- Email: [email protected]
Cardiac abnormalities in asymptomatic human immunodeficiency virus carriers: An echocardiographic and radionuclide angiographic follow-up
S 122
Abstracts Wednesday afternoon, April 9, 1997
Journal of Nuclear Cardiology January/February 1997, Part 2
100.49
100.51
SIGNIFICANCE OF RESTING LEFT ~ROGNOSTIC NTRICULAR EJECTION FRACTION IN BONE
CARDIAC ABNORMALITIES IN ASYMPTOMATIC HUMAN IMMUNODEFICIENCY VIRUS CARRIERS: AN ECHOCARDIOGRAPHIC AND RADIONUCLIDE ANGIOGRAPHIC FOLLOW-UP. C. Morillon, J. Sztajzel, M. JeanprStre, R. Lerch, O. Hubmann, A. Righetti. Cardiology Center, University Hospital, Geneva, Switzerland. We have previously shown that cardiac abnormalities, especialy right ventricular involvement, are frequent in asymptomatic patients (pts) human immunodeficiency virus (HIV) infected. 53 asymptomatic pts were initially studied by both RNA and echocardiography. At rest, 62 % of these pts had cardiac abnormalities including right ventricular impairment (43%), left ventricular abnormalities (4%), and dysfunction of both cavities (15%). Are these cardiac abnormalities transient or persistent? In order to answer this question, we investigate 36 pts. During the follow-up (FU) of 31+10 months, 9 died, 9 refused iterative investigations and 18 (15 males, mean age 38+6, 3 pts with AIDS) were reinvestigated. Of these 18 pts, 15 had fight ventricular impairment (dilatation and/or dysfunction), at the first RNA, persisting in 13 pts during FU. Moreover, diastolic left ventficular function is pathologic in 8 of these 13pts. Left ventricular ejection fraction decreases (63+4.7 vs 60+6.5, NS) during FU. No pt had pulmonary hypertension on echocardiography. In conclusion, these preliminary data show that the frequent right ventricular abnormalities, detected by RNA in earlier stage of disease are in the great majority persistent, in the absence of pulmonary involvement.
MARROW TRANSPLANT PATIENTS. A.F. Jacobson. VA Medical Center, Seattle, WA, USA. Although patients (pts) undergoing bone marrow transplantation (BMT) often have previously received chemotherapy with potential myocardial toxicity, the prognostic utility of pre- and post-BMT determination of resting left ventricular ejection traction (EF) has received limited attention. During a ten-year period, Tc-99m-labeled red blood cell radionuclide ventriculography (RNVG) (normal (nl) EF _>50%) was performed on 310 pts (mean age 36, range 19-63) prior to BMT. 207 pts who survived to 3 months post-BMT also had a second RNVG 21-139 (mean-75) days post-BMT. One-year survival (1YS) was examined relative to pre- (EF1) and post-BMT EF (EF2). EF1 range was 36% to 86%, being normal in 254 pts (82%). 1YS was 55% both in pts with nl and low EF1. Among all EF1 groups, only pts with EF1 >70% had significantly poorer 1YS ((3/12; 25% vs 168/298; 56%) p<0.025). Results were similar for EF2 (range 30%-78%); 1YS was 70% in pts with nl EF2, 67% in pts with EF2<50% (p=ns). 1YS was lower in EF2_>70% pts (6/11;55%) compared with the others (137/196;70%), but the difference did not reach significance (p=0.15). In BMT pts, high EF (270%) is associated with a poorer prognosis, while 1YS is similar for those with lower nl (5069%) and moderately reduced EF (30-49%).
W E D N E S D A
Y P M A P R I
L 9
100.50
100.52
EJECTION FRACTION CHANGES WITH DIFFERENT FORMS OF STRESS. STUDY IN HEALTHY VOLUNTEERS I. Coma-Canella, MJ. Garcia-Velloso, A. Maeeira, A. Cabrera, V. Albadalejo, A. Villas, JA. Richter. Chnica Universttaria de Navarra, Pamplona, Spain.
MONITORING OF THE LEFT VENTRICULAR FUNCTION WITH A MULTIDETECTOR NUCLEAR PROBE. IN VIVO TEST/NG A. Millaire, J. Rousseau, C. Foucher-Hossein,H. Bedoni, P. de Groote, X. Marehandise, G. Ducloux.Universityof Lille, France.
Pharmacologic stress tests are widely used instead of physical exercise. It is assumed that an increase in eiection fraction (EF) <5 units is abnormal, but no study has compared the EF response among different forms of stress. For this reason 40 healthy volunteers (aged 22_+1.5) were submitted to equilibrium radionuclide angiography in baseline conditions (b) and during different stress tests (s). Four groups with 10 persons each were established : 1supine bicycle ergometry (EX); 2- dobutamine (DB); 3adenosine triphosphate (ATP) and 4-dipyridamole (i)P). NS difference amon~ grouos was found in age, baseline EF, heart rate and-systolic blood pressure. The EF increased significantly with each form of stress. Comparative values among groups are shown in the table :
We have developped an original ambulatory nuclear probe for monitoringthe left ventricular ejectionfraction (EF). The probe is made of 5 iodide cesium detectors (D). The central D (area 2.25 cm2) is designedfor assessing the global EF and the 4 peripheral D (area 1 cm2) are designed for detecting artifactual probe displacements and assessing regional EFs. Twenty five patients were investigated(20 males, 5 females, age 55 ,t: 15 years). Data acquisition was performed at rest after labeling red blood ceils with 20 mCi 99~1"cand after positioning the probe under gamma camera. The data of each D were compared to those obtained x~qth the ganama camera (global EF and regional EF by sectorial analysis). An artifactual probe displacementwas then performed with a further return to the correct position. Correlations concerning global EF (r = 0.71) and regional EFs (anterior region : r = 0.60 ; lateral region : r = 0.51 ; inferior region : r = 0.52 ; septal region : r = 0.52) were significant (p<0.01). The artifactual probe displacement could be blindly detected by 2 independent observers and was diagnosed by the occurrence of a backgroundlike signal in at least 1 peripheral D. In conclusion, our study suggests that our probe provides an accurate tool to assess the left ventricularcontractilityin patients. The multidetectordesign is an advantageby allowingdetectionof artifactual probe displacements and could allow the detectionof regional contractilitydisorders.
b EF s EF A EF
EX 6~+4 76+_.3 13+5
DB 65+4 81+4' 16_+6'
ATP 62+_5 7i+4 9+_.3
DP 63+_4 67+4 4+-3
~qS <0.05 <0.05
The EF reached higher values with DB vs : EX, ATP and DP. It also reached higher values with EX vs DP. The increment in EF (AEF) was si~ificantly hi daer with EX vs DP. It was also higher witli DB vs D P a n d ATP. In conclusion, the EF increases with every form of stress, but the highest values occur with DB and the lowest with DP.
Abstracts Wednesday afternoon, April 9, 1997
Journal of Nuclear Cardiology January/February 1997, Part 2
100.49
100.51
SIGNIFICANCE OF RESTING LEFT ~ROGNOSTIC NTRICULAR EJECTION FRACTION IN BONE
CARDIAC ABNORMALITIES IN ASYMPTOMATIC HUMAN IMMUNODEFICIENCY VIRUS CARRIERS: AN ECHOCARDIOGRAPHIC AND RADIONUCLIDE ANGIOGRAPHIC FOLLOW-UP. C. Morillon, J. Sztajzel, M. JeanprStre, R. Lerch, O. Hubmann, A. Righetti. Cardiology Center, University Hospital, Geneva, Switzerland. We have previously shown that cardiac abnormalities, especialy right ventricular involvement, are frequent in asymptomatic patients (pts) human immunodeficiency virus (HIV) infected. 53 asymptomatic pts were initially studied by both RNA and echocardiography. At rest, 62 % of these pts had cardiac abnormalities including right ventricular impairment (43%), left ventricular abnormalities (4%), and dysfunction of both cavities (15%). Are these cardiac abnormalities transient or persistent? In order to answer this question, we investigate 36 pts. During the follow-up (FU) of 31+10 months, 9 died, 9 refused iterative investigations and 18 (15 males, mean age 38+6, 3 pts with AIDS) were reinvestigated. Of these 18 pts, 15 had fight ventricular impairment (dilatation and/or dysfunction), at the first RNA, persisting in 13 pts during FU. Moreover, diastolic left ventficular function is pathologic in 8 of these 13pts. Left ventricular ejection fraction decreases (63+4.7 vs 60+6.5, NS) during FU. No pt had pulmonary hypertension on echocardiography. In conclusion, these preliminary data show that the frequent right ventricular abnormalities, detected by RNA in earlier stage of disease are in the great majority persistent, in the absence of pulmonary involvement.
MARROW TRANSPLANT PATIENTS. A.F. Jacobson. VA Medical Center, Seattle, WA, USA. Although patients (pts) undergoing bone marrow transplantation (BMT) often have previously received chemotherapy with potential myocardial toxicity, the prognostic utility of pre- and post-BMT determination of resting left ventricular ejection traction (EF) has received limited attention. During a ten-year period, Tc-99m-labeled red blood cell radionuclide ventriculography (RNVG) (normal (nl) EF _>50%) was performed on 310 pts (mean age 36, range 19-63) prior to BMT. 207 pts who survived to 3 months post-BMT also had a second RNVG 21-139 (mean-75) days post-BMT. One-year survival (1YS) was examined relative to pre- (EF1) and post-BMT EF (EF2). EF1 range was 36% to 86%, being normal in 254 pts (82%). 1YS was 55% both in pts with nl and low EF1. Among all EF1 groups, only pts with EF1 >70% had significantly poorer 1YS ((3/12; 25% vs 168/298; 56%) p<0.025). Results were similar for EF2 (range 30%-78%); 1YS was 70% in pts with nl EF2, 67% in pts with EF2<50% (p=ns). 1YS was lower in EF2_>70% pts (6/11;55%) compared with the others (137/196;70%), but the difference did not reach significance (p=0.15). In BMT pts, high EF (270%) is associated with a poorer prognosis, while 1YS is similar for those with lower nl (5069%) and moderately reduced EF (30-49%).
W E D N E S D A
Y P M A P R I
L 9
100.50
100.52
EJECTION FRACTION CHANGES WITH DIFFERENT FORMS OF STRESS. STUDY IN HEALTHY VOLUNTEERS I. Coma-Canella, MJ. Garcia-Velloso, A. Maeeira, A. Cabrera, V. Albadalejo, A. Villas, JA. Richter. Chnica Universttaria de Navarra, Pamplona, Spain.
MONITORING OF THE LEFT VENTRICULAR FUNCTION WITH A MULTIDETECTOR NUCLEAR PROBE. IN VIVO TEST/NG A. Millaire, J. Rousseau, C. Foucher-Hossein,H. Bedoni, P. de Groote, X. Marehandise, G. Ducloux.Universityof Lille, France.
Pharmacologic stress tests are widely used instead of physical exercise. It is assumed that an increase in eiection fraction (EF) <5 units is abnormal, but no study has compared the EF response among different forms of stress. For this reason 40 healthy volunteers (aged 22_+1.5) were submitted to equilibrium radionuclide angiography in baseline conditions (b) and during different stress tests (s). Four groups with 10 persons each were established : 1supine bicycle ergometry (EX); 2- dobutamine (DB); 3adenosine triphosphate (ATP) and 4-dipyridamole (i)P). NS difference amon~ grouos was found in age, baseline EF, heart rate and-systolic blood pressure. The EF increased significantly with each form of stress. Comparative values among groups are shown in the table :
We have developped an original ambulatory nuclear probe for monitoringthe left ventricular ejectionfraction (EF). The probe is made of 5 iodide cesium detectors (D). The central D (area 2.25 cm2) is designedfor assessing the global EF and the 4 peripheral D (area 1 cm2) are designed for detecting artifactual probe displacements and assessing regional EFs. Twenty five patients were investigated(20 males, 5 females, age 55 ,t: 15 years). Data acquisition was performed at rest after labeling red blood ceils with 20 mCi 99~1"cand after positioning the probe under gamma camera. The data of each D were compared to those obtained x~qth the ganama camera (global EF and regional EF by sectorial analysis). An artifactual probe displacementwas then performed with a further return to the correct position. Correlations concerning global EF (r = 0.71) and regional EFs (anterior region : r = 0.60 ; lateral region : r = 0.51 ; inferior region : r = 0.52 ; septal region : r = 0.52) were significant (p<0.01). The artifactual probe displacement could be blindly detected by 2 independent observers and was diagnosed by the occurrence of a backgroundlike signal in at least 1 peripheral D. In conclusion, our study suggests that our probe provides an accurate tool to assess the left ventricularcontractilityin patients. The multidetectordesign is an advantageby allowingdetectionof artifactual probe displacements and could allow the detectionof regional contractilitydisorders.
b EF s EF A EF
EX 6~+4 76+_.3 13+5
DB 65+4 81+4' 16_+6'
ATP 62+_5 7i+4 9+_.3
DP 63+_4 67+4 4+-3
~qS <0.05 <0.05
The EF reached higher values with DB vs : EX, ATP and DP. It also reached higher values with EX vs DP. The increment in EF (AEF) was si~ificantly hi daer with EX vs DP. It was also higher witli DB vs D P a n d ATP. In conclusion, the EF increases with every form of stress, but the highest values occur with DB and the lowest with DP.