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revious studies have shown the usefulness of lowdose dobutamine stress echocardiography (DSE) for the assessment of viable myocardium and the prediction of functional recovery after revascularization in patients with chronic coronary disease. [1][2][3][4][5][6][7][8] However, there were wide ranges of sensitivity, specificity, and accuracy (74-91%, 73-95%, and 73-91%, respectively) for prediction of reversible dysfunction, possibly because most studies included patients with various degrees of regional and global left ventricular (LV) function. In addition, more precise equipment may be required in order to obtain a satisfactory level of the accuracy with DSE.Recently, a cardiac cycle-dependent variation of ultrasonic integrated backscatter (IBS-CV), which reflects intramural contractile performance and myocardial thickening, [9][10][11][12] has been anticipated as useful for assessing myocardial viability and predicting LV functional recovery in patients with reperfused acute myocardial infarction. 13 In the setting of acute myocardial infarction, the characteristic of salvageable myocardium was reversibility of the blunted amplitude of IBS-CV. Pasquet et al reported that resting IBS-CV closely paralleled contractile reserve in patients with chronic LV ischemic dysfunction, 14 but further study is required to elucidate several aspects of the usefulness of IBS. We have Japanese Circulation Journal Vol. 65, May 2001 gradually increased the number of opportunities for evaluating the pertinence of revascularization in patients with chronic LV ischemic dysfunction, and so we designed this study to determine the sensitivity, specificity, and accuracy of resting % systolic wall thickening (resting WT), resting IBS-CV, DSE, and low-dose dobutamine stress IBS-CV (DSE-IB) in predicting functional recovery in patients with chronic LV ischemic dysfunction, and we also evaluated the effect of global LV function on the accuracy of this study. Methods Study PopulationWe studied 48 patients with a previous (mean 9±5 months after the onset) myocardial infarction between June and December, 1998. For inclusion in the study, the following criteria needed to be fulfilled.1. Previous myocardial infarction including at least one akinetic segment as demonstrated by transthoracic echocardiography.2. A suitable acoustic window to allow DSE with IBS. 3. Clinical evidence of myocardial ischemia, and scheduling for percutaneous transluminal coronary angioplasty (PTCA).4. No cardiac event during the follow-up period after revascularization.All patients underwent combined low-and high-dose DSE with IBS and radionuclide ventriculography (RNV) before PTCA. For a mean of 10 months (range, 5-24 months) after PTCA, transthoracic echocardiography at rest and the IBS study were repeated. All patients gave This study was designed to assess the diagnostic accuracy of the percentage of resting systolic wall thickening (WT), dobutamine stress echocardiography (DSE), resting cyclic variation of integrated backscatter (IBS-CV), and low-dose dobutamine...

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Upper torso deep vein thrombosis usually occurs in association with an indwelling venous catheter and/or malignancy as part of a paraneoplastic syndrome. However, idiopathic internal jugular vein thrombosis is a rare but potentially fatal condition. We report a 59-year-old woman who presented with severe dizziness. Ultrasonography and contrast-enhanced multislice computed tomography revealed thrombi in the left internal jugular vein. This patient had no malignancy, coagulation disorder, or infection. A ventilation/perfusion scan of the lungs showed no evidence of pulmonary embolism. This is a rare case of idiopathic thrombosis of the internal jugular vein.

Background. Ischemia produces a sequence of events beginning with a decline in coronary flow reserve, myocardial perfusion abnormalities, and wall motion abnormalities. We hypothesized that low-dose dobutamine stress, combined with myocardial contrast echocardiography (MCE) and transthoracic Doppler echocardiography (TTDE), could detect myocardial ischemia preceding wall motion abnormalities according to this ischemic cascade.Methods. Ninety-six patients suspected of having stable angina pectoris underwent TTDE, MCE, and semi-quantitative dobutamine stress echocardiography (Semi-DSE). Wall motion was assessed using a scoring system. The contrast agent, Levovist, was injected intravenously to assess the coronary flow velocity (CFV) ratio in the left anterior descending coronary artery (LAD) and myocardial perfusion abnormalities in the LAD territory. The CFV ratio was calculated as the CFV during low-dose dobutamine stress divided by the baseline CFV. Time-intensity data for MCE were fitted for y = A (1 e t ) from which the rate of the intensity rise ( ) was calculated and the ratio was derived at baseline and during stress.Results. Semi-DSE and low-dose dobutamine stress combined with TTDE and MCE were obtained successfully in 85patients. The sensitivity and specificity of Semi-DSE for detecting 75% LAD stenosis were 79% and 93%, respectively. In the LAD territory, Semi-DSE showed 6 false negative and 4 false positive findings. However, failures of the CFV ratio and ratio to increase >1.81 and >1.23 times that at baseline, respectively, indicated the presence of critical LAD stenosis, especially in 3 out of 6 false negative cases.Conclusions. Low-dose dobutamine stress combined with TTDE and MCE is a useful method for detecting critical LAD stenosis during Semi-DSE. This method overcomes the limitations of Semi-DSE. (J Echocardiogr 2006; 4: 69-77)