sodium-pertechnetate-tc-99m and Heart-Failure

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

In recent years, there has been increased recognition of the relative importance of abnormalities of diastolic function in patients with essential hypertension. Indeed, diastolic dysfunction may be the earliest indicator of hypertensive heart disease. In this article, the mechanisms governing normal ventricular relaxation and the factors that may cause diastolic dysfunction are reviewed. Noninvasive clinical methods, particularly Doppler echocardiography and radionuclide angiography, for determination of diastolic function are outlined, and the limited experience in the management of hypertensive patients with abnormalities of diastolic function is discussed. When congestive heart failure develops in a patient with hypertension, it is especially important to determine whether it is due primarily to systolic or to diastolic left ventricular dysfunction.

Topics: Adrenergic beta-Antagonists; Blood Pressure; Calcium Channel Blockers; Diastole; Echocardiography; Heart Failure; Heart Rate; Heart Ventricles; Humans; Hypertension; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume

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

Adriamycin cardiotoxicity begins with the first dose of therapy. The insult may be subclinical initially, but with continued treatment can result in clinical congestive heart failure. Therefore, a study for the detection of early cardiotoxicity of adriamycin by left ventricular ejection fraction (LVEF) estimation using technetium (Tc)-99m multiple-gated acquisition (MUGA) scan and echocardiography (ECHO) was conducted.. LVEF was assessed in 42 patients with different cancers, advised to receive adriamycin (average received dose = 95.2 ± 6.82 mg/cycle, protocol dose = 65 ± 10 mg/m) in each of six cycles. The percentage of LVEF (%LVEF) was determined as a baseline after every successive cycle, simultaneously, by a Tc-99m MUGA scan (reference method) and ECHO.. A significant decline of 12.17 ± 5.01 and 9.26 ± 4.82 (P < 0.001) in %LVEF was noted at the end of adriamycin therapy, estimated by a Tc-99m MUGA scan and ECHO respectively. Thirteen of 42 (31%) and six of 42 (14%) patients developed protocol-defined cardiotoxicity, determined by a Tc-99m MUGA scan and ECHO, respectively. The incidence of cardiotoxicity was 2.4, 2.4, 4.8, 16, and 31.2% at the median cumulative adriamycin dose of 210, 380, 450 , 550 , and 615 mg/m, respectively.. Subclinical adriamycin cardiotoxicity was detectable from the third cycle and if not detected earlier continued therapy may progress to severe and irreversible cardiotoxicity. A decline of 5% or more of %LVEF instead of 10% should be considered as a significant marker of subclinical cardiotoxicity. A Tc-99m MUGA scan is more sensitive than ECHO for the estimation of subtle changes in %LVEF. Ideally, %LVEF must be determined at baseline and after every cycle, and if not possible then preferably from the third cycle onwards.

Topics: Adolescent; Adult; Antineoplastic Agents; Doxorubicin; Echocardiography; Female; Heart; Heart Failure; Humans; Male; Middle Aged; Radionuclide Ventriculography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Stroke Volume; Ventricular Function, Left

Left heart failure (LHF) is a common and frequently overlooked condition owing to insufficient diagnostic methods. This can potentially delay onset of treatment. Our clinical experience with ventilation/perfusion single photon emission computed tomography (V/P SPECT) indicates that perfusion shows an antigravitational distribution pattern in LHF. The aim of the study was to test the hypothesis that LHF diagnosis can be made on the basis of V/P SPECT, and to develop and perform a first evaluation of objective parameters for LHF diagnostics in terms of perfusion gradients.. This retrospective study included 247 consecutive patients with clinical suspicion of pulmonary embolism (PE), who were examined with V/P SPECT. Perfusion gradients were developed and quantified in dorso-ventral and cranio-caudal directions. Quantitative results were compared with visual interpretation of patients with normal and heart failure patterns. Patients with LHF pattern were retrospectively followed up by review of medical records to confirm or discard heart failure diagnosis at the time of V/P SPECT examination.. LHF pattern on V/P SPECT was identified in 36 patients (15%), normal ventilation/perfusion pattern was found in 67 patients (27%), and PE in 62 patients (25%). The follow-up confirmed heart failure diagnosis in 32 of the 36 cases with LHF pattern, leading to a positive predictive value of 88% for LHF diagnosis based on V/P SPECT. Dorso-ventral perfusion gradients discriminated normal from LHF patients.. In patients with suspected PE, LHF is common. Appropriate V/P SPECT pattern recognition, supported by objectively determined dorso-ventral perfusion gradients, allows the diagnosis of LHF. A positive perfusion gradient in the dorso-ventral direction should lead to consideration of heart failure as a possible explanation for the symptoms in these patients.

Topics: Female; Heart Failure; Humans; Male; Middle Aged; Pulmonary Embolism; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Pentetate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ventilation-Perfusion Ratio

The purpose of this study was to determine whether restrictive left ventricular (LV) filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure.. We recently demonstrated a diastolic ventricular interaction in approximately 50% of a series of patients with chronic heart failure, as evidenced by paradoxic increases in LV end-diastolic volume despite reductions in right ventricular end-diastolic volume during volume unloading achieved by lower body negative pressure (LBNP). We reasoned that such an interaction would impede LV filling in mid and late diastole, but would be minimal in early diastole, resulting in a restrictive LV filling pattern.. Transmitral flow was assessed using pulsed wave Doppler echocardiography in 30 patients with chronic heart failure and an LV ejection fraction < or = 35%. Peak early (E) and atrial (A) filling velocities and E wave deceleration time were measured. Left ventricular end-diastolic volume was measured using radionuclide ventriculography before and during -30-mm Hg LBNP.. Nine of the 11 patients with and 2 of the 16 patients without restrictive LV filling patterns (E/A > 2 or E/A 1 to 2 and E wave deceleration time < or = 140 ms) increased LV end-diastolic volume during LBNP (p = 0.001). The change in LV end-diastolic volume during LBNP was correlated with the baseline A wave velocity (r = -0.52, p = 0.005) and E/A ratio (r = 0.50, p = 0.01).. Restrictive LV filling patterns are associated with diastolic ventricular interaction in patients with chronic heart failure. Volume unloading in the setting of diastolic ventricular interaction allows for increased LV filling. Identifying patients with chronic heart failure and restrictive filling patterns may therefore indicate a group likely to benefit from additional vasodilator therapy.

Topics: Atrial Function, Left; Atrial Function, Right; Blood Flow Velocity; Blood Pressure; Cardiac Output; Cardiac Volume; Diastole; Echocardiography, Doppler, Pulsed; Female; Forecasting; Gated Blood-Pool Imaging; Heart Failure; Humans; Lower Body Negative Pressure; Male; Middle Aged; Mitral Valve; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Stroke Volume; Vasodilator Agents; Ventricular Dysfunction, Left; Ventricular Function, Right; Ventricular Pressure

Amlodipine improves exercise capacity in patients with chronic congestive heart failure (HF), but the mechanisms of this effect are unknown.. To test the hypothesis, in a canine model of acute, ischemic HF, that amlodipine increases vascular capacitance and reduces cardiac filling pressures.. Amlodipine was given to 13 anesthetized, splenectomized dogs (six controls and seven with HF). Aortic, left ventricular end-diastolic (LVEDP) and portal venous (Pportal) pressures, cardiac output, portal flow (ultrasonic probe) and intestinal blood volume (IBV, 99mTc blood-pool scintigraphy) were measured. Intestinal vascular conductance (= 1/resistance) and vascular capacitance (CAP) were measured before and 15 mins after repetitive 150 micrograms/kg dosages of amlodipine (maximum cumulative dosage, 1000 micrograms/kg). Pportal-IBV curves were obtained by impeding portal flow (pneumatic cuff), and change in CAP was defined by the change in IBV at Pportal = 7.5 mmHg. HF was induced by microsphere embolization of the left coronary artery.. CAP increased in the control group (+ 28%, P < 0.01) but decreased (-9%, P < 0.05) in the HF group. Left ventricular stroke work increased in the control group (P < 0.05), while it decreased (P < 0.05) in the HF group, suggesting a negative inotropic effect. In the control group, LVEDP increased after amlodipine was given (P < 0.05) but did not change significantly in the HF group.. In the acute experimental HF model, amlodipine failed to increase intestinal vascular CAP or decrease filling pressures, and may have had a negative inotropic effect. The experiment failed to demonstrate a beneficial hemodynamic effect of amlodipine in acute HF, and the mechanism of benefit of this agent in chronic HF remains unclear.

Topics: Acute Disease; Amlodipine; Analysis of Variance; Animals; Calcium Channel Blockers; Cardiovascular System; Disease Models, Animal; Dogs; Drug Evaluation, Preclinical; Heart Failure; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Time Factors; Vascular Capacitance; Vascular Resistance

The objective of our study was to evaluate impedance cardiography (IMP) as a noninvasive method to determine the left ventricular ejection fraction (LVEF). METHODS. A total of 24 patients, 8 men and 16 women, aged 45.0 +/- 12.9 years, participated in the study. They used cardiotoxic chemotherapeutic drugs or suffered from cardiac failure. LVEF was measured by means of IMP (LVEFimp) and radionuclide ventriculography (LVEFnuc). LVEFimp was calculated in three ways. Capan and colleagues [13] proposed a formula in which LVEF (LVEFCap) can be calculated from the systolic time intervals, namely, left ventricular ejection time and preejection time. Judy and colleagues [14] described a systolic (S) and a diastolic (D) part in the first derivative curve of the impedance signal. The ratio S/D might equal the LVEF (LVEFJud). A new LVEF calculation was introduced (LVEFimp) in this study based on the first derivative of the impedance signal, the thoracic impedance, and heart rate.. Mean LVEFCap was 59.9 +/- 8.4%, which did not differ from LVEFnuc (59.9 +/- 7.1%). However the correlation between both methods was not significant (r = 0.29). Mean LVEFJud was 63.9 +/- 17.4%, which was not significantly different from LVEFnuc, with a fair correlation (r = 0.55). Mean LVEFimp was 59.2 +/- 9.4%, with a better correlation with radionuclide ventriculography (r = 0.75).. The results of this study indicate that the equations that have been used until now can be improved. The new equation provides reliable LVEF values in this group of patients.

Topics: Antibiotics, Antineoplastic; Cardiography, Impedance; Diastole; Doxorubicin; Electrocardiography; Female; Heart; Heart Failure; Heart Rate; Humans; Linear Models; Male; Middle Aged; Radionuclide Ventriculography; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Stroke Volume; Systole; Tin Polyphosphates; Ventricular Function, Left

The aim of this study was to compare three automatic programs (P1, P2, P3) for evaluating radionuclide left ventricular ejection fraction (LVEF) and to emphasize the clinical consequences. Gated radionuclide ventriculography was performed in 73 subjects, 15 of whom were healthy and 58 of whom had experienced heart failure. All scintigraphic data were processed with the three programs. Good inter-observer, intra-observer and automatic-manual reproducibility were observed using each of the three programs. On the other hand, in the normal subjects, the three mean normal LVEF values were significantly different from each other (P1 = 77 +/- 5%, P2 = 63 +/- 7%, P3 = 68 +/- 8%; P < 0.0001) In the pathological patients, the values obtained with P2 were significantly different from those obtained using P1 and P3 (P1= 32 +/- 15%, P2 = 26 +/- 13%; P < 0.0001), Moreover, the linear regression studies between the three automatic programs were always significantly different from the identity line equation (y = x). This study shows that LVEF criteria for normality depend on the program used, and inter-program measurement of LVEF is poorly reproducible. Caution is recommended when comparing data obtained from different centres (or different computers), either in the follow-up of a given patient or in gathering results from patient groups.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Automation; Cardiomyopathies; Case-Control Studies; Heart Failure; Humans; Middle Aged; Myocardial Ischemia; Observer Variation; Regression Analysis; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Stroke Volume; Tomography, Emission-Computed; Ventricular Function, Left

This study was undertaken to determine which exercise and radionuclide ventriculographic variables predict prognosis in advanced heart failure.. Although cardiopulmonary exercise testing is frequently used to predict prognosis in patients with advanced heart failure, little is known about the prognostic significance of ventriculographic variables.. The results of maximal symptom-limited cardiopulmonary exercise testing and first-pass radionuclide ventriculography in patients with advanced heart failure referred for evaluation for cardiac transplantation were analyzed.. Sixty-seven patients with advanced heart failure (mean [+/- SD]; age 51 +/- 10 years, New York Heart Association functional classes III (58%) and IV (18%); mean left ventricular ejection fraction 0.22 +/- 0.07) underwent simultaneous upright bicycle ergometric cardiopulmonary exercise testing and first-pass rest/exercise radionuclide ventriculography. Mean peak oxygen consumption (VO2) was 11.8 +/- 4.2 ml/kg per min, and mean peak age- and gender-adjusted percent predicted oxygen consumption (%VO2) was 38 +/- 11.9%. Univariate predictors of overall survival included right ventricular ejection fraction > or = 0.35 at rest and > or = 0.35 at exercise and %VO2 > or = 45% (all p < 0.05). In a multivariate proportional hazards survival model, right ventricular ejection fraction > or = 0.35 at exercise (p < 0.01) and %VO2 > or = 45% (p = 0.01) were selected as independent predictors of overall survival. Univariate predictors of event-free survival included right ventricular ejection fraction > or = 0.35 at rest (p = 0.01) and > or = 0.35 at exercise (p < 0.01), functional class II (p < 0.05) and %VO2 > or = 45% (p = 0.05). Right ventricular ejection fraction > or = 0.35 at exercise (p = 0.01) was the only independent predictor of event-free survival in a multivariate proportional hazards model. Cardiac index at rest, VO2, left ventricular ejection fraction at rest, and exercise-related increase or decrease > 0.05 in left or right ventricular ejection fraction were not predictive of overall or event-free survival in any univariate or multivariate analysis.. 1) Right ventricular ejection fraction > or = 0.35 at rest and exercise is a more potent predictor of survival in advanced heart failure than VO2 or %VO2; 2) %VO2 rather than VO2 predicts survival in advanced heart failure; 3) neither %VO2 nor VO2 predicts survival to the combined end point of death or admission for inotropic or mechanical support in patients with advanced heart failure.

Topics: Disease-Free Survival; Exercise Test; Exercise Tolerance; Female; Follow-Up Studies; Heart Failure; Heart Transplantation; Humans; Life Tables; Male; Middle Aged; Oxygen Consumption; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Sodium Pertechnetate Tc 99m; Stroke Volume; Treatment Outcome; Ventricular Function, Right; Ventriculography, First-Pass

To evaluate the necessity of an objective cardiopulmonary exercise test in the selection procedure of patients for heart failure studies, 50 patients with congestive heart failure New York Heart Association (NYHA) class II and III and a left ventricular ejection fraction less than 40% were subjected to a cardiopulmonary exercise test. The results of the exercise test were compared with the independent clinical estimation of NYHA class and data of measurements obtained at rest. The NYHA classification separated the patients with a mild to moderate impairment of aerobic capacity from patients with a moderate to severe impairment of aerobic capacity very well, but 32% of the NYHA class II patients had a near normal aerobic capacity, and 29% of the NYHA class III patients had a very severe impairment of aerobic capacity, more compatible with NYHA class IV. Only data from exercise measurements showed differences between groups. The determination of maximal aerobic capacity for an objective assessment of patients' performance at exercise is necessary for a proper selection procedure of patients for heart failure studies.

Topics: Adult; Aged; Clinical Trials as Topic; Evaluation Studies as Topic; Exercise Test; Female; Heart Failure; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The relative contribution of inotropic and vasodilator effect to amrinone-induced hemodynamic improvement in congestive heart failure (CHF) is unknown. In 9 patients with CHF, the effects of amrinone and nitroprusside on hemodynamic and radionuclide measurements were compared to determine whether reduced afterload accounts for the amrinone-induced decrease in left ventricular end-systolic volume. In each patient, the end-systolic pressure-volume relation was derived using nitroprusside. After terminating nitroprusside treatment, intravenous amrinone (3 mg/kg) caused end-systolic volume to decrease from 148 +/- 32 ml/m2 (mean +/- standard deviation) to 133 +/- 32 ml/m2 (p less than 0.05), causing an increase in cardiac index from 1.9 +/- 0.8 to 2.7 +/- 0.8 liters/min/m2 (p less than 0.001). Arterial end-systolic pressure decreased in all patients during amrinone administration, from 96 +/- 22 to 84 +/- 19 mm Hg (p less than 0.005), as did systemic vascular resistance. Nitroprusside doses needed to match the decrease in LV end-systolic volume induced by amrinone caused significantly greater decreases in arterial end-systolic pressure than did amrinone (p less than 0.01). The amrinone-induced decrease in end-systolic volume exceeded that predicted for a pure vasodilator based on arterial end-systolic pressure and the nitroprusside-derived pressure-volume relation in 6 patients. In 3 patients, the decrease in end-systolic volume did not exceed that expected for a pure vasodilator. In conclusion, after amrinone treatment, afterload reduction occurs in all patients with severe CHF and is the sole effect in some.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aminopyridines; Amrinone; Cardiac Output; Cardiotonic Agents; Female; Heart; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Myocardial Contraction; Nitroprusside; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Vascular Resistance; Vasodilation

This is an account of 2 groups of 10 patients each who received Starr Edwards ball valves in either the mitral (M) or aortic (A) position on average 14.7 +/- 3 or 14.9 +/- 2.4 years ago, respectively. Non-invasive scintigraphic studies were performed using the first pass of 18 to 20 mCi 99 m-Technetium Pertechnetate. Enddiastolic and endsystolic volumes were found elevated at rest: (M) EDV 135 +/- 50 ml, ESV 63 +/- 30 ml; (A) EDV 163 +/- 41 ml, ESV 69 +/- 25 ml. The response to maximum exercise--during which the heart rate increased from 85 +/- 23 min-1 to 133 +/- 33 min-1--was abnormal, since none of the volumes changed significantly. During exercise, therefore, the increase of the cardiac output was totally heart rate dependent: (M) 6.1 +/- 2.3 to 9.3 +/- 2.3 l/min; (A) 7.0 +/- 1.9 to 10.9 +/- 3.1 l/min. The dynamics of the rapid diastolic filling rate of the left ventricle (RFR) and the mean pulmonary transit time (MTT) served as functional parameters of the Starr Edwards ball valves in the mitral position. The rapid filling rate increased from 205 +/- 98 to 321 +/- 58 ml/sec, whereas MTT decreased from 7.4 +/- 1.4 to 5.4 +/- 2.1 sec. In patients with aortic valve replacement the left ventricular ejection rate was assessed, it rose from 233 +/- 80 to 459 +/- 232 ml/sec. The significant changes of the parameters proved that the Starr Edwards ball valve mechanism functions satisfactorily 11 to 19 years post-operatively.

Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Cardiac Output; Exercise Test; Follow-Up Studies; Heart Failure; Heart Valve Prosthesis; Hemodynamics; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

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

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

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

We studied 33 patients (28 males, 5 females) with first inferior acute myocardial infarction (AMI) and 12 normal volunteers. They underwent first-pass (FP) and equilibrium-gated radionuclide angiography (EGRA) within 4 days of the onset of symptoms. The parameters [ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR)] of the time-activity curve (TAC) of both ventricles [left ventricle (LV), right ventricle (RV)] were computed. The regional wall motion (RWM) was evaluated by parametric images (amplitude and phase). In 43% of the patients with AMI, we found a depressed RVEF, while the LVEF was decreased in only 33%. The sensitivity of diastolic parameters was shown to be clearly superior to that of the systolic parameters (RVPFR, 78%; LVPFR, 79%). The abnormalities of the overall performance of both ventricles were significantly correlated with those of the RWM. The abnormal RVEF allowed us to assess the necrotic involvement of the RV, while a depressed RVPFR suggested an impaired RV compliance mostly on an ischemic basis. Congestive heart failure (CHF) and shock syndrome were significantly correlated with depressed RV parameters, while the LVEF, despite RWM abnormalities, was in the normal range. EGRA with computation of the TAC parameters of both ventricles appeared to be useful for in-hospital prognostic evaluation, therapeutic planning and clinical follow-up of patients with inferior myocardial infarction.

Topics: Adult; Aged; Cardiac Output; Female; Follow-Up Studies; Heart; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Topics: Diagnosis, Differential; Gallium Radioisotopes; Heart Failure; Humans; Male; Middle Aged; Radionuclide Imaging; Retroperitoneal Fibrosis; Sodium Pertechnetate Tc 99m; Vena Cava, Inferior

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

The effect of a standardized meal on left ventricular (LV) ejection fraction (EF) was determined by equilibrium radionuclide angiography in 16 patients with stable congestive heart failure but without pulmonary or valvular heart disease. LVEF was determined in the fasting state and 15, 30, and 45 minutes after a meal. Patients with moderately depressed fasting LVEF (30 to 50%), Group I, had a mean increase of 6.9 +/- 2.9% (p less than 0.005) in the LVEF at 45 minutes after the meal. Patients with severely depressed fasting LVEF (less than 30%), Group II, had no change after the meal. It is concluded that significant increases in LVEF may occur after meals in patients with moderate but not severe left ventricular dysfunction. Equilibrium radionuclide angiography studies that are not standardized for patients' mealtimes may introduce an important unmeasured variable that will affect the validity of data in serial studies of left ventricular function.

Topics: Adult; Aged; Cardiac Output; Fasting; Female; Food; Heart Failure; Heart Ventricles; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Time Factors

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

After in-vivo labeling of red blood cells with 99mTcO4, the radioactivity of different parts of the body is proportional to the regional blood volume. This technique allows the simultaneous registration of drug-induced changes of the local blood volume. We examined the influence of nitroglycerin on the blood volume distribution in patients with coronary artery disease (n = 10) and chronic heart failure (n = 8). Compared with the controls (n = 8) we observed in the nitroglycerin-groups a significant decrease of blood volume over the heart and the liver, whereas there was an increase of the blood volume over the extremities. It is pointed out that functional whole-body scanning is a useful radiological technique for the non-invasive study of pharmacologically caused changes of the local blood volume in man.

Topics: Adult; Aged; Angina Pectoris; Blood Volume; Blood Volume Determination; Erythrocytes; Heart Failure; Humans; Middle Aged; Nitroglycerin; Sodium Pertechnetate Tc 99m; Technetium

Simultaneous hemodynamic and radionuclide angiographic assessment was made at rest and during exercise in nine patients with severe chronic congestive heart failure to determine the value of radionuclide left ventricular ejection fraction measurement in predicting the hemodynamic response to short-term treatment with oral hydralazine. Hydralazine, 50 to 100 mg orally every 6 hours, produced significant increases in cardiac index and stroke volume index at rest and during exercise (p less than 0.01) and in left ventricular stroke work index at rest (p less than 0.01) and during exercise (p less than 0.05), significant decreases in systemic vascular resistance at rest and during exercise (p less than 0.01) and significant increases in radionuclide angiographic left ventricular ejection fraction at rest (control 0.21 +/- 0.06 vs. hydralazine 0.26 +/- 0.07, p less than 0.01) and during exercise (control 0.21 +/- 0.08 vs. hydralazine 0.24 +/- 0.09, p less than 0.05). However, there were no statistically significant correlations between changes in radionuclide ejection fraction with hydralazine and changes in hemodynamic variables with hydralazine, either at rest or during exercise. Patients responding hemodynamically to hydralazine could not be separated from those not responding on the basis of the radionuclide ejection fraction at rest or changes in ejection fraction with hydralazine.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Cardiac Catheterization; Cardiac Output; Chronic Disease; Drug Evaluation; Female; Heart Failure; Heart Ventricles; Hemodynamics; Humans; Hydralazine; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Rest; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium

Topics: Aged; Blood Pressure; Cardiac Output; Electrocardiography; Erythrocytes; Heart; Heart Failure; Humans; Isosorbide Dinitrate; Male; Middle Aged; Physical Exertion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium; Vascular Resistance

Although the resting hemodynamic effects of captopril in congestive heart failure are known, little information is available about the hemodynamic response to captopril during exercise or about changes in noninvasive measurements of the size and function of both ventricles. In this study, 14 stable New York Heart Association class III patients were given 25 mg or oral captopril. Rest and exercise hemodynamic measurements and blood pool scintigrams were performed simultaneously before and 90 minutes after captopril. The radionuclide studies were analyzed for left and right ventricular end-diastolic volumes, end-systolic volumes, ejection fractions and pulmonary blood volume. The primary beneficial responses at rest were decreases in left and right ventricular end-diastolic volumes from 388 +/- 81 to 350 +/- 77 ml (p less than 0.01) and from 52 +/- 26 to 43 +/- 20 volume units (p less than 0.01), respectively, and in their corresponding filling pressures, from 24 +/- 10 to 17 +/- 9 mm Hg and 10 +/- 5 to 6 +/- 5 mm Hg (both p less than 0.001). Although stroke volume did not increase significantly, both left and right ventricular ejection fractions increased slightly, from 19 +/- 6% to 22 +/- 5% and from 25 +/- 9% to 29 +/- 11%, respectively (both p less than 0.01). During exercise, similar changes were noted in both hemodynamic and radionuclide indexes. Thus, in patients with moderate symptomatic limitation from chronic heart failure, captopril predominantly reduces ventricular volume and filling pressure, with a less significant effect on cardiac output. These effects persist during exercise, when systemic vascular resistance is already very low. Radionuclide techniques are valuable in assessing the drug effect in these subjects, particularly when ventricular volumes are also measured.

Topics: Aged; Blood Pressure; Captopril; Cardiac Output; Erythrocytes; Heart; Heart Failure; Heart Rate; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Contraction; Physical Exertion; Proline; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Vascular Resistance

Topics: Heart; Heart Failure; Humans; Neoplasms; Pericardial Effusion; Pericarditis, Tuberculous; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium

Although noninvasive techniques are often used to assess the effect of vasodilator therapy in patients with congestive heart failure, it is unknown whether changes in noninvasively determined left ventricular ejection fraction, volume, or dimension reliably reflect alterations in intracardiac pressure and flow. Accordingly, we compared the acute effect of sodium nitroprusside on left ventricular volume and ejection fraction (determined scintigraphically) with its effect on intracardiac pressure and forward cardiac index (determined by thermodilution) in 12 patients with severe, chronic congestive heart failure and a markedly dilated left ventricle. Nitroprusside (infused at 1.3 +/- 1.1 [mean +/- standard deviation] microgram/kg/min) caused a decrease in mean systemic arterial, mean pulmonary arterial, and mean pulmonary capillary wedge pressure as well as a concomitant increase in forward cardiac index. Simultaneously, left ventricular end-diastolic and end-systolic volume indexes decreased, but the scintigraphically determined cardiac index did not change significantly. Left ventricular ejection fraction averaged 0.19 +/- 0.05 before nitroprusside administration and increased by less than 0.05 units in response to nitroprusside in 11 of 12 patients. The only significant correlation between scintigraphically and invasively determined variables was that between the percent change in end-diastolic volume index and the percent change in pulmonary capillary wedge pressure (r = 0.68, p = 0.01). Although nitroprusside produced changes in scintigraphically determined left ventricular ejection fraction, end-systolic volume index, and cardiac index, these alterations bore no predictable relation to changes in intracardiac pressure, forward cardiac index, or vascular resistance. Furthermore, nitroprusside produced a considerably greater percent change in the invasively measured variables than in the scintigraphically determined ones.

Topics: Blood Pressure; Cardiac Catheterization; Cardiac Output; Cardiac Volume; Erythrocytes; Female; Ferricyanides; Heart; Heart Failure; Humans; Male; Middle Aged; Nitroprusside; Pulmonary Wedge Pressure; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stroke Volume; Technetium