SPECT for detection of both IRA stenosis (85% vs 62%, P = .02) and MVD (85% and 64%, P = .004). CONCLUSION: MCE was comparable to SPECT for the detection of IRA stenosis and MVD after thrombolysis.

Coronary Angiography↗
PubMed2006

Accurate assessment of aortic stenosis with intravenous contrast.

We came across an interesting case of calcific aortic stenosis in which severity was inaccurately assessed on two-dimensional and Doppler echocardiogram resulting in catheterization. Use of intravenous transpulmonary contrast agent enhanced the Doppler signal enabling better quantification of the transvalvular gradient. Use of contrast in such difficult to image patients is very useful in establishing a correct diagnosis.

Aged↗
PubMed2006

Contrast echocardiography for the assessment of myocardial viability.

PURPOSE OF REVIEW: The availability of an accurate, non-invasive method for distinguishing viable from irreversibly damaged myocardium, after acute myocardial infarction or in chronic coronary artery disease, is important in clinical decision making. Such a tool would enable physicians to identify patients most likely to benefit from revascularization strategies in patients with coronary artery disease and left ventricular dysfunction. Myocardial contrast echocardiography is a new technique that utilizes acoustically active gas-filled microspheres (microbubbles), which remain exclusively in the intravascular space and allow the simultaneous assessment of global and regional myocardial structure, function, and perfusion. An increasing body of data supports its role in assessing myocardial viability and predicting the recovery of function. RECENT FINDINGS: Myocardial contrast echocardiography accurately differentiates 'stunning' from necrosis, delineates transmural extent of infarction, predicts recovery of regional and global left ventricular systolic function in the recuperative phase, identifies patients at high risk of left ventricular remodelling, and provides incremental viability data when performed in conjunction with low-dose dobutamine echocardiography. SUMMARY: Technological advances have positioned myocardial contrast echocardiography as a safe, practical bedside technique for the evaluation of myocardial viability. It has comparable accuracy with other non-invasive imaging techniques, such as dobutamine stress echocardiography, radionuclide scintigraphy and cardiac magnetic resonance imaging.

Coronary Artery Disease↗
PubMed2006

Myocardial contrast echocardiography: Role in clinical cardiology.

Recent updates in the field of echocardiography have resulted in improvements in both image quality and techniques allowing echocardiography to maintain its position as the primary non-invasive imaging modality. In particular, the development of new ultrasound contrast agents and imaging techniques have now made possible the assessment of myocardial perfusion. Myocardial contrast echocardiography utilises acoustically active gas filled microspheres (microbubbles), which have rheology similar to that of red blood cells. The detection of myocardial perfusion during echocardiographic examinations permits simultaneous assessment of global and regional myocardial structure, function, and perfusion, enabling the optimal non-invasive assessment of coronary artery disease. Myocardial contrast echocardiography is equally adept in assessing chronic coronary artery disease as well as acute coronary syndromes. Furthermore, its use is not limited solely to diagnostic assessment. Preliminary evidence suggests that targeted microbubbles may be useful in enhancing delivery of genes / drugs and in clot lysis.

Animals↗
PubMed2005

Clinical significance of perfusion techniques utilising different physiological mechanisms to detect myocardial viability: a comparative study with myocardial contrast echocardiography and single photon emission computed tomography.

Myocardial uptake using (99m)Tc-sestamibi single photon emission computed tomography (SPECT) depends largely on myocardial microvascular volume. Myocardial contrast echocardiography (MCE) is a relatively new technique that detects not only microvascular volume but also blood flow. These differing mechanisms may affect the relative accuracies of MCE and SPECT for detecting myocardial viability (MV) early after acute myocardial infarction (AMI) and thrombolysis. Accordingly 56 patients underwent resting transthoracic echocardiography, low-power MCE and SPECT 7+/-2 days following first AMI and thrombolysis. Contractile reserve (CR) was assessed 3 months following revascularization. The sensitivity and specificity of MCE and SPECT were 83% and 78% (p=ns) and 78% and 45% (p<0.01) respectively. MCE was the only multivariate predictor of global recovery of function and CR (OR=3.5, p=0.01). The different physiological mechanisms employed by MCE and SPECT translate into different relative accuracies for the detection of MV.

Humans↗