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Correlation of real time 2-dimensional echocardiography with postmortem studies
ABSTRACTS
DOBUTAMINE AND DOPAMINE--COMPARATIVE CARDIOVASCULAR EFFECTS OF MAINTENANCE DOSES IN SEVERE CARDIAC FAILURE. Carl V. Leier, MD; Paul Heban, MD; Pat Huss, RN; Charles A. Bush, MD; Richard P. Lewis, MD, FACC, Ohio State University, Columbus, Ohio. mwelve patients with end-stage congestive cardiomyopathy underwent a single crossover study of dobutamine (Db) and dopamine (Dp)-24 hr IV infusion each-in order to compare their cardiovascular properties. Based on heart rate response (<20% increase over baseline) and ventricular irritability ((12 PVC's/min), the mean maintenance doses of Db and Dp were determined to be 7.1 and 4.0 mcg/kg/min. respectively. Measurements during control (C) and infusion periods included cardiac index (CI), left ventricular filling pressure (LVFP), mean arterial pressure (MAP) and total systemic resistance (TSR). Upper extremity blood flow (UEF) by venous phlethysmography, hepatic blood flow (HBF) by indocyanine green clearance and renal blood flow (RBF) by PAH clearance were performed on 6 of the patients. Results: C Db C Dp CI L/M2/min 2.43+.2 3.09&l+ 2.492.2 2.76k.2 1922 LVFP 1822 18+2 20+2 m"'Hg MAP 79+3 7973 88>@ 836 mmHg TSR units 19T6 1972 15+3* 1971 ml/lOOml/min 3.5+1.1 4.&9* UEF 3.75.2 4&S mllmin HBF 8187227 623C124 665+161 663+91 RBF ml/min 5917130 6877151 65OzlO5 875z163 (" = p(O.05 9= p
CLINICAL USEFULNESS AND SAFETY OF THE ERGONOVINE TEST IN PATIENTS WITH CHEST PAIN R. Charles Curry, Jr., M.D.,F.A.C.C., Carl J. Pepine, M.D. F.A.C.C., James H. Varnell, M.D., Michael B. Sabom, M.D., C. Richard Conti, M.D.,F.A.C.C., University of Florida, Gainesville, Florida Ergonovine maleate( a vasoconstrictor,hasbeenshown to provoke attacks of Prinzmetal's variant angina defined as cyclic chest pain with transient ST segment+ due to coronary artery spasm(CAS). A safe methodtodetect patients(pts) with VA would be clinically usefulinthediagnosis and evaluation of treatment of this disorder. We, therefore, gave EM to 130 ptsbeingevaluatedforchestpain during cardiac catheterization and angiography in order to determine the usefulness and safety oftheEMtest.The pts were divided according to the presence(Group I) or absence (Group II) of VA on clinical presentation. EM(.05-.4mg Iy) was given as clinical, ECG, blood pressure, and coronary diameters were studied. EM chest pain/ Complications STt/CAS Group d pts (mg) 10 .05-.2 10 CHB (2), VT (2) I 2 44BP (2) .2-.4 II 120 ffBP=>50 mmHe. rise in svstolic blood pressure,CHB=complete heart block,-VT=short b&St of ventricular tachycardia Pts with chest pain and STf(>lmm) following EMdemonstrated CAS in one or both major coronary arteries with total or subtotal obliteration of the major arterial branchpredieted by the ECG. Two ptswithout VAwho responded to EMhad severe coronary artery disease(CAD) and a history of rest angina. No seriouscomplicationsrequiringtherapyotherthan sublingual nitroglycerin occurred. Attacks of VA following EM were all relieved in 5-10 min from onset. Conclusion: EM appears clinically useful and safe in testingfor CASduringcatheterization and angiography.
TUESDAY, MARCH 7, 1978 AM CL/N/CAL APPLtCATtON OF CROSS-SECTIONAL ECHOCARDIOGRAPHY 830 to 12:OO EVALUATION OF MODELS FOR QUANTIFYING LEFT VENTRICULAR SIZE BY 2-DIMENSIONAL ECHOCARDIOGRAPHY H.L. Wyatt, PhD, Ming Heng, MD, Samuel Meerbaum, PhD, FACC, Robert Davidson, MD, FACC, Eliot Corday, MD, FACC, John Hestenes, PhD, Cedars-Sinai Medical Center, Los Angeles, Calif. A study was performed to evaluate several mathematical models for quantifying left ventricular (LV) volume and mass using an 84’ phased array sector scanner (PASS). In 10 formalin-fixed dog hearts, 6 to 10 short axis and 1 to 2 long axis endocardial outlines from PASS were used to calculate LV volume by Simpson's rule and by formulae derived from an ellipsoidal model. Calculated LV volumes were compared to direct fluid volume determination, ranging from 13 to 109 ml. Results are tabulated (MD= mean difference, SEE=standard error of estimate, r= correlation coefficient, A= LV cross-sectional area. L=LV length from long view, D=LV diameter). LV MATHEMATICAL MODEL MD(m1) SEE(m1) Simpson's rule, all sections 3.1 2.7 .'99 A2/L, one long view 12.2 12.5 .83 D3, One short view 17.4 25.1 .87 213 AL, one short view 7.4 4.2 .98 516 AL, one short view 4.2 5.2 .98 ~3/2. one short view 4.9 7.0 97 In 12 anesthetized closed-chest dogs, LV mass determined from endocardial and epicardial PASS outlines at end diastole were compared to post-mortem weights, ranging from 78 to 211 gm. Best correlations were obtained with LW= 5/6 AL (MD=9.0 gm, SEE=9.6 gm, r=.96) and Simpson's rule (MD=9.1 gm, SEe9.9 gm, r=.95). Conclusion: LV size can be accurately determined with PASS not only by Simpson's rule but also by a simple formula (5/6 AL) using only one short axis section. Satisfactory validation of the latter model facilitates reliable LV quantitation throughout the cardiac cycle CORRELATION
OF REAL TIME
P-DIMENSIONAL
GRAPHY
POSTMORTEM
STUDIES.
WITH
F.A.C.C., Hutchins, Medical
Bernadine H. Bulkley, M.D., M.D., Steven J. Mason, M.D. Institutions,
Baltimore,
ECHOCARDIO-
James L. Weiss,
M.D.,
F.A.C.C., Graver M. The Johns Hopkins
Maryland.
To assess the accuracy of wide angle phased array P-dimensional (D) echocardicgraphic determination of myocardial lesions, comparisons were made between independent 2-D
echo readings of left
ventricular (LV) function and morphologic evidence of myocardial injury in 14 autopsied patients: 3 had normal hearts; 4, valve disease; and 7,coronary artery disease. Of the I4 patients, 4 had normal myocardium and by echo, normal wall motion or diffuse hypokinesis;
ten patients
had old or recent myocardial
infarction:
4 hod small lesions (2 transmural, 2 subendocardial) involving*S% of LV myocardium; 6 large tmnsmural lesions involving>20% of LV myocardium. Of the IO infarcts, 9 were detected by regional motion abnormalities of either akinesis or dyskinesis, and
wall
absence of systolic thickening of LV wall. Most myocardial segments immediately adjacent to scar showed wall motion abnormalities suggesting injury, but were morphologically normal. Two small infarcts detected by 2-D echo had been clinically silent. The one infarct which was not detected clinically or by 2-D echo was a healed circumferential subendocardial infarct in a potient with remote valve surgery. The results suggest that 2-D echo evidence of regional wall motion abnormality and absence of systolic wall thickening is sensitive in detecting segmental myocordial lesions but may overestimate their extent, possibly because segmenk adjacent to the lesions were reversibly ischemic. This method may not recognize subendocardial injury if it involves the entire left ventricular circumference.
February 1979
The American Journal of CARDIOLOGY
Volume 41
369
DOBUTAMINE AND DOPAMINE--COMPARATIVE CARDIOVASCULAR EFFECTS OF MAINTENANCE DOSES IN SEVERE CARDIAC FAILURE. Carl V. Leier, MD; Paul Heban, MD; Pat Huss, RN; Charles A. Bush, MD; Richard P. Lewis, MD, FACC, Ohio State University, Columbus, Ohio. mwelve patients with end-stage congestive cardiomyopathy underwent a single crossover study of dobutamine (Db) and dopamine (Dp)-24 hr IV infusion each-in order to compare their cardiovascular properties. Based on heart rate response (<20% increase over baseline) and ventricular irritability ((12 PVC's/min), the mean maintenance doses of Db and Dp were determined to be 7.1 and 4.0 mcg/kg/min. respectively. Measurements during control (C) and infusion periods included cardiac index (CI), left ventricular filling pressure (LVFP), mean arterial pressure (MAP) and total systemic resistance (TSR). Upper extremity blood flow (UEF) by venous phlethysmography, hepatic blood flow (HBF) by indocyanine green clearance and renal blood flow (RBF) by PAH clearance were performed on 6 of the patients. Results: C Db C Dp CI L/M2/min 2.43+.2 3.09&l+ 2.492.2 2.76k.2 1922 LVFP 1822 18+2 20+2 m"'Hg MAP 79+3 7973 88>@ 836 mmHg TSR units 19T6 1972 15+3* 1971 ml/lOOml/min 3.5+1.1 4.&9* UEF 3.75.2 4&S mllmin HBF 8187227 623C124 665+161 663+91 RBF ml/min 5917130 6877151 65OzlO5 875z163 (" = p(O.05 9= p
CLINICAL USEFULNESS AND SAFETY OF THE ERGONOVINE TEST IN PATIENTS WITH CHEST PAIN R. Charles Curry, Jr., M.D.,F.A.C.C., Carl J. Pepine, M.D. F.A.C.C., James H. Varnell, M.D., Michael B. Sabom, M.D., C. Richard Conti, M.D.,F.A.C.C., University of Florida, Gainesville, Florida Ergonovine maleate( a vasoconstrictor,hasbeenshown to provoke attacks of Prinzmetal's variant angina defined as cyclic chest pain with transient ST segment+ due to coronary artery spasm(CAS). A safe methodtodetect patients(pts) with VA would be clinically usefulinthediagnosis and evaluation of treatment of this disorder. We, therefore, gave EM to 130 ptsbeingevaluatedforchestpain during cardiac catheterization and angiography in order to determine the usefulness and safety oftheEMtest.The pts were divided according to the presence(Group I) or absence (Group II) of VA on clinical presentation. EM(.05-.4mg Iy) was given as clinical, ECG, blood pressure, and coronary diameters were studied. EM chest pain/ Complications STt/CAS Group d pts (mg) 10 .05-.2 10 CHB (2), VT (2) I 2 44BP (2) .2-.4 II 120 ffBP=>50 mmHe. rise in svstolic blood pressure,CHB=complete heart block,-VT=short b&St of ventricular tachycardia Pts with chest pain and STf(>lmm) following EMdemonstrated CAS in one or both major coronary arteries with total or subtotal obliteration of the major arterial branchpredieted by the ECG. Two ptswithout VAwho responded to EMhad severe coronary artery disease(CAD) and a history of rest angina. No seriouscomplicationsrequiringtherapyotherthan sublingual nitroglycerin occurred. Attacks of VA following EM were all relieved in 5-10 min from onset. Conclusion: EM appears clinically useful and safe in testingfor CASduringcatheterization and angiography.
TUESDAY, MARCH 7, 1978 AM CL/N/CAL APPLtCATtON OF CROSS-SECTIONAL ECHOCARDIOGRAPHY 830 to 12:OO EVALUATION OF MODELS FOR QUANTIFYING LEFT VENTRICULAR SIZE BY 2-DIMENSIONAL ECHOCARDIOGRAPHY H.L. Wyatt, PhD, Ming Heng, MD, Samuel Meerbaum, PhD, FACC, Robert Davidson, MD, FACC, Eliot Corday, MD, FACC, John Hestenes, PhD, Cedars-Sinai Medical Center, Los Angeles, Calif. A study was performed to evaluate several mathematical models for quantifying left ventricular (LV) volume and mass using an 84’ phased array sector scanner (PASS). In 10 formalin-fixed dog hearts, 6 to 10 short axis and 1 to 2 long axis endocardial outlines from PASS were used to calculate LV volume by Simpson's rule and by formulae derived from an ellipsoidal model. Calculated LV volumes were compared to direct fluid volume determination, ranging from 13 to 109 ml. Results are tabulated (MD= mean difference, SEE=standard error of estimate, r= correlation coefficient, A= LV cross-sectional area. L=LV length from long view, D=LV diameter). LV MATHEMATICAL MODEL MD(m1) SEE(m1) Simpson's rule, all sections 3.1 2.7 .'99 A2/L, one long view 12.2 12.5 .83 D3, One short view 17.4 25.1 .87 213 AL, one short view 7.4 4.2 .98 516 AL, one short view 4.2 5.2 .98 ~3/2. one short view 4.9 7.0 97 In 12 anesthetized closed-chest dogs, LV mass determined from endocardial and epicardial PASS outlines at end diastole were compared to post-mortem weights, ranging from 78 to 211 gm. Best correlations were obtained with LW= 5/6 AL (MD=9.0 gm, SEE=9.6 gm, r=.96) and Simpson's rule (MD=9.1 gm, SEe9.9 gm, r=.95). Conclusion: LV size can be accurately determined with PASS not only by Simpson's rule but also by a simple formula (5/6 AL) using only one short axis section. Satisfactory validation of the latter model facilitates reliable LV quantitation throughout the cardiac cycle CORRELATION
OF REAL TIME
P-DIMENSIONAL
GRAPHY
POSTMORTEM
STUDIES.
WITH
F.A.C.C., Hutchins, Medical
Bernadine H. Bulkley, M.D., M.D., Steven J. Mason, M.D. Institutions,
Baltimore,
ECHOCARDIO-
James L. Weiss,
M.D.,
F.A.C.C., Graver M. The Johns Hopkins
Maryland.
To assess the accuracy of wide angle phased array P-dimensional (D) echocardicgraphic determination of myocardial lesions, comparisons were made between independent 2-D
echo readings of left
ventricular (LV) function and morphologic evidence of myocardial injury in 14 autopsied patients: 3 had normal hearts; 4, valve disease; and 7,coronary artery disease. Of the I4 patients, 4 had normal myocardium and by echo, normal wall motion or diffuse hypokinesis;
ten patients
had old or recent myocardial
infarction:
4 hod small lesions (2 transmural, 2 subendocardial) involving*S% of LV myocardium; 6 large tmnsmural lesions involving>20% of LV myocardium. Of the IO infarcts, 9 were detected by regional motion abnormalities of either akinesis or dyskinesis, and
wall
absence of systolic thickening of LV wall. Most myocardial segments immediately adjacent to scar showed wall motion abnormalities suggesting injury, but were morphologically normal. Two small infarcts detected by 2-D echo had been clinically silent. The one infarct which was not detected clinically or by 2-D echo was a healed circumferential subendocardial infarct in a potient with remote valve surgery. The results suggest that 2-D echo evidence of regional wall motion abnormality and absence of systolic wall thickening is sensitive in detecting segmental myocordial lesions but may overestimate their extent, possibly because segmenk adjacent to the lesions were reversibly ischemic. This method may not recognize subendocardial injury if it involves the entire left ventricular circumference.
February 1979
The American Journal of CARDIOLOGY
Volume 41
369