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PubMed1991

[Right ventricular function in sleep apnea syndrome and chronic obstructive pulmonary disease].

The factors that contribute to the development of chronic cor pulmonale (CCP) in sleep apnea syndrome (SAS) are being continuously reviewed, as well as the role played by the coexistence of chronic obstructive pulmonary disease (COPD). Right ventricular function was evaluated in 20 SAS patients, 10 of whom presented associated (COPD). In all of them the following tests were performed while fasting: blood gasometry, spirometry, body mass index and isotopic ventriculography which included the determination of righ ventricular ejection fraction (RVEF). The RVEF of the group presenting COPD (mean +/- DS) (0.43 +/- 0.07) was not significantly different from the group without COPD (0.46 +/- 0.09). When the patients were regrouped according to the presence of hypoxemia during the day (paO2 less than 70 mmHg) a significant difference was evidenced between the mean value of the RVEF group with hypoxemia (n = 10) (0.40 +/- 0.02) and that of the group with normoxemia (n = 10) (0.50 +/- 0.09) (p less than 0.05). There were no statistically significant differences between the degree of obstruction and the BMI in either group. These results suggest that the worsening of RVF is more frequent in SAS patients who present daytime hypoxemia.

Adult↗
PubMed1991

Evaluation of right ventricular regional perfusion with technetium-99m-sestamibi SPECT.

To evaluate technetium-99m-sestamibi as a right ventricular perfusion imaging agent, 25 normal volunteers and 25 patients with suspected coronary disease were studied with both sestamibi and thallium-201 SPECT. All patients underwent cardiac characterization. Compared to thallium-201 images, visualization of the right ventricle was superior for sestamibi in all cases. After computer masking of the left ventricle, count profiles for each 6-mm right ventricular short-axis slice were extracted and plotted in a bull's-eye type polar map with images normalized to maximal right ventricular counts. On sestamibi right ventricular polar maps, 7 of 11 patients (64%) with right coronary stenosis had fixed or reversible inferior right ventricular defects. None of the 25 volunteers or patients without right coronary stenosis had right ventricular defects (true-negative rate = 100%). We conclude that sestamibi SPECT provides an accurate means to assess right ventricular regional perfusion, with data presentation and interpretation facilitated by the polar map display.

Adult↗
PubMed1991

[Evaluation of a single oral dose of nifedipine on the right- ventricular ejection fraction in patients with chronic obstructive lung diseases].

Nineteen patients (12 males, 7 females, mean age 59 +/- 10 years) with chronic obstructive lung disease and lowered ventilatory reserves in partial and full respiratory insufficiency (FEV1 f = 51 +/- 19%; MEF 50 = 23 +/- 13% pred. value, R(aw) = 220 +/- 120%; pO2 = 59 +/- 5; pCO2 = 41 +/- 10 mmHg) were included in the study. All had RVEF measured using radionuclide angiocardiography before and 60 minutes after oral administration of 20 mg of nifedipine. In all RVEF was initially reduced by 25%. After administration of NF in 12 patients a statistically significant increase of RVEF was seen (by a mean value of 12 = +/- 8%). iN 7 no significant increase could be seen. The two groups reactive and non-reactive to NF did not differ in age, sex, degree of ventilatory impairment, hypoxia, and initial decrease of RVEF.

Administration, Oral↗
PubMed1991

[Quantitative evaluation of right ventricular function by transesophageal echocardiography: report of a case with classical right ventricular infarction].

We were able to diagnose right ventricular infarction (RVI) by transesophageal echocardiography (TEE) in a patient with acute inferior infarction, and it was confirmed by cardiac catheterization. To evaluate right ventricular (RV) function quantitatively, area shortening (AS) and regional AS (rAS) were measured from RV images obtained by TEE. The AS correlated with RV ejection fraction obtained by radionuclide angiography (r = 0.72). The patient with RVI showed depressed RV function by AS measurement with decreased rASs of all regions in the acute phase. In the chronic phase, RV function of the patient improved, especially in the region of the ventricular septum and apex regions. These results indicate availability of TEE and that RV function can be evaluated by TEE.

Aged↗
PubMed1991

[Assessment of right ventricular afterload in mitral valve diseases with radionuclide angiography].

Right ventricular function at rest and during exercise was studied in 33 patients with mitral valve disease by equilibrium gated radionuclide angiography using 99mTc in vivo labeled red blood cells. Radionuclide measurements of right ventricular ejection fraction (RVEF) were correlated with mean pulmonary arterial pressure (mPAP). RVEF decreased significantly with exercise. There was no significant correlation between RVEF at rest and mPAP. However, mPAP showed significant negative correlation with RVEF during exercise and with the changes of RVEF from rest to exercise. It is concluded that RVEF during exercise in mitral valve disease is affected by right ventricular afterload, and the measurements of RVEF at rest and during exercise by equilibrium gated radionuclide angiography is useful to assess right ventricular afterload.

Adult↗
PubMed1990

[Variations in QT interval and ventricular volume during exercise-induced myocardial ischemia].

Aim of this study was to evaluate the possible relationship among myocardial ischemia, left ventricular volume changes and QT interval changes during exercise in patients with coronary artery disease. QT interval, expressed as absolute value, corrected according to Bazett (QTc = aT/RR0.5) and Fridericia (QTf = QT/RR0.33) and calculated by adapting reciprocal changes in QT and heart rate during exercise to the exponential fit proposed by Sarma (QTs = A-B*exp (-K*RR], was compared to the scintigraphic finding of myocardial ischemia and to the changes in left ventricular volumes during exercise. We studied 151 patients (130 men and 21 women, mean age 56 +/- 11 years) with suspected or already ascertained coronary artery disease, who underwent a simultaneous evaluation of regional ventricular function and myocardial perfusion by means of first pass radionuclide angiography (multielement gamma-camera) and computerized tomography, with 2 injections of 99mTc-MIBI at rest and at peak of a computerized bicycle stress test. QT and RR intervals were measured on an averaged ECG complex through a magnifying lens, and the absolute values of left ventricular volumes were computed by radionuclide angiography. According to scintigraphic findings, patients were divided into normal subjects (n = 7) and ischemic patients with (n = 63) and without (n = 81) evidence of a previous myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Effects of anteroseptal myocardial infarction on systolic and diastolic filling function of the right ventricle].

To assess the effects of wall motion abnormalities of the anterior left ventricle and interventricular septum on right ventricular (RV) systolic and diastolic filling function, multiple-gated radionuclide angiography was performed at rest in 53 patients with previous anteroseptal myocardial infarction and 14 normal subjects. There were 26 patients with left ventricular ejection fraction (LVEF) greater than or equal to 45% (group 1) and 27 with LVEF less than 45% (group 2). Six measurements were obtained simultaneously in both ventricles: 1) EF, 2) peak ejection rate, 3) duration of systole, 4) peak filling rate, 5) time to the peak filling rate, and 6) ratio of the peak filling rate to the peak ejection rate. The mean RV ejection fraction and the peak ejection rate in groups 1 and 2 were similar to those in the normal subjects. The ratio of the peak RV filling rate to the peak RV ejection rate, a sensitive indicator of diastolic filling function, decreased significantly in group 1 (0.61 +/- 0.15, p less than 0.02) and group 2 (0.59 +/- 0.15, p less than 0.02) as compared with that in the normal subjects (0.74 +/- 0.14). This indicates an impairment of early diastolic RV filling compared with RV systolic function. Thus, RV systolic function appears to be normally maintained even when anteroseptal wall motion is severely impaired; however, even in the presence of mild anteroseptal wall motion abnormality, RV filling may be impaired without reduced RV systolic function.

Aged↗
PubMed1990

Perfusion and function at rest and treadmill exercise using technetium-99m-sestamibi: comparison of one- and two-day protocols in normal volunteers.

The purpose of this study was to explore the feasibility of performing rest and exercise technetium-99m-sestamibi (99mTc-sestamibi) studies on the same day. We prospectively studied 34 asymptomatic volunteers using two different protocols (17 patients studied using one-day protocol and 17 patients studied using two-day protocol). For the one-day protocol, the rest study was performed first. For the two-day protocol, the exercise study was performed first followed by a second-day rest study. Left and right ventricular ejection fractions, myocardium/lung, myocardium/liver, myocardium/spleen, and myocardium/gallbladder count ratios were similar for the one- and two-day groups. No significant difference was observed in any variable measured. These data suggest that 99mTc-sestamibi can be used for rest and treadmill exercise studies performed on the same day to provide assessment of ventricular function and perfusion similar to studies performed on separate days.

Abdomen↗
PubMed1990

[The role of non-invasive methods in the diagnosis of heart failure].

A survey is given on the validity of the non-invasive methods in the diagnostics of the cardiac insufficiency. Thereby the value of the echocardiography is emphasized not only in the etiologic clarification but also in the judgement of the cardiac (ventricular) function, the results of which can give the indication for invasive diagnostics in patients with cardiac insufficiency at stage III and IV NYHA. In the stages I and II NYHA of cardiac insufficiency this question and that one of the estimation of the functional capacity of the body are clarified by the use of tolerance tests. The ventriculography of radionuclides under conditions of exercise allows a far-reaching insight into the cardiac function, such as with the help of the parameter of the left ventricular ejection fraction.

Echocardiography↗
PubMedDate not supplied

Role of radionuclide ventriculography in evaluating cardiac function.

The role of nuclear cardiology techniques for evaluating cardiac function has become increasingly important among other diagnostic techniques. The current status of radionuclide imaging of left and right ventricular function allows accurate diagnosis of cardiac patients with both coronary and noncoronary disease. The combination of gated first-pass and equilibrium radionuclide ventriculography makes it possible to assess more completely cardiac function than by either technique alone. Of particular interest to most imaging physicians is the current position of exercise ventriculography in the diagnostic setting, especially since this test has undergone new scrutiny in its application to broader patient segments. This technique and issues related to its place in the diagnostic environment are discussed in this review article, with emphasis on relevance to the clinical laboratory.

Cardiomyopathies↗
PubMed1990

Determination of diastolic function by radionuclide ventriculography.

Diastolic filling can be measured by radionuclide ventriculography with use of several techniques including those based on gated and list-mode acquisitions, the first-pass method, and the nuclear probe. Radionuclide ventriculography specifically assesses volumes, rates of volume change, and intervals during ventricular filling. Normal values for diastolic filling measurement vary depending on the individual radionuclide methods used and the age of the patient. Comparative studies of the radionuclide method with contrast angiographic and Doppler echocardiographic techniques for measuring diastole are discussed, and the advantages and disadvantages of the radionuclide techniques are explored. The role of radionuclide assessment of diastolic function in specific clinical examples of hypertrophic cardiomyopathy, hypertension, anthracycline-induced cardiomyopathy, and coronary artery disease is reviewed. Radionuclide ventriculography is an accurate and easily applicable procedure for studying left ventricular volume changes in diastole.

Aged↗
PubMed1979

Validity of left-ventricular ejection fractions measured at rest and peak exercise by equilibrium radionuclide angiography using short acquisition times.

To validate ejection fraction (EF) calculations from 5 and 2 minutes of multiple-gated equilibrium radionuclide angiographic data and to establish its utility during alterations in cardiac performance, we studied 38 patients with chest pain suggestive of coronary artery disease. Twenty-four patients underwent contrast ventriculography (CV) as well as first-pass (FP) and equilibrium (EQ) radionuclide angiography at rest, and 14 additional patients had both radionuclide tests performed at rest as well as during peak supine bicycle exercise. The resting 5-min acquisition ejection fractions were compared between each method and the following correlations were generated: r = .92, n = 24 (CV-EQ), r = .92, n = 24 (CV-FP), and r = .95, n = 38 (FP-EQ). The variability of EQ-EF calculations between two independent observers was less than 2%; the mean absolute difference between two sequential 2-min acquisitions and the 5-min recordings was -.1 +/- 1.6%, and the reproducibility of sequential 2-min ejection fractions was excellent (r = .98). EQ and FP ejection fractions at symptom-limited exercise correlated well (r = .96, n = 14). We conclude that equilibrium radionuclide angiography is a valid method to measure EF both at rest as well as during peak exercise even when 2-min acquisition periods are used.

Adult↗
PubMed1991

Left ventricular dysfunction and blood glycohemoglobin levels in young diabetics.

Left ventricular function including regional wall motion (RWM) was evaluated by 99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection/cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.

Adolescent↗
PubMed1992

Analysis of left ventricular function from gated first-pass and multiple gated equilibrium acquisitions.

99mTechnetium-sestamibi is a new myocardial perfusion imaging agent that offers significant physical advantages over 201thallium for myocardial perfusion imaging. One of these advantages is that it can be used in the assessment of ventricular function by means of first-pass radionuclide angiography (FPRNA), acquired during the injection of the tracer. In this study we compared gated list mode first-pass acquisition with 99mTc-sestamibi (FP-MIBI) to multiple gated equilibrium radionuclide ventriculography (MUGA) with 99mTc-labelled red blood cells for the determination of global left ventricular ejection fraction (LVEF). The study population consisted of 20 patients (mean age 54 years) who were submitted to stress-rest perfusion imaging. Resting FPRNA was performed using 99mTc-sestamibi and the reference data were acquired within a week with the MUGA technique. A linear correlation between FP LVEF and MUGA LVEF gave an r = 0.974 (p < 0.01). Diastolic and systolic timing and velocity parameters had lower correlations between these two methods. We conclude that global LVEF can be precisely measured with 99mTc-sestamibi when compared to usually employed MUGA technique with 99mTc-labelled red blood cells.

Cardiac Output↗
PubMed1991

[Assessment of right atrial and ventricular function by radionuclide ventriculography using continuous infusion of 81mKr].

The purpose of this study is to assess the right atrial and ventricular function by radionuclide ventriculography using continuous infusion of 81mKr in normal subjects and in patients with heart disease. 1) Reproducibility of RVEF measurement by continuous infusion of 81mKr was good (interobserver; gamma = 0.97, p less than 0.001, n = 20: intraobserver; gamma = 0.97, p less than 0.001, n = 20). This method had a excellent correlation with RVEF of 99mTc first-pass technique (gamma = 0.92, p less than 0.001, n = 20). 2) RVEF was measured in 10 normal volunteers, 76 patients with myocardial infarction (OMI), 20 patients with dilated cardiomyopathy (DCM), 5 patients with arrhythmogenic right ventricular dysplasia (ARVD) and 5 patients with primary pulmonary hypertension (PPH). In OMI and DCM, their RVEF was lower than that of normal volunteers and, in ARVD and PPH, lower than that of OMI and DCM. There was a significant inverse correlation between RVEF, mean pulmonary artery pressure and right ventricular end-diastolic volume index. 3) The effect of the location of right coronary artery (RCA) lesions on RVEF during exercise was also evaluated. Ten normal volunteers and 27 patients with OMI were studied at rest and during exercise. The patients with OMI were divided into two groups: those without proximal RCA lesions (non RCA group, n = 12) and those with proximal RCA lesions (RCA group, n = 15). Although there were no significant increases of RVEF during exercise in both group, the percent change in RVEF was less in RCA group than in non RCA group. These findings suggested that proximal RCA stenosis is a major determinant of exercise RVEF. 4) To assess the right atrial function, right atrial volume curve was measured in 10 normal volunteers, 32 patients with OMI and 4 patients with PPH. The curve was clearly divided into 4 phase; filling phase (312 +/- 40 msec), early ejection phase (276 +/- 53 msec), plateau an index of right atrial reservoir function, was 0.41 +/- 0.05 and Contractile Volume/Stroke Volume (Contr. V/SV), as an index of right atrial pump function, was 0.23 +/- 0.05 in normal volunteers. In OMI and PPH, atrial reservoir function decreased and atrial pump function increased. It was concluded that radionuclide ventriculography using continuous infusion of 81mKr was useful to assess the right heart function.

Atrial Function, Right↗
PubMed1978

Left-ventricular ejection fraction and segmental wall motion by peripheral first-pass radionuclide angiography.

A computerized edge-detection method was developed to obtain radionuclide ventriculograms for analysis of left-ventricular ejection fraction and segmental wall motion from first-pass studies following i.v. injection of radionuclide. The accuracy of this technique was examined in 21 patients undergoing cardiac catheterization. Tc-99m DTPA was injected into an antecubital vein, with data acquisition in the 30 degrees RAO projection by a gamma scintillation camera interfaced to a computer. A computerized profile analysis was used to determine objectively the edge of the left-ventricular blood pool. Time-activity curves were generated, and the ejection fraction was calculated from sequential end-diastolic and end-systolic count rates. The values for ejection fraction correlated well with those obtained by single-plane contrast ventriculography (r = 0.95). End-diastolic and end-systolic images were reconstructed from the time-activity curve. To analyze segmental wall motion, the left-ventricular outline was divided into five segments and the motion of each segment was graded qualitatively from 1 to 5. Seventy-five of 105 segments had the same grade as the wall motion determined by contrast angiography, and 102 of 105 were within one grade. (P less than 0.001). These findings demonstrate the accuracy of this improved technique for objective, rapid, and noninvasive determination of left-ventricular function.

Adult↗