sodium-pertechnetate-tc-99m and Cardiomyopathy--Dilated

Functional state of left ventricle was studied in 43 patients with dilated cardiomyopathy. All the patients showed pronouncedly reduced total ejection, stroke volume and cardiac index, increased final diastolic and final systolic volumes, decreased ejection rate indices. Analysis of regional contractility of left ventricle allowed to detect significant fall of ejection fraction in 96.3% of segments. Diastolic dysfunction was characterized by disorders of isovolumetric relaxation, changes in hemodynamical structure and contribution of atrial systole to ventricular filling, decrease of volumetric compliance of left ventricle. The data obtained give a reason to consider that appropriate therapy of dilated cardiomyopathy should be carried out with taking into account both systolic and diastolic left ventricle dysfunction.

Topics: Adult; Cardiomyopathy, Dilated; Chronic Disease; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Ventricular Function, Left

Assessment of myocardial contractility function and its diastolic features (according to the results of radionuclide ventriculography with 99mTc-pertechnetate) in patients with dilatory cardiomyopathy (DCMP) revealed a significant decrease in the total ejection fraction, regional ejection fractions, cardiomegaly (an increase in the end-diastolic volume combined with an increase in end-systolic volume and a decrease in the stroke volume) and a decrease in ejection rate indices. Differential criteria for the diagnosis of DCMP and CHD were a greater degree of cardiodynamic indices and a diffuse decrease in myocardial regional contractility function in the former and heterogeneity of changes in regional contractility in the latter pathology. The process of diastolic filling in DCMP patients was characterized by a marked decrease in a filling rate at reduced time of its achievement, and in CHD patients by a decrease in a maximum filling rate in combination with increased time of its achievement.

Topics: Adult; Cardiomyopathy, Dilated; Coronary Disease; Diagnosis, Differential; Diphosphates; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Ventriculography; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pyrophosphate

Authors performed quantitative assessment of 13 global and regional, left ventricular wall motion parameters obtained from 52 radioactive blood pool cardiac scintigrams. Of these performed in 1986 examinations, authors selected 3 equipotent patients' groups (myocardial infarction, cardiac aneurysm, cardiomyopathy) thus the contractility disorders were located in inferior wall segments. 13 examinations of the same material, without contractility disorders were selected (standard). Using time-activity curve authors measured following global parameters: ejection fraction (EFg1), mean ejection rate (MER), peak ejection rate (PER), peak filling rate (PFR), time from the end-systole to peak filling rate (tPFR) and regional parameters such as: regional and local ejection fraction (EFr and EF1), time from the beginning of the cycle to the end-diastole (ED) and to the end-systole (ES), contractility (KURCZ), amplitude of contractions. (AMPL) and of phase (PHASE) as well as standardized variables of amplitude distribution (SDU). The most significant quantitative parameter was EFgl. Dyskinesis symptom was the most important for cardiac eneurysm diagnosis. Phase shift served a confirmation of aneurysm earlier diagnosed using a cinematic display.

Topics: Cardiomyopathy, Dilated; Erythrocytes; Heart; Heart Aneurysm; Heart Ventricles; Humans; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m

To determine right (RV) and left ventricular (LV) volumes, a new technique was developed using ECG-gated single-photon emission computed tomography (SPECT). RV volumes of nine patients and LV volumes of 22 patients measured by SPECT and biplane contrast cineangiography were compared. In addition, volume and ejection fraction (EF) of the RV and LV were obtained by SPECT for 10 normal controls, 21 patients with old myocardial infarction (OMI), eight patients with hypertrophic cardiomyopathy (HCM) and 12 patients with dilated cardiomyopathy (DCM), and these results were compared. The intracardiac blood pool was labeled with Tc-99m sodium pertechnetate and 32 images were recorded through 180 degrees by a rotating gamma-camera. End-diastolic and end-systolic counts during 50 msec were recorded during 50 or 60 cardiac cycles. These counting data were reconstructed as tomographic images of vertical long-axial slices with thickness of a pixel without any attenuation correction. The numbers of voxels within the % cut-off level were summed, and the sum was multiplied by the one voxel volume. The cut-off level for ventricular delineation was determined as 45% by phantom studies. 1. The values obtained from SPECT and contrast angiography correlated well. 2. In normal controls, LV end-diastolic and end-systolic volumes were significantly less than those of the RV (p less than 0.05, p less than 0.001) and LVEF was significantly greater than the RVEF (p less than 0.001). 3. In OMI (single vessel disease), both end-diastolic and end-systolic volumes of the LV were significantly greater than those of normals (p less than 0.01, p less than 0.001) and LVEF was significantly less. In HCM end-systolic volumes of the RV were significantly less (p less than 0.05) than those of the normals. 4. LV volume was greater and LVEF was extremely low both in DCM and in OMI (multivessel disease) compared to that of the normals. In DCM, RV end-systolic volumes was greater and RVEF was lower than that of OMI (multi-vessel disease), indicating the deterioration of RV contractility , primarily in DCM. From these findings, it was concluded that this noninvasive technique may be useful for estimating left and right ventricular volumes.

Topics: Adult; Aged; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radiography; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, Emission-Computed

12 patients with cardiomyopathy were examined by MRT and first pass angiocardiography. MRT provides detailed images of cardiac anatomy and abnormalities without using any contrast medium. The first pass method is an excellent complement to MRT. The functional imaging describes regional wall motion of myocardium exactly. Both non-invasive methods are useful for the diagnosis of cardiomyopathy.

Topics: Cardiac Output; Cardiomyopathies; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Electrocardiography; Gold Radioisotopes; Heart Ventricles; Humans; Magnetic Resonance Spectroscopy; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Thirty-three cases of anthracycline related cardiotoxicity occurred in our institution in patients with a previously negative cardiovascular history, physical examination, and normal ECG. A total of 95 RNCA studies were performed in this group (73 studies included both rest and exercise RNCA). Twenty-one patients had two or more serial studies. Seventeen had a normal, baseline prechemotherapy study and 16 had studies done following the initiation of therapy. Fourier analysis, consisting of amplitude and phase images, were created for each study. In the subset with a baseline study, the rest LVEF became abnormal first in two of 17 patients (12%), the rest or stress LVEF in ten of 17 (59%), the rest Fourier image analysis in ten of 17 (59%), and the rest or stress Fourier image analysis in 16 of 17 (94%). In the subset without a baseline study, the rest LVEF was abnormal in ten of 16 (63%), the rest or stress LVEF in 15 of 16, (94%), the rest Fourier image analysis in 16 of 16 (100%), and the rest or stress Fourier image analysis in 16 of 16 (100%). The authors conclude that: 1) the exercise RNCA is superior to the rest RNCA alone in the early detection of anthracycline related cardiotoxicity, 2) the single most sensitive indicator of cardiotoxicity is Fourier image analysis; and 3) sequential rest and stress RNCA studies with Fourier amplitude and phase analysis is the most sensitive, noninvasive method of evaluating patients who receive potentially cardiotoxic agents.

Topics: Adolescent; Adult; Aged; Antibiotics, Antineoplastic; Cardiomyopathy, Dilated; Daunorubicin; Doxorubicin; Electrocardiography; Epirubicin; Female; Fourier Analysis; Heart Failure; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Fifty-four patients with a cardiomyopathy were studied by RNCA and Fourier amplitude and phase image analysis. The study group included patients with ischemic cardiomyopathy (27) and an equal number of patients with a primary cardiomyopathy: drug-induced (22), idiopathic (three), radiation-induced (one), and amyloidosis (one). Twenty-eight patients had rest studies alone and 26 had both rest and stress studies (80 total). The mean rest LVEF in the ischemic group was 27.9%, in the drug-induced group 36.5%, and in the idiopathic group 30%. The stress LVEF decreased in 92% of patients with ischemic cardiomyopathy and 45% of patients with primary (drug-induced) cardiomyopathy. Fourier amplitude and phase images were generated for each study. Amplitude and phase images were abnormal in all patients with an ischemic cardiomyopathy. LV amplitude abnormalities were regional and phase was directional. A zone of dysynergy on phase analysis was present in 44% of patients with ischemic cardiomyopathy. In the drug-induced primary cardiomyopathy group, all patients had abnormal amplitude and 86% had abnormal phase. Amplitude abnormalities were global rather than regional and phase patterns were nondirectional. Only one patient had a zone of dysynergy on the phase image. We conclude that the stress LVEF alone cannot consistently differentiate between ischemic and primary cardiomyopathies and that Fourier amplitude and phase analysis may be useful in determining the etiology of a cardiomyopathy (ischemic vs primary).

Topics: Adolescent; Adult; Aged; Antibiotics, Antineoplastic; Cardiomyopathy, Dilated; Coronary Disease; Erythrocytes; Female; Fourier Analysis; Heart; Heart Failure; Humans; Male; Middle Aged; Naphthacenes; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Tin Polyphosphates

Forty-one patients (25 male, 16 female) were studied by RNCA in our institution. There were 42 rest studies and 24 stress studies (66 studies total). Sixteen patients were normal, 15 had ASHD, seven had a cardiomyopathy, and three had left-sided valvular regurgitation. Each study was preprocessed using both the standard nine-point smoothing method and Fourier filtering. Amplitude and phase images were also generated. Both preprocessing methods were compared with respect to image quality, border definition, reliability and reproducibility of the LVEF, and cine wall motion interpretation. Image quality and border definition were judged superior by the consensus of two independent observers in 65 of 66 studies (98%) using Fourier filtered data. The LVEF differed between the two processes by greater than .05 in 17 of 66 studies (26%) including five studies in which the LVEF could not be determined using nine-point smoothed data. LV wall motion was normal by both techniques in all control patients by cine analysis. However, cine wall motion analysis using Fourier filtered data demonstrated additional abnormalities in 17 of 25 studies (68%) in the ASHD group, including three uninterpretable studies using nine-point smoothed data. In the cardiomyopathy/valvular heart disease group, ten of 18 studies (56%) had additional wall motion abnormalities using Fourier filtered data (including four uninterpretable studies using nine-point smoothed data). We conclude that Fourier filtering is superior to the nine-point smooth preprocessing method now in general use in terms of image quality, border definition, generation of an LVEF, and cine wall motion analysis. The advent of the array processor makes routine preprocessing by Fourier filtering a feasible technologic advance in the development of the RNCA study.

Topics: Adult; Aged; Angina Pectoris; Cardiomyopathy, Dilated; Coronary Disease; Female; Filtration; Fourier Analysis; Heart; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Tin Polyphosphates

Topics: Adolescent; Adult; Angiography; Blood Pressure; Cardiac Output; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Contrast Media; Coronary Disease; Erythrocytes; Female; Heart; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume