Relation between coronary anatomy and serial changes in left ventricular function on exercise: a study using first pass radionuclide angiography with gold-195m.

Caplin, John L.; Dymond, D. S.; O'keefe, J. C.; Flatman, W. D.; Dyke, L; Banim, S. O.; Spurrell, R. A. J.

doi:10.1136/hrt.55.2.120

Cited by 14 publications

(2 citation statements)

References 20 publications

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“…In a recent study that assessed the time course of changes in left ventricular function on exercise by rapid sequential first pass radionuclide angiography with gold-195m we found an overall increase in ejection fraction on exercise in patients with normal coronary arteries; however, all the subjects were male. 3 This study has shown that patients with syndrome X are a non-homogeneous group and that in this group women are more likely than men to develop left ventricular dysfunction on exercise. Previous studies have also shown that falls in left ventricular ejection fraction and the development of wall motion abnormalities are associated with a reduced exercise capacity in women,'4 and this is confirmed by the current data.…”

Section: Discussionmentioning

confidence: 89%

Sex differences in exercise induced left ventricular dysfunction in patients with syndrome X.

Favaro¹,

Caplin²,

Fettiche³

et al. 1987

Heart

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SUMMARY Clinical, electrocardiographic, and scintigraphic data were reviewed from 32 patients (18 men and 14 women) who had syndrome X (chest pain, evidence of ischaemia, and normal coronary arteries without coronary vasospasm). The mean (SD) resting left ventricular ejection fraction, determined by first pass radionuclide angiography was 62-6 (9-2)% and was > 50% in all subjects. There was no significant difference between men and women. On exercise, left ventricular ejection fraction decreased significantly to 57-4 (13-0)%. In 17 of 32 subjects there was a fall in left ventricular ejection fraction of > 5%, and regional wall motion abnormalities developed in 12 subjects. The fall in left ventricular ejection fraction on exercise was significant in women (from 61-9 (8-5)% at rest to 54 0 (9-8)% on exercise) but not in men (from 63-2 (9-8)% at rest to 60 0 (14 8)% on exercise). Exercise left ventricular ejection fraction fell by > 5 % in 10 (71 %) of 14 women and in seven (39%) of 18 men. Dyskinetic segments developed in eight (57%) of 14 women and only four (22%) of men. Exercise duration in women was significantly shorter than in men (4-1 (1 5) vs 6 6 (2-1) minutes) and was the only one of several clinical and scintigraphic variables that correlated with the change in left ventricular ejection fraction on exercise.In this selected group of subjects with chest pain and angiographically normal coronary arteries, exercise induced left ventricular dysfunction, as shown by a fall in ejection fraction or the development of regional abnormalities, is a common finding. These are more likely to occur in women than men and are associated with a lower exercise capacity. The data suggest that the sex of the patient is important in the interpretation of the non-invasive evaluation of subjects suspected of having syndrome X.Most of the clinical manifestations of ischaemic heart disease are due to fixed or dynamic obstruction of epicardial coronary arteries. Coronary angiography remains the gold standard by which normality or abnormality of the coronary circulation is judged and its importance in clinical decision making and prognosis cannot be denied.' None the less, there is a subset of patients in whom there is evidence of ischaemia in the absence of abnormal coronary arteriograms or evidence of coronary vasospasm. This clinical group has been labelled as syndrome X.2 These patients have func- Accepted for publication 24 November 1986 tional rather than anatomical ischaemia and are particularly difficult to manage. They have been investigated by various invasive and non-invasive methods.This study assessed the frequency of exercise induced left ventricular dysfunction in a group of these patients and examined the differences in response between male and female patients.Patients and methods STUDY POPULATIONThe records of 174 patients were reviewed. They had been referred to the Nuclear Cardiology Laboratory in the years 1982-86 and had undergone (within one year) both coronary arteriography for a primary diagnosis of po...

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Section: Discussionmentioning

confidence: 89%

Sex differences in exercise induced left ventricular dysfunction in patients with syndrome X.

Favaro¹,

Caplin²,

Fettiche³

et al. 1987

Heart

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“…Aliquots of approximately 0.5 mls of gold-195m, with an activity of 550-700 MBq, were introduced into the tubing via the three-way tap, and flushed into the vein using a rapid injection from syringe. Details of the mercury-195m/gold-195m (A.E.R.E., Harwell, England) have been previously described (7) as well as its safety and clinical use in man (8)(9)(10). The studies were performed using a multicrystal gamma camera (Baired Atomic System-77), using a framing interval of 30 msec and a data acquisition time of 30 second.…”

Section: Radionuclide Angiographymentioning

confidence: 99%

Effects of projection and background correction method upon calculation of right ventricular ejection fraction using first-pass radionuclide angiography

1985

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There is no consensus as to the best projection or correction method for first-pass radionuclide studies of the right ventricle. We assessed the effects of two commonly used projections, 30 degrees right anterior oblique and anterior-posterior, on the calculation of right ventricular ejection fraction. In addition two background correction methods, planar background correction to account for scatter, and right atrial correction to account for right atrio-ventricular overlap were assessed. Two first-pass radionuclide angiograms were performed in 19 subjects, one in each projection, using gold-195m (half-life 30.5 seconds), and each study was analysed using the two methods of correction. Right ventricular ejection fraction was highest using the right anterior oblique projection with right atrial correction 35.6 +/- 12.5% (mean +/- SD), and lowest when using the anterior posterior projection with planar background correction 26.2 +/- 11% (p less than 0.001). The study design allowed assessment of the effects of correction method and projection independently. Correction method appeared to have relatively little effect on right ventricular ejection fraction. Using right atrial correction correlation coefficient (r) between projections was 0.92, and for planar background correction r = 0.76, both p less than 0.001. However, right ventricular ejection fraction was far more dependent upon projection. When the anterior-posterior projection was used calculated right ventricular ejection fraction was much more dependent on correction method (r = 0.65, p = not significant), than using the right anterior oblique projection (r = 0.85, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

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Nonischemic changes in right ventricular function on exercise. Do normal volunteers differ from patients with normal coronary arteries?

Caplin

Maltz

Flatman

et al. 1988

Clinical Cardiology

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Summary:Factors other than ischemia may alter right ventricular function both at rest and on exercise. Normal volunteers differ from cardiac patients with normal coronary arteries with regard to their lejl ventricular response to exercise. This study examined changes in right ventricular function on exercise in 2 1 normal volunteers and 13 patients with normal coronary arteries, using first-pass radionuclide angiography. There were large ranges of right ventricular ejection fraction in the two groups, both at rest and on exercise. Resting right ventricular ejection fraction was 40.2f 10.6% (mean f SD) in the volunteers and 38.6f9.7% in the patients, p=not significant, and on exercise rose significantly in both groups to 46.1 f9.9% and 45.8*9.7%, respectively. The difference between the groups was not significant. In both groups some subjects with high resting values showed large decreases in ejection fraction on exercise, and there were significant negative correlations between resting ejection fraction and the change on exercise, r= -0.59 (p

show abstract

Relation between coronary anatomy and serial changes in left ventricular function on exercise: a study using first pass radionuclide angiography with gold-195m.

Cited by 14 publications

References 20 publications

Sex differences in exercise induced left ventricular dysfunction in patients with syndrome X.

Sex differences in exercise induced left ventricular dysfunction in patients with syndrome X.

Effects of projection and background correction method upon calculation of right ventricular ejection fraction using first-pass radionuclide angiography

Nonischemic changes in right ventricular function on exercise. Do normal volunteers differ from patients with normal coronary arteries?

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