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PubMed2000

Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable?

AIMS: To prospectively compare the agreement of left ventricular volumes and ejection fraction by M-mode echocardiography (echo), 2D echo, radionuclide ventriculography and cardiovascular magnetic resonance performed in patients with chronic stable heart failure. It is important to know whether the results of each technique are interchangable, and thereby how the results of large studies in heart failure utilizing one technique can be applied using another. Some studies have compared cardiovascular magnetic resonance with echo or radionuclude ventriculography but few contain patients with heart failure and none have compared these techniques with the current fast breath-hold acquisition cardiovascular magnetic resonance. METHODS AND RESULTS: Fifty two patients with chronic stable heart failure taking part in the CHRISTMAS Study, underwent M-mode echo, 2D echo, radionuclude ventriculography and cardiovascular magnetic resonance within 4 weeks. The scans were analysed independently in blinded fashion by a single investigator at three core laboratories. Of the echocardiograms, 86% had sufficient image quality to obtain left ventricular ejection fraction by M-mode method, but only 69% by 2D Simpson's biplane analysis. All 52 patients tolerated the radionuclude ventriculography and cardiovascular magnetic resonance, and all these scans were analysable. The mean left ventricular ejection fraction by M-mode cube method was 39+/-16% and 29+/-15% by Teichholz M-mode method. The mean left ventricular ejection fraction by 2D echo Simpson's biplane was 31+/-10%, by radionuclude ventriculography was 24+/-9% and by cardiovascular magnetic resonance was 30+/-11. All the mean left ventricular ejection fractions by each technique were significantly different from all other techniques (P<0.001), except for cardiovascular magnetic resonance ejection fraction and 2D echo ejection fraction by Simpson's rule (P=0.23). The Bland-Altman limits of agreement encompassing four standard deviations was widest for both cardiovascular magnetic resonance vs cube M-mode echo and cardiovascular magnetic resonance vs Teichholz M-mode echo at 66% each, and was 58% for radionuclude ventriculography vs cube M-mode echo, 44% for cardiovascular magnetic resonance vs Simpson's 2D echo, 39% for radionuclide ventriculography vs Simpson's 2D echo, and smallest at 31% for cardiovascular magnetic resonance-radionuclide ventriculography. Similarly, the end-diastolic volume and end-systolic volume by 2D echo and cardiovascular magnetic resonance revealed wide limits of agreement (52 ml to 216 ml and 11 ml to 188 ml, respectively). CONCLUSION: These results suggest that ejection fraction measurements by various techniques are not interchangeable. The conclusions and recommendations of research studies in heart failure should therefore be interpreted in the context of locally available techniques. In addition, there are very wide variances in volumes and ejection fraction between techniques, which are most marked in comparisons using echocardiography. This suggests that cardiovascular magnetic resonance is the preferred technique for volume and ejection fraction estimation in heart failure patients, because of its 3D approach for non-symmetric ventricles and superior image quality.

Echocardiography↗

PubMed1985

Tomographic gated blood pool radionuclide ventriculography: analysis of wall motion and left ventricular volumes in patients with coronary artery disease.

The use of planar radionuclide ventriculography to evaluate global and segmental ventricular function is limited by the superimposition of structures in some projections and the gross segmental resolution of the planar technique. Preliminary reports have suggested the feasibility of tomographic gated radionuclide ventriculography with rotating detector systems. This study tested the hypotheses that 1) tomographic radionuclide ventriculography detects segmental dysfunction at rest not identified with multiview planar studies and single plane contrast ventriculography, and 2) ventricular volumes and ejection fraction calculated from these studies provide data similar to those obtained with angiography and planar radionuclide ventriculography. Gated blood pool tomograms were acquired over 180 degrees at 15 frames per cardiac cycle during the initial 90% of the cardiac cycle. Compared with the multiview planar technique tomographic ventriculography showed an increased sensitivity for detecting left ventricular segments with significant coronary artery stenosis (97 versus 74%, p less than 0.025) without any loss in specificity. Compared with both planar radionuclide and contrast ventriculography, tomographic radionuclide ventriculography also detected more noninfarcted left ventricular segments supplied by stenosed coronary arteries (81 versus 39 and 32%, respectively, p less than 0.01). Tomographic radionuclide ventriculographic measurements of left ventricular volumes and ejection fraction showed close correlations with angiographic and planar radionuclide determinations. Gated blood pool tomography is a sensitive method for the evaluation of segmental wall motion and an accurate method for the measurement of global left ventricular volumes and ejection fraction.

Adult↗

PubMed1993

Lack of agreement between measurement of ejection fraction by impedance cardiography versus radionuclide ventriculography.

OBJECTIVE: To determine the limits of agreement between left ventricular ejection fraction estimated using systolic time intervals from impedance cardiography and left ventricular ejection fraction estimated by radionuclide ventriculography. DESIGN: A prospective study for diagnostic tests using radionuclide ventriculography as the criterion standard. SETTING: A large military teaching hospital. PATIENTS: Twenty ambulatory adults scheduled for radionuclide ventriculography. MEASUREMENTS AND MAIN RESULTS: A regression equation to estimate ejection fraction from systolic time intervals is available in a widely used impedance-based cardiac monitoring device. The estimated ejection fraction is then used in an equation with stroke volume estimated by the same device to calculate an end-diastolic volume. We studied the agreement of the ejection fraction as estimated by this device with the ejection fraction estimated by radionuclide ventriculography by obtaining simultaneous estimates of ejection fraction over a broad range of adult patients. Twenty ejection fraction pairs were analyzed. The correlation of ejection fraction by impedance cardiography to ejection fraction by radionuclide ventriculography was significant (r2 = .55; p < .002). However, the mean difference between the technologies was -8.85%, with a standard deviation of the differences of 7.15%, resulting in a 95% confidence range for agreement of -23.2% to +5.5%. CONCLUSIONS: The 95% confidence range defining the limits of agreement between ejection fraction by impedance cardiography and ejection fraction by radionuclide ventriculography is not clinically acceptable. In the opinion of the authors impedance cardiography should not be used in place of radionuclide ventriculography for the assessment of ejection fraction at this time.

Adult↗

PubMed2004

Assessment of left ventricular function with steady-state-free-precession magnetic resonance imaging. Reference values and a comparison to left ventriculography.

UNLABELLED: Ejection fraction (EF) and end-diastolic and end-systolic volume index (EDVI/ ESVI) derived from ventriculography are important prognostic parameters. Cine magnetic resonance imaging (MRI) using a steady-state, free-precession sequence (SSFP) offers excellent delineation of the endocardial borders and highly reproducible and accurate results for cardiac volumes. We evaluated MRI volumetry against routine x-ray ventriculography. In 200 patients EF, EDVI and ESVI were measured with MRI volumetry and x-ray ventriculography. The same MRI protocol was applied to 102 healthy persons in order to establish reference values. In healthy subjects mean EF was 68.8% +/- 5.4% (range 59-84%), mean EDVI 69 +/- 10 (43-90) and mean ESVI 22 +/- 5.8 (10-35 ml). In the patients, overall correlation (Spearman's R) of MRI with ventriculography was 0.86 for EF, 0.77 for EDVI and 0.88 for ESVI. For postextrasystolic beats (38% of the measurements), R was 0.73/0.65/0.73 for EF/EDVI/ESVI. MRI correlated best with biplane ventriculography during sinus rhythm (0.96/0.85/0.93); the worst correlation (0.78/0.81/0.83) resulted from patients with wall motion abnormalities in comparison to monoplane x-ray ventriculography. CONCLUSION: Contemporary MRI volumetry compares well to invasive data obtained under optimal conditions. In view of the known limitations of single plane ventriculography, MRI seems to allow exact volumetry independent from regional wall motion abnormalities.

Cardiac Catheterization↗

PubMed2006

Multi-slice computer tomography of left ventricular function with automated analysis software in comparison with conventional ventriculography.

PURPOSE: To evaluate the accuracy of left ventricular volumetric and functional parameters from multi-slice computed tomography using automated analysis software, and to correlate results with those of invasive left ventriculography. MATERIALS AND METHODS: In 145 consecutive patients (mean age, 61 years+/-12) known or suspected to have coronary artery disease, a 16-channel multi-slice computed tomography (Philips Mx8000 IDT 16) was performed using a standard technique. Using short-axis secondary multi-slice computed tomography reformations, we determined end-diastolic and end-systolic left ventricular volumes and ejection fraction with a commercially available analysis software capable of automated contour detection. Conventional left ventriculography was performed according to standard techniques within the following 24 h. Bland-Altman analysis was performed to calculate the limits of agreement and systematic errors between multi-slice computed tomography and conventional left ventriculography. RESULTS: As determined by computer tomography, mean end-systolic (53+/-29 mL) left ventricular volumes had an acceptable correlation with conventional ventriculography (67+/-50 mL; r=0.74; p<0.001) and mean end-diastolic (119+/-33 mL) left ventricular volumes a poor correlation with conventional ventriculography measurements (154+/-69 mL; r=0.41). Left ventricular ejection fraction (57%+/-14 versus 55%+/-14 for conventional ventriculography; r=0.79) showed a very good correlation (p<0.001). Bland-Altman analysis showed acceptable limits of agreement (+/-9.2% for ejection fraction) without systematic errors. CONCLUSION: The use of a multi-slice computed tomography with an automatic calculation software has a good correlation with conventional ventriculography findings and could accurately assess left ventricular function, but should not be used for ventricular volumes, because of biased estimations.

Cineradiography↗

PubMed2003

[Left ventricular functional parameters using ECG-gated multidetector spiral CT in comparison with invasive ventriculography].

PURPOSE: To evaluate the accuracy of left ventricular function using a multidetector CT (MDCT) with retrospective ECG-gating and to compare the results with conventional ventriculography. MATERIALS AND METHODS: In 26 patients, retrospectively ECG-gated MDCT of the heart (Volume Zoom, Siemens, Germany) as well as conventional coronary angiography including ventriculography was performed to exclude or follow coronary artery disease. CT examination (120 KV, 400 mAs) was carried out with 4 x 1 mm collimation (500 ms gantry rotation time). For CT angiography, 150 ml of contrast media was injected intravenously at a flow rate of 4 ml/s. All data sets of the functional cardiac parameters were reconstructed in end-systolic and end-diastolic phase. End-systolic volume (ESV), end-diastolic volume (EDV) and ejection fraction (EF) were determined from multiplanar reformations orthogonally through the cardiac short axis and analyzed using special evaluation software (ARGUS, Siemens). The results were compared with ESV, EDV and EF obtained from invasive ventriculography. RESULTS: In all cases, a sufficient quality of the MDCT images was achieved. EDV (150.1 +/- 16.2 ml MDCT vs. 138.7 +/- 16.9 ml ventriculography; mean difference 11.4 +/- 12.7 ml; r = 0.51) had an acceptable correlation to conventional ventriculography, and ESV (58.1 +/- 14.6 ml vs. 50.2 +/- 13.4 ml; mean difference 7.9 +/- 8.8 ml; r = 0.81) and EF (60.9 +/- 13.6 % vs. 64.9 +/- 12.7 %; mean difference 4.0 +/- 6.2 %; r = 0.79) showed a good correlation. In comparison with invasive ventriculography, MDCT tended to overestimate significantly EDV (p = 0.008) and ESV (p = 0.003) and to underestimate EF (p = 0.001). CONCLUSION: MDCT of the heart with retrospective ECG-gating enables efficient estimation of left ventricular function, providing important additional information of non-invasive cardiac imaging using MDCT. However, EDV and EVS were significantly overestimated and EF was underestimated in MDCT compared to ventriculography.

Aged↗

PubMedDate not supplied

The use of gated radionuclide ventriculography as a noninvasive method of evaluating right ventricular function in dogs with experimentally induced congestive heart failure.

Gated radionuclide ventriculography was evaluated as a noninvasive method of quantifying right ventricular function in dogs with experimentally induced congestive heart failure. Gated radionuclide ventriculography measurements of right ventricular function (right ventricular ejection fraction, right ventricular average emptying rate, and right ventricular average filling rate) were related to standard hemodynamic and echocardiographic measurements. Congestive heart failure was induced by rapid ventricular pacing in eight normal dogs. Hemodynamic, echocardiographic, and gated radionuclide ventriculography measurements were obtained before and after development of biventricular failure. Congestive heart failure resulted in significant changes in all hemodynamic, echocardiographic, and gated radionuclide ventriculography measurements with the exception of systemic arterial pressure. Right ventricular ejection fraction was inversely related to pulmonary artery systolic, diastolic, and mean pressure, and right ventricular average emptying rate was inversely related to the pulmonary artery systolic, diastolic, and mean pressure. Right ventricular ejection fraction was inversely related to left ventricular filling pressure, (pulmonary capillary wedge pressure). Neither the echocardiographic measurements of right ventricular size (right ventricular internal diastolic dimension) nor the right ventricular end-diastolic pressure were related to right ventricular ejection fraction and right ventricular average emptying rate. However, echocardiographic measurements of right ventricular dimension were related to right ventricular filling pressure. The gated radionuclide ventriculography indexes of right ventricular function, right ventricular ejection fraction and right ventricular average emptying rate, are affected by afterload but unaffected by preload, whereas the echocardiographic measurement of right ventricular dimension is related to preload. Gated radionuclide ventriculography provides right ventricular data which is unique from that obtained by standard echocardiographic imaging. Also, gated radionuclide ventriculography has potential value as a noninvasive means of estimating a change in pulmonary artery pressure.

Animals↗

PubMed1998

Prognostic value of predischarge radionuclide ventriculography at rest and exercise after acute myocardial infarction treated with thrombolytic therapy or primary coronary angioplasty. The Zwolle Myocardial Infarction Study Group.

BACKGROUND: Previous studies have demonstrated the prognostic value of radionuclide ventriculography at rest and exercise in patients post myocardial infarction (MI). The number of studies in patients treated with modern reperfusion techniques, including thrombolysis or primary angioplasty, however, is limited. HYPOTHESIS: The aim of this study was to evaluate the prognostic significance of predischarge radionuclide ventriculography at rest and exercise in patients with acute MI treated with thrombolysis or primary angioplasty. METHODS: A total of 272 consecutive patients with acute MI who were randomized to thrombolysis or primary coronary angioplasty underwent predischarge resting and exercise radionuclide ventriculography. Left ventricular ejection fraction at rest, decrease in ejection fraction during exercise > 5 units below the resting value, angina pectoris, ST-segment depression, and exercise test ineligibility were related to subsequent cardiac events (cardiac death, nonfatal reinfarction) during follow-up. RESULTS: During a mean follow-up of 30 +/- 10 months, cardiac death occurred in 11 (4%) patients and nonfatal reinfarction in 14 (5%) patients. Resting left ventricular ejection fraction was the major risk factor for cardiac death. In patients with an ejection fraction < 40%, cardiac death occurred in 16% compared with 2% in those with an ejection fraction > or = 40% (p = 0.0004). In addition, cardiac death tended to be higher in patients ineligible than in those eligible for exercise testing (11 vs. 3%, p = 0.08). None of the other exercise variables (decrease in ejection fraction during exercise > 5 units below the resting value, angina pectoris or ST-segment depression) were predictive for cardiac death. When all exercise test variables in each patient were combined and expressed as a risk score, a low risk (n = 185) and a higher risk (n = 87) group of patients could be identified, with cardiac death occurring in 1 and 10%, respectively. As the predictive accuracy of a negative test was high, radionuclide ventriculography was of particular value in identifying patients at low risk for cardiac death. Radionuclide ventriculography was not able to predict recurrent nonfatal MI. CONCLUSION: In patients with MI treated with thrombolysis or primary angioplasty, radionuclide ventriculography may be helpful in identifying patients at low risk for subsequent cardiac death. In this respect, left ventricular ejection fraction at rest was the major determinant. Variables reflecting residual myocardial ischemia were of limited prognostic value. Identification of a large number of patients at low risk allows selective use of medical resources during follow-up in this subgroup and has significant implications for the cost effectiveness of reperfusion therapies.

Aged↗

PubMed1994

Comparison of dobutamine infusion and exercise during radionuclide ventriculography in the risk stratification after acute myocardial infarction.

Forty-eight patients with acute myocardial infarction were subjected to radionuclide ventriculography during exercise and dobutamine infusion after a mean duration of 25 +/- 18 days following acute myocardial infarction. The results were compared and correlated with coronary angiography. Two patterns of abnormal response of radionuclide ventriculography were identified: (1) a worsening of the baseline wall motion abnormality confined to the infarcted area, and (2) fresh regional wall motion abnormalities in areas with normal motion at rest. Of 44 patients with significant coronary artery lesions (> or = 70% diameter stenosis), 18 had single vessel disease and 26 had multivessel disease. Dobutamine and exercise radionuclide ventriculography identified 23 and 21, respectively, of 26 multivessel disease patients yielding sensitivities of 88% and 80%. Seven of 18 single vessel disease patients showed a worsening of baseline wall motion abnormality of infarct area on dobutamine infusion radionuclide ventriculography. Subgroup analysis of coronary angiograms of single vessel disease revealed that 10 of 18 patients had subtotal occlusion of infarct-related artery supplying a hypokinetic area and the rest had a totally occluded coronary artery supplying an akinetic area. Dobutamine infusion and exercise radionuclide ventriculography detected 7 and 6 of these 10 patients implying the presence of jeopardized myocardium in infarcted/peri-infarct area. Dobutamine stress radionuclide ventriculography is an acceptable alternative to exercise testing to stratify risk following acute myocardial infarction.

Coronary Angiography↗

PubMed2006

Pretargeting for the implantation of stimulation electrodes into the subthalamic nucleus: a comparative study of magnetic resonance imaging and ventriculography.

OBJECTIVE: The optimal imaging modality for preoperative targeting of the subthalamic nucleus (STN) for high-frequency stimulation is controversially discussed. Commonly used methods were stereotactic magnetic resonance imaging (MRI), stereotactic ventriculography, and fusion between MRI and stereotactic computer tomography. All of these techniques not only have their own advantages but also specific limitations and drawbacks. The purpose of this study was to evaluate the accuracy of the preoperative MRI targeting as compared with ventriculography in terms of both the STN target as well as the internal landmarks. METHODS: Thirty patients with Parkinson's disease who underwent bilateral surgery for STN-high-frequency stimulation received both stereotactic ventriculography and stereotactic MRI. The theoretical target was determined by each of these two imaging modalities. The final electrode placement was performed after extensive electrophysiological evaluation using microrecording and microstimulation. The real target was assumed to be given by the electrode contact with the best clinical result assessed by the United Parkinson's Disease Rating Scale in the postoperative follow-up. In addition, the coordinates of the two landmarks, anterior commissure and posterior commissure, were determined using both imaging methods. RESULTS: The mean targeting error was 4.1 +/- 1.7 mm (mean +/- standard deviation) for MRI and 2.4 +/- 1.1 mm for ventriculography (P < 0.0001). The mean target mismatch between the two imaging methods was 2.9 +/- 1.2 mm. The length of the anterior commissure-posterior commissure distance differed significantly (P < 0.0001) between MRI (27.6 +/- 1.6 mm) and ventriculography (25.0 +/- 1.3 mm). The mismatch was mainly induced by an anterior diplacement of the anterior commissure by 1.9 +/- 2.2 mm (P < 0.0001) in MRI determination, as compared with ventriculography. CONCLUSION: Our findings show that the indirect targeting of the STN using coordinates based on radiological landmarks is more accurate than the direct targeting using anatomic visualization of the target structure. Regardless of the imaging procedure, electrophysiological mapping is required for optimal electrode placement, although in 20% of cases, the target determined by MRI falls out of the radius explored by electrophysiology.

Brain Mapping↗

PubMed1999

A prospective comparison between three-dimensional magnetic resonance imaging and ventriculography for target-coordinate determination in frame-based functional stereotactic neurosurgery.

OBJECT: The purpose of this prospective study was to compare stereotactic coordinates obtained with ventriculography with coordinates derived from stereotactic computer-reconstructed three-dimensional magnetic resonance (3D-MR) imaging in functional stereotactic procedures. METHODS: In 15 consecutive patients undergoing functional stereotactic procedures, both preoperative frame-based stereotactic 3D-MR imaging and intraoperative ventriculography were performed. Differences between 3D-MR imaging and ventriculography in X, Y, and Z coordinates of the anterior commissure (AC), posterior commissure (PC), and target area were calculated, as well as the 3D distance between the position of AC, PC, and target within stereotactic space as obtained using both methods. The position of the stereotactic MR imaging fiducial markers measured using 3D-MR imaging compared well with the markers' known position embedded in the software (mean error 0.4 mm, maximal error for an individual slice 1.2 mm). For the individual coordinates, only for Y-PC was a difference found between 3D-MR imaging and ventriculography that significantly exceeded half the size of a pixel, the theoretical limit of precision when using a digitized imaging technique. However, the mean difference was smaller than 1 mm. The mean 3D distance between the 3D-MR imaging- and ventriculography-derived coordinates was 1.09 mm for AC, 1.13 mm for PC, and 1.29 mm for the targets. CONCLUSIONS: With these data it is shown that there is sufficient agreement between ventriculography-derived and 3D-MR imaging-derived stereotactic coordinates to justify the use of 3D-MR imaging target determination in frame-based functional stereotactic neurosurgery.

Brain Mapping↗

PubMed1986

Prospective comparison of exercise digital subtraction and exercise first pass radionuclide ventriculography.

In order to test the comparative sensitivities of first-pass radionuclide and digital subtraction ventriculography in detecting wall motion abnormalities during exercise, 29 patients referred for coronary angiography were submitted to both types of stress ventriculograms. Resting and exercise ventriculograms by both techniques were reviewed by independent observers and the five equal ventricular wall segments were graded as normal, mildly, moderately, severely hypokinetic, akinetic, or dyskinetic. Of the 29 patients, 24 had arteriographically defined ischemic potential (at least greater than 50% obstruction of a major coronary artery supplying viable myocardium). Exercise digital subtraction ventriculography correctly identified 17 (71%) of these by a worsening of wall motion during exercise, while radionuclide ventriculography identified only eight (33%) by the wall motion response. When either a worsening of wall motion or the failure to increase ejection fraction by at least 5 points were used as criteria for an abnormal test, the sensitivities of digital and radionuclide ventriculographies were 96% and 79%, respectively. Though the number of patients without ischemic potential (5 patients) was too small to judge the relative specificities, digital subtraction ventriculography appears to be more sensitive than radionuclide ventriculography in identifying exercise-induced wall motion abnormalities and in predicting coronary occlusions.

Angiography↗

PubMed1984

Detection of left ventricular wall motion abnormalities for the diagnosis of coronary artery disease: a comparison of exercise radionuclide and pacing intravenous digital ventriculography.

Intravenous digital ventriculography before and after pacing was compared with equilibrium gated nuclear ventriculography at rest and after exercise. Specifically, the relative abilities of the 2 techniques to detect resting and stress-related wall motion abnormalities were tested. Twelve normal patients and 28 patients with coronary artery disease (CAD) were tested. Neither technique produced a new wall motion abnormality in a patient with normal coronary arteries. Six patients with CAD had a history of a myocardial infarction (MI); an abnormality at rest was present in all 6 by both techniques. Of the 22 patients with CAD and a normal baseline ventriculogram, a wall motion abnormality developed in 18 during digital ventriculography with pacing; a wall motion abnormality developed in 15 with exercise nuclear ventriculography. Wall motion abnormalities by nuclear ventriculography (performed in the left anterior oblique projection) tended to be apical; digital ventriculography (performed in the right anterior oblique projection) more often produced an abnormality of the anterior or inferior wall, which could be predictive of coronary anatomy. Thus, the 2 techniques are substantially equivalent for the detection of wall motion abnormalities in CAD.

Adult↗

PubMed1992

Comparison of single and biplane ventriculography for determination of left ventricular volume and ejection fraction.

This study was done to compare single and biplane left ventriculography in quantitating left ventricular (LV) volumes and ejection fraction. LV volumes and ejection fraction were measured from a 30 degrees right anterior oblique single plane ventriculogram and a 30 degrees right anterior oblique 60 degrees left anterior oblique biplane ventriculogram in 152 men (aged 59 +/- 9 [mean +/- standard deviation] years), of whom 102 had hypokinesia, akinesia, or dyskinesia. There was excellent agreement between the results of single and biplane ventriculography with respect to LV end-diastolic volume (r = 0.96), end-systolic volume (r = 0.98) and ejection fraction (r = 0.97). The end-diastolic and end-systolic volumes measured by biplane ventriculography were consistently slightly larger than those measured by single plane, whereas ejection fractions measured by the 2 techniques were remarkably similar, even for the 46 patients with biplane ejection fractions less than 0.50 and the 102 with hypokinesia, akinesia or dyskinesia. Thus, LV volumes and ejection fractions determined by single plane ventriculography correlate very well with those determined by biplane ventriculography, even in patients with hypokinesia, akinesia, or dyskinesia and depressed LV systolic performance. Biplane ventriculography appears to provide little information that cannot be obtained reliably from single plane.

Adult↗

PubMed1984

Comparison of two-dimensional echocardiography with gated radionuclide ventriculography in the evaluation of global and regional left ventricular function in acute myocardial infarction.

Two-dimensional echocardiography and gated radionuclide ventriculography were performed in 93 patients (66 men, 27 women; mean age 61 years) with 95 episodes of acute myocardial infarction within 48 hours and at 10 days after infarction. Electrocardiographic sites of infarction were: 35 anterior, 49 inferoposterior and 11 nonlocalized. Abnormal motion of the anterior wall, septum or apex was seen in 97 and 100% of anterior infarctions by radionuclide ventriculography and echocardiography, respectively. Abnormal motion of an inferior or posterior wall segment was seen in 91% of inferoposterior infarctions by echocardiography versus 61% seen by radionuclide ventriculography. Ejection fractions determined by echocardiography and radionuclide ventriculography correlated well (r = 0.82) and did not change from the first 48 hours to 10 days after infarction (0.48 +/- 0.14). Similarly, wall motion score showed minimal change from the first 48 hours to 10 days. In-hospital mortality was 37 and 42% in patients with an ejection fraction of 0.35 or less by echocardiography and radionuclide ventriculography, respectively. No mortality was seen in patients with an ejection fraction above 0.40 by either test. The echocardiographic wall motion score was also predictive of mortality (40 versus 2%; score less than or equal to 0.50 versus greater than 0.50). The 1 year mortality rate in the 81 short-term survivors was 17%. Mortality was lowest in patients with an ejection fraction above 0.49 or wall motion score above (0.79 (2 to 5%) and worse in those with an ejection fraction below 0.36 or wall motion score below 0.51 (36 to 63%) by either technique. Thus in acute myocardial infarction, echocardiography and radionuclide ventriculography provide a comparable assessment of left ventricular function and wall motion in anterior infarction. Echocardiography appears more sensitive in detecting inferoposterior wall motion abnormalities. Both techniques are capable of identifying subgroups of patients with a high risk of death during the acute event and with an equally high mortality rate over a 1 year follow-up period.

Adult↗

PubMed1985

Accuracy of radionuclide ventriculography for estimation of left ventricular volume changes and end-systolic pressure-volume relations.

Estimation of left ventricular end-systolic pressure-volume relations depends on the accurate measurement of small changes in ventricular volume. To study the accuracy of radionuclide ventriculography, paired radionuclide and contrast ventriculograms were obtained in seven dogs during a control period and when blood pressure was increased in increments of 30 mm Hg by phenylephrine infusion. The heart rate was held constant by atropine infusion. The correlation between radionuclide and contrast ventriculography was excellent. In the individual animals, the average r value for left ventricular volume was 0.96 +/- 0.03 (+/- SD) (p = 0.001, n = 7) and the mean r value for end-systolic volume changes was 0.90 +/- 0.08 (n = 7, range 0.76 to 0.99). For the entire series, there were 33 end-systolic volume changes, and there was an equally strong radionuclide-contrast correlation (r = 0.89, p less than 0.001, n = 33), even though the volume changes averaged only 11.9 +/- 8.2 ml (range 0.3 to 38.1). The systolic pressure-volume relations were linear for both radionuclide and contrast ventriculography (r = 0.98 and 0.97, respectively, n = 7). The mean slope for radionuclide ventriculography (2.9 +/- 1.4) was lower than the mean slope for contrast ventriculography (4.8 +/- 1.7) (p = 0.004); however, the slopes correlated well (r = 0.81, n = 7, p = 0.026). The radionuclide-contrast volume relation was compared using background subtraction, attenuation correction, neither of these or both. By each method, radionuclide ventriculography was valid for measuring small changes in left ventricular volume and for defining end-systolic pressure-volume relations.

Animals↗

PubMed1981

Comparison of radionuclide and contrast ventriculography for detection and quantitation of regions of myocardial ischemia in dogs.

Radionuclide and contrast ventriculography were evaluated for their ability to estimate myocardial ischemia. In 14 closed-chest, sedated dogs, a small and larger region of ischemia were produced by inflating balloon occluders on the left anterior descending coronary artery. The systemic arterial pressure, atrial-paced heart rate, global ejection fraction by radionuclide and contrast ventriculography, regional wall-motion abnormalities (as the percentage of abnormally contracting segments), and regional myocardial blood flow (using the microsphere technique) were measured during an initial control period, two separate ischemic periods, and a final control period. The regional ischemic weights based on myocardial blood flow ranged from 0 to 38.5 g and were grouped as zero, small (range 0 to less than 10 g, mean 3.40 g), and large regions of ischemia (greater than 10 g, mean 24.8 g). Regional wall-motion abnormalities were sensitive qualitative indicators of ischemia. Receiver operating characteristic analysis showed that both ventriculographic methods were highly sensitive, specific, and accurate for detecting regional ischemia. Contrast ventriculography was slightly superior for detecting small regions less than 4 g, but the methods were equal for regions greater than 4 g. The arterial pressure and heart rate were unchanged during ischemia. For small regions of ischemia, the global ejection fraction did not fall using either the contrast or radionuclide technique, but it fell significantly when large regions were produced. There was a quantitative relationship between the percentage of abnormally contracting segments and the grams of myocardial ischemia (for radionuclide ventriculography, r = 0.65, P = 0.003, and for contrast ventriculography, r = 0.75, P less than 0.001), but for many small regions of ischemia, wall-motion changes were greater than anticipated, suggesting hypofunction of the continguous normal tissue. This study demonstrated that both radionuclide and contrast ventriculography were quite sensitive and specific for detecting measured amounts of regional ischemia. The functional changes resulting from ischemia are quantitatively related to the extent of regional ischemia, small areas resulting in regional wall motion abnormalities, and large areas producing both reduced global ejection fraction and wall motion changes.

Animals↗

PubMed2000

Two- and three-dimensional CT ventriculography: a new application of helical CT.

OBJECTIVE: We propose a new application of helical CT, CT ventriculography, which can produce two-dimensional (2D) and three-dimensional (3D) images of different cardiac phases (plus animation). We sought to determine the accuracy of CT ventriculography for assessing left ventricular volumes. MATERIALS AND METHODS: With a single breath-hold, the patient's entire heart was scanned with an ECG-gating technique (3-mm-thick collimation, 2 mm per rotation table speed, 0.8 sec per rotation, and 50 rotations through 10 cm in total). Using a 0.2-mm (0.08-sec) interval (10 slices per rotation) overlapping reconstruction, about 500 axial slices were obtained and reordered to separate different cardiac cycles. Then, 2D cardiac axes and 3D images were reconstructed and animated movies of the 2D and 3D images were produced. In 21 patients, the left ventricular end-diastolic volume, end-systolic volume, and ejection fraction were assessed and compared with left ventriculography. Correlations and agreements between CT and left ventriculography were determined. RESULTS: Close correlations between CT and left ventriculography were obtained (r = 0.95, 0.98, and 0.91, for end-diastolic volume, end-systolic volume, and left ventricular ejection fraction, respectively; p < 0.0001 for all values). The limits of agreement between CT and left ventriculography were 44.3 to -44.5 ml for end-diastolic volume, 19.8 to -29.0 ml for end-systolic volume, and 19.7% to -9.5% for left ventricular ejection fraction. CONCLUSION: This cardiac application of helical CT provides a clear morphology along the cardiac axes and 3D images and an assessment of left ventricular volumes (end-diastolic volume, end-systolic volume, and left ventricular ejection fraction).

Adult↗