sodium-pertechnetate-tc-99m and Coronary-Disease

Regional and global left ventricular dysfunction caused by coronary artery disease may be reversible in a significant proportion of cases. This fact has important clinical implications. Apart from symptoms of angina and angiographic severity of coronary artery disease, potential for an improvement in left ventricular dysfunction should be taken into account when considering revascularization for the management of patients with coronary artery disease. Because left ventricular function is an important determinant of long-term prognosis in patients with coronary artery disease, identification and appropriate treatment of reversible left ventricular dysfunction may improve prognosis in many patients with significant left ventricular dysfunction. Table 1 describes the impact of myocardial viability in relation to the clinical objectives in various groups of patients with coronary artery disease. The choice of the optimal technique for the detection of myocardial viability is a matter of ongoing debate. There is no consensus in the literature for an optimal investigative approach to predict an improvement in left ventricular function following revascularization. Most of the studies in this field are based on small numbers of patients. Further studies in larger patient populations are needed. This debate is further complicated by the fact that none of the available technologies provides a quantitative estimate of viable myocardium or the extent of improvement that can be expected following revascularization. Currently the choice of technique depends on the clinical question to be answered, the local availability of the technique, and local expertise. Obviously, cost considerations may also play an important role in choice of technique. In patients with chronic stable coronary artery disease in whom reversibility of stress-induced perfusion abnormalities is the question, stress-redistribution-rest Tl-201 imaging may be the preferred modality. In patients with congestive heart failure, in whom reversibility of left ventricular function is the issue, PET imaging or rest Tl-201 imaging may provide the appropriate answer. In post-infarction patients, choice of test may depend on whether detection of residual ischemia or stunned myocardium is the issue.

Topics: Acetates; Carbon Radioisotopes; Coronary Disease; Deoxyglucose; Echocardiography; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Heart; Heart Failure; Humans; Iodine Radioisotopes; Male; Myocardial Stunning; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Tomography, Emission-Computed

Radionuclide angiocardiography and myocardial perfusion imaging with exercise are valuable methods to assess patients undergoing percutaneous transluminal coronary angioplasty. Successful angioplasty results in improvement in ventricular systolic and diastolic function and regional perfusion. Complications of angioplasty, such as periprocedural infarction and side branch occlusion, can be documented noninvasively. Radionuclide methods have also been demonstrated to be of prognostic value in predicting coronary artery restenosis and recurrent cardiac symptoms. However, to avoid underestimating the success of coronary revascularization, studies must be scheduled long enough following angioplasty to allow transient abnormalities associated with artery dilation to resolve.

Topics: Angioplasty, Balloon, Coronary; Coronary Disease; Exercise Test; Heart; Humans; Recurrence; Sodium Pertechnetate Tc 99m; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Developments over the past decade have allowed one to visualize the right and left ventricles using radionuclide techniques and to study the influence of a wide range of physiologic, pharmacologic and surgical interventions on global and regional ventricular function thereby providing important diagnostic insight and improved therapeutic capabilities. These tests are relatively non-invasive, they can be performed serially, they may be performed in patients that are seriously ill, and they have no recognized risk other than low level radiation exposure. With continued improvement in noninvasive imaging and processing and in the sophistication of associated computer systems, one may expect significant and wide ranging additional contributions in the assessment of myocardial function using radionuclide ventriculographic techniques.

Topics: Cardiac Output; Coronary Disease; Diastole; Exercise Test; Heart; Heart Failure; Heart Valve Diseases; Heart Ventricles; Humans; Myocardial Infarction; Pain; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Technetium; Thorax; Ventricular Function

Topics: Cardiovascular Diseases; Coronary Circulation; Coronary Disease; Heart Valve Diseases; Humans; Isometric Contraction; Mitral Valve Prolapse; Myocardial Contraction; Physical Exertion; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Thallium

Topics: Blood Volume Determination; Coronary Disease; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

The aim of this study was to assess the optimal method to evaluate asynchrony in equilibrium radionuclide angiography (RNA).. We studied 20 patients (14 males and 6 females, age range 25-60 yr) with RNA during atrial and sequential atrioventricular (AV) pacing, which increased left ventricular (LV) asynchrony. Both studies were performed at the same heart rate. Asynchrony was assessed either on phase images, by computing the standard deviation of the phase distribution (SD-P) and by sector analysis. Systolic and diastolic asynchrony were evaluated as the coefficient of variation of time to end systole (CV-TES) and time to peak filling rate (CV-TPFR) in four sectors. In addition, phase values were computed on time-activity curves from the same sectors, and their standard deviation (SD-Psec) was computed.. During atrial pacing SD-P was 32.3 degrees +/- 6.7 degrees and did not change during AV pacing (32.1 degrees +/- 5.6 degrees, p = n.s.). Both CV-TES and CV-TPFR had a significant increase during AV pacing (from 7.7% +/- 3.9% to 11.5% +/- 6.4%, p < 0.01, and from 8.4 degrees +/- 5.8 degrees to 12.9 degrees +/- 6.7 degrees, p < 0.001). AV pacing led to a significant increase in SD-Psec (from 6.3 degrees +/- 4.0 degrees to 12.6 degrees +/- 9.7 degrees, p < 0.05). Moreover, reproducibility was assessed in 15 additional age-matched patients. The results of the reproducibility study indicate a better repeatability for CV-TES and CV-TPFR.. The findings of this study suggest that sector analysis with calculation of indices of LV systolic and diastolic asynchrony is better suited for quantitation of LV temporal nonuniformity.

Topics: Cardiac Catheterization; Cardiac Pacing, Artificial; Cardiomyopathy, Hypertrophic; Coronary Disease; Erythrocytes; Female; Fourier Analysis; Gated Blood-Pool Imaging; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Myocardial Contraction; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Ventricular Function, Left

In the context of a multicentre study on the use of technetium 99m hexakis-2-methoxyisobutylisonitrile (99mTc-Sestamibi), we evaluated the accuracy of the ventricular function assessed at rest by means of first-pass radionuclide angiocardiography acquired during the injection of the tracer for myocardial perfusion scintigraphy. The results were compared with first-pass studies performed using reference tracers sodium pertechnetate Tc 99m or technetium 99m diethylene triamine penta-acetic acid or with gated radionuclide angiocardiography. A total of 66 patients of the 105 enrolled in the study could be evaluated. The comparison of the first-pass studies was possible in 33 subjects with regard to the left ventricular ejection fraction, yielding r = 0.909 (P less than 10(-6)), and in 22 cases with regard to the right ventricular ejection fraction, yielding r = 0.712 (P less than 0.001). The comparison between the first-pass study using 99mTc-Sestamibi and the equilibrium gated radionuclide angiocardiography was possible for the left ventricular ejection fraction in 26 cases, with r = 0.937 (P less than 10(-6)), and for the right ventricular ejection fraction in 15 subjects, with r = 0.783 (P less than 0.001). In conclusion, the assessment of ventricular function performed by acquiring a first-pass radionuclide angiocardiograph during the injection of 99mTc-Sestamibi for perfusion myocardial scintigraphy can be considered reliable and accurate, when compared with the usually employed techniques. This result confirms the feasibility of a combined evaluation of perfusion and function at rest and during stress testing, which represents one of the most interesting advantages offered by the use of 99mTc-Sestamibi.

Topics: Coronary Disease; Female; Humans; Male; Middle Aged; Nitriles; Organotechnetium Compounds; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pentetate; Technetium Tc 99m Sestamibi; Ventricular Function; Ventriculography, First-Pass

The ECG and hemodynamic responses to a standard ionic radiographic contrast agent (diatrizoate) were measured and compared to those induced by iopamidol, a newly developed nonionic agent, during left ventriculography. Studies were performed using randomized double-blind techniques in 46 patients with suspected coronary artery disease who were scheduled for cardiac catheterization. A nuclear probe was used to measure left ventricular ejection fraction and relative ventricular volume before and immediately after left ventriculography. Bolus injections of diatrizoate and iopamidol induced similar significant decreases in left ventricular end-diastolic and end-systolic volume and similar significant increases in both left ventricular end-diastolic pressure (p less than 0.05) and systolic ejection fraction (p less than 0.01 vs baseline). Both agents induced modest increases in heart rate, but only the increase induced by diatrizoate was significant (p less than 0.01). The maximal rate of left ventricular pressure rise was not significantly altered by either agent. Iopamidol induced a slight increase in QRS duration (p less than 0.05); neither agent effected a significant change in QT duration. We conclude that the hemodynamic effects during left ventriculography using diatrizoate and iopamidol are similar. These findings do not justify the large-scale substitution of more expensive nonionic radiographic contrast agents for standard ionic agents such as diatrizoate in left ventriculography.

Topics: Cardiac Catheterization; Clinical Trials as Topic; Coronary Disease; Diatrizoate; Double-Blind Method; Electrocardiography; Heart Ventricles; Hemodynamics; Humans; Iopamidol; Iothalamic Acid; Radiography; Radionuclide Imaging; Random Allocation; Sodium Pertechnetate Tc 99m; Stroke Volume

The purposes of this study were to evaluate the right ventricular (RV) volume and mass using cardiac multidetector computed tomography (MDCT) and to compare the cardiac MDCT results with those from first-pass radionuclide angiography (FPRA). Twenty patients were evaluated for the RV end-diastolic volume (RVEDV), the RV end-systolic volume (RVESV), the RV ejection fraction (RVEF), and RV mass using cardiac MDCT with a two-phase reconstruction method based on ECG. The end-diastolic phase was reconstructed at the starting point of the QRS complex on ECG, and the end-systolic phase was reconstructed at the halfway point of the ascending T-wave on ECG. The RV mass was measured for the end-systole. The RVEF was also obtained by FPRA. The mean RVEF (47+/-7%) measured by cardiac MDCT was well correlated with that (44+/-6%) measured by FPRA (r=0.854). A significant difference in the mean RVEF was found between cardiac MDCT and FPRA (p=0.001), with an overestimation of 2.9+/-5.3% by cardiac MDCT versus FPRA. The interobserver variability was 4.4% for the RVEDV, 6.8% for the RVESV, and 7.9% for the RV mass, respectively. Cardiac MDCT is relatively simple and allows the RV volume and mass to be assessed, and the RVEF obtained by cardiac MDCT correlates well with that measured by FPRA.

Topics: Adult; Aged; Aged, 80 and over; Cardiac Volume; Coronary Disease; Electrocardiography; Erythrocytes; Female; Heart Ventricles; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Observer Variation; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, X-Ray Computed; Ventricular Function; Ventricular Function, Right; Ventriculography, First-Pass

We analyzed the relationship between regional severity of emphysema, which was evaluated by three-dimensional fractal analysis (3D-FA) of Technegas SPECT images, and coronary heart disease (CHD). For 22 patients with emphysema who underwent Technegas SPECT, we followed up CHD events. The follow-up period was 5.4+/-0.5 (mean +/- SD) years. We defined the upper-lung fractal dimension (U-FD) and lower-lung fractal dimension (L-FD) obtained with 3D-FA of Technegas SPECT images as the regional severity of emphysema. FD became greater with the progression of emphysematous change. During the follow-up period, CHD events occurred in 6 (27%) of the 22 patients. The ratio of U-FD to L-FD for patients with CHD events (0.87+/-0.22) was significantly smaller than for patients without CHD events (1.52+/-0.38) (p = 0.0015). These findings suggest that severer emphysema in the lower lung indicates a higher risk of CHD than that in the upper lung.

Topics: Aged; Coronary Disease; Data Interpretation, Statistical; Emphysema; Female; Fractals; Humans; Hypertension; Lung; Male; Predictive Value of Tests; Respiratory Function Tests; Risk Factors; Smoking; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

Radioactive wires and other linear sources are currently being used in clinical trials as endovascular brachytherapy to prevent restenosis after percutaneous transluminal coronary angioplasty. A new concept is the use of a liquid-filled balloon containing a beta-emitting radioisotope. A major advantage is optimal delivery of the radioactivity to the vessel wall. Rhenium-188 (188Re) is a high-energy beta-emitter that is routinely available from a 188W/188Re generator in liquid form. Since 188Re-perrhenate could be released in the unlikely event of balloon rupture, we investigated whether, in analogy to pertechnetate, subsequent use of perchlorate can reduce the uptake of perrhenate in the thyroid. We performed static (n = 9) and dynamic (n = 11) thyroid scintigraphy with 99Tcm-pertechnetate to estimate the overall reduction in activity within 30 min and the washout from the thyroid after oral administration of 600 mg perchlorate (T1/2). In two patients, 188Re was injected to estimate the whole-body distribution and the discharge of thyroid activity after perchlorate use. Based on MIRD Dose Estimate Report No. 8 (valid for 99Tcm-pertechnetate), the radiation burden was calculated for intravenous administration of 188Re and competitive blocking with perchlorate. In 20 patients, 99Tcm uptake by the thyroid was reduced by 85% within 30 min by perchlorate. The mean (+/- S.D.) washout rate (T1/2) was 8 +/- 2 min in 11 patients. Perrhenate showed a whole-body distribution similar to that of pertechnetate and the thyroid activity could be displaced (T1/2 = 6.3 and 9.3 min, respectively) by oral administration of perchlorate, with reductions in uptake of 83% and 75% within 30 min, respectively. Whole-body scanning demonstrated no regional accumulation of 188Re-perrhenate with excretion by urine. Dose estimates gave an effective dose equivalent of 0.42 mSv MBq-1, which decreased to 0.16 mSv MBq-1 after perchlorate blocking. 188Re has favourable properties for endovascular brachytherapy via a balloon catheter and, in the unlikely event of balloon rupture, whole-body radiation can be reduced to 38% by subsequent oral administration of perchlorate.

Topics: Administration, Oral; Adult; Aged; Angioplasty, Balloon, Coronary; Brachytherapy; Catheterization; Coronary Disease; Female; Humans; Male; Middle Aged; Perchlorates; Radioisotopes; Radionuclide Imaging; Recurrence; Rhenium; Sodium Compounds; Sodium Pertechnetate Tc 99m; Thyroid Gland

This investigation assesses the prognostic value of radionuclide measurements of cardiac function in patients undergoing coronary artery bypass grafting (CABG). Radionuclide angiograms during exercise and at rest were obtained in 182 patients before (< or = 30 days), early (< or = 3 months), and late (< or = 3 years) after CABG. Cox proportional hazard regression analysis was used to identify independent predictors of 44 cardiac deaths that occurred a median 12 years after bypass. Although the exercise ejection fractions before and early after CABG were significantly related to subsequent cardiac death (chi-square = 10.84, p = 0.001, and chi-square = 7.4, p = 0.006, respectively), the late postoperative exercise ejection fraction was the strongest predictor (chi-square = 13.9, p = 0.0002), contributing above and beyond clinical and catheterization data. These data document the validity of the exercise ejection fraction as an important predictor of cardiac death after CABG and suggest the potential clinical application of serial measurements of the exercise ejection fraction as an important noninvasive adjunct to postoperative evaluation of these patients.

Topics: Cardiac Catheterization; Coronary Artery Bypass; Coronary Disease; Exercise Test; Female; Follow-Up Studies; Heart; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Radionuclide Angiography; Risk Factors; Sodium Pertechnetate Tc 99m; Stroke Volume; Time Factors

To date cardiac positron emission tomography (PET) studies have focussed on the measurement of myocardial blood flow, metabolism and receptors while left ventricular (LV) function and dimensions have been derived from other modalities. The main drawback of this approach is the difficulty of data co-registration, which limits clinical interpretation. The aim of this study was to evaluate whether it is possible to measure absolute cardiac volumes, and consequently LV function parameters such as ejection fraction, and wall motion with gated PET. Nineteen patients underwent a PET scan and planar radionuclide ventriculography (MUGA) within 9+/-9 days. A 9-min scan (16 gates/cardiac cycle) was acquired after inhalation of 3 MBq/ml of oxygen-15 labelled carbon monoxide at the rate of 500 ml/min over 4 min using a multislice PET camera. Noise reduction was performed on the gated image to enhance the definition of the ventricles before reslicing to the short-axis view. A threshold value was used to detect the edge of the LV at each gate. LV volumes at each gate were estimated by summing the volume of voxels within the LV boundary. PET measurements of LV volumes were as follows: LV end-diastolic volume ranged from 72 to 233 ml and LV end-systolic volume ranged from 24 to 203 ml. Phantom experiments supported the validity of this approach for estimating volumes. LV ejection fraction measured with MUGA was 38.4%+/-16.3% (range 15%-71%) and that measured with PET was 39.6%+/-17.7% (range 9%-72%) (P=NS). The LV ejection fraction measurements were highly correlated (r2=0.824). These results indicate that: (1) absolute end-diastolic and end-systolic volumes can be quantified using gated PET and (2) LV ejection fraction can be accurately measured by gated PET simultaneously with the other physiological PET parameters.

Topics: Coronary Disease; Deoxyglucose; Erythrocytes; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Gated Blood-Pool Imaging; Humans; Hypertrophy, Left Ventricular; Male; Oxygen Radioisotopes; Phantoms, Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, Emission-Computed; Ventricular Function, Left

The purpose of this study was to determine the correspondence of mental stress-induced ischemia in the laboratory with ambulatory ischemia and to assess the relationship between hemodynamic responses to mental stress and the occurrence of ischemia. Although exercise testing is usually used to elicit myocardial ischemia, ischemia during daily life usually occurs at relatively low heart rates and in the absence of strenuous physical exercise. Mental stress has been shown to trigger ischemic events in the laboratory at lower heart rates but at blood pressures comparable to exercise. We therefore compared the extent to which mental stress and exercise testing identify patients who develop ischemia out of hospital.. One hundred thirty-two patients with documented coronary disease and recent evidence of exercise-induced myocardial ischemia underwent 48-hour ambulatory monitoring and radionuclide ventriculography during exercise and mental stress testing. Patients who displayed mental stress-induced ischemia in the laboratory were more likely to exhibit ischemia during daily life (P < .021). Furthermore, patients who exhibited ischemia during ambulatory monitoring displayed larger diastolic blood pressure (P < .006), heart rate (P < .039), and rate-pressure product responses (P < .018) during mental stress.. Among patients with prior positive exercise stress tests, mental stress-induced ischemia, defined by new wall motion abnormalities, predicts daily ischemia independent of exercise-induced ischemia. Exaggerated hemodynamic responses during mental stress testing also identify individuals who are more likely to exhibit myocardial ischemia during daily life and mental stress.

Topics: Activities of Daily Living; Coronary Disease; Electrocardiography, Ambulatory; Erythrocytes; Exercise Test; Female; Gated Blood-Pool Imaging; Hemodynamics; Humans; Male; Middle Aged; Myocardial Ischemia; Sodium Pertechnetate Tc 99m; Stress, Psychological

Improvement in left ventricular (LV) performance after coronary artery bypass surgery remains the gold standard in myocardial viability assessment. The time-related changes, however, are not well known. This study examined the LV ejection fraction (EF) by gated blood pool imaging early (6 +/- 4 days) and late (62 +/- 24 days) after surgery in patients with normal preoperative EF (group 1, n = 12) and those with LV dysfunction (group 2, n = 15). There were no changes in the clinical status between the early and late studies, and all patients had normal sinus rhythm. Group 1 had no significant change in EF (preoperatively 62%, early postoperatively 64%, late postoperatively 63%; p = NS). In group 2, EF was 26% +/- 8% preoperatively; 30% +/- 10% early postoperatively; and 34% +/- 8% late postoperatively (p < 0.05). Postoperatively there was > or = 5% improvement in EF in 4 patients early and 11 patients late (p < 0.05). Patients who showed early improvement continued to do so in the late study but, additionally, 7 patients showed improvement only in the late study. Thus the timing of EF measurement after surgery is important in patients with LV dysfunction but not in patients with normal LV function. Early assessment may underestimate the prevalence and degree of recovery.

Topics: Aged; Chi-Square Distribution; Coronary Artery Bypass; Coronary Disease; Female; Gated Blood-Pool Imaging; Heart; Humans; Linear Models; Male; Middle Aged; Postoperative Period; Sodium Pertechnetate Tc 99m; Time Factors; Tissue Survival; Ventricular Function, Left

The effectiveness of sequential imaging of early regional left ventricular contraction in the detection of ischemic abnormalities was assessed in 47 patients (15 with previous infarction) with angiographically proven coronary artery disease, and 11 normal volunteers, undergoing first pass radionuclide angiography with a multielement gamma camera at rest and at peak exercise. Global left ventricular hemodynamic parameters, and functional images of regional ejection fraction and ejection rate were compared to 6 pairs of sequential rate images showing the decrease and the increase of regional left ventricular volume during a time-interval of 80-280 ms (at rest) and 50-175 ms (at stress) from end-diastole. Diagnostic accuracy of sequential images (67-91%) was higher than that of ejection rate image (71-72%), and of global hemodynamic parameters (33-60%), in the detection of coronary patients. Regional sensitivity of stress sequential increase and decrease image achieved 77% and 100%, respectively. During early systole sensitivity of stress sequential increase and decrease images approached 100% even at rest, subsequently decreasing because of normalizing contraction. Thus, the analysis of early systolic dysfunction provided by dynamic sequential functional images of ejection rates proved to be an effective diagnostic tool in the detection of myocardial ischemic dysfunction.

Topics: Adult; Aged; Coronary Disease; Diastole; Female; Gated Blood-Pool Imaging; Hemodynamics; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Ventricular Function, Left; Ventriculography, First-Pass

Patients with coronary artery disease often have impaired left ventricular diastolic filling despite normal global systolic function. The influence of regional systolic asynchrony on diastolic function was assessed by radionuclide angiography in 60 patients with coronary artery disease and normal ejection fraction at rest: group 1 (n = 30) with normal wall motion at rest and group 2 (n = 30) with abnormal wall motion. Data were compared with those obtained from 19 normal volunteers. Age, heart rate, ejection fraction and echocardiographic end-diastolic dimension did not differ among the three groups. Peak filling rate in group 1 and group 2 was similar (2.5 +/- 0.5 and 2.3 +/- 0.6 end-diastolic counts/s, respectively) and significantly lower than that in the normal subjects (2.8 +/- 0.7 end-diastolic counts/s; p less than 0.01 vs. group 2, p less than 0.05 vs group 1). Time to peak filling rate was prolonged in group 2 (184 +/- 27 ms) compared with that in normal subjects (162 +/- 19 ms; p less than 0.01) and group 1 (172 +/- 15 ms; p less than 0.05). Left ventricular end-diastolic pressure was significantly higher in group 2 than in group 1 (14 +/- 7 vs. 10 +/- 5 mm Hg, respectively; p less than 0.05). Asynchrony was assessed by sector analysis of the radionuclide left ventricular region of interest. Diastolic asynchrony was similar in the two patient groups (30 +/- 23 ms in group 2, 26 +/- 16 ms in group 1) and was higher in both groups than in the normal subjects (16 +/- 8 ms; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Analysis of Variance; Coronary Angiography; Coronary Disease; Erythrocytes; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Myocardial Contraction; Sodium Pertechnetate Tc 99m; Stroke Volume; Ventricular Function, Left

The features of diastolic filling of the left ventricle (LV) were examined in relation to the nature of its hypertrophy in patients with coronary heart disease (CHD). A total of 110 male patients with CHD concurrent with essential hypertension or without it who underwent contrast ventriculography in order to determine LV diastolic stiffness. Radionuclide ventriculography was performed in 49 patients at rest and during exercise. The CHD patients with moderate LV concentric hypertrophy had more adequate LV diastolic filling in the presence of concurrent essential hypertension. Abnormal diastolic filling was more pronounced in CHD patients without hypertrophy or its eccentric development than in those without essential hypertension.

Topics: Adult; Cardiomegaly; Coronary Disease; Diastole; Hemodynamics; Humans; Male; Middle Aged; Radionuclide Ventriculography; Severity of Illness Index; Sodium Pertechnetate Tc 99m; Ventricular Function, Left

Impairment of left ventricular function during controlled myocardial ischemia induced by coronary angioplasty has been reported from angiographic and echocardiographic studies. Ejection fraction, peak ejection, peak filling rates, and end-systolic and end-diastolic volumes were investigated before, during and after coronary occlusion on-line with a nonimaging scintillation probe. The study consisted of 18 patients (mean age 59 +/- 10 years) with coronary artery stenosis of greater than 70%. During balloon inflation of 60 seconds' duration, coronary occlusion pressure was 31.6 +/- 12 mm Hg. There was no significant change in heart rate. Delay between first and second dilatation was 109 +/- 63 seconds. Ejection fraction decreased from 53 +/- 16 to 40 +/- 12% (first dilatation, p less than 0.01) and to 39 +/- 14% (second dilatation, p less than 0.01) and recovered to 51 +/- 16% 5 minutes after the second dilatation. Peak ejection rate was significantly reduced during the first and second balloon inflations. Peak filling rate decreased from 2.5 +/- 0.8 to 2.0 +/- 0.7 end-diastolic volume.s-1 (first dilatation, p less than 0.01) and to 1.8 +/- 0.7 end-diastolic volume.s-1 (second dilatation, p less than 0.01) and remained reduced at 2.2 +/- 0.7 end-diastolic volume.s-1 (p = not significant) at 5 minutes after the second dilatation. End-systolic and end-diastolic volumes increased significantly during the first and second dilatations and returned to normal after dilatation. It is concluded that short, controlled myocardial ischemia during coronary angioplasty leads to a decrease in systolic and diastolic left ventricular function. Sequential dilatations do not further decrease function if a sufficient interval is kept.

Topics: Angioplasty, Balloon, Coronary; Cardiac Output; Cardiac Volume; Cesium; Coronary Disease; Coronary Vessels; Diastole; Electrocardiography; Gated Blood-Pool Imaging; Humans; Iodides; Male; Middle Aged; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Time Factors; Ventricular Function, Left

Total and regional (by 7 zones) contractility of left ventricular functions in 25 patients with hypertrophic cardiomyopathy (HCMP) were characterized by a different combination of normal and elevated values of total and regional ejection fractions, rate indices of systolic expulsion. Normal or slightly changed values of the end-diastolic volume were combined with normal or elevated values of the stroke volume. Comparative analysis of the values characterizing cardiodynamics, led to working out criteria of differential diagnosis in HCMP patients with heart pain and in CHD patients with myocardial hypertrophy (predominance of the signs of left ventricular hyperfunction in the former and contractility hypofunction and asynergy in the latter). Changes in the diastolic filling of the left ventricle indicated its disturbed diastolic function in both groups of patients.

Topics: Adolescent; Adult; Cardiomyopathy, Hypertrophic; Coronary Disease; Diagnosis, Differential; Humans; Middle Aged; Myocardial Contraction; Sodium Pertechnetate Tc 99m; Ventricular Function, Left; Ventriculography, First-Pass

Twenty-two patients with coronary artery disease were studied first by radionuclide angiography (RNA) and then by contrast ventriculography. Cardiac medications were discontinued at least 72 hr before study. The patients were studied during atrial pacing at heart rates close to their spontaneous sinus rhythm. Contrast ventriculography was performed at 50 frames/sec in the 30 degrees right anterior oblique projection using 40 ml of a nonionic contrast medium (iopamidol) at a flow rate of 10-12 ml/sec. The contours of the left ventricular silhouette at contrast ventriculography were traced, frame by frame, on a graphic table with a digitizing penlight. Equilibrium 99mTc RNA was performed in the best septal 45 degrees left anterior oblique projection, acquiring 150,000 cts/frame, at 50 frames/sec and with a 5% gate tolerance. Time-activity curves from both end-diastolic and end-systolic ROIs were built and interpolated. Both RNA and contrast ventriculography volume curves were filtered with Fourier five harmonics. A close relationship was found between RNA and contrast ventriculography measurements of peak filling rate normalized to end-diastolic cps (r = 0.87, p less than 0.001) and stroke count (r = 0.87, p less than 0.001), ejection fraction (r = 0.94, p less than 0.001). Thus, in patients with coronary artery disease, LV filling can be accurately assessed using RNA.

Topics: Algorithms; Cineangiography; Coronary Disease; Erythrocytes; Female; Gated Blood-Pool Imaging; Heart Ventricles; Humans; Iopamidol; 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

The effects of postextrasystolic potentiation during spontaneous ventricular ectopy on both left and right ventricular function were studied in 12 patients with the aid of list-mode radionuclide ventriculography. The left ventricular ejection fraction showed a significant increase (+ 11.0 +/- 5.0%; p less than .001) with associated mild increases in end-diastolic volumes (+ 4.9 +/- 4.6; p less than .01) and significant decreases in end-systolic volumes (-13.4% +/- 7.3%; p less than .001). A more heterogeneous response was seen for the right ventricle. Right ventricular ejection increased significantly in 8/12 patients (+ 3.3 +/- 3.0%; p less than .02). Despite a large increase in end-diastolic volumes (+ 10 +/- 7.9%; p less than .001), there were only mild changes in end-systolic volumes (+ 2.2 +/- 9.0; p = NS). It is concluded that, for spontaneous ventricular ectopy in man, the increase in right ventricular ejection fraction reflects improved ventricular filling whereas the increase in left ventricular ejection fraction is linked to improved emptying.

Topics: Adult; Aged; Cardiac Complexes, Premature; Cardiac Output; Cardiomyopathies; Coronary Disease; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Differential evaluation was carried out of hypertrophy as a factor possibly of compensatory or that of furthering disturbances of the coronary circulation and contractile function of the myocardium. Echocardiography, radionuclide ventriculography tests with physical loads revealed that only moderate hypertrophy of the left ventricle in IHD patients with hypertensive disease (grade II) may be considered as one of the compensatory factors maintaining the functional state of the left ventricle myocardium.

Topics: Cardiomegaly; Coronary Disease; Echocardiography; Exercise Test; Heart Ventricles; Hemodynamics; Humans; Hypertension; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Adult; Aged; Coronary Disease; Erythrocytes; Female; Hematocrit; Humans; Male; Middle Aged; Myocardial Contraction; Physical Exertion; Plasma Volume; Radionuclide Angiography; Sodium Pertechnetate Tc 99m

Ambulatory radionuclide monitoring of left ventricular function was performed with the nuclear Vest device in 35 patients early after acute myocardial infarction. Patients were evaluated during post-infarction treadmill, other activities that included mental stress and cold pressor challenge, and with stress thallium imaging and cardiac catheterization. Of the 35 patients evaluated, 14 had ischemic responses on treadmill testing and 21 had negative responses. By contrast, 20 had redistribution by thallium imaging suggesting ischemia. Vest studies demonstrated 56 responses suggestive of ischemia in 23 patients. Twenty-two occurred during exercise and 13 with mental stress. Seventy-five percent were silent and only 39% had associated electrocardiographic changes. Vest responses were compared in patients whose thallium scan was indicative of ischemia (thallium-positive) and those without ischemia (thallium-negative). Ejection fraction was higher in the thallium-positive group (0.52 +/- 0.11), as compared with thallium-negative patients (0.44 +/- 0.1). With exercise, ejection fraction decreased for the thallium-positive patients from 0.52 +/- 0.11 to 0.40 +/- 0.09 at peak exercise. For thallium-negative patients, ejection fraction changes were not significant. During mental stress, ejection fraction decreased from 0.51 +/- 0.11 to 0.45 +/- 0.12 for thallium-positive patients while thallium-negative patients were unchanged. Vest-measured decreases in ejection fraction of greater than or equal to 5 units during exercise were highly sensitive (90%), specific (73%) and predictive (82%) of a positive thallium scan. The same response for mental stress was specific (87%) and predictive (85%) of a positive scan result.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cold Temperature; Coronary Disease; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Monitoring, Physiologic; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stress, Psychological; Stroke Volume; Thallium Radioisotopes

Topics: Adult; Aged; Coronary Disease; Female; Heart; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Respiratory Insufficiency; Sodium Pertechnetate Tc 99m

During a three-year period, complete revascularization of diffusely diseased left anterior descending (LAD) coronary arteries was accomplished by extensive endarterectomy in conjunction with bypass grafting in 37 patients in whom conventional bypass was not feasible. This group constituted 7.0% of all patients undergoing nonemergency coronary revascularization during this period. The left internal mammary artery was used to bypass the endarterectomized LAD artery in 22 patients. There was 1 (2.7%) operative death and 1 perioperative myocardial infarction. At follow-up, which was 100% with a mean of 41.4 months, all endarterectomy patients were in New York Heart Association Functional Class I or II. Twenty-four endarterectomy patients underwent first-pass radionuclide angiographic stress testing 20 months after operation. Twenty patients (83%) had excellent postoperative exercise tolerance, achieving 5 to 7 mets on treadmill testing. Left ventricular functional reserve was preserved, as evidenced by an increase of global ejection fraction from 48 +/- 15% at rest to 59 +/- 18% (p less than 0.005) with exercise. A similar increase was measured in the proximal and distal anterior wall segmental ejection fractions. No difference in response to exercise was found between the internal mammary artery and the vein graft groups. Thus, complete revascularization of the diffusely diseased LAD artery can be accomplished by adjunct endarterectomy without added morbidity or mortality and with excellent functional results.

Topics: Adult; Aged; Cardioplegic Solutions; Coronary Artery Bypass; Coronary Disease; Coronary Vessels; Endarterectomy; Evaluation Studies as Topic; Exercise Test; Female; Follow-Up Studies; Humans; Hypothermia, Induced; Male; Middle Aged; Myocardial Revascularization; Radionuclide Imaging; Recurrence; Saphenous Vein; Sodium Pertechnetate Tc 99m; Stroke Volume

Right ventricular ejection fraction (RVEF) determinations at rest (R) and exercise (E) are a means of demonstrating exercise-induced RV dysfunction. Not all patients are able to maintain peak (P) cardiac workloads during a gated RVEF study or, if a first-pass study is performed, for multiple acquisitions. Reductions from P cardiac workloads have been shown to potentiate LV function; however, the effect on RVEF has not been studied. Supine exercise radionuclide ventriculography was performed on 26 patients: nine normal subjects and 17 patients with coronary artery disease (CAD) (greater than 50% stenosis of one or more coronary artery). Gated RVEF's were obtained from sequential left anterior oblique views obtained at R, P, and at a workload reduced approximately 40% from P work levels postpeak (PP). In normals, RVEFs were at R, P, and PP 27, 38 and 44. In CAD patient RVEFs were 31, 35 and 39, at R, P, and PP, respectively. The conclusions are that RVEF improves from rest to PP exercise levels in normal subjects and in CAD patients and from P to PP levels in normal subjects. This improvement must be considered in interpreting exercise RV studies to aid in the detection of patients with CAD.

Topics: Adult; Coronary Disease; Erythrocytes; Female; Heart; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

Stress induced changes in left ventricular ejection fraction are widely used in the detection and assessment of coronary artery disease. This study demonstrates that right ventricular dysfunction may also occur, and assesses its significance in terms of coronary artery anatomy. This study involved 14 normal subjects and 26 with coronary artery disease investigated by equilibrium radionuclide ventriculography, at rest and during maximal dynamic exercise. Mean normal resting right ventricular ejection fraction (RVEF) was 0.40 (SD 0.118), and all normal subjects increased RVEF with stress (mean delta RVEF + 0.13 SD 0.099). Mean delta RVEF in the subjects with coronary artery disease was significantly lower at 0.00 (SD 0.080), but there was overlap between the two groups. The largest falls in RVEF were seen if the right coronary artery was occluded without retrograde filling. In this subgroup with the most severely compromised right ventricular perfusion (nine subjects), RVEF always fell with stress, and mean delta RVEF was -0.08 (SD 0.050). There was no significant correlation between delta LVEF and delta RVEF, implying that the right ventricular dysfunction was due to right ventricular ischaemia, rather than secondary to left ventricular dysfunction. Stress induced right ventricular ischaemia can therefore be detected readily by radionuclide ventriculography.

Topics: Adult; Coronary Disease; Humans; Middle Aged; Physical Exertion; Sodium Pertechnetate Tc 99m; Stroke Volume

Results of 203 patients who underwent first pass radionuclide angiography (FP) and quantitative equilibrium radionuclide ventriculography (qERNV) were stored in a data base system and evaluated statistically. Eighty eight of these patients also underwent exercise equilibrium radionuclide ventriculography (E-qERNV). In patients with coronary artery disease (CAD) without previous myocardial infarction (MI), evaluation of global and regional ejection fraction (gEF, rEF) at rest revealed a poor sensitivity of 64%, the specificity was about 71% (qERNV). FP at rest revealed similar values of sensitivity (69%) and specificity (83%). Additional assessment of stress induced changes of gEF, significantly (P less than 0.05) improved sensitivity of qERNV in CAD patients without a history of previous MI to 84% (specificity 86%). In patients with one previous MI, however, similar values of sensitivity were found (R-FP: 87%, R-qERNV: 84%, E-qERNV: 93%). In patients with several MI's, sensitivity was above 90% at rest and during exercise (R-FP: 96%, R-qERNV: 93%, E-qERNV: 100%).

Topics: Coronary Disease; Heart; Humans; Physical Exertion; Radionuclide Angiography; Sodium Pertechnetate Tc 99m; Stroke Volume

The purpose of this investigation was to evaluate the relation of coronary artery stenosis and associated pressure gradient to the magnitude of exercise-induced left ventricular dysfunction in patients with single vessel coronary artery disease. The percent stenosis and minimal cross-sectional area were measured before and after percutaneous transluminal coronary angioplasty and compared with radionuclide measurements of left ventricular function before and after angioplasty in 41 patients with proximal left anterior descending coronary artery lesions, providing 82 points of comparison. The gradient could be measured for 75 comparisons. Forty stenoses less than 50% were associated with a mean left ventricular exercise ejection fraction of 0.66 +/- 0.08 (mean +/- SD), 25 stenoses from 50 to 75% with a mean ejection fraction of 0.59 +/- 0.12 and 17 stenoses greater than 75% with a mean ejection fraction of 0.49 +/- 0.08. Thirty-five stenoses with a gradient less than 20 mm Hg were associated with a mean ejection fraction of 0.65 +/- 0.09, 24 with a gradient from 20 to 50 mm Hg with a mean ejection fraction of 0.58 +/- 0.13 and 16 with a gradient greater than 50 mm Hg with a mean ejection fraction of 0.53 +/- 0.10. These data document a relation between the magnitude of coronary artery stenosis and associated gradient to exercise-induced left ventricular dysfunction in homogeneous patient groups. However, discordance of these variables occurs commonly in individual patients.

Topics: Adult; Aged; Angioplasty, Balloon; Coronary Circulation; Coronary Disease; Exercise Test; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Pressure; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

During exercise radionuclide ventriculography (RVG), many patients cannot maintain peak workload for acquisition of more than a left anterior oblique view. To acquire further views, the workload may have to be reduced. In this study of 16 normals and 20 patients with coronary disease, the workload at peak exercise was reduced by approximately 40%. By paired t-test analysis, there was a rise in the left ventricular ejection fraction (LVEF) in patients with coronary disease from the peak exercise workload to the reduced workload level (postpeak) (52.4 +/- 15.3 to 59.3 +/- 13.7, P = .0001). There was also improvement in LVEF in the normals at the postpeak workload (71.3 +/- 11.7 to 75.1 +/- 13.7, P = .05). Of five coronary disease patients with exercise-induced wall motion abnormalities, four returned to baseline motion at the reduced exercise levels. Partial workload reduction can lead to an increase in LVEF and improvement in wall motion and thus, may result in false-negative studies.

Topics: Adult; Coronary Disease; Erythrocytes; False Negative Reactions; Female; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

Topics: Adrenergic beta-Antagonists; Adult; Aged; Coronary Disease; Coronary Vessels; Electrocardiography; Exercise Test; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The antithrombotic effects of prostacyclin infusion on myocardial platelet deposition were studied in a canine model during and after global ischemia. Eleven isolated heart preparations were subjected to 1 hour of cardioplegic arrest under moderate hypothermia (27 degrees to 28 degrees C), including a control group (n = 7) and a prostacyclin-treated group (n = 4). The hearts of four other dogs were continuously perfused for 180 minutes. Platelet deposition was measured at 15 minute intervals throughout the 3 hour study. Serial full-thickness myocardial biopsy specimens were analyzed for activity of 111In-labeled platelets with 99mTc-labeled erythrocyte correction for tissue blood content. The pattern of platelet distribution was determined by scintiscans of each heart, taken with a gamma camera at the end of the 60 minute reperfusion period. Substantial myocardial platelet deposition was found in the control hearts after ischemia but not in the prostacyclin-treated group (p less than 0.05). Furthermore, prostacyclin infusion had a significant disaggregatory effect on intracoronary platelet deposits when the precardioplegic and postcardioplegic biopsy specimens were analyzed (p less than 0.05). Three hours of continuous perfusion did not increase tissue 111In-labeled platelet activity. Ex vivo images showed platelet deposition to be a diffuse patchy process with significantly more 111In activity in the endocardium than in the epicardium after global ischemia (p less than 0.05). These data show the potent antithrombotic properties of prostacyclin in preventing and disaggregating ischemia-induced intracoronary platelet deposition during and after cardioplegic arrest.

Topics: Animals; Coronary Disease; Dogs; Epoprostenol; Erythrocytes; Heart; Heart Arrest, Induced; Hypothermia, Induced; In Vitro Techniques; Indium; Myocardial Revascularization; Myocardium; Oximes; Platelet Aggregation; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Time Factors

First-pass radionuclide angiography (FPRA) in the 30 degree right anterior oblique and equilibrium gated radionuclide angiography (EGNA) in the 45 degree left anterior oblique were used for quantitative measurements of left ventricular ejection fraction (LVEF). Equipment used was a 400T gamma-camera interfaced with a Simis III Informatek computer. The results were compared with contrast angiography (CA). The aim of this study was to determine the sensitivity of both radionuclide techniques. The present data are based on 65 patients in whom CA and EGNA were performed. In 47 patients both FPRA and EGNA were performed. Results suggested that in ischemic heart disease (IHD) and valvular heart disease (VHD) the EGNA technique is well correlated with CA (r = 0.9 and 0.73, respectively). FPRA correlated well only with CA in IHD (r = 0.86), but not in VHD (r = 0.18). This study indicates that both FPRA and EGNA are sensitive, noninvasive techniques for measuring ejection fraction in IHD, while in VHD, EGNA is more sensitive technique than FPRA.

Topics: Adolescent; Adult; Aged; Angiography; Coronary Disease; Erythrocytes; Heart; Heart Valve Diseases; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

This study examined the impairment in systolic and diastolic performance of both ventricles during pacing-induced myocardial ischemia in 12 men with coronary artery disease. Simultaneous hemodynamic, ECG, and radionuclide angiographic assessments were made: pre pacing (pre-P); intermediate pacing (P-1); maximum pacing (P-2); and immediately after pacing (post pacing (P-P). The prepacing measurements were made with the patient in the supine position and during leg elevation. Pacing produced a leftward and upward shift in the diastolic pressure-volume relation, a progressive decrease in left ventricular (LV) end-diastolic volume (p less than 0.003) and right ventricular (RV) end-diastolic volume (p less than 0.01), concomitant with an increase in the pulmonary artery wedge pressure (p less than 0.004) and the right atrial pressure (p less than 0.04). The shift in the LV pressure-volume relation was associated with an initial increase (P-1), followed by a decrease (P-2) in the peak filling rate (p less than 0.001). Pacing also resulted in systolic dysfunction: abnormal LV ejection fraction responses in eight patients, LV regional wall motion abnormalities in eight patients, and abnormal RV ejection fraction responses in seven patients. Leg elevation resulted in a 7% increase in cardiac output, a 20% increase in RV end-diastolic volume, a 28% increase in right atrial pressure, a 29% increase in pulmonary artery wedge pressure, and a 10% increase in LV end-diastolic volume (p less than 0.05). Thus, the ischemic response to pacing results in systolic and diastolic LV and RV dysfunction, with the diastolic impairment being more frequent than the systolic impairment.

Topics: Aged; Blood Pressure; Cardiac Output; Cardiac Pacing, Artificial; Cardiac Volume; Coronary Disease; Electrocardiography; Heart; Heart Rate; Heart Ventricles; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

The authors have provided a comparative analysis of various modifications of radionuclide ventriculography and assessment of their potentialities for clinical use. A total of 120 patients with chronic nonspecific lung diseases, coronary heart disease and rheumatic heart disease were examined. It was established that the most accurate information to assess myocardial contractility was obtained by a method of the determination of the ejection fraction by the "activity-time" curve with a fixed zone of interest, and the universal patient's position was the left front oblique projection. The right ventricular ejection fraction was determined in parallel with the study of the left ventricular ejection fraction characterizing myocardial contractility in cardiovascular pathology. The study of the former extended significantly the potentialities of radionuclide ventriculography, allowed the assessment of the hemodynamic state of the lesser circulation and compensatory potentialities of the right ventricle of the heart in cardiopulmonary pathology.

Topics: Adult; Aged; Coronary Disease; Heart; Humans; Lung Diseases, Obstructive; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Rheumatic Heart Disease; Sodium Pertechnetate Tc 99m; Stroke Volume

The results of 22 absolute left ventricular volume (LVV) determinations by a radionuclide (RN) method are compared to the results obtained by contrast ventriculography (CV). Another 10 patients were analysed in order to evaluate the interstudy, interobserver and intraobserver variances. Good correlation was shown between the RN and CV measurements of the end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and ejection fraction (EF), but the RN method overestimates the EDV and ESV. The EF was underestimated, but no difference could be shown for the SV. On the inter- and intraobserver levels, regression analysis yielded excellent correlation (r greater than 0.99 in all cases) with no statistically significant difference (P less than 0.05). The interstudy variance was minimal as indicated by regression analysis (r greater than 0.87) and no statistically significant difference (P less than 0.05) could be shown between studies. The results indicate that the RN method of LVV determination can be used in intervention studies over a limited period.

Topics: Adult; Aged; Coronary Disease; Humans; Middle Aged; Mitral Valve Stenosis; Radiography; Radionuclide Imaging; Reference Values; Sodium Pertechnetate Tc 99m; Stroke Volume

50 patients after coronary artery bypass grafting were matched with 50 not-operated patients. After a follow-up period of four years they were investigated by first pass radionuclide angiography. Revascularized myocardial areas showed significantly higher regional ejection fraction during exercise and in territories with prior myocardial infarction. The results proved the hemodynamic benefits of coronary artery bypass grafting even in territories with poor myocardial function.

Topics: Angina Pectoris; Cardiac Output; Coronary Artery Bypass; Coronary Disease; Gold Radioisotopes; Humans; Myocardial Contraction; Postoperative Complications; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The relationship between radionuclide and thermodilution measurement of stroke volumes (SV) was investigated in 30 patients without valvular regurgitation or intracardiac shunt (group A) at rest and during exercise. Both attenuated radionuclide right ventricular (RV) and left ventricular (LV) SV measurements correlated well with the SV determined by the thermodilution method (r = 0.87 and r = 0.93, all P less than 0.001). The reliability of the radionuclide method to estimate SV was evaluated prospectively in two additional groups of patients. In 11 patients without valvular regurgitation or intracardiac shunt (group B) the radionuclide RVSV and LVSV closely approximated to thermodilution SV at rest and during exercise. In 15 patients with aortic regurgitation (group C) the radionuclide stroke volume ratio correlated well with the angiographic regurgitant fraction. Thus, both RVSV and LVSV and the severity of aortic regurgitation can be reliably measured with gated radionuclide ventriculography.

Topics: Cardiac Output; Coronary Disease; Erythrocytes; Female; Heart; Heart Diseases; Heart Failure; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Thermodilution

A semi-automated, variable-region-of-interest method of analysis was used to measure both global and segmental left ventricular (LV) and global right ventricular (RV) contraction with ECG-gated first-pass and equilibrium radionuclide ventriculography. Normal values were defined in 20 healthy volunteers, and in 24 symptomatic patients, the results were compared with right anterior oblique (RAO) contrast left ventriculography. The global LV ejection fraction (LVEF) obtained by equilibrium imaging in the left anterior oblique (LAO) projection correlated closely with the results obtained by the gated first-pass method in the RAO projection (r = 0.95) and those obtained with contrast left ventriculography (r = 0.94); furthermore, the interobserver variability was small (r = 0.985). The normal values for LVEF obtained using radionuclide techniques and contrast ventriculography did not differ, but with the equilibrium radionuclide method, the RV ejection fraction (RVEF) values were underestimated in comparison to those obtained by the RAO gated first-pass technique. In five patients with localised inferior segmental akinesis at contrast angiography, the RAO first-pass cine display demonstrated a corresponding wall-motion abnormality in all cases, but LAO equilibrium cine displays did so in only one out of five patients. For segmental quantitation of LV contraction, a computer programme defined the ventricular edge, divided the RAO LV images into five segments and determined both the segmental area contraction (SAC) and the counts-based segmental ejection fraction (SEF). Radionuclide SAC measurements correlated very strongly with SEF measurements (r = 0.94-0.99). Both radionuclide SAC and radionuclide SEF correlated well with contrast angiographic SAC, except in the inferobasal segment.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Coronary Disease; Female; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

Topics: Aged; Blood Pressure; Cardiac Output; Coronary Disease; Heart; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole

This study determines the noninvasive prognostic predictors (using radionuclide angiography) in patients with severe left ventricular dysfunction (resting ejection fraction less than or equal to 35 percent) secondary to coronary artery disease. We retrospectively evaluated 94 such patients using rest and exercise radionuclide ventriculography. At a mean follow-up of 16 months, cardiac events occurred in 22 patients: ten patients died of cardiac causes, five patients sustained nonfatal myocardial infarction, and seven patients developed severe congestive heart failure (class 4). Results indicate that patients with severe left ventricular dysfunction may be stratified into different risk groups according to left ventricular size. Marked left ventricular dilatation identifies a subgroup at high risk.

Topics: Actuarial Analysis; Adult; Aged; Cardiomegaly; Coronary Disease; Exercise Test; Female; Heart Ventricles; Humans; Male; Middle Aged; Prognosis; Rest; Retrospective Studies; Risk; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, Emission-Computed

The use of planar radionuclide ventriculography to evaluate global and segmental ventricular function is limited by the superimposition of structures in some projections and the gross segmental resolution of the planar technique. Preliminary reports have suggested the feasibility of tomographic gated radionuclide ventriculography with rotating detector systems. This study tested the hypotheses that 1) tomographic radionuclide ventriculography detects segmental dysfunction at rest not identified with multiview planar studies and single plane contrast ventriculography, and 2) ventricular volumes and ejection fraction calculated from these studies provide data similar to those obtained with angiography and planar radionuclide ventriculography. Gated blood pool tomograms were acquired over 180 degrees at 15 frames per cardiac cycle during the initial 90% of the cardiac cycle. Compared with the multiview planar technique tomographic ventriculography showed an increased sensitivity for detecting left ventricular segments with significant coronary artery stenosis (97 versus 74%, p less than 0.025) without any loss in specificity. Compared with both planar radionuclide and contrast ventriculography, tomographic radionuclide ventriculography also detected more noninfarcted left ventricular segments supplied by stenosed coronary arteries (81 versus 39 and 32%, respectively, p less than 0.01). Tomographic radionuclide ventriculographic measurements of left ventricular volumes and ejection fraction showed close correlations with angiographic and planar radionuclide determinations. Gated blood pool tomography is a sensitive method for the evaluation of segmental wall motion and an accurate method for the measurement of global left ventricular volumes and ejection fraction.

Topics: Adult; Aged; Arterial Occlusive Diseases; Cardiac Catheterization; Cardiac Volume; Coronary Disease; Coronary Vessels; Erythrocytes; Female; Humans; Male; Middle Aged; Myocardial Contraction; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, Emission-Computed

To study the pathologic and prognostic significance of--and possible underlying mechanisms for--a pathological exercise ECG in athletes, two age-matched groups were selected from a total population of 117 middle-aged and old endurance athletes: Group A: 21 with a pathological exercise-ECG, and group B: 21 with normal exercise-ECGs. Data from 201-thallium perfusion scintigraphy, 99 m-technetium multiple gated acquisition ventriculography (MUGA), resting echocardiography and 3 years follow-up are as follows: None had thallium findings indicating reversible myocardial ischaemia, but one from group A had a probable old myocardial infarction. All had normal resting MUGA, but group A men slightly more often presented a subnormal increase in ejection fraction according to exercise MUGA than group B men (9/20 vs 4/21). The former also more often had ventricular hypertrophy (LVH) (19/21 vs 14/21). However, apart from slightly longer ventricular filling time among group A men the echocardiograms revealed no group differences e.g. in cardiac dimensions or in indices of systolic or diastolic function. Regardless of exercise-ECG response, 18/42 athletes had one or more value of left ventricular dimensions or diameter exceeding the 95th percentile of the normal range. Since one patient from group A had asymmetric septal hypertrophy, one developed cardiomyopathy during the 3 years follow-up and one had a previous myocardial infarction, only 3/21 had cardiac disease which might explain the pathological exercise-ECG. Thus, pathological exercise-ECG rarely signifies heart disease in athletes, and very rarely coronary heart disease. Rather, the pathological exercise-ECG may be related to LVH and various subtle alterations in cardiac physiology following long-term endurance training.

Topics: Adult; Cardiac Output; Cardiomegaly; Coronary Disease; Echocardiography; Electrocardiography; Exercise Test; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radioisotopes; Radionuclide Imaging; Skiing; Sodium Pertechnetate Tc 99m; Thallium

We have compared the inotropic drug dobutamine to supine bicycle exercise as a means of inducing stress in radionuclide ventriculography studies. Dobutamine has the following properties, making it favorable for widespread usage: 1) ability to be given safely in a peripheral vein, 2) rapid onset, and 3) short duration of action. Each patient underwent supine bicycle progressive resistance testing of 2 minutes per stage followed 30 minutes later by dobutamine administration. Accuracy of diagnosis was 0.93 and sensitivity was 0.89 with dobutamine, while with bicycle the accuracy was 0.93 and sensitivity was 0.94. While not designed to replace supine bicycle testing, incremental infusions of dobutamine appear to be nearly equal in accuracy and sensitivity, providing a satisfactory technique for cardiac evaluation of previously excluded patients.

Topics: Catecholamines; Coronary Disease; Dobutamine; Erythrocytes; Exercise Test; Humans; Infusions, Parenteral; Posture; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

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: Cardiac Output; Coronary Disease; Humans; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Cardiomyopathy, Hypertrophic; Coronary Disease; Fourier Analysis; Heart; Humans; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

A new scintigraphic count-based method for measuring absolute left ventricular volumes is presented. It is a fast and simple technique that allows geometrical assumptions to be avoided and is free of radiation attenuation corrections. This method requires the acquisition of an image of the left ventricle in the right anterior oblique projection and the collection of gated blood pool images in the left anterior oblique projection. To assess the accuracy of the method scintigraphic stroke volumes were compared with those derived from thermodilution measurements during cardiac catheterization in 20 subjects, and to assess its precision the technique was applied to phantom data of known radionuclide volumes. Excellent correlations were found between the scintigraphic and both the thermodilution (r = .98) and phantom data (r = .99). The reproducibility (r = .97) of results was investigated by repeating data acquisition and analysis for 15 subjects on two different days, and the interobserver variability (r = .97) of the method was studied by having two computer operators calculate volumes for the same patient data for 20 randomly selected studies.

Topics: Adult; Aged; Atrial Fibrillation; Cardiac Catheterization; Cardiac Output; Cardiac Volume; Coronary Disease; Female; Heart Valve Diseases; Heart Ventricles; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Thermodilution

Topics: Coronary Disease; Heart Diseases; Heart Function Tests; Humans; Radioisotope Dilution Technique; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

To investigate the function of coronary collateral vessels, especially from view point of supplying arteries, radionuclide angiocardiography was performed before and during a symptom-limited ergometer exercise in 54 patients with effort angina. In single vessel disease, during exercise, left ventricular ejection fraction (EF) (%) increased in the cases with coronary collateral vessels (supplied from patent arteries) (72 +/- 7----77 +/- 8, p less than 0.025), but decreased in those without (66 +/- 10----61 +/- 10, P less than 0.001). In multivessel disease, EF decreased during exercise even in those with collaterals (supplied from stenosed arteries) (67 +/- 10----59 +/- 8, p less than 0.001). It is concluded that angiographic appearance of the coronary arteries supplying collateral vessels is a major predictive factor of the function of coronary collateral vessels and of left ventricle during exercise.

Topics: Adult; Aged; Angina Pectoris; Angiocardiography; Blood Pressure; Collateral Circulation; Coronary Circulation; Coronary Disease; Coronary Vessels; Female; Heart Rate; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The incidence of new regional abnormalities of left ventricular wall motion induced by a peripheral cold stimulus has been examined in 75 patients who all underwent coronary arteriography. When analysis was carried out from a cine loop display a new wall motion abnormality had a sensitivity of 12% and a specificity of 100% for coronary artery disease. From stroke volume images the sensitivity was 35% and the specificity 87%. It is concluded that cold pressor induced wall motion changes are too insensitive to be a useful method of screening for coronary artery disease.

Topics: Adult; Cardiac Output; Cold Temperature; Coronary Disease; Coronary Vessels; Evaluation Studies as Topic; Female; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

Forty-one patients were evaluated with exercise-gated radionuclide ventriculography before and within 4 days after successful transluminal coronary angioplasty and 4 to 12 months later. Patients were subgrouped according to the degree of restenosis demonstrated angiographically at 4 to 12 months (Group I [n = 23]: less than or equal to 20%; Group II [n = 10]: greater than 20% but less than 50%; Group III [n = 8]: greater than or equal to 50%). Patients with abnormal findings on gated radionuclide ventriculography (less than 5 point increase in ejection fraction or wall motion deterioration) early after angioplasty were eventually found to have a greater degree of restenosis than were patients with normal findings (41.2 +/- 30.3 versus 19.0 +/- 25.4% restenosis, p less than 0.0001). The accuracy of abnormal radionuclide ventriculography in predicting 50% or greater restenosis was 73% immediately after angioplasty and 77% at the time of follow-up angiography. Gated radionuclide ventriculographic results were abnormal in 5% of Group I patients compared with 75% of Group III patients (p less than 0.01) early after angioplasty; at late follow-up, they were abnormal in 27% of Group I patients compared with 88% of Group III patients (p less than 0.01). Group I patients had a greater increase in ejection fraction than did Group III patients at early (+11.3 +/- 7.5 versus + 3.5 +/- 6.5 points, p less than 0.01) and late (+11.8 +/- 7.8 versus -1.9 +/- 8.7 points, p less than 0.0005) follow-up. It is concluded that gated radionuclide ventriculography is useful in predicting coronary restenosis after transluminal coronary angioplasty.

Topics: Aged; Angioplasty, Balloon; Constriction, Pathologic; Coronary Disease; Coronary Vessels; Female; Follow-Up Studies; Heart; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Stroke Volume; Time Factors

One hundred and one subjects (52 men, 49 women) with low probability coronary disease and normal resting left ventricular ejection fraction performed upright bicycle exercise to target without angina, ischemic ECG change, or segmental wall motion abnormality. Fifteen millicuries of Tc-99m pertechnetate were injected at rest and during peak exercise, and images were processed with first pass technique (RNA). The responses were not uniform. Group 1 was characterized by the resting end diastolic volume index (EDVI) usually greater than 80 ml/M2, a peripheral resistance drop (decreases R) of 0.20-0.50, an increase in cardiac index (increases CI) of 2.8-5.5 1/minute/M2, accompanied by decreasing EDVI and ESVI with exercise, stroke volume index (SVI) remaining essentially unchanged, and left ventricular ejection fraction (EF) usually increasing. Group 2 was characterized by the resting EDVI less than 80 ml/M2, and with the same decreases R and increases CI; EDVI, ESVI, SVI all increased and EF tended to decrease. Group 3 was characterized by decreases R greater than 0.50, increases CI greater than 5.5 1/minute M2, the exercise EDVI usually increasing, ESVI usually decreasing, SVI usually increasing, and EF usually increasing. There were no significant differences (alpha = 0.01) in exercise-related changes between men and women within each group.

Topics: Blood Pressure; Coronary Disease; Electrocardiography; Exercise Test; Female; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Probability; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume; Vascular Resistance

Fourier amplitude and phase image analysis were evaluated in 66 patients. Thirty patients served as a control group and 36 had coronary artery disease (CAD). Each patient in our control group had a rest and exercise radionuclide cineangiogram (RNCA) study (60 total). The amplitude and phase images for controls were uniform. No statistically significant difference in the histogram distribution of amplitude or phase occurred between rest and exercise. Twenty-five patients with CAD had a prior myocardial infarction (MI). Fourier analysis, when compared to the left ventricular ejection fraction (LVEF) and visual cine wall motion analysis, improved the sensitivity of the rest RNCA study to detect CAD from 68% to 92%. Regional Fourier amplitude and phase image analysis demonstrated an 85% sensitivity in localizing regions of previous infarction. Thirteen of 25 patients with prior MI and an additional 11 patients with recent onset of angina but no previous infarction, had exercise RNCA studies. When compared to cardiac catheterization data, regional Fourier amplitude and phase image analysis demonstrated sensitivities of 87% and 80%, respectively, in correctly identifying clinically significant major coronary artery involvement in these two subsets of patients. Fourier amplitude and phase image analysis were also able to distinguish normals from patients with previous MI, and patients with CAD but no prior infarction. All comparisons were statistically significant. We conclude that the semiquantitative image analysis of Fourier amplitude and phase data increases the clinical utility of the RNCA study in patients with CAD.

Topics: Adult; Aged; Cardiac Catheterization; Coronary Disease; Exercise Test; Female; Fourier Analysis; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume

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

This study was designed to investigate the potential role of radionuclide angiographic phase imaging in defining ventricular pacing sites. Twenty patients were paced from multiple right ventricular and left ventricular sites. Ten patients had both normal wall motion and normal electrocardiograms (ECGs), while 10 patients had segmental wall motion abnormalities and/or bundle branch block. Both continuous pacing and premature ventricular stimuli were performed. Multiple (two to three) views of each pacing site were obtained by radionuclide angiography and the ventricular site was determined by subsequent phase imaging. Simultaneous 12-lead ECGs were also obtained. The phase-imaging technique accurately localized all 35 right ventricular and 21 of 25 (84%) left ventricular sites to a specific segment. Statistically, this localization ability was independent of baseline wall motion or conduction system disease. In addition, sites as close as 1.5 cm were identified. The 12-lead ECG distinguished left ventricular from right ventricular pacing sites in all patients. Segmental localization by ECG in the right ventricle was accurate in 24 of 35 (69%) and in the left ventricle in 17 of 25 (68%). Thus, radionuclide angiographic phase imaging provides excellent descriptive information regarding the focus of ventricular pacing ectopy and can define both sites of continuous pacing and intermittent premature ventricular stimulation. These findings provide a basis for further assessment of the role of phase imaging in the evaluation of patients with spontaneous ventricular ectopy.

Topics: Bundle-Branch Block; Cardiac Complexes, Premature; Cardiac Pacing, Artificial; Coronary Disease; Electrocardiography; Heart Valve Diseases; Heart Ventricles; Humans; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Wolff-Parkinson-White Syndrome

Exercise thallium-201 perfusion scans and gated equilibrium blood pool scans were performed in 120 catheterized patients with a chest pain syndrome. Eighty-six patients had coronary artery disease and 34 patients did not. The effects of gender, propranolol, exercise level, exercise ischemia, history of typical angina, history of previous myocardial infarction, electrocardiographic Q waves, number of diseases vessels and extent of coronary artery obstruction on diagnostic accuracy were evaluated. The overall sensitivity and specificity of thallium scans were 76 and 68%, respectively, and those of gated blood pool scans 80 and 62% (p = not significant). Propranolol decreased the specificity of thallium scans (propranolol = 42%; no propranolol = 87%, p less than 0.05). Thallium scans and anginal history were less sensitive for detecting coronary disease in women (men: thallium = 79%; angina = 77%; women: 54 and 46%, respectively; p less than 0.05). Exercise level did not significantly affect the diagnostic accuracy of either scan. Thallium and gated scans were both highly sensitive (95%) in detecting disease in 20 patients with a prior myocardial infarction, angina and a positive electrocardiogram. The sensitivity of the thallium scan significantly decreased as the number of diseased vessels decreased. Both thallium and gated scans were less frequently positive in patients with atypical angina or no Q waves, but were not significantly influenced by electrocardiographic ischemia. The sensitivity and specificity of both scans were low in 57 patients with the combination of atypical angina, no history of infarction and equivocal stress electrocardiogram thallium = 61 and 63%, respectively; gated = 61 and 67%). When stress thallium scan evaluation included the electrocardiogram and thallium scan interpretation, the diagnostic accuracy was 81%. When all the information from gated scans (wall motion, ejection fraction, pulmonary blood volume) was combined for final gated scan evaluation, the diagnostic accuracy was 83%. When electrocardiographic data were added to all three gated scan variables, diagnostic accuracy was 77%. In conclusion, thallium perfusion and gated blood pool scans have reasonable diagnostic accuracy for coronary artery disease in a group of patients with a moderately high prevalence of disease. However, combined variables from each test are needed to provide reliable diagnostic accuracy.

Topics: Coronary Circulation; Coronary Disease; Electrocardiography; Erythrocytes; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Physical Exertion; Propranolol; Radioisotopes; Radionuclide Imaging; Sex Factors; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Thallium

This study was designed to more clearly define the relation between various invasive hemodynamic measurements and left ventricular (LV) timing intervals, ejection rate and filling rate derived from the radionuclide angiographic volume curve. Twenty-eight patients were studied with simultaneous intracardiac micromanometer pressure and dP/dt recordings, gated radionuclide angiography and M-mode echocardiography. These techniques permitted multiple variables of systolic and diastolic function to be measured at a constant atrial paced rate of 100 beats/min. There was a strong correlation between peak ejection rate and ejection fraction (r = -0.97) and between peak ejection rate and maximum positive dP/dt (r = -0.85). There also was a strong correlation between peak filling rate and maximum negative dP/dt (r = -0.85). A weaker correlation existed between the time constant of LV relaxation and the peak filling rate (r = -0.49) and between the LV end-diastolic pressure and the peak filling rate (r = -0.62). There was no correlation between the modulus of chamber stiffness and filling rates, and no association was observed between the time to peak filling rate and the hemodynamic variables. Thus, under the conditions studied, the measured peak ejection and filling rate, determined from the radionuclide angiographic volume curve, correlated well with accepted invasive hemodynamic measurements.

Topics: Adult; Aged; Cardiac Catheterization; Cardiomyopathy, Hypertrophic; Coronary Disease; Echocardiography; Erythrocytes; Female; Heart; Hemodynamics; Humans; Male; Manometry; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Time Factors

The general and regional contractility of the left ventricle was studied in 69 patients with chronic coronary heart disease (CHD) and in 10 practically healthy persons using the method of radionuclide ventriculography (RNVG). The contractility indicators in dynamic and static RNVG were correlated. A high degree of correlation was obtained between them as well as with the findings of radiopaque ventriculography. It was established that data processing with the help of a cardiosynchronizer is of high informative value, significant and can be used in RNVG variants thus making it possible to use the same program of processing. The frequency of the methods and mean dispersion of the results were assessed. Numerical values of the general and regional contractility in healthy persons and in patients with varying severity of chronic CHD were determined.

Topics: Adult; Chronic Disease; Coronary Disease; Diphosphates; Heart; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Pentetic Acid; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed

Topics: Cardiac Output; Cardiomyopathies; Coronary Circulation; Coronary Disease; Coronary Vessels; Heart; Heart Diseases; Heart Valve Diseases; Heart Ventricles; Humans; International Cooperation; Lung Diseases, Obstructive; Myocardial Infarction; Perfusion; Quality Control; Radionuclide Imaging; Reference Values; Societies, Medical; Sodium Pertechnetate Tc 99m; Terminology as Topic; Tomography, Emission-Computed; World Health Organization

The acute hemodynamic effects of an i.v. bolus of verapamil, 0.1 mg/kg or 0.06-0.075 mg/kg, were examined by serial radionuclide studies in 46 patients with coronary artery disease. In 20 patients with ejection fractions (EFs) greater than 35% (group 1A), verapamil, 0.1 mg/kg given over 1-11/2 minutes, had a biphasic effect: first, a transient decrease in EF accompanied by increased left ventricular (LV) volumes and cardiac output equivalents; then, an overshoot of EF to values above control, accompanied by a decrease in peripheral vascular resistance and a drastic decrease in LV volumes, while cardiac output equivalent remained slightly elevated. In eight patients with EFs less than 35% (group 1B), only the first effect on EF was noted. In 10 patients with EFs greater than 35% (group 2), verapamil, 0.06-0.075 mg/kg, exerted qualitatively similar but milder effects on hemodynamic function. Finally, verapamil, 0.1 mg/kg given more slowly, over 2-21/2 minutes, produced no significant changes in EF or LV volumes in another eight patients (group 3). The acute effects of verapamil are thus both time-related and dose-dependent. They are also related to the baseline functional reserve of the left ventricle. This study documents that verapamil exerts a depressant effect on LV function. However, the transient nature of this depression and the quick recovery to normal or above-normal values indicate that verapamil, in the doses used in this study, is safe to use intravenously in patients with coronary artery disease.

Topics: Adult; Aged; Cardiac Output; Cardiac Volume; Coronary Disease; Depression, Chemical; Dose-Response Relationship, Drug; Female; Heart; Hemodynamics; Humans; Injections, Intravenous; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Vascular Resistance; Verapamil

Topics: Adult; Angiography; Coronary Disease; Exercise Test; False Positive Reactions; Female; Humans; Isometric Contraction; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Sixteen asymptomatic patients with coronary artery disease and silent myocardial ischemia were studied with exercise radionuclide ventriculography. Radionuclide ventriculograms were analyzed for changes in ejection fraction globally and in three regions. Results were compared with radionuclide ventriculograms in 24 symptomatic patients. Both groups (silent myocardial ischemia and angina) were similar in prevalence of multivessel disease and previous myocardial infarction, as well as in age and sex. Global ejection fraction decreased by 0.06 in both groups during exercise; regional ejection fraction also decreased by similar amounts in the two groups. Furthermore, the percent of regions with normal ejection fraction at rest that demonstrated a decrease during exercise was identical: 19 (60%) of 33 versus 26 (60%) of 46. These exercise radionuclide ventriculographic results suggest that abnormalities in regional and global left ventricular wall motion are similar in patients with coronary artery disease with and without silent myocardial ischemia.

Topics: Angiography; Cardiac Output; Coronary Disease; Heart Ventricles; Humans; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

A multivariate analysis (MVA) system was derived retrospectively from a population of 76 males with coronary artery disease and 18 control subjects. Posterior probabilities were then derived from such a system prospectively in a new male population of 11 subjects with normal coronary arteries and hemodynamics and 63 patients with coronary artery disease. The sensitivity was 84% compared to that for change in ejection fraction (delta EF) greater than or equal to 5 criterion of 71% (p less than 0.01), the specificity was 91% compared to 73% for the delta EF greater than or equal to 5 criterion (p greater than 0.05), and the correct classification rate was 85% compared to 72% for the delta EF greater than or equal to 5 criterion (p less than 0.01). The significant variables were: change in EF with exercise, percent maximal heart rate, change in end-diastolic volume (delta EDV) with exercise, change in R wave, and exercise duration. Application of the multivariate approach to radionuclide imaging with stress, including both exercise and nuclear parameters, significantly improved the diagnostic accuracy of the test and allowed for a probability statement concerning the likelihood of disease.

Topics: Adult; Aged; Analysis of Variance; Coronary Disease; Exercise Test; Hemodynamics; Humans; Male; Middle Aged; Probability; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium

Cold pressor stimulation (CPS) was compared with supine bicycle exercise during radionuclide ventriculography as a procedure for diagnosing coronary artery disease (CAD). Thirty patients were studied. In the 18 patients with angiographically proved CAD, left ventricular ejection fraction (LVEF) decreased a mean of 5.0 +/- 1.0 ejection fraction units (+/- SEM) in response to CPS. Only two patients developed a new wall motion abnormality. In response to maximal supine exercise, the CAD group showed a mean decrease in LVEF from rest of 1.9 +/- 1.1%. Nine patients developed an exercise-induced wall motion abnormality. In the 12 patients with angiographically proved normal coronary arteries, LVEF decreased a mean of 5.8 +/- 1.3 units in response to CPS and increased a mean of 9.2 +/- 1.2% in response to exercise. Thus, the LVEF response to CPS was not significantly different in the CAD and normal groups (5.0 +/- 1.0 vs 5.8 +/- 1.3, NS). These same patients demonstrated the expected difference in LVEF response to exercise. We conclude that CPS produces similar changes in LVEF in patients with and without CAD, and therefore is not useful in diagnosing ischemic heart disease.

Topics: Adult; Aged; Blood Pressure; Cold Temperature; Coronary Angiography; Coronary Disease; Erythrocytes; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

The accuracy of rest and exercise radionuclide angiocardiography (RNA) and exercise treadmill testing (ETT) for diagnosis of three-vessel or left main coronary artery disease (extensive CAD) was determined in 544 patients. ETT and RNA sensitivities were similar (88% vs 92%, NS), but ETT was more specific than RNA (46% vs 34%, p less than 0.01). The prevalence of extensive CAD in patients with a positive treadmill (41%) increased only 3% when the RNA was also positive. However, in the 292 patients with a negative or indeterminate ETT, a positive RNA increased this prevalence from 16% to 23%, while a negative RNA decreased this prevalence to 5%. These results support the initial use of ETT followed by RNA if the treadmill is negative or indeterminate for diagnosis in a population with a high prevalence of extensive CAD. This approach separates patients into subgroups with a high or low probability of extensive CAD.

Topics: Adult; Aged; Cardiac Catheterization; Coronary Disease; Exercise Test; Female; Follow-Up Studies; Heart; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Two-dimensional echocardiography (2-D echo) was performed in 73 patients evaluated for coronary artery disease (CAD) and in four normal volunteers before and immediately after a maximal treadmill exercise test. Diagnostic images were obtained from the apical and parasternal windows. In 17 patients with normal coronary arteriograms, ejection fraction (EF) increased from 66 +/- 9% (+/- SD) at rest to 73 +/- 8% after exercise (p less than 0.001), while in 56 patients with proved CAD, EF fell from 56 +/- 13% at rest to 53 +/- 16% after exercise (p less than 0.01). The sensitivity of postexercise 2-D echo for detecting CAD (based on abnormal EF response and/or regional dyssynergy) was 91% (51 of 56 patients) and the specificity was 88% (15 of 17). Sensitivity for one-, two- and three-vessel disease was 64% (seven of 11), 95% (20 of 21) and 100%, respectively. Patients with multivessel disease showed a significant fall in a wall motion score index, from 0.79 +/- 0.25 to 0.63 +/- 0.26. Exercise radionuclide ventriculography (RNV) was also performed in 41 of the subjects (17 normals and 24 CAD patients) on a bicycle ergometer. The overall sensitivity of 2-D echo in this subgroup was 92%, compared with 71% for RNV. The sensitivity of 2-D echo for one-vessel disease (n = 4) was 50%, that for two-vessel disease (n = 12) was 100% and that for three-vessel disease (n = 12) was 100%. Respective values for RNV were 0%, 80% and 90%. The specificity of 2-D echo was 88% and that of RNV was 82%. A significantly higher peak heart rate response was observed on the treadmill than on the bicycle ergometer in both CAD patients and normal subjects. We conclude that postexercise 2-D echo is a clinically applicable technique for the diagnosis and evaluation of CAD patients and compares favorably with exercise RNV.

Topics: Adult; Aged; Coronary Disease; Echocardiography; Electrocardiography; Erythrocytes; Exercise Test; Female; Heart; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

To examine the effects of nifedipine on changes in ventricular function produced by cold, the cold pressor test was administered to eight patients with angiographically documented coronary artery disease. Radionuclide ventriculograms were obtained at baseline and during the cold pressor stimulus both before and after administration of nifedipine, 10 mg buccally; thus, four serial radionuclide ventriculograms were obtained per patient. The cold pressor stimulus did not produce any significant difference in the mean (+/- standard deviation) peak rate-pressure product during the control or nifedipine test (10,900 +/- 3,390 versus 10,600 +/- 3,700). However, the increase in systolic blood pressure (p = 0.05) and the peak systolic blood pressure achieved (p less than 0.001) were greater during the control (134 +/- 19 to 160 +/- 25 mm Hg) than during the nifedipine (125 +/- 18 to 145 +/- 21 mm Hg) cold pressor test. The mean global left ventricular ejection fraction decreased during the control cold pressor test from a baseline value of 0.60 +/- 0.08 to 0.52 +/- 0.08 (p = 0.004). After nifedipine, this variable did not change during the repeat cold pressor test (0.63 +/- 0.09) compared with the repeat baseline value (0.63 +/- 0.11). Therefore, the difference in left ventricular ejection fraction response during control versus nifedipine cold pressor testing was highly significant (p less than 0.0001). In patients with obstructive coronary artery disease, nifedipine abolished the decrease in left ventricular ejection fraction observed during the control cold pressor test and may be of value to protect patients from cold-induced left ventricular dysfunction. The mechanism may be a combination of coronary artery vasodilation and systolic unloading of the left ventricle.

Topics: Adult; Blood Pressure; Cardiac Output; Cold Temperature; Coronary Disease; Coronary Vessels; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Nifedipine; Oxygen Consumption; Pyridines; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

The predictive value of radionuclide ventriculography was studied in 34 patients with depressed left ventricular ejection fraction (less than 40%) and clinically evident congestive heart failure secondary to atherosclerotic coronary artery disease. In addition to left ventricular ejection fraction, right ventricular ejection fraction and extent of left ventricular paradox were obtained in an attempt to identify a subgroup at increased risk of mortality during the ensuing months. The 16 patients who were alive after a 2 year follow-up period had a higher right ventricular ejection fraction and less extensive left ventricular dyskinesia. When a right ventricular ejection fraction of less than 35% was used as a discriminant, mortality was significantly greater among the 21 patients with a depressed right ventricular ejection fraction (71 versus 23%), a finding confirmed by a life table analysis. Depressed right ventricular function was further linked to more severely compromised left ventricular function, as confirmed by a greater reduction in left ventricular ejection fraction and by an increased extent of left ventricular dyskinesia. These patients had a greater prevalence of chronic obstructive pulmonary disease and previous inferior myocardial infarction but the differences between groups were not statistically significant. It appears that the multiple factors contributing to the reduction in right ventricular ejection fraction make it a useful index not only for assessing biventricular function, but also for predicting patient outcome.

Topics: Actuarial Analysis; Adult; Aged; Cardiac Output; Coronary Disease; Erythrocytes; Female; Follow-Up Studies; Heart; Heart Failure; Humans; Male; Middle Aged; Prognosis; Radionuclide Imaging; Risk; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Time Factors

Investigations on 106 patients with coronary artery disease were performed to improve the diagnosis of myocardial ischemia by combining myocardial scintigraphy and gated blood studies. The results show that it is possible to enhance the detection of coronary artery disease and to classify haemodynamic efficiency. In addition we found that in investigations performed on patients with arrhythmia and under stress conditions the "hybrid-technique" is superior to the framemode acquisition method.

Topics: Adult; Aged; Coronary Disease; Erythrocytes; False Negative Reactions; False Positive Reactions; Female; Humans; Male; Methods; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Adult; Blood Pressure; Cardiac Output; Coronary Disease; Electrocardiography; Exercise Test; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p = not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p = 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p = not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

Topics: Adult; Aged; Aging; Cardiac Catheterization; Cardiac Output; Coronary Disease; Electrocardiography; Exercise Test; Female; Heart; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Septal and lateral wall motion and septal thickening were evaluated with quantitative two-dimensional echocardiography in 20 patients who underwent cardiac surgery without complications. Postoperative mean ejection fraction (48 +/- 10%) measured by radionuclide ventriculography was unchanged from the preoperative value (45 +/- 8%). Mean postoperative systolic thickening of the septum (33 +/- 15%) was also unchanged from the preoperative value (26 +/- 10%). However, septal endocardial motion as measured by an external frame-of-reference (fixed-axis) system fell from a 22 +/- 10% mean percent shortening (MPS) of septal radii to a postoperative value of -8 +/- 15% (p less than .001). Fixed-axis analysis also led to an increase in MPS of lateral radii: preoperative 16 +/- 5%; postoperative 28 +/- 9% (p less than .001). With an internal frame-of-reference (floating-axis) system, which compensates for the effects of translation and rotation on wall motion, postoperative MPS of septal radii (22 +/- 10%) was unchanged from preoperative MPS (25 +/- 8%; p = NS). Similarly, MPS of lateral wall radii was unchanged (preoperative, 15 +/- 5%; postoperative, 12 +/- 5%; p = NS). Thus systolic translation of the ventricle accounts for abnormal postoperative septal motion seen in a fixed-axis system and can be corrected by a floating-axis system. These data have important implications for the noninvasive evaluation of regional wall motion after cardiac surgery. Systems using a fixed external frame of reference such as radionuclide ventriculography are prone to systematic error. A combination of systolic thickening analysis by two-dimensional echocardiography and analysis of endocardial motion by the floating-axis system is a more appropriate method for evaluating the effects of cardiac surgery on regional left ventricular function.

Topics: Adult; Aged; Cardiac Surgical Procedures; Coronary Disease; Echocardiography; Electrocardiography; Endocardium; Heart; Heart Septum; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Two-dimensional echocardiographic determination of right ventricular ejection fraction was compared with right ventricular ejection fraction obtained by first pass radionuclide angiography in 39 patients with coronary artery disease. Apical four chamber and two chamber right ventricular views were obtained in 34 (87%) of the 39 patients, while a subcostal four chamber view was obtained in 31 patients (80%). Right ventricular ejection fraction by two-dimensional echocardiography was calculated by the biplane area-length and Simpson's rule methods using two paired orthogonal views and utilizing a computerized light-pen method for tracing the right ventricular endocardium. A good correlation (r = 0.74 to 0.78) was found between radionuclide angiographic and two-dimensional echocardiographic right ventricular ejection fraction for each method used. Patients with acute inferior myocardial infarction had the lowest right ventricular ejection fraction by radionuclide angiography and two-dimensional echocardiography (p less than 0.05 compared with patients with right coronary artery obstruction and no infarction). There were no differences in right ventricular ejection fraction between patients with acute and old inferior myocardial infarction by both techniques. No correlation was found between left and right ventricular ejection fraction by radionuclide angiography (r = 0.16). It is concluded that 1) right ventricular ejection fraction by two-dimensional echocardiography correlates well with radionuclide angiographic measurements and can reliably evaluate right ventricular function in coronary artery disease, 2) patients with inferior myocardial infarction have reduced right ventricular ejection fraction, and 3) changes in left ventricular ejection fraction do not directly influence right ventricular function.

Topics: Adult; Aged; Cardiac Output; Coronary Disease; Echocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Coronary Disease; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

The incremental value of clinical assessment, exercise electrocardiography (ECG) and biplane radionuclide ventriculography (RVG) in the prediction of coronary artery disease (CAD) was assessed in 105 men without myocardial infarction who were undergoing coronary angiography for investigation of chest pain. Independent clinical assessment of chest pain was made prospectively by 2 physicians. Graded supine bicycle exercise testing was symptom-limited. Right anterior oblique ECG-gated first-pass RVG and left anterior oblique ECG-gated equilibrium RVG were performed at rest and exercise. Regional wall motion abnormalities were defined by agreement of 2 of 3 blinded observers. A combined strongly positive exercise ECG response was defined as greater than or equal to 2 mm ST depression or 1.0 to 1.9 mm ST depression with exercise-induced chest pain. A multivariate logistic regression model for the preexercise prediction of CAD was derived from the clinical data and selected 2 variables: chest pain class and cholesterol level. A second model assessed the incremental value of the exercise test in prediction of CAD and found 2 exercise variables that improved prediction: RVG wall motion abnormalities, and a combined strongly positive ECG response. Applying the derived predictive models, 37 of the 58 patients (64%) with preexercise probabilities of 10 to 90% crossed either below the 10% probability threshold or above the 90% threshold and 28 (48%) also moved across the 5 and 95% thresholds. Supine exercise testing with ECG and biplane RVG together, but neither test alone, effectively adds to clinical prediction of CAD. It is most useful in men with atypical chest pain and when the ECG and RVG results are concordant.

Topics: Adult; Cholesterol; Coronary Angiography; Coronary Disease; Electrocardiography; Exercise Test; Heart; Humans; Male; Middle Aged; Myocardial Contraction; Pain; Probability; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thorax

In 19 patients (mean age 55.3 years) with severe, diffuse coronary artery disease and stable angina pectoris, coronary artery bypass surgery was performed with an average of 5.36 anastomoses per patient. At 15.5 +/- 8 months postoperatively, radionuclide ventriculograms were obtained in the RAO projection (first-pass-technique) at rest and during maximal exercise by means of a multicrystal camera. To assess the effects of revascularization on the myocardial function, analysis was performed for global ejection fraction (GEF) as well as three regional ejection fraction (GEF) as well as three regional ejection fractions (REF) corresponding to the vascular beds of the three major coronary arteries. During exercise global ejection fraction increased in 13 patients (68.4%) an average of 9.5%-points from 51.5 to 61.0%, in one patient (5.2%) remained unchanged and in five patients (26.3%) decreased an average of 9.6% %-points from 62.6 to 53.0% (all changes p less than 0.05). The classification of the various myocardial regions was based on the preoperative coronary angiogram as well as intraoperative in-situ findings according to the status of the coronary vessels, the extent of revascularization and the presence of remote myocardial infarctions. Regions of group I had a significantly higher fraction of complete revascularizations, that is 79.9%. 61.1% of group-II-territories were incompletely revascularized. The weighted balance of the three regions supplied by the left anterior descending artery, the circumflex and the right coronary artery explains the postoperative response of the global ejection fraction to exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Angina Pectoris; Cardiac Output; Coronary Artery Bypass; Coronary Disease; Female; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Angiocardiography; Cardiac Volume; Coronary Disease; Electrocardiography; Female; Humans; Male; Middle Aged; Myocardial Contraction; Myocardial Infarction; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Adult; Aged; Blood Volume; Cardiac Volume; Cardiomyopathies; Computers; Coronary Disease; Female; Heart Septal Defects, Atrial; Heart Valve Diseases; Heart Ventricles; Humans; Male; Middle Aged; Radiography; Radioisotope Dilution Technique; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

The cardiovascular responses to combined static-dynamic effort, postprandial dynamic effort and dynamic effort alone were evaluated by upright bicycle ergometry during equilibrium-gated blood pool scintigraphy in 24 men, mean age 59 +/- 8 years, with chronic ischemic heart disease. Combined static-dynamic effort and the postprandial state elicited a peak cardiovascular response similar to that of dynamic effort alone; work load 643 +/- 156 and 638 +/- 161 vs 650 +/- 153 kg-m/min, respectively; heart rate 147 +/- 14 and 145 +/- 14 vs 143 +/- 17 beats/min; systolic pressure 195 +/- 26 and 200 +/- 25 vs 197 +/- 25 mm Hg; and rate-pressure product 286 +/- 48 and 292 +/- 55 vs 282 +/- 52. Heart rate, intraarterial systolic and diastolic pressures, rate-pressure product and ejection fraction were similar for the three test conditions at the onset of ischemia and at peak effort. The prevalence and extent of exercise-induced ischemic left ventricular dysfunction, ST-segment depression, angina pectoris and ventricular ectopic activity were also similar during the three test conditions. Direct and indirect measurements of systolic and diastolic blood pressure were highly correlated. The onset of ischemic ST-segment depression and angina pectoris correlated as strongly with heart rate alone as with the rate-pressure product during all three test conditions. The cardiovascular response to combined static-dynamic effort and to postprandial dynamic effort becomes more similar to that of dynamic effort alone as dynamic effort reaches a symptom limit. If significant ischemic and arrhythmic abnormalities are absent during symptom-limited dynamic exercise testing, they are unlikely to appear during combined static-dynamic or postprandial dynamic effort. This simplifies, the task of formulating guidelines for physical effort in patients with chronic ischemic heart disease, especially in providing "clearance" to perform avocational and vocational tasks involving combined static-dynamic and postprandial dynamic effort.

Topics: Aged; Angina Pectoris; Blood Pressure; Coronary Disease; Eating; Erythrocytes; Exercise Test; Heart; Heart Rate; Humans; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Recent evidence indicates that the left anterior oblique projection (LAO) multigated radionuclide ventriculogram (RVG) underestimates presence and extent of apical and inferior left ventricular (LV) wall motion abnormalities. We investigated, prospectively, the sensitivity and specificity of a modified anterior projection (MAP), which incorporates cephalad tilting. Thirty-three consecutive patients undergoing cardiac catheterization suspected to have coronary artery disease were studied with RVG, using both the MAP and LAO views. LAO views were analyzed using the ejection fraction image (REFI), and the regional ejection fraction (REF) of the inferoapical region. The MAP studies were analyzed using stroke volume image (SVI) to evaluate apical and inferior LV regions. Results were as follows: (Formula: see text), Both intraobserver and interobserver variabilities were comparable to those of conventional angiographic studies used in detection of apical and inferior asynergy. It is concluded that the multigated MAP offers additional information about abnormalities of the LV inferior and apical regions.

Topics: Angiography; Coronary Disease; Heart Septum; Heart Ventricles; Humans; Male; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Resting first-pass radionuclide angiocardiography (RNA) was used to derive left-ventricular (LV) peak diastolic filling rates (PFR) in normals (Group 1:N = 12) and in patients with coronary artery disease (CAD), both without (Group 2:N = 27) and with previous myocardial infarction (Group 3:N = 23). Resting peak filling rates were significantly depressed in both Group 2 (1.61 +/- 0.36; p less than 0.01) and Group 3 (1:35 +/- 0.26; p less than 0.001) patients when compared with Group 1, normals (2.14 +/- 0.63). Even though LV systolic function of Group 2 patients was normal and comparable to that in Group 1 (EF = 0.55 +/- 0.06 against EF 0.55 +/- 0.06 NS), diastolic dysfunction [PFR less than 1.61 end diastolic volume/sec (EDV/sec)] was present at rest in 14 of 27 (52%). Depressed PFR values was also seen in 20 of 23 Group 3 patients (87%). It appears that (a) resting PFR is a sensitive and easily obtainable parameter of the diastolic dysfunction associated with CAD; (b) abnormal PFR values are seen in almost all patients with previous myocardial damage, and (c) a significant proportion of CAD patients without any evidence of abnormal systolic function have depressed resting PFR of the LV.

Topics: Adult; Aged; Coronary Disease; Female; Heart Rate; Humans; Male; Middle Aged; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Topics: Cardiac Output; Coronary Angiography; Coronary Disease; Heart; Heart Aneurysm; Heart Ventricles; Humans; Myocardial Contraction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

To investigate the role of the cold pressor test (CPT) with radionuclide angiocardiography in the diagnosis of coronary artery disease (CAD), we performed angiocardiography in 52 patients (18 with angiographically normal coronary arteries and 34 with CAD) during the resting state, CPT, and supine bicycle exercise (EX). In normal subjects, left ventricular ejection fraction (EF) was unchanged between rest (58 +/- 9%) and CPT (59 +/- 9%, p = ns), but increased during maximal EX (69 +/- 9%, p less than 0.01). In CAD patients, EF fell from 55 +/- 9% at rest to 49 +/- 9% during CPT (p less than 0.01), and to 53 +/- 11% during EX (p = ns vs. rest). Twenty-seven CAD patients (79%) developed new or worsening areas of dyssynergy during CPT, vs. 25 patients (73%) during EX. Thus, the cold pressor test with radiocardiography appears to be a useful noninvasive test for the diagnosis and functional evaluation of CAD, particularly in patients unable to perform a satisfactory exercise test.

Topics: Adult; Aged; Cold Temperature; Coronary Disease; Exercise Test; Humans; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Angina Pectoris; Coronary Disease; Electrocardiography; Evaluation Studies as Topic; Exercise Test; Heart Ventricles; Humans; Physical Exertion; Prognosis; Radiography; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thallium

Most exercise radionuclide studies utilise the supine bicycle ergometer during imaging, although exercise on a treadmill results in greater cardiovascular stress. Twenty-three patients were studied to compare the radionuclide left ventricular ejection fraction (LVEF) estimated immediately following treadmill exercise with that obtained at peak supine bicycle exercise in patients with coronary artery disease (CAD) and patients with normal coronary arteries. In 14 patients with CAD the rest LVEF was 47 +/- 7% (mean +/- SD) by first pass and 49 +/- 10% by equilibrium blood pool techniques. Immediately following maximum treadmill exercise, 13 of the 14 patients with coronary artery disease showed either no change or a decrease in LVEF, the LVEF was 49 +/- 7% (P = NS) and 47 +/- 8% (P = NS) by first pass and equilibrium determinations respectively. In comparison the LVEF during peak supine bicycle exercise decreased significantly to 42 +/- 12% (P less than 0.01). In nine patients with angiographically normal coronary arteries the rest LVEF was 51 +/- 4% by first pass and 54 +/- 6% by equilibrium, increasing to 67 +/- 7% (P less than 0.01) and 64 +/- 7% (P less than 0.01) respectively following treadmill exercise. During peak bicycle exercise LVEF increased in the normal patients to 61 +/- 7% (P less than 0.05). These data suggest that quantitative radionuclide angiography following either maximum treadmill exercise or during peak bicycle exercise can discriminate between patients with coronary artery disease and normal subjects, although the magnitude of left ventricular functional changes are greater during bicycle stress.

Topics: Adult; Aged; Cardiac Output; Coronary Disease; Exercise Test; Humans; Middle Aged; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Technetium Tc 99m Pentetate

In 49 patients in whom gated equilibrium ventriculography and cardiac catheterization were performed within a 6 day interval, total and fractional portions of global and regional right ventricular ejection fraction (RVEF) were correlated with pulmonary arterial systolic pressure. Pulmonary arterial systolic pressure was normal (30 mm Hg or less) in 27 patients (Group I) and elevated (31 mm Hg or greater) in 22 patients (Group II). The second-half regional RVEF was 38 +/- 8% (mean +/- standard deviation) with a range of 30 to 54% for Group I and 22 +/- 6% with a range of 13 to 32% for Group II. The difference between the means was statistically significant (p less than 0.001). Use of a second-half regional RVEF of 30% as the criterion of elevated pulmonary arterial systolic pressure resulted in a sensitivity of 0.86 and a specificity of 1.00. A power curve fit in which pulmonary arterial systolic pressure = 10.91 (second-half regional RVEF)-0.87 allowed accurate estimation (r = -0.85) of pulmonary arterial systolic pressure from the second-half regional RVEF. It is concluded that second-half regional RVEF may be used to accurately detect pulmonary arterial hypertension and to estimate its extent.

Topics: Adult; Aged; Blood Pressure; Cardiac Catheterization; Cardiac Output; Coronary Disease; Erythrocytes; Female; Heart; Humans; Hypertension, Pulmonary; Male; Middle Aged; Myocardial Contraction; Oxygen Inhalation Therapy; Pulmonary Artery; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Examination of the time course of left ventricular ejection has been found useful in several clinical applications. Equilibrium gated radionuclide angiography provides non-invasive means to obtain the ventricular ejection curve. To evaluate the accuracy of the equilibrium gated radionuclide left ventricular volume curve we compared equilibrium gated radionuclide date with biplane cine-angiography in 16 patients examining each set of data on a point by point basis. The cine-angiographic data consisted of 60 frame per second biplane cineangiograms and the radionuclide data consisted of 28 points spanning the cardiac cycle. All data was normalized for the patient's heart rate and stroke volume. The equilibrium gated radionuclide angiographic data accurately reproduced the contrast angiographic data at each point on the curve. This result justifies using the equilibrium gated radionuclide time activity curve to evaluate parameters such as early systolic ejection rates or rates of maximum ventricular ejection.

Topics: Cardiac Output; Cineangiography; Coronary Disease; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Determination of left ventricular (LV) enddiastolic volume (EDV) was achieved by calibration of the system (single-crystal gamma camera, equipped with a converging collimator) to a volume phantom (egg). A good correlation (r = 0.92) was found with EDV values, obtained from cineventriculography. Images, derived from enddiastole (ED) and endsystole (ES) were corrected for background by "parabolic background subtraction", which is a realistic form of background correction in view of the LV-shape. Regional ejection fraction (REF) was calculated by an electronical operation using the ejection fraction formula and these ED and ES images. REF values reflect regional or segmental LV pump function and are superior to one- or two-dimensional parameters (e.g. visual assessment of asynergy, hemiaxis shortening) since REF values include the third dimension by referring to regional volumes. In addition, per cent-akinetic segment may be replaced by REF. Results from the literature show that first-tracer passage with a single crystal gamma camera at rest (n = 534) yield equivalent results in comparison with cineventriculography. Therefore, this nuclear procedure may be routinely used. REF values complete the diagnostic parameter as yet available.

Topics: Cineradiography; Coronary Disease; Heart; Humans; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Technetium Tc 99m Pentetate

Rest and exercise radionuclide angiocardiographic measurements of left ventricular function were obtained in 496 patients who underwent cardiac catheterization for chest pain. Two hundred forty-eight of these patients also had an exercise treadmill test. An ejection fraction less than 50% was the abnormality of resting left ventricular function that provided the greatest diagnostic information. In patients with normal resting left ventricular function, exercise abnormalities that were optimal for diagnosis of coronary artery disease were an injection fraction at least 6% less than predicted, an increase greater than 20 ml in end-systolic volume and the appearance of an exercise-induced wall motion abnormality. The sensitivity and specificity of the test were lower in patients who were taking propranolol at the time of study and in patients who failed to achieve an adequate exercise end point. In the 387 patients with an optimal study, the test had a sensitivity of 90% and a specificity of 58%. Radionuclide angiocardiography was more sensitive and less specific than the exercise treadmill test. The high degree of sensitivity of the radionuclide test suggests that it is most appropriately applied to patient groups with a high prevalence of disease, including those considered for cardiac catheterization.

Topics: Adult; Aged; Angina Pectoris; Blood Volume; Cardiac Catheterization; Coronary Disease; Coronary Vessels; Female; Heart Ventricles; Humans; Male; Physical Exertion; Propranolol; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Quantitative radionuclide angiography (with the first pass technique and a computerized multicrystal camera) was used to evaluate hemodynamic changes in three subject groups during symptom-limited upright exercise. The 12 normal subjects had significant increases in heart rate, stroke volume, left ventricular ejection fraction and cardiac output during exercise; changes in end-diastolic and end-systolic volumes were not significant. In the 24 patients with coronary artery disease there were significant increases in heart rate and cardiac output during exercise, but insignificant changes in end-diastolic, end-systolic and stroke volumes and ejection fraction. The change in diastolic volume in these patients was determined by the extent of coronary artery disease, propranolol therapy, end point of exercise and presence of collateral vessels. Furthermore, patients with previous myocardial infarction had a lower ejection fraction and higher end-diastolic and end-systolic volumes during exercise than those without myocardial infarction. In the 12 patients with chronic aortic regurgitation of moderate to severe degree, there was a decrease in the end-diastolic volume during exercise. This response was distinctly different from that of the normal subjects or the patients with coronary artery disease. All three groups had a significant decrease in pulmonary transit time during exercise. It is concluded that changes in cardiac output in normal subjects during upright exercise are related to augmentation of stroke volume and tachycardia, whereas in patients with coronary artery disease they are related mainly to tachycardia. Left ventricular dilatation during exercise occurred in some normal subjects and in patients with coronary artery disease but was not a consistent finding. However, a decrease in left ventricular end-diastolic volume is common in patients with aortic regurgitation. Such a decrease may be explained by a reduction in the regurgitant volume per beat caused by shortening of the diastolic filling period or a decrease in systemic vascular resistance, or both.

Topics: Adult; Aged; Aortic Valve Insufficiency; Coronary Disease; Electrocardiography; Exercise Test; Female; Heart; Hemodynamics; Humans; Male; Middle Aged; Physical Exertion; Posture; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

The volume ejected early in systole has been proposed as an indicator of abnormal left ventricular function that is present at rest in patients with coronary artery disease with a normal ejection fraction and normal wall motion. The volume ejected in systole was examined by calculating the percent change in ventricular volume using both computer-assisted analysis of biplane radiographic ventriculograms at 60 frames/s and equilibrium gated radionuclide ventriculograms. Ventricular emptying was examined with radiographic ventriculography in 33 normal patients and 23 patients with coronary artery disease and normal ejection fraction. Eight normal subjects and six patients with coronary artery disease had both radiographic ventriculography and equilibrium gated radionuclide ventriculography. In all patients, there was excellent correlation between the radiographic and radionuclide ventricular emptying curves (r = 0.971). There were no difference in the ventricular emptying curves of normal subjects and patients with coronary artery disease whether volumes were measured by radiographic or equilibrium gated radionuclide ventriculography. It is concluded that the resting ventricular emptying curves are identical in normal subjects and patients with coronary artery disease who have a normal ejection fraction and normal wall motion.

Topics: Contrast Media; Coronary Disease; Heart Ventricles; Humans; Myocardial Contraction; Radionuclide Imaging; Regression Analysis; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Technetium; Tomography, X-Ray Computed

Twenty patients with ischemic heart disease were studied with biplane contrast left ventriculography and gated bloob pool scans. An ejection fraction (EF) image was calculated from each gated blood pool scan. The EF image and contrast ventriculograms were divided into three regions and seven segments respectively. The sites of asynergy observed in each study were compared. Segments two, three and six of the contrast ventriculogram corresponded to the anteroseptal and inferoapical regions of the EF image, but it was difficult to differentiate between these segments on the EF image. Segments three and four corresponded to the inferoapical region and segments five and seven corresponded to the posterolateral region. Diffuse asynergy with a low EF (less than 30%) causes a large defect on the EF image. The mean regional EF obtained from the EF image correlated well with the EF calculated from the left ventricular volume curve (n = 50, r = 0.94).

Topics: Angiocardiography; Coronary Disease; Electrocardiography; Heart Ventricles; Humans; Models, Biological; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Cardiac Output; Coronary Disease; Diastole; Electrocardiography; Heart; Heart Aneurysm; Heart Function Tests; Heart Ventricles; Humans; Lung; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

In 40 patients with chronic ischaemic heart disease [IHD) and 10 healthy subjects the total and local myocardial contractility was assessed during threshold-level exercise. The patients were subjected to radionuclide ventriculography in a modification recording the first passage of the radioindicator through the heart cavities. In the control subjects the exercise induced a 27% increase in the total ejection fraction, with increased contractility of all left ventricular segments. In the patients with IHD the reactions to exercise varied. In 40% of the patients the total ejection fraction increased adequately, in 17.5% the increase was nonadequate, in 20% no increase was observed, and in 22.5% the ejection fraction decreased. The most marked reduction in myocardial contractility was found in patients who had sustained myocardial infarction and reacted positively to the exercise test. In 34 patients there were observed left ventricular segments showing a paradoxical response of contractility to exercise--a decrease in the local ejection fraction. This pathological local reaction occurred rather in a normal function at rest than in a myocardium with hypokinetic segments at rest.

Topics: Adult; Cardiac Output; Coronary Disease; Heart Ventricles; Humans; Middle Aged; Myocardial Contraction; Myocardial Infarction; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium