Sectoranalysis of left ventricular function by fully automated equilibrium radionuclide ventriculography

Hemodynamic effects of celiprolol in patients with ischemic and non-ischemic cardiomyopathy

In this study, the effect of celiprolol (beta-1-antagonist with beta-2-agonistic activity) on hemodynamic and electrocardiographic parameters of patients with congestive heart failure due to ischemic (iCMP) and non-ischemic (niCMP) origin should be evaluated. Sixteen patients were included into the study, nine with iCMP, seven with niCMP. All patients were investigated by radionuclide ventriculography (99mTc), right heart floating catheterization, and late potential analysis and measurement of heart rate variability. All patients received 200 mg celiprolol after a 3-day period of 100 mg celiprolol/day. All patients showed, after a follow-up period of 3 months, a significant improvement of the left ventricular ejection fraction. The changes of hemodynamic parameters were more pronounced in patients with niCMP. Heart rate did not decrease in patients with niCMP. A 3-month therapy with celiprolol as an additional therapy to a preexisting heart failure therapy leads to a significant improvement of the ejection fraction in patients with congestive heart failure. Patients with niCMP seemed to profit more from this additional beta-blocking therapy.

Comparison between factor analysis of dynamic structures and Fourier analysis in detection of segmental wall motion abnormalities: a clinical evaluation

To evaluate Factor Analysis of Dynamic Structures (FADS) versus or in association with other methods, a protocol was set up including as 'gold standard' investigation the left ventricular angiography (LVA) and processing by Fourier Analysis (FA), and FADS with different variants. To refine the diagnosis of Regional Wall Motion Abnormalities (RWMA), processing was done on a sectorial basis for more accurate spatial localization and functional description. 53 patients were studied (8 normal, 45 with coronary artery disease). FADS gave better results than FA on a sectorial basis. Total agreement between FADS and LVA was obtained in 208/265 (78%), while FA was in agreement with LVA in only 167/265 segments (63%). Globally, FADS was significantly better than FA (Z-test: p < 0.05). When only the diagnosis of maximal abnormality was considered, FA and FADS are statistically equivalent. The superiority of FADS vs FA is more obvious in the diagnosis of hypokinesia. Most FA discrepancies corresponded to underestimation of WMA.

Effect of pacing rate on regional left ventricular wall motion. Assessment by quantitative analysis of equilibrium radionuclide angiography

We evaluated the hemodynamic impact of right ventricular pacing at different stimulation frequencies. Fourteen patients with a right ventricular pacemaker (VVI pacing with retrograde P wave) but without clinical and electrocardiographic evidence of coronary artery disease underwent two equilibrium radionuclide angiographies: one under low heart rate (50/60 beats per minute) and the other under fast heart rate (90/100 beats per minute). Left ventricular global and sectorial ejection fractions, amplitude and phase images of first harmonic, and sectorial phases of left ventricle were analyzed. In twelve patients (84.7%), sectorial ejection fraction abnormalities in the left ventricular apicoseptal and inferoapical regions were observed under low heart rate, and worsened under fast heart rate, while new onset sectorial ejection fraction abnormalities under fast heart rate were observed in the other two patients with normal sectorial ejection fraction under low heart rate. Sectorial ejection fractions of left ventricular apicoseptal and inferoapical regions significantly changed between low and high heart rate (- 14.1 +/- 3.8%, p < 0.005; - 7.5 +/- 2.4%, p < 0.01 respectively). Left ventricular sectorial phases were abnormal in only two patients (14.3%) under low heart rate, and in twelve patients (84.7%) under fast heart rate. Our study confirms that left ventricular regional wall motion abnormalities during VVI pacing significantly worsen under fast heart rate in comparison to those under low heart rate.

Serial evaluation of left ventricular function by radionuclide ventriculography at rest and during exercise after orthotopic heart transplantation

Discrepant results have previously been reported concerning long-term left ventricular function in the human transplanted heart as assessed by radionuclide ventriculography. In this study, radionuclide ventriculograms were obtained at rest and during exercise in 19 patients < 6 months, 7-12 months, 13-24 months and > 24 months after transplantation. Ejection fraction decreased significantly from < 6 months to 13-24 months after transplantation (rest: 69.1% +/- 9.7% to 56.7% +/- 8.3%, P < 0.05; exercise: 70.4% +/- 11.3% to 59% +/- 8%, P < 0.05). Heart rate increased significantly during exercise after > 2 years (90.2 +/- 10.5 beats/min to 103.5 +/- 15 beats/min, P < 0.05) but not within 6 months after transplantation (98.5 +/- 12.8 beats/min to 99.07 +/- 15.8 beats/min). Left ventricular end-diastolic volume remained unchanged. Peak filling rate at rest decreased significantly from 4.2 +/- 0.96 edv/s < 6 months after transplantation to 3.3 +/- 0.66 edv/s (P < 0.05) 13-24 months and 3.3 +/- 0.64 edv/s (P < 0.05) > 24 months after cardiac transplantation. Exercise peak filing rate did not change significantly. It is concluded that radionuclide ventriculography demonstrates a decrease in systolic left ventricular function in the long-term course after cardiac transplantation. A significant increase in exercise peak heart rate may be due to autonomic reinnervation. Differences in the literature concerning left ventricular function may be due to different observation intervals following cardiac transplantation.

Radionuclide evaluation of cardiac function during sleep in children with bronchopulmonary dysplasia

The influence of sleep on cardiac function in severe bronchopulmonary dysplasia was assessed in five children 1.5 to 5 years of age. Left and right ventricular ejection fractions (LVEF and RVEF) were investigated by equilibrium radionuclide ventriculography in five children undergoing polygraphic monitoring during the different states of alertness: wakefulness, nonrapid eye movement sleep, and rapid eye movement sleep. Intraobserver and interobserver LVEF and RVEF measurement reproducibility was high. During quiet, supine wakefulness, LVEF was normal, but RVEF was low. During sleep, a decrease in both LVEF and RVEF, expressed as a percentage of the awake value, was marked in the two children with the most nocturnal desaturation and longest duration of paradoxic rib cage motion during inspiration. It is concluded that radionuclide ventriculography can be easily performed during sleep in children and can provide useful information regarding right ventricular function during sleep in children with severe bronchopulmonary dysplasia.

Controlled reperfusion during emergency coronary artery bypass surgery after angioplasty failure restores immediate segmental contractility

This study tests the hypothesis that careful control of the composition of the initial reperfusate and the conditions of the reperfusion during emergency CABG will restore immediate segmental contractility in the previously ischemia area despite ischemic intervals of greater than 2 hours. Between January 1987, and October 1990, 41 consecutive patients with acute coronary occlusion (90% due to PTCA failures) were reperfused during emergency myocardial revascularization according to one of two different protocols: in 25 patients the reperfusate was normal blood given at systemic pressure ("uncontrolled reperfusion"); in 16 patients the ischemic segment was reperfused during the first 20 minutes with a regional blood cardioplegic solution (substrate-enriched, hyperosmotic, hypocalcemic, alkalotic, diltiazem-containing) at 37 degrees C at a pressure of 50 mmHg. Thereafter, total bypass was prolonged for an additional 30 minutes before extracorporeal circulation was discontinued ("controlled reperfusion"). Assessment of regional contractility (echocardiography, radionuclide ventriculography), electrocardiographic evidence of myocardial infarction, release of CK and CK-MB enzymes, and hospital mortality were performed. Quantification of regional contractility was done with a scoring system from 0 (normokinesis) to 4 (dyskinesis). Data are expressed as mean +/- standard error of the mean. Both groups were well matched for age, sex, and the distribution of the occluded artery. In the controlled reperfusion group there was a higher incidence of previous infarctions (50% vs 30%), additional significant stenosis (1.1 +/- 0.2 vs 0.8 +/- 0.1), and cardiogenic shock (38% vs 20%) as compared to uncontrolled reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)