[Congestive heart insufficiency. Evaluation using isotopic methods].

Abstract

Radioisotopic cardiac studies became, on the last decade, one of the more useful non-invasive methods for the diagnostic evaluation and follow-up of patients with heart disease. Such a contribution of nuclear cardiology is specially noticeable on ischemic heart disease: radionuclide angiography (RNA) allows quantification of left and right ventricular dysfunction, and therefore stands as an ideal technique for the prognostic approach of congestive heart failure. As to diagnosis, RNA is useful in the analysis of regional wall motion abnormalities of ischemic heart disease and detection of ventricular aneurysms. Clinical examples are given of these specific situations. In dilated cardiomyopathies RNA gives not only a measure of ventricular dysfunction, but also a diagnostic information, often definitive, of the diffuse involvement of all left ventricle, and commonly of the right ventricle. Ischemic heart disease, on the other hand, displays different degrees of segmental wall motion impairment together with areas of normal contractility. These aspects are documented with cases of our Registry. Also discussed is the inotropic stimulation technique for the evaluation of the functional reserve of left ventricle in patients with severe rest L.V. dysfunction. Focus is given to the clinical value of isotopic studies for the quantification of valvular regurgitations and pre-operative serial studies in order to define an optimum surgical timing. An attempt is done to grade the practical importance of the different exams of Nuclear Cardiology on the diagnostic and prognostic evaluation on heart disease patients, with a cost benefit relation perspective and comparing with other methods, classic of recent ones, available for the management of patients with heart failure.