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LV diastolic function in patients with heart failure: Assessment by multigated radionuclide angiography and effect of inotropic therapy
S 108
Abstracts Wednesday afternoon, April 21, 1999
Journal of Nuclear Cardiology January/February 1999, Part 2
54.28
54.30 LV Diastolic Function in Patients with Heart Failure: Assessment by Multigated Radionuclide Angiography and Effect of Inotropic Therapy.
Hossam Sherif MSe, Alia Abdel Fattah MD, Waheed Radwan MD, Salama ~IussienMD and Sherif Mokhtar MD Critical Care Medicine Department, Cairo University, Egypt. Cardiac failure is a pathophysiologie sSate in which , the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues, or to do so only from an elevated filling pressure.Since the normal LV operates below the bend of the pressure- volume curve, LV impairment of both systolic and diastolic functions, leads to rightward displacement of the curve (an increase in volume at any level of pressure), and lowers the pressure necessary to provide the preload. In this study, we assessed both LV systolic & diastolic functions in patients with systolic heart failure, under the effect of a commonly used inotrope (dobutamine), utilizing the technique of multigated equilibriumradionculide angiography.Twentypts were included (17males, mean age: 48.5+14.8, range: 22-63ys,)all had CHF due to dilated eardiomyopathy(12pts) or ischemic ¢ardiomyopatby(Spts).In addition, 14 normal males were included as eontrols (mean age: 41.95:9.16, range: 2855ys). After full clinical evaluation, 12-lead ECG, chest X-ray, 2D, M-mode and Doppler examination,all pts and controls were subjected to the technique of multigated equilibrium radionculide angiography utilizing a MulfiSPECT Siemens scintillation gamma camera. With the patient on his back a bolus of 25mCi 99mTe-perteelmetate was injected intravenously, best acquisition and separation of both ventricles Were obtained by lelt anterior oblique view. LV%EF was obtained using the manual approach. The volumctrie measurements were obtained using the count-proportional non-geometric method. The peak filling rate (PFR), time to PFR, the peak eruptingrate (PER) and time to PER, were obtained from the camera sottware using the LV time-activity curve, before treatment and followin h dose dobutarnine. Variable
Controls
Base L i n e
511g/kg/min
20btg/kg/min
%EF 76.8+7.5 t 8.9&-_4.7 23.4-+3.2 27.3+4.5 Cl(L/min/m2) 3.57+0.6 1.76+0.6 2.38_+0.7 2.98_+1.2 PFR(EDV/see) 2.88+1.2 0.82_+0.7 1.51_+0.2 2.36~-_0.7 Compared to controls, cardiac pts with CHF had significantly imparied LV systolic and diastolic parameters, Both showed better improvement with high dose dobutamine than low dose dobutamine. In conclusion: The simple technique of multigated equilibrium radionuelide angiography had unmasked the impairment in the LV diastolic function in patients with already impaired systolic function, and has shown the benefits exerted by a classic positive inotropic traditionally known to improve the systolic function of the failing heart.
RADIONUCLIDE VENTRICULOGRAPHY IN ASSESSMENT OF VENTRICULAR FUNCTION 1N CHILDREN WITH COMMON VENTRICLE D. Sobic-Saranovic, I. Jovanovic, S. Pavlovic, N. Kozarevic, M. Duldc, V. Parezanovic, S. Simeunovic. Institute of Nuclear Medicine, CCS, Belgrade, Yugoslavia Common ventricle (CV) is a term used to describe heart with univentricular atrioventricular connection in which both or a common atrioventricular valve open in a main single ventricular chamber. Assessment ofventficular function of CV is very difficult, with echocardiography and selective ventriculography due to complex heart malformations. The purpose of this study was to find out is it possible to assess ventricular function of CV by radionuclide ventriculography (fLNV). We studied seven children with CV, 5 boys and 2 girls, mean age 11 years. Five of them had surgical treatment (operation Fontan or Glenn) 6 month to 5 years before our investigation. RNV was performed in three projections: anterior, LAO 45 and LL 70 to 90 degrees. Beside EF as systolic parameter, phase and amplitude images were also assessed in all children in order to evaluate regional function of CV. In 5 children EF was normal (60%,57%,63%,49%and 50%, respectively). In two patients with cyanosis and hepatomegaly EF of the common ventricle was 34% and 36 % , respectively. In those two children phase images revealed nonsynhronised, almost dyskinetic apical part of the common ventricle. Our preliminary results indicate that radionuclide ventriculography provides clinically usefifl quantitative information regarding global systolic function of CV. In addition, its regional function could be evaluated by phase and amplitude images. Further clinical validation is necessary, especially in follow-up of chidren with CV.
54.29
54.31
EFFECT OF HEART RATE AND DOBUTAMINE STRESS ON LEFT VENTRICULAR EJECTION
RELATIONSHIP BETWEEN CLINICAL DATA AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION ASSESSED BY RADIONUCLIDE VENTRICULOGRAPHY IN ESSENTIAL HYPERTENSION
FRACTION (EF) A S S E S S E D BY RADIONUCLIDE VENTRICULOGRAPHY IN PACEMAKER PATIENTS D. H~tung, W . M H ~ t m g t, tL S~%ke, K. Homl, T. H e k n h o k O Grosset, H.U. KlSn 1, H.J. Otto, [1visian ofNtrJe~Medidre, iDivision
ofCardiobgy,O~o-von~e-Univos~y, Magdeburg,C.mrmy Sensor controlled pacing rate (PR) in VVIR pacemakers does not take into account the individuality of the rate dependent EF. This study investigated the effect of PR at rest (R) and stress (S) on EF, using radionuclide ventriculography (RNV). Methods: 9 patients (lf, 8m, 65 ± 13 years) with VVIR pacemakers after His-bundle-ablation were studied. In steps of 5 bpm, RNV (Tc-99rn labeled red blood cells) w a s o b t a i n e d at R a n d S ( l o w d o s e d o b u t a m i n e ) . R e s u l t s : T h e d i f f e r e n c e b e t w e e n m i n i m a l (rain) a n d m a x i m a l ( m a x ) E F at R a n d S (R: 2 8 . 9 vs. 4 7 . 8 %, p < 0 . 0 0 1 ; S: 4 6 , 3 vs. 5 9 . 4 %, p < 0 . 0 0 1 ) w a s s i g n i f i c a n t . T h e A P R b e t w e e n m i n a n d m a x E F at R a n d S s h o w e d a l a r g e interi n d i v i d u a l r a n g e (R: 25 - 75 b p m ; S: 5 - 75 b p m ) . A l s o , the m a x E F at R w a s quite s i m i l a r to rain E F at S ( 4 7 . 8 v s . 4 6 . 2 %, n.s.). N o s i g n i f i c a n t d i f f e r e n c e in P R b e t w e e n rain E F a n d m a x E F at R a n d S w a s o b s e r v e d (rain EF: 113 vs. 106 b p m , n.s.; m a x E F : 65 v s . 68 b p m , n.s.). E F at R ~and S c o r r e l a t e d at i d e n t i c a l P R ( r = 0 . 6 8 6 , p < 0 . 0 0 1 ) . C o n c l u s i o n : T h e E F at R a n d S s h o w e d a s i g n i f i c a n t d i f f e r e n c e w i t h a w i d e i n t e r - i n d i v i d u a l rate w i n d o w . T h u s , the clear correlation b e t w e e n R a n d S m a y a l l o w i n d i v i d u a l o p t i m i z a t i o n o f p a c e m a k e r s e n s o r p a r a m e t e r s at rest.
D.V. Teffenberg, V.A. Kuznetsov, V.Yu. Smaznov, V.V. Drozdov. Institute of Clinical and Preventive Cardiology, Tyumen, Russia. To assess the relationship between diastolic left ventricular (LV) dysfunction and clinical characteristics 40 patients with essential hypertension (EH) (21 men and 19 women, mean age 50.5+_8.5 years) with reduced peak of LV filling rate estimated by radionuclide ventriculography were selected in gr. I. 93 hypertensive patients with normal parameters of LV peak filling rate (66 men and 27 women, mean age 47.3+_8.5 years) comprised gr. If. The severity of EH was the similar in both groups. In 75% of patients in gr. I EH was combined with ischemic heart disease (IHD) compared with 55.9% in gr. II (p<0.05). The frequency of severe angina pectoris (III class on Canadian Classification) was higher in gr. I (43.3% vs 19.2%, p<0.05). Number of patients with heart failure (HF) of l-II class NYI-IA was higher in gr. I - 55% in comparison with 34.5% in gr. II (p<0.05). More frequent disorder of LV diastolic function was revealed in women (in gr. I - 47.5% vs 29% in gr. II, p<0.05). LV ejection fraction was significantly lower in gr. I (55_+8.49% and 62.2+_8.96%, respectively, p<0.0001). The same difference between groups I and II was established on left atrial dimension measured by echocardiography 01.9_+_4.9 mm and 39.1_+5.1 ram, respectively, p < 0.05). Thus, LV diastolic dysfunction in patients with EH is related to gender, IHD, more severe HF and decreasing o f LV systolic function.
Abstracts Wednesday afternoon, April 21, 1999
Journal of Nuclear Cardiology January/February 1999, Part 2
54.28
54.30 LV Diastolic Function in Patients with Heart Failure: Assessment by Multigated Radionuclide Angiography and Effect of Inotropic Therapy.
Hossam Sherif MSe, Alia Abdel Fattah MD, Waheed Radwan MD, Salama ~IussienMD and Sherif Mokhtar MD Critical Care Medicine Department, Cairo University, Egypt. Cardiac failure is a pathophysiologie sSate in which , the heart is unable to pump blood at a rate commensurate with the requirements of the metabolizing tissues, or to do so only from an elevated filling pressure.Since the normal LV operates below the bend of the pressure- volume curve, LV impairment of both systolic and diastolic functions, leads to rightward displacement of the curve (an increase in volume at any level of pressure), and lowers the pressure necessary to provide the preload. In this study, we assessed both LV systolic & diastolic functions in patients with systolic heart failure, under the effect of a commonly used inotrope (dobutamine), utilizing the technique of multigated equilibriumradionculide angiography.Twentypts were included (17males, mean age: 48.5+14.8, range: 22-63ys,)all had CHF due to dilated eardiomyopathy(12pts) or ischemic ¢ardiomyopatby(Spts).In addition, 14 normal males were included as eontrols (mean age: 41.95:9.16, range: 2855ys). After full clinical evaluation, 12-lead ECG, chest X-ray, 2D, M-mode and Doppler examination,all pts and controls were subjected to the technique of multigated equilibrium radionculide angiography utilizing a MulfiSPECT Siemens scintillation gamma camera. With the patient on his back a bolus of 25mCi 99mTe-perteelmetate was injected intravenously, best acquisition and separation of both ventricles Were obtained by lelt anterior oblique view. LV%EF was obtained using the manual approach. The volumctrie measurements were obtained using the count-proportional non-geometric method. The peak filling rate (PFR), time to PFR, the peak eruptingrate (PER) and time to PER, were obtained from the camera sottware using the LV time-activity curve, before treatment and followin h dose dobutarnine. Variable
Controls
Base L i n e
511g/kg/min
20btg/kg/min
%EF 76.8+7.5 t 8.9&-_4.7 23.4-+3.2 27.3+4.5 Cl(L/min/m2) 3.57+0.6 1.76+0.6 2.38_+0.7 2.98_+1.2 PFR(EDV/see) 2.88+1.2 0.82_+0.7 1.51_+0.2 2.36~-_0.7 Compared to controls, cardiac pts with CHF had significantly imparied LV systolic and diastolic parameters, Both showed better improvement with high dose dobutamine than low dose dobutamine. In conclusion: The simple technique of multigated equilibrium radionuelide angiography had unmasked the impairment in the LV diastolic function in patients with already impaired systolic function, and has shown the benefits exerted by a classic positive inotropic traditionally known to improve the systolic function of the failing heart.
RADIONUCLIDE VENTRICULOGRAPHY IN ASSESSMENT OF VENTRICULAR FUNCTION 1N CHILDREN WITH COMMON VENTRICLE D. Sobic-Saranovic, I. Jovanovic, S. Pavlovic, N. Kozarevic, M. Duldc, V. Parezanovic, S. Simeunovic. Institute of Nuclear Medicine, CCS, Belgrade, Yugoslavia Common ventricle (CV) is a term used to describe heart with univentricular atrioventricular connection in which both or a common atrioventricular valve open in a main single ventricular chamber. Assessment ofventficular function of CV is very difficult, with echocardiography and selective ventriculography due to complex heart malformations. The purpose of this study was to find out is it possible to assess ventricular function of CV by radionuclide ventriculography (fLNV). We studied seven children with CV, 5 boys and 2 girls, mean age 11 years. Five of them had surgical treatment (operation Fontan or Glenn) 6 month to 5 years before our investigation. RNV was performed in three projections: anterior, LAO 45 and LL 70 to 90 degrees. Beside EF as systolic parameter, phase and amplitude images were also assessed in all children in order to evaluate regional function of CV. In 5 children EF was normal (60%,57%,63%,49%and 50%, respectively). In two patients with cyanosis and hepatomegaly EF of the common ventricle was 34% and 36 % , respectively. In those two children phase images revealed nonsynhronised, almost dyskinetic apical part of the common ventricle. Our preliminary results indicate that radionuclide ventriculography provides clinically usefifl quantitative information regarding global systolic function of CV. In addition, its regional function could be evaluated by phase and amplitude images. Further clinical validation is necessary, especially in follow-up of chidren with CV.
54.29
54.31
EFFECT OF HEART RATE AND DOBUTAMINE STRESS ON LEFT VENTRICULAR EJECTION
RELATIONSHIP BETWEEN CLINICAL DATA AND LEFT VENTRICULAR DIASTOLIC DYSFUNCTION ASSESSED BY RADIONUCLIDE VENTRICULOGRAPHY IN ESSENTIAL HYPERTENSION
FRACTION (EF) A S S E S S E D BY RADIONUCLIDE VENTRICULOGRAPHY IN PACEMAKER PATIENTS D. H~tung, W . M H ~ t m g t, tL S~%ke, K. Homl, T. H e k n h o k O Grosset, H.U. KlSn 1, H.J. Otto, [1visian ofNtrJe~Medidre, iDivision
ofCardiobgy,O~o-von~e-Univos~y, Magdeburg,C.mrmy Sensor controlled pacing rate (PR) in VVIR pacemakers does not take into account the individuality of the rate dependent EF. This study investigated the effect of PR at rest (R) and stress (S) on EF, using radionuclide ventriculography (RNV). Methods: 9 patients (lf, 8m, 65 ± 13 years) with VVIR pacemakers after His-bundle-ablation were studied. In steps of 5 bpm, RNV (Tc-99rn labeled red blood cells) w a s o b t a i n e d at R a n d S ( l o w d o s e d o b u t a m i n e ) . R e s u l t s : T h e d i f f e r e n c e b e t w e e n m i n i m a l (rain) a n d m a x i m a l ( m a x ) E F at R a n d S (R: 2 8 . 9 vs. 4 7 . 8 %, p < 0 . 0 0 1 ; S: 4 6 , 3 vs. 5 9 . 4 %, p < 0 . 0 0 1 ) w a s s i g n i f i c a n t . T h e A P R b e t w e e n m i n a n d m a x E F at R a n d S s h o w e d a l a r g e interi n d i v i d u a l r a n g e (R: 25 - 75 b p m ; S: 5 - 75 b p m ) . A l s o , the m a x E F at R w a s quite s i m i l a r to rain E F at S ( 4 7 . 8 v s . 4 6 . 2 %, n.s.). N o s i g n i f i c a n t d i f f e r e n c e in P R b e t w e e n rain E F a n d m a x E F at R a n d S w a s o b s e r v e d (rain EF: 113 vs. 106 b p m , n.s.; m a x E F : 65 v s . 68 b p m , n.s.). E F at R ~and S c o r r e l a t e d at i d e n t i c a l P R ( r = 0 . 6 8 6 , p < 0 . 0 0 1 ) . C o n c l u s i o n : T h e E F at R a n d S s h o w e d a s i g n i f i c a n t d i f f e r e n c e w i t h a w i d e i n t e r - i n d i v i d u a l rate w i n d o w . T h u s , the clear correlation b e t w e e n R a n d S m a y a l l o w i n d i v i d u a l o p t i m i z a t i o n o f p a c e m a k e r s e n s o r p a r a m e t e r s at rest.
D.V. Teffenberg, V.A. Kuznetsov, V.Yu. Smaznov, V.V. Drozdov. Institute of Clinical and Preventive Cardiology, Tyumen, Russia. To assess the relationship between diastolic left ventricular (LV) dysfunction and clinical characteristics 40 patients with essential hypertension (EH) (21 men and 19 women, mean age 50.5+_8.5 years) with reduced peak of LV filling rate estimated by radionuclide ventriculography were selected in gr. I. 93 hypertensive patients with normal parameters of LV peak filling rate (66 men and 27 women, mean age 47.3+_8.5 years) comprised gr. If. The severity of EH was the similar in both groups. In 75% of patients in gr. I EH was combined with ischemic heart disease (IHD) compared with 55.9% in gr. II (p<0.05). The frequency of severe angina pectoris (III class on Canadian Classification) was higher in gr. I (43.3% vs 19.2%, p<0.05). Number of patients with heart failure (HF) of l-II class NYI-IA was higher in gr. I - 55% in comparison with 34.5% in gr. II (p<0.05). More frequent disorder of LV diastolic function was revealed in women (in gr. I - 47.5% vs 29% in gr. II, p<0.05). LV ejection fraction was significantly lower in gr. I (55_+8.49% and 62.2+_8.96%, respectively, p<0.0001). The same difference between groups I and II was established on left atrial dimension measured by echocardiography 01.9_+_4.9 mm and 39.1_+5.1 ram, respectively, p < 0.05). Thus, LV diastolic dysfunction in patients with EH is related to gender, IHD, more severe HF and decreasing o f LV systolic function.