Systolic time intervals in 15 patients with constrictive pericarditis and seven patients with restrictive cardiomyopathy were compared in order to assess their value in the differential diagnosis of the two disorders. Clinical examination had failed to make the distinction. Right heart catheterization was helpful in diagnosing restriction but failed to differentiate patients with constrictive pericarditis from those with restrictive cardiomyopathy. The systolic time intervals clearly separated the two groups. The PEP/LVET was normal in all patients with constrictive pericarditis (0.34 +/- 0.01) and abnormal in all patients with restrictive cardiomyopathy (0.70 +/- 0.09, P less than 0.001). In 13 patients (five with restrictive cardiomyopathy and eight with constrictive pericarditis) the results of quantitative left ventricular angiocardiography were available. A high correlation (r=-0.90, P less than 0.01) between the PEP/LVET and the ejection fraction confirmed the validity of the PEP/LVET as a measure of left ventricular performance in these patients. Thus the systolic time intervals clearly distinguished between constrictive pericarditis and restrictive cardiomyopathy and are a reliable non-invasive technique for making the difficult differential diagnosis.

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This study assesses the relationship between segmental myocardial function and coronary perfusion in patients with high-grade stenosis of the left anterior descending artery. Twenty-five patients with critical lesions (> 70%) were divided into two groups according to the absence or presence of normal echocardiographic septal motion. Twelve patients had abnormal echocardiographic septal motion (AESM) and 13 patients had normal septal motion. Septal perfusion was evaluated by intracoronary injections of radiolabeled macroaggregated albumin (MAA) particles. Of the parameters analyzed abnormal septal perfusion was best related to AESM. Among the 12 patients with AESM, ten had absent resting septal perfusion. Of the 13 patients with normal septal ECHOCARDIOGRAPHY HAS NOW BECOME a useful and accepted noninvasive procedure for evaluating left ventricular performance.' Although the procedure has been most helpful in assessing left ventricular function when the ventricle is diffusely diseased, the echocardiogram is also of proven benefit in defining abnormal contractility in patients with coronary artery disease.8 '0 However, since all segments of the ventricle are not accessible by echocardiography and since coronary disease may produce segmental ventricular dysfunction, it is not always possible to detect all diseased segments of the ventricle. On the other hand, the echocardiogram can provide useful information regarding the interventricular septum, a structure which is not easily evaluated by conventional angiographic techniques."' 12 An important and common cause of abnormal echocardiographic septal motion (AESM) is high grade obstruction of the left anterior descending artery.5' 10, 13 This abnormality of the septum when seen in the presence of significant obstruction of the left anterior descending would seem to imply myocardial ischemia and/or infarction or fibrosis of the septum. A recent report which includes pathological studies related septal thinning to scarring of the septum.'2 Some authors have further suggested that AESM implies not only a critical left anterior descending lesion, but that the lesion is proximal to the first septal perforator branch.10 13Despite the usefulness of coronary angiography in defining the presence of significant obstruction of the major coronary arteries, the procedure does not allow visualization of small vessels and therefore does not provide complete information concerning resting myocardial perfusion. motion, only two had abnormal septal perfusion. Septal width was also significantly thinner in patients with AESM. When angiographic collateralization was associated with septal perfusion as detected by injection of MAA into the right coronary artery, normal septal motion was present (five patients). When no septal perfusion resulted from right coronary injection, even though collaterals were seen angiographically, AESM was found (four patients). Thus, in patients with severe left anterior descending stenosis the presence of abnormal echocardiographic septal motion strongly sug...

A quantitative method for the analysis of 201thallium myocardial scintigrams, developed in an experimental infarcted dog heart model, has been compared with two nonquantitative methods for interpretation of stress myocardial scintigrams in two groups of patients studied with coronary angiography: 11 with normal coronary arteries and 14 with coronary artery disease. Three independent observers interpreted scintigrams which were 1) not computer processed; 2) corrected for background activity in lungs and chest wall; and 3) processed by a computer method which uses a uniform threshold of counts determined from the dog model to define perfusion defects. Interobserver variability as well as sensitivity and specificity of detecting coronary disease were examined. In patients with coronary artery disease interobserver variability was improved by using the computer technique: observers agreed as to the existence of a perfusion defect in 93% of the scintigrams as compared to 55% and 81% for the unprocessed and background-subtracted images respectively. No false positive indications of coronary disease were obtained by any of the three techniques. Use of the computer method did not improve the sensitivity of detecting coronary disease, however--71% compared to 64% for unprocessed images and 79% for background-substracted images. The advantages of this quantitative computer method are increased consistency of interpretation and lack of false positive diagnoses of coronary disease. An improved sensitivity of detection may be gained by varying thallium count thresholds according to anatomic location in the heart.