- Email: [email protected]
Ventricular synchronization assessed by phase analysis in a radionuclide angiography in individuals with normal cardiac function
S106
Abstracts Wednesday afternoon,April 21, 1999
54.20
Journal of Nuclear Cardiology January/February 1999, Part 2
54.22
VENTRICULAR SYNCHRONIZATION ASSESSED BY PHASE ANALYSIS IN A RADIONUCLIDE ANGIOGRAPHY IN INDIVIDUALS WITH NORMAL CARDIAC FUNCTION A.Peix, J.F.Toussaint, P.Kolar, C.Alonso, T.Lavergne, N.Rotoni, G.Berger, M.Paillard. Broussais Hosp, Paris, France
IS SEQUENTIAL RNA EVALUATION OF RIGHT VENTRICULAR FUNCTION EFFECTIVE FOR DETECTION OF DOXORRUBICIN TOXICITY ? MV Similes, AO Pintya, BP Similes, G Veras, JV Carvalho, JA Matin-Nero. Medical School of Ribeir~o Preto - University o f Sgo Paulo, Brazil.
Radionuclide angiography (RNA) makes possible the ventricular contractility and synchronization assessment. We determined the beginning, the total duration and the difference between the activation time of both ventricles in 50 individuals with normal cardiac function. An equilibrium RNA in LAO and left lateral (LL) views was performed. Four ROI were drawn: on the LV and RV ventricles in LAO; on apex and base in LL. The initial time (T0), the mean or peak time (T1), the total activation time (Tt) for each ventricle anit the biventrieular time (TLv-Rv), were measured in the histogram of the first Fourier harmonic (LAO view). In the LL view, the apex-base activation time (TA-B)was measured. The LVEF was 62+5% and the RVEF was 41+7%. The RV activated 28 ms before the LV, with a Tt 16 ms longer than for the LV. The TLV-RVwas 16+22 ms. The propagation was from apex to base, with a TA-Bof 29+39 ms. We conclude that there is a physiologic asynchronism between LV and RV measured by phase analysis in the RNA. Intraventricular values superior to 213ms for the LV, 207ms for the RV and 107ms for the TAB represent an intraventricular activation disturbance.
There is only anecdotal evidence of isolated right ventricular (RV) failure in doxorrubicin chemotherapy (DX). We aimed to assess the relative effects of DX cardiotoxicity (DC) on RV and (LV) function. 30 pts (53+17 yrs., 22 male) underwent baseline and serial equilibrium RNA during DX (294+136 mg/m2 bsa). Functional criteria for DC was LV ejection fraction (EF) < 50 or RVEF < 45%. A significant decrease in LVEF after DX was detected [-74-1.4 EF units (mean+SEM), p<0.001] that correlated with DX cumulative dose (19<0.05). There was no significant decrease in RVEF after DX. Eight pts had DX cardiotoxicity by decreased LVEF, confirmed by endomyocardial biopsy, and simultaneous RV dysfunction occurred in only one case. Two pts showed mild (values > 45%) isolated RVEF decrease with normal LVEF and requiring no limitation of DX dosage. Conclusion: Isolated RV failure is not common in DX, and sequential monitoring of RVEF does not seem to be incrementally effective for early detection of DC.
54.21
54.23
NITROGLYCERIN-RADIONUCLIDE ANGIOGRAPHY IMPROVES DETECTION OF REVERSIBLE LEFT VENTRICULAR DYSFUNCTION BEFORE CABS. J.F.Batista, J.Tain, R.Stusser, O.Pereztol, D.Lopez, L.Rochela, M.Borron. CIC, Havana, Cuba.
"PRECONDITIONING" AGAINST LEFT VENTRICULAR (LV) DYSFUNCTION FOLLOWS EXERCISE-INDUCED ISCHAEMIA Andrew D Kelion, Adrian P Banning, Terence Webb, Maureen Gardner, Oliver JM Ormerod. Cardiology Department, John Radcliffe Hospital, Oxford, UK.
Our aim was to determine the usefulness of the Radionuclide Angiography with Nitroglycerin (NTG-RNA) to predict left ventricular (LV) dysfimction reversibility in patients referred to coronary artery bypass surgery (CABS). The studies was done on forty patients with proven coronary artery disease (CAD) and impaired LV function submitted to CABS without consider the RNA results. The sample was divided in two groups by RNA data: One (n=26) with an increment of 5% or higher in LVEF and/or wall motion abnormalities (WMA) recovery comparing rest and NTG-RNA before surgery, and two (n=14) without relevant changes. Group one showed a higher incidence of patients without prior myocardial infarction and also evidenced an increment of LVEF after surgery, while group two found no relevant changes (p>0.05). Reversible defects by NTG-RNA before CABS correlated closely with the findings observed with RNA at rest without NTG postsurgery (19>0.05). These results suggest the usefulness of NTG-RNA to detect patients with impaired LV function who will improve it after r evascularization.
"Warm-up" angina may represent ischaemic preconditioning (]PC). We investigated whether protection occurs against LV dysfunction. 11 patients with multivessel disease and normal rest LV underwent 2 supine bicycle exercise tests 30min apart. Patients had practice tests and stopped antianginals. Gated RNV was used to derive regional ejection fractions (REFs) for 9 LV segments. Exercise time and max STD were the same for each test, but the onset of angina was delayed by 1.8min during test 2 (P<0.01), whilst a higher RPP was reached before angina (P<0.01) or lmm STD (P---0.03) occurre~ HR and BP during equivalent RNV acquisitions were comparable between tests. Segments whose REF fell during test 1 ("ischaemic") showed persistent reduction (stunning) 15rain (P
Abstracts Wednesday afternoon,April 21, 1999
54.20
Journal of Nuclear Cardiology January/February 1999, Part 2
54.22
VENTRICULAR SYNCHRONIZATION ASSESSED BY PHASE ANALYSIS IN A RADIONUCLIDE ANGIOGRAPHY IN INDIVIDUALS WITH NORMAL CARDIAC FUNCTION A.Peix, J.F.Toussaint, P.Kolar, C.Alonso, T.Lavergne, N.Rotoni, G.Berger, M.Paillard. Broussais Hosp, Paris, France
IS SEQUENTIAL RNA EVALUATION OF RIGHT VENTRICULAR FUNCTION EFFECTIVE FOR DETECTION OF DOXORRUBICIN TOXICITY ? MV Similes, AO Pintya, BP Similes, G Veras, JV Carvalho, JA Matin-Nero. Medical School of Ribeir~o Preto - University o f Sgo Paulo, Brazil.
Radionuclide angiography (RNA) makes possible the ventricular contractility and synchronization assessment. We determined the beginning, the total duration and the difference between the activation time of both ventricles in 50 individuals with normal cardiac function. An equilibrium RNA in LAO and left lateral (LL) views was performed. Four ROI were drawn: on the LV and RV ventricles in LAO; on apex and base in LL. The initial time (T0), the mean or peak time (T1), the total activation time (Tt) for each ventricle anit the biventrieular time (TLv-Rv), were measured in the histogram of the first Fourier harmonic (LAO view). In the LL view, the apex-base activation time (TA-B)was measured. The LVEF was 62+5% and the RVEF was 41+7%. The RV activated 28 ms before the LV, with a Tt 16 ms longer than for the LV. The TLV-RVwas 16+22 ms. The propagation was from apex to base, with a TA-Bof 29+39 ms. We conclude that there is a physiologic asynchronism between LV and RV measured by phase analysis in the RNA. Intraventricular values superior to 213ms for the LV, 207ms for the RV and 107ms for the TAB represent an intraventricular activation disturbance.
There is only anecdotal evidence of isolated right ventricular (RV) failure in doxorrubicin chemotherapy (DX). We aimed to assess the relative effects of DX cardiotoxicity (DC) on RV and (LV) function. 30 pts (53+17 yrs., 22 male) underwent baseline and serial equilibrium RNA during DX (294+136 mg/m2 bsa). Functional criteria for DC was LV ejection fraction (EF) < 50 or RVEF < 45%. A significant decrease in LVEF after DX was detected [-74-1.4 EF units (mean+SEM), p<0.001] that correlated with DX cumulative dose (19<0.05). There was no significant decrease in RVEF after DX. Eight pts had DX cardiotoxicity by decreased LVEF, confirmed by endomyocardial biopsy, and simultaneous RV dysfunction occurred in only one case. Two pts showed mild (values > 45%) isolated RVEF decrease with normal LVEF and requiring no limitation of DX dosage. Conclusion: Isolated RV failure is not common in DX, and sequential monitoring of RVEF does not seem to be incrementally effective for early detection of DC.
54.21
54.23
NITROGLYCERIN-RADIONUCLIDE ANGIOGRAPHY IMPROVES DETECTION OF REVERSIBLE LEFT VENTRICULAR DYSFUNCTION BEFORE CABS. J.F.Batista, J.Tain, R.Stusser, O.Pereztol, D.Lopez, L.Rochela, M.Borron. CIC, Havana, Cuba.
"PRECONDITIONING" AGAINST LEFT VENTRICULAR (LV) DYSFUNCTION FOLLOWS EXERCISE-INDUCED ISCHAEMIA Andrew D Kelion, Adrian P Banning, Terence Webb, Maureen Gardner, Oliver JM Ormerod. Cardiology Department, John Radcliffe Hospital, Oxford, UK.
Our aim was to determine the usefulness of the Radionuclide Angiography with Nitroglycerin (NTG-RNA) to predict left ventricular (LV) dysfimction reversibility in patients referred to coronary artery bypass surgery (CABS). The studies was done on forty patients with proven coronary artery disease (CAD) and impaired LV function submitted to CABS without consider the RNA results. The sample was divided in two groups by RNA data: One (n=26) with an increment of 5% or higher in LVEF and/or wall motion abnormalities (WMA) recovery comparing rest and NTG-RNA before surgery, and two (n=14) without relevant changes. Group one showed a higher incidence of patients without prior myocardial infarction and also evidenced an increment of LVEF after surgery, while group two found no relevant changes (p>0.05). Reversible defects by NTG-RNA before CABS correlated closely with the findings observed with RNA at rest without NTG postsurgery (19>0.05). These results suggest the usefulness of NTG-RNA to detect patients with impaired LV function who will improve it after r evascularization.
"Warm-up" angina may represent ischaemic preconditioning (]PC). We investigated whether protection occurs against LV dysfunction. 11 patients with multivessel disease and normal rest LV underwent 2 supine bicycle exercise tests 30min apart. Patients had practice tests and stopped antianginals. Gated RNV was used to derive regional ejection fractions (REFs) for 9 LV segments. Exercise time and max STD were the same for each test, but the onset of angina was delayed by 1.8min during test 2 (P<0.01), whilst a higher RPP was reached before angina (P<0.01) or lmm STD (P---0.03) occurre~ HR and BP during equivalent RNV acquisitions were comparable between tests. Segments whose REF fell during test 1 ("ischaemic") showed persistent reduction (stunning) 15rain (P