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Comparison of mitral regurgitation using color doppler echocardiographic techniques and radionuclide ventriculography
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E S D A Y
Abstracts Tuesday morning, April 25, 1995
JOURNALOF NUCLEARCARDIOLOGY March/April 1995, Part 2
Pll-253
P12-255
EVALUATIONOF B-BLOKER THgRAPYIN PATIENTSWITR ~ILATg~ C~IOk~OPA~C~ --STUIIY BY 1331-MIBGMYOCARDIALSPECT--
LEFT VENTRICULAR ISCHAEMIA DETECTED BY PERFUSION STUDIES IN PATIENTS WITH SEVERE AORTIC STENOSIS AND NORMAL CORONARY ARTERIES.
Junichi Yamazaki, Mihoko lida, Masaki Igarashi, Hiromitsu Hosoi, Satoshi [shiguro, Hiroshi Muto, Toshio Kabano, Takeshi Morishita. Ist,Dep. of Int. Med.,Ohmori Hospital, TOHO Univ. School of Mad., Tokyo, JAPAN
Dennis G. Caralis, Amjad All, Eugene F. Uretz. Rush University, Rush Medical College, Rush-Presbyterian St. Luke's Medical Center, Chicago, USA.
NlBG-myocardial SPECT were performed on 16 patients with DCM before and after or during /3-blocker therapy, and severity of DCM and therapeutic effect due to /3blocker were evaluated. The washout rate(WR) of the LV, extent score(ES) and severity score (SS) were calculated from short axial images using the Bull's eye method, The correlation between LVEF and WR which was obtained after /3-blocker therapy was significant(r=-0. TS1), In the early image after/3-blocker thrapy, correlation between LVEF and SS was significantly demonstrated (r= -0.635),Similarly correlation between WR and SS in the delayed image w~s significantly de~onstruted {r=-0.573}. The normalization of the LV function and remarkable improvement of the WR were found in 3 of 4 cases where NIBO-myocardial SPECT imaging was performed before and after /3-blocker therapy. It was suggested that MIBG is useful for evaluation of the severity of DCM, indication of /3-blocker therapy, decision of the maintenance dose and evaluation of the prognosis.
We tested the hypothesis that severe Aortic Stenosis (AS) can be a cause of myocardial Ischaemia (Is) in patients (pts) with angiographically normal coronary arteries. (Is) was determined by myocardial perfusion Scintigraphic and Tomographic images with Thallium-201 IV injection following low level exercise, at rest and after reinjection 24 hours later, Entry criteria into this study: pts with severe AS, no other structural cardiac abnomalities by echocardiography and normal coronary arteries. Study population: ten consecutive male patients, age range 47-66 years, Range of Aortic Valve area: 0.4-0.8 cm=/m =. Range of Mean Valve Gradient: 60-105 mmHg. Eight pts had significant (ls~: primarily Reversible Defects and Persistent Defects as w e l l with viable myocardial segments. Following valve replacement, the ischaemic changes normalized. Two of the eight pts with severe AS had no myocardial perfusion abnormalities.
Severe AS can be a cause of LV (Is) in pts with normal coronary arteries.
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Pll-254
P12-256
DECREASED CARDIAC SYMPATHETIC ACTIVITY AFTER 6 WEEKS TREATMENT WITH ENALAPRtL IN PATIENTS WITH CONGESTIVE HEART FAILURE; A QUANTATIVE MIBGSPECT ANALYSIS.
COMPARISON OF MITRAL REGLrRGITATION USING COLOR DOPPLER ECHOCARDIOGRAPHIC TECHNIQUES A.WD RADIONUCLIDE VENTRICULOGRAPHY.
G. Aernout Somsen, Bob van Vlies, dudocus J.J. Borm, Paul A.R. de Milliano, Eric A. van Royen, Kong I. Lie. Academic Medical Center, Amsterdam, The Netherlands. In patients with congestive heart failure (CHF) cardiac noradrenaline (NA) content is decreased 'as can be visualised by MIBG-SPECT. ACE-inhibitors improve prognosis and functional capacity and reduce plasma noradrenaline (NA). Whether ACE-inhibitors increase cardiac NA content reflecting reduced cardiac sympathetic actMty (CSA) is not known. To assess the effect of ACE-inhibition on CSA quantitative MIBG-SPECT data before and after 6 weeks enalapril treatment were compared in 23 stable, NYHA class 2-3, CHF patients. SPECT images were obtained 4 hours after injection of 185 MBq MIBG. A dedicated program (CASPAN) was used to quantitate myocardial MIBG uptake. Absolute myocardial MIBG activity was calculated using the 1231 activity in a venous blood sample. The average dose of enalapril was 13.5(_+6.11) mg/bid. Myocardial MIBG activity increased from 16.5(+_8.4) to 20.0(+-9.5) Bq/ml/MBq-iniected dose (p=0,013). Conclusion: enalapril lowers cardiac sympathetic activity in CHF patients. This might be one of the explanations for the favourable effects of enalapril.
SPavlovic, B.~ujisic, KKovacic, D.Sobic, ,.Mari~kovic, N.Kozarevic, VBosnjakovic, Nuclear Medicine Institute and Institute for Cardiovascular Diseases, Clinical Center of Serbia. Belgrade Values of re~urgitant indices estimated by radiqnuclide. ventriculograpfiy were correlated with seventy of mitral regurgitatmn determined using different transthoracic and transesophageal color Doppler (CD) techniques. There were 51 patients with different stages of mitral regyf~itation diagnosed by cardiac cathe'fe.risation.. The following parameters were determined . using transthoracic echocardiography: regurgitant iet lentil (JL), ratio of regurgitant jet length and leIt atriaI length (RJLAL), re~i-.~itant jet area (ILIA), ratio ot regurgitant jet area and left atrial area (RJAAz~),. regu~.gitant 3at wiatli (RJWT) and regurgitant jet width derived f r o m tra'nsesophageal ectiod~diography (RJWE).The results were as follows: " CD ]L - I~)LAL /RJA RJAAA RIVT /pav~
I N CORRELATION i SIGNIFICANCE , COEFFICIENT i 39 0.63 p<0.001 [ 39 0.40 p<0.05 '51i 0,50 ' P<0.001 i 51 0.30 i p<0.05 31 0.66 I p<:O.O01 s4 l 0.7s t, p
The best agreement in mitral regur~tation assessment y,~.as found between regurgitant index and regur~tant jet width obtained using transesophageal echocardiograp-hy
T U
E S D A Y
Abstracts Tuesday morning, April 25, 1995
JOURNALOF NUCLEARCARDIOLOGY March/April 1995, Part 2
Pll-253
P12-255
EVALUATIONOF B-BLOKER THgRAPYIN PATIENTSWITR ~ILATg~ C~IOk~OPA~C~ --STUIIY BY 1331-MIBGMYOCARDIALSPECT--
LEFT VENTRICULAR ISCHAEMIA DETECTED BY PERFUSION STUDIES IN PATIENTS WITH SEVERE AORTIC STENOSIS AND NORMAL CORONARY ARTERIES.
Junichi Yamazaki, Mihoko lida, Masaki Igarashi, Hiromitsu Hosoi, Satoshi [shiguro, Hiroshi Muto, Toshio Kabano, Takeshi Morishita. Ist,Dep. of Int. Med.,Ohmori Hospital, TOHO Univ. School of Mad., Tokyo, JAPAN
Dennis G. Caralis, Amjad All, Eugene F. Uretz. Rush University, Rush Medical College, Rush-Presbyterian St. Luke's Medical Center, Chicago, USA.
NlBG-myocardial SPECT were performed on 16 patients with DCM before and after or during /3-blocker therapy, and severity of DCM and therapeutic effect due to /3blocker were evaluated. The washout rate(WR) of the LV, extent score(ES) and severity score (SS) were calculated from short axial images using the Bull's eye method, The correlation between LVEF and WR which was obtained after /3-blocker therapy was significant(r=-0. TS1), In the early image after/3-blocker thrapy, correlation between LVEF and SS was significantly demonstrated (r= -0.635),Similarly correlation between WR and SS in the delayed image w~s significantly de~onstruted {r=-0.573}. The normalization of the LV function and remarkable improvement of the WR were found in 3 of 4 cases where NIBO-myocardial SPECT imaging was performed before and after /3-blocker therapy. It was suggested that MIBG is useful for evaluation of the severity of DCM, indication of /3-blocker therapy, decision of the maintenance dose and evaluation of the prognosis.
We tested the hypothesis that severe Aortic Stenosis (AS) can be a cause of myocardial Ischaemia (Is) in patients (pts) with angiographically normal coronary arteries. (Is) was determined by myocardial perfusion Scintigraphic and Tomographic images with Thallium-201 IV injection following low level exercise, at rest and after reinjection 24 hours later, Entry criteria into this study: pts with severe AS, no other structural cardiac abnomalities by echocardiography and normal coronary arteries. Study population: ten consecutive male patients, age range 47-66 years, Range of Aortic Valve area: 0.4-0.8 cm=/m =. Range of Mean Valve Gradient: 60-105 mmHg. Eight pts had significant (ls~: primarily Reversible Defects and Persistent Defects as w e l l with viable myocardial segments. Following valve replacement, the ischaemic changes normalized. Two of the eight pts with severe AS had no myocardial perfusion abnormalities.
Severe AS can be a cause of LV (Is) in pts with normal coronary arteries.
P
M A P
R I L 2 5
Pll-254
P12-256
DECREASED CARDIAC SYMPATHETIC ACTIVITY AFTER 6 WEEKS TREATMENT WITH ENALAPRtL IN PATIENTS WITH CONGESTIVE HEART FAILURE; A QUANTATIVE MIBGSPECT ANALYSIS.
COMPARISON OF MITRAL REGLrRGITATION USING COLOR DOPPLER ECHOCARDIOGRAPHIC TECHNIQUES A.WD RADIONUCLIDE VENTRICULOGRAPHY.
G. Aernout Somsen, Bob van Vlies, dudocus J.J. Borm, Paul A.R. de Milliano, Eric A. van Royen, Kong I. Lie. Academic Medical Center, Amsterdam, The Netherlands. In patients with congestive heart failure (CHF) cardiac noradrenaline (NA) content is decreased 'as can be visualised by MIBG-SPECT. ACE-inhibitors improve prognosis and functional capacity and reduce plasma noradrenaline (NA). Whether ACE-inhibitors increase cardiac NA content reflecting reduced cardiac sympathetic actMty (CSA) is not known. To assess the effect of ACE-inhibition on CSA quantitative MIBG-SPECT data before and after 6 weeks enalapril treatment were compared in 23 stable, NYHA class 2-3, CHF patients. SPECT images were obtained 4 hours after injection of 185 MBq MIBG. A dedicated program (CASPAN) was used to quantitate myocardial MIBG uptake. Absolute myocardial MIBG activity was calculated using the 1231 activity in a venous blood sample. The average dose of enalapril was 13.5(_+6.11) mg/bid. Myocardial MIBG activity increased from 16.5(+_8.4) to 20.0(+-9.5) Bq/ml/MBq-iniected dose (p=0,013). Conclusion: enalapril lowers cardiac sympathetic activity in CHF patients. This might be one of the explanations for the favourable effects of enalapril.
SPavlovic, B.~ujisic, KKovacic, D.Sobic, ,.Mari~kovic, N.Kozarevic, VBosnjakovic, Nuclear Medicine Institute and Institute for Cardiovascular Diseases, Clinical Center of Serbia. Belgrade Values of re~urgitant indices estimated by radiqnuclide. ventriculograpfiy were correlated with seventy of mitral regurgitatmn determined using different transthoracic and transesophageal color Doppler (CD) techniques. There were 51 patients with different stages of mitral regyf~itation diagnosed by cardiac cathe'fe.risation.. The following parameters were determined . using transthoracic echocardiography: regurgitant iet lentil (JL), ratio of regurgitant jet length and leIt atriaI length (RJLAL), re~i-.~itant jet area (ILIA), ratio ot regurgitant jet area and left atrial area (RJAAz~),. regu~.gitant 3at wiatli (RJWT) and regurgitant jet width derived f r o m tra'nsesophageal ectiod~diography (RJWE).The results were as follows: " CD ]L - I~)LAL /RJA RJAAA RIVT /pav~
I N CORRELATION i SIGNIFICANCE , COEFFICIENT i 39 0.63 p<0.001 [ 39 0.40 p<0.05 '51i 0,50 ' P<0.001 i 51 0.30 i p<0.05 31 0.66 I p<:O.O01 s4 l 0.7s t, p
The best agreement in mitral regur~tation assessment y,~.as found between regurgitant index and regur~tant jet width obtained using transesophageal echocardiograp-hy