Alteration of diastolic filling rate during exercise radionuclide angiography: a highly sensitive technique for detection of coronary artery disease.

Myocardial contrast two-dimensional (2D) echocardiography is a relatively new technique which was developed and validated in animals to determine myocardial perfusion. However, human studies are scarce. Therefore, myocardial contrast 2D echocardiography was performed in 32 patients with suspected coronary artery disease immediately after coronary arteriography. Two milliliters of sonicated iopamidol (microbubbles size 12 ± 4 pm) was injected intracoronarily during continuous recording of échocardiographie apical four-chamber view. Visible myocardial contrast was achieved in 82% of patients (25 patients) and 62% of injections (96 injections). Perfusion defects were detected in 5 of 6 patients with > 90% stenosis without collateral circulation and in none of the 7 patients with collateral flow. Normally contracting segments were opacified in every instance, while this occurred only in 7 of 15 areas with contraction abnormalities. No wall motion abnormalities resulted from intracoronary sonicated iopamidol. Minor transient electrocardiographic changes (ST-T segment changes) were noted, which were similar as seen after routine coronary arteriography. Patients showed no complaints after injection of the echocontrast. Myocardial contrast 2D echocardiography is a potential useful method for the real-time analysis of myocardial perfusion in humans.

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Myocardial Contrast Two-Dimensional Echocardiography: Initial Observations during Cardiac Catheterization

Cate¹,

Widimský²,

Serruys³

et al. 1988

“…This may, in part, account for our finding of increased peak filling rates in normals and patients. Poliner et al [17], using the peak filling rate in the first half of diastole, overcame this problem and were able to describe a directional change in exercise peak filling rate…”

Section: Sensitivitymentioning

confidence: 99%

Left Ventricular Diastolic Function in Patients with Chronic Stable Angina: Comparison with Normal Subjects

Hinge¹,

Raftery²,

Rodrigues³

et al. 1988

An automated method for assessing left ventricular diastolic function from equilibrium radionuclide ventriculography has been developed and the technique used to study 55 normal subjects and 65 patients with reproducible effort angina. Mean (±SD) resting peak filling rate was 3.0 ± 0.5 EDV/s in normal subjects but only 2.18 ± 0.5 EDV/s in the patients (p < 0.001). Similar abnormalities in early filling rate (p < 0.001), time to peak filling rate (p < 0.01) and first one-third filling fraction (p < 0.001) were observed. Peak filling rate was more sensitive (40%) than resting ejection fraction (20%) for detecting ischaemic heart disease. Patients with triple vessel disease had lower peak filling rate values than those with single vessel disease, and diastolic function was lower in those with abnormal resting ejection fraction (< 49 %). There was no correlation between age and diastolic function in the normal subjects (r = 0.13). A similar lack of correlation was found between peak filling rate at rest (r = 0.14) but on exercise a weak correlation was detected (r = 0.52; p < 0.002) in patients. There was no difference in diastolic filling indices between normal men and women. Left ventricular diastolic function can be reliably assessed using equilibrium radionuclide ventriculography. Measurement of diastolic filling indices may be useful for monitoring therapeutic interventions in patients and for long term follow-up.

“…Left ventricular diastolic abnormalities are common in patients with various cardiac diseases even with nor mal global and regional systolic function [1][2][3], Recently attention has been focused on the need for noninvasive techniques to assess the diastolic properties of left ven tricles (LV) and their abnormalities. Therefore, various studies have been undertaken utilizing two-dimensional Doppler (2DD) echocardiography and equilibrium gated radionuclide angiography (RNA) in normal sub trai anulus, LV dimension, and geometric assumptions [15].…”

Section: Introductionmentioning

confidence: 99%

Influence of Normalization Techniques upon Two-Dimensional Doppler-Derived Peak Filling Rate: Comparison with Radionuclide Angiography

Bonaduce¹,

Morgano²,

Breglio³

et al. 1989

In this study we evaluated if two-dimensional Doppler (2DD)-derived peak filling rate (PFR) normalized to stroke volume (SV) could provide a useful index of diastolic function that can be compared to PFR obtained with radionuclide angiography (RNA). Forty-five patients, 22 with clinical evidence of healed myocardial infarction (MI) and 23 of primary hypertension underwent 2DD and RNA study within 24 h. 2DD- and RNA-derived PFR were normalized to end-diastolic volume (PFR-EDV) and to SV (PFR-SV): PFR determined by 2DD correlated with RNA in the total study population (r = 0.45; p < 0.01), in MI (r = 0.51; p < 0.01) and in hypertensive (H) patients (r = 0.43; p < 0.05) when both were normalized to SV; however, when normalized to end-diastolic volume, 2DD-derived PFR also correlated with RNA in the total study population (r = 0.36; p < 0.05) and in H patients (r = 0.48; p < 0.05) but not in MI patients (r = 0.37; NS). Furthermore, PFR-SV and PFR-EDV measured by RNA closely correlated in the total study population (r = 0.81; p < 0.001), in MI (r = 0.86; p < 0.001), and in H patients (r = 0.86; p < 0.001), while, when assessed by 2DD, the r values of the correlations between the same parameters in the total study population (r = 0.44; p < 0.01), in MI (r = 0.47; p < 0.05) and in H patients (r = 0.43; p < 0.05) were lower. Thus, 2DD-derived PFR normalized to SV more than to EDV might be useful in assessing left ventricular diastolic filling abnormalities in cardiac patients, in particular in those with healed MI.