BACKGROUNDRegional ejection fraction (EF(R)) measured by real-time three-dimensional echocardiography (RT-3DE) provides a novel method for quantifying left-ventricular (LV) regional systolic function. We aimed to explore the diagnostic value of regional ejection fraction (EFR) derived from RT-3DE in detecting LV aneurysms in patients with myocardial infarction.

METHODSThirty-eight patients with myocardial infarction were prospectively enrolled and underwent electrocardiography (ECG), two-dimensional echocardiography (2-DE), RT-3DE and left ventriculography (LVG). Subjects with a negative EFR in at least one segment on RT-3DE were considered as having a ventricular aneurysm. We compared the sensitivity, specificity, Youden's index, and positive and negative predictive values of ECG, 2-DE and RT-3DE in determining LV aneurysm with detection by LVG.

RESULTSOn LVG an LV aneurysm was diagnosed in 16 (42.1%) patients. The sensitivity and specificity were 62.5% and 86.4% for ECG, 81.2% and 95.4% for 2-DE, and 100.0% and 90.9% for RT-3DE in diagnosing LV aneurysm. Youden's indexes for ECG, 2-DE and RT-3DE were 0.49, 0.77 and 0.91, respectively. Positive and negative predictive values were 76.9% and 76.0% for ECG, 92.9% and 87.5% for 2-DE, and 88.9% and 100.0% for RT-3DE.

CONCLUSIONSRT-3DE-derived EFR provides a novel, reliable index in the diagnosis of LV aneurysm and has excellent sensitivity and specificity.

Adult ; Aged ; Coronary Angiography ; methods ; Echocardiography, Three-Dimensional ; methods ; Female ; Heart Aneurysm ; diagnosis ; Humans ; Male ; Middle Aged ; Prospective Studies ; Radionuclide Ventriculography ; methods ; Stroke Volume ; physiology

OBJECTIVEThe aim of this study was to assess the accuracy of adenosine (99m)Tc-MIBI myocardial perfusion SPECT for the diagnosis of coronary artery disease.

METHODSA total of 89 patients [mean age (57 +/- 9) years,62 men, 27 women] were included in this study. Adenosine was infused intravenously at a rate of 140 microg.kg(-1).min(-1) for 6 minutes. At the end of 3 minute of adenosine infusion, 925MBq of (99m)Tc-MIBI was injected intravenously. SPECT myocardial imaging acquisition was obtained 1 hour after adenosine infusion. Coronary angiography was performed in all patients.

RESULTSThirty-one patients had significant coronary artery stenosis and 58 had normal coronary angiography. Adenosine myocardial perfusion imaging was abnormal in twenty-two out of the 31 patients with significant coronary artery stenosis (sensitivity, 71%). Fifty-three out of the 58 patients with normal angiography had a normal adenosine myocardial perfusion imaging (specificity, 91%). The positive predictive value and negative predictive value of adenosine (99m)Tc-MIBI myocardial perfusion imaging for detection of coronary artery disease was 81% and 84% respectively.

CONCLUSIONAdenosine myocardial perfusion imaging is probably an accurate method for detecting coronary artery disease.

Adenosine ; Adult ; Aged ; Coronary Artery Disease ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Radionuclide Ventriculography ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon ; Young Adult

38 participants of study were divided into two groups. There were 28 subjects (25 males, 3 females) in case group, who had former myocardial infarction (MI) and history of MI. The mean age of case group was 62.5+/-7.4 years. 10 healthy subjects were involved in the control group. It was found that radionuclide ventriculography is a reliable explorative method for evaluation of left ventricular function in the patients with former MI. Sensitivity, specificity and parameters of EFx% (40.3+/-14.0), PER (2.3+/-0.7), 1/3ER (1.9+/-0.8) all decreased significantly in comparison with those of the control group. Left ventricular dysfunction on ventriculography related to site of MI and clinical level of heart failure. In the patient with former MI, there was relative closed correlation between EFx%, 1/3ER and grade of heart failure and PER had modest negative correlation with grade of heart failure
Myocardial Infarction ; Radionuclide Ventriculography

35 cases of OMI (with an average of 12 months after acute MI) and 44 control subjects were studied by echo- and radionucleidoventriculography. Results shown a larger dilatation of the left ventricle of OMI patients in comparing with the controls. 81.1% of OMI patients had heart wall movement disorders and their location identified by echo was consistent with the MI location diagnosed by ECG. There is a positive proportional relation between WMSI and the severity of heart failure.
Myocardial Infarction ; Radionuclide Ventriculography

The study was conducted on 25 healthy subjects (15 males, 10 females) with age ranged from 15 - 60 years. None have heart disease that identified by physical examination, cardiogram and echocardiography. Method of R.A with SPECT and S.A.G.E - Cardiac software was used. Main measurements were emptying parameters, filling parameters and wall motion. Findings suggested that indices of EF, PFR and TPF were similar to that of other oversea studies. Indices of TES, PER, TPE, 1/3EF, 1/3ER, MFR, 1/3FF, 1/3FR were showed but could not compare with other authors because of data limitation in literature. Indices of REF and RRS of wall motion were lower than that of other studies.
Ventricular Function ; Radionuclide Ventriculography

This study was performed on 41 subjects including 10 control subjects aged 57.8+/-6.5 and 31 patients aged 62.5+/-7.4 with old myocardial infarction (OMI), using radionuclide ventriculography (RVG). In conclusion, RVG is a useful method to assess left ventricular systolic function in patients with OMI. Some parameters such as sensitivity, specificity, areas under ROC curve: EF% (93.55; 60.00; 0.912), PER (93.55; 70.00; 0.903) and 1/3ER (93.60; 80.00; 0.929) respectively are higher than those of RVG are. EF% (42.014.9), PER (2.30.7), 1/3ER (1.90.8) in patients with OMI decreased in comparing with the controls. There was a correlation between the classes of clinical heart failure and EF%, PER, 1/3ER respectively (r=-0.52; r=-0.56; r=0.38; p<0.05) in patients with OMI
Myocardial Infarction ; Radionuclide Ventriculography

Echocardiographic automatic boundary detection (ABD) is a new on-line technique which automatically outlines the left ventricular endocardial border and instantly calculates the left ventricular area and volume from two dimensional echocardiographic images. To determine if left ventricular ejection fraction (LVEF) can be derived using the ABD method, 25 consecutive patients with dilated cardiomyopathy, aged 52.1 +/- 15.2 (range 14 approximately 75), underwent complete echocardiographic examination with both the ABD method and radionuclide ventriculography (RVG). End-diastolic and end-systolic left ventricular areas were obtained on-line from the apical four chamber view. Left ventricular length was also measured from an apical view. Left ventricular volumes and ejection fraction were calculated using the single plane area-length method. ABD measurements could be obtained in all patients. Linear regression analysis compared ejection fraction derived by ABD and RVG. The mean radionuclide LVEF was 20.9 +/- 6.8% and mean ABD-derived LVEF was 22.7 +/- 5.8%. Linear regression analysis revealed that the ABD-derived LVEF is closely correlated with the RVG-derived LVEF (r = 0.87, p<0.001). In conclusion, ABD echocardiography is a new on-line technique which may be used to accurately calculate LVEF in patients with dilated cardiomyopathy.
Adolescent ; Adult ; Aged ; Cardiac Output ; Cardiomyopathy, Congestive/*diagnosis/*physiopathology ; *Computer Systems ; *Echocardiography ; Evaluation Studies ; Female ; Human ; Male ; Middle Age ; *Radionuclide Ventriculography ; *Stroke Volume ; Support, Non-U.S. Gov't ; *Ventricular Function, Left

BACKGROUND: This clinical trial was performed to evaluate the hemodynamic and side effects of enoximone, a newly developed phosphodiesterase inhibitor, in moderately severe congestive heart failure in Korean population and to base the development of long acting oral preparations in the future. METHODS: Principal admission criteria for this trial were a left ventricular ejection fraction of less than 45% by radionuclide ventriculography, NYHA functional class II or III and a documented congestive cardiomyopathy. Exclusion criteria were restrictive cardiomyopathy, valvular heart disease, multisystemic lillness and uncontrolled ventricular tachyarrhythmia. The hemodynamic measurements were made by using the thermodilution Swan-Ganz catheter and radial arterial canulation. Enoximone was administered(continuous infusion) for 24 hours after initial bolus. The hemodynamic parameters to be observed were blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance. The clinical reponse, hematology, blood chemistry, and Holter monitoring were checked before and after enoximone trial. RESULTS: The following results are obtained. 1) The included patients were 15 females, 24 males, total 39 patients and mean age of 55.3 years old(28-70 years old). 2) The causes of congestive cardiomyopathy were idiopathic 35(89.9%), hypertensive 3(7.7%), and alcoholic 1(2.6%). 3) The mean ejection fraction measured by radionuclide left ventriculography were 28. 6%. 4) THe cardiac output was significantly increased(50%), and pulmonary capillary wedge pressure(38%), systemic vascular resistance(34%), pulmonary vascular resistance(27%) were significantly decreased during enoximone infusion. 5) NYHA Functional Class was improved by 1 step with enoximone. 6) There were no significant changes in hematology, blood chemistry, and Holter monitoring with enoximone. CONCLUSION: From the above results, the short term intravenous enoximone was very effective in moderately severe congestive heart failure in congestive cardiomyopathy without major adverse effects in Korean.
Alcoholics ; Blood Pressure ; Capillaries ; Cardiac Output ; Cardiomyopathy, Dilated ; Cardiomyopathy, Restrictive ; Catheters ; Chemistry ; Electrocardiography, Ambulatory ; Enoximone* ; Estrogens, Conjugated (USP)* ; Female ; Heart Failure* ; Heart Rate ; Heart Valve Diseases ; Hematology ; Hemodynamics* ; Humans ; Male ; Pulmonary Wedge Pressure ; Radionuclide Ventriculography ; Stroke Volume ; Tachycardia ; Thermodilution ; Vascular Resistance

BACKGROUND: Recently, the incidence of acute myocardial infarction increased with prolongation of life spans, improvements in food and life styles in Korea, But only few studies were reported after the newly developed diagnostic methods and treatment modalities were introduced. So, the study on left ventricular ejection fraction, findings in coronary angiography, uses of thrombolytic agents was needed. METHOD: A retrospective clinical study was done on 654 patients with acute myocardial infarction who had been admitted to Severance hospital from January 1985 to December 1991 within 30 days after the onset of symptoms. Coronary angiogram and radionuclide ventriculography was done as usual methods. RESULT: The mean age was 58.5 years, and the ratio of males to females was 3.3:1, The major risk factors were smoking, hypertension and diabetes mellitus in males. and hypertension, diabetes mellitus and obesity in females. Arrhythmias were found in 360 patients(56.4%). The most frequent arrhythmia was premature ventricular contraction. Sinus bradycardia and atrioventricular were more frequent in inferior infarction but sinus tachycardia, ventricular tachycardia were more frequent in anterior infarction. The peak serum CK and CK-MB levels were higher in patients of anterior infarction than in those of inferior and non-Q wave infarction. The left ventricalar ejection fractions were higher in the patients with non-Q wave infarction, inferior infarction than in the patients with anterior infarction. There was no difference in left ventricular ejection fraction between patients who received thrombolytic therapy and not treated patients. Coronary angiograms were performed in 362 patients and 184 patients (50.8%) had one-vessel disease. The short-term mortality rate was 15.1%. The most common cause of death was cardiogenic shock(60.6%). Poor prognosis was found in patients with a history of previous myocardial infarction, those over 60 years old, those with a complete heart block and those of the female sex. The short-term mortality was higher in anterior infarction than inferior infarction and short-term mortality was higher in Q wave infarction than non-Q wave infarction. CONCLUSION: This study suggests that smoking was the most common risk factor but hypercholesterolemia and obesity were less significant. According to coronary angiogram, one-vessel disease was the most common, and the rate of insignificant reduction in luminal diameter was higher than western countries. The short-term mortality rate of acute myocardial infarction was higher than those of western countries. The cause of high mortality rate was considered due to delay in transportation of patients to hospital. The education about acute myocardial infarction should be done to public and transportation system must be improved.
Adult* ; Arrhythmias, Cardiac ; Bradycardia ; Cause of Death ; Coronary Angiography ; Diabetes Mellitus ; Education ; Female ; Fibrinolytic Agents ; Heart Block ; Humans ; Hypercholesterolemia ; Hypertension ; Incidence ; Infarction ; Korea ; Life Style ; Life Support Care ; Male ; Middle Aged ; Mortality ; Myocardial Infarction* ; Obesity ; Phenobarbital ; Prognosis ; Radionuclide Ventriculography ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke Volume ; Tachycardia, Sinus ; Tachycardia, Ventricular ; Thrombolytic Therapy ; Transportation ; Transportation of Patients ; Ventricular Premature Complexes

BACKGROUND: In patients with myocardial infarction, one needs to know the location, extent and severity of wall motion abnormalities to assess prognosis and guide therapy. Thus more precise quantatative estimates of regional ventricular function are required. Regional wall motion has generally been assessed by displaying the multiple cardiac images of RVG as endless-loop movie, but the cinematic display was not objective. We used the usefulness of the phase analysis in evaluating the global left ventricular function and regional wall motion abnormalities of patients with myocardial infarction. The accuracy of the RVG cinematic display in detecting regional wall motion abnormalities in patients with myocardial infarction was also evaluated. METHODS: Studied cases were 97 patients with myocardial infarction and 20 normals with low likelihood of coronary artery disease. Coronary angiography and contrast left ventriculography were performed in all patients with myocardial infarction. The regional wall myocardial infarction(presence) is defined when the EKG presented the evidence of myocardial infarction, left ventriculogram showed RWMA(regional wall motion abnormality) along with stenosis of 50% or greater of the regional supplying coronary artery. Each patient was imaged in 45 left anterior oblique(LAO) view, anterior(Ant) view and left lateral(Lt Lat) view. We evaluated Left ventricular ejection fraction(LVEF) from time-activity curve. We constructed the histogram for the left ventricle and both ventricle separately to obtain the global and total phase angle(GPA, TPA), standard deviation of phase angle(GSDPh, TSDPh), full width half maximum(GFWHM, TFWHM). The left ventricle was divided into 7 segments. LAO projection ; septal, apical, basal lateral, apical lateral, Ant projection ; anterolateral, Lt Lat projection ; inferior, posterior, Phase angle(RPA) and full width half maximum(RFWHM) from the histogram (regional 7 segments) were examined. On the RVG cinematic display, the standard 4 grading system was used, normal, hypokinesia, akinesia, dyskinesia. The observer evaluated regional wall motion abnormality of the 7 segments for all cases. The sensitivity of the above parameters and RVG cinematic display was evaluated. We analyzed the regional parameters among the patents with regional wall myocardial infarction(presence), those without regional wall myocardial infarction(absence) and control group using the t-test. The statistical analysis was done by one way ANOVA between regional phase analysis and RVG cinematic display. RESULTS: The sensitivity of LVEF was lowest(70.1%) and the GFWHM was highest among the global parameters(89.1%). But RFWHM showed even higher sensitivity(96.9%), thus regional phase analysis was also required. The RVG cinematic display was also sensitive(92.7%), but less sensitive than the RFWHM. On regional phase analysis the RPA of septal, apical, inferior, posterior walls of the left ventricle was able to separate presence group from absence group and also presence group from control group and the RPA of the apical lateral wall could separate presence group from absence group. The RPA of basal lateral and anterolateral wall was inaccurate in diagnosing the regional wall myocardial infarction, because basal lateral wall was overlapped by adjacent vascular structures, and the area of anterolateral wall dose not correlate completely beteen the RVG & the left ventriculogram, also the anterolateral wall can be supplied by the obtuse marginal branch of left circumflex artery. The RFWHM of all regional walls of left ventricle could separate presence group from absence group and presence group from control group. We found good correlation between regional phase analysis & left ventriculogram for detection of regional wall myocardial infartion. On RVG cinematic display, the RPA of the normal group was different from that of dyskinesia, akinesia and hypokinesia groups. The RPA of the dyskinesia group was also different from that of skinesia and hypokinesia groups by oneway ANOVA(p<0.05). The RFWHM of the dskinesia group was different from that of the normal group and hypokinesia group. RVG cinematic display correlated well with regional phase analysis and also quantitation of wall motion. CONCLUSIONS: Thus RVG cinematic display was useful and can not be replaced by phase analysis. But the regional phase analysis was sensitive and objective in diagnosing the wall motion abnormality in myocardial infarction.
Ants ; Arteries ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Dyskinesias ; Electrocardiography ; Heart Ventricles ; Humans ; Hypokinesia ; Myocardial Infarction* ; Prognosis ; Radionuclide Ventriculography ; Ventricular Function ; Ventricular Function, Left