Three dimensional reconstruction of the heart with rotational acquisition: methods and clinical applications.
Explore the source record for details and available documents.
Echocardiography↗
Biomedical subjects
A Salustri
Publications and source records attributed to A Salustri.
Hyaluronic acid and proteoglycan accumulation in the cumulus oophorus matrix.
A factor produced by the oocytes induces in vitro FSH-treated cumulus and mural granulosa cells to synthesize hyaluronic acid. In the present study we examined hyaluronic acid synthesis by the two cell populations in vivo. After injection of hCG into PMSG-primed immature mice, cumulus and mural granulosa cells adjacent to the antrum synthesized a large amount of such glycosaminoglycan, while the outermost layers layers of mural granulosa cells did not. The results suggest that in vivo differences in hyaluronic acid synthesis between follicle cell subpopulations depend on a diffusion gradient of the oocyte factor. We also identified a proteoglycan species synthesized by cumulus cells which may contribute to hyaluronic acid organization in the intercellular spaces.
Animals↗
Prediction of improvement of ventricular function after first acute myocardial infarction using low-dose dobutamine stress echocardiography.
This study was performed to assess the prevalence of spontaneous improvement of regional left ventricular function in patients after acute myocardial infarction, and to evaluate the role of low-dose dobutamine stress echocardiography for its prediction. In 57 patients with a first acute myocardial infarction (thrombolysis, n = 27; Q-wave, n = 49), regional wall motion was evaluated with 2-dimensional echocardiography at rest, during a low-dose dobutamine stress test performed within 1 week after hospital admission, and at 3-month follow-up. Myocardial viability was considered if there was an improvement of > or = 1 grade in dyssynergic segments from rest to low-dose dobutamine infusion; recovery of regional function was defined as an improvement of > or = 1 grade between rest and follow-up echocardiograms. Wall motion score index decreased from rest to low-dose dobutamine echocardiography (1.46 +/- 0.29 to 1.39 +/- 0.30, p < 0.0001), and this change persisted at follow-up study (1.37 +/- 0.30). No differences were found between patients who did and did not undergo thrombolyis, or between those who had Q-wave and non-Q-wave infarction. At baseline echocardiography, 189 of 627 segments were dyssynergic (85 hypokinetic, 104 akinetic). Viability at low-dose dobutamine stress echocardiography was more frequent in hypokinetic than in akinetic segments (30 of 85 vs 12 of 104, odds ratio 4.18, 95% confidence interval [CI] 1.87 to 9.48).(ABSTRACT TRUNCATED AT 250 WORDS)
Dobutamine↗
High-resolution separation of disaccharide and oligosaccharide alditols from chondroitin sulphate, dermatan sulphate and hyaluronan using CarboPac PA1 chromatography.
Recent literature indicates that specific glycosaminoglycan structures are involved in various biological processes, such as anticoagulation, growth factor activation and viral infection. The initial step in the structural analysis of glycosaminoglycans is a definitive compositional analysis of its characteristic disaccharide repeat structures. Current chromatographic or electrophoretic procedures may have limitations in analysing glycosaminoglycan samples that are in low abundance, contain novel structures that need to be further characterized, or are metabolically labelled from radioactive precursors as a result of biosynthetic experiments. This study presents a new methodology for analysing disaccharides and oligosaccharides derived from chondroitin sulphate, dermatan sulphate and hyaluronan that fulfils the above criteria. The procedure involves the separation of reduced forms of these glycoconjugates on a CarboPac PA1 column using alkaline eluants. This study adopted a strategy which uses specific enzymes to release these disaccharides from their glycosaminoglycan forms. A borohydride reduction reaction was modified to be compatible with the buffer conditions commonly used with these enzymes in order to quantitatively reduce the disaccharides to their alditol forms (thereby stabilizing them to alkaline pH). Chromatography conditions were established which separated all known disaccharide alditol structures from chondroitin sulphate, dermatan sulphate and hyaluronan with extremely high resolution in a single run. Integrated pulsed amperometry was compared to UV absorbance measurement at 232 nm as two sensitive methods for detecting these reduced disaccharides; most of them could be routinely detected in the range of 50-500 ng. Data are presented applying this method to quantify hyaluronan in a biological sample which contains approximately 5000 cells and only approximately 10 ng of hyaluronan. Additional data are presented to demonstrate that this procedure will also separate oligosaccharide alditols derived from hyaluronan.
Borohydrides↗
Atropine increases the accuracy of dobutamine stress echocardiography in patients taking beta-blockers.
Dobutamine-atropine stress echocardiography is used for the non-invasive diagnosis of coronary artery disease, but stress test results may be influenced by beta-blockers. The aim of this study was to assess if the addition of atropine can compensate for the presence of beta-blockers in dobutamine stress echocardiography. Twenty-six patients referred for evaluation of chest pain were studied twice, on and off metoprolol 100 mg b.i.d. (in random order sequence) with a wash-out period of at least 48 h. Dobutamine stress echocardiography was performed using up to 40 micrograms.kg-1.min-1, followed, if necessary, by the addition of atropine to achieve 85% of the age-predicted maximal heart rate, unless symptoms or markers of ischaemia appeared. Atropine was given to patients on beta-blockers more often [(22/26) vs (6/26)] than to those off beta-blockers (P < 0.001). Heart rate at every stage of the test was lower on beta-blockers. Chest pain occurred in patients on beta-blockers significantly less than in those off beta-blockers (8% vs 46%), and the addition of atropine made no significant difference (31% vs 46%). During dobutamine stress, new wall motion abnormalities occurred in three patients on beta-blockers (12%); this number increased to 15 after the addition of atropine (57%). New or worsened wall motion abnormalities occurred in 12 patients (46%) off beta-blockers with dobutamine alone and in 14 patients after adding atropine (53%).(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
[Dynamic transthoracic and transesophageal tridimensional echocardiography using rotational technique. A new perspective in echocardiography].
BACKGROUND: For many years, there has been a long-standing interest in developing three-dimensional echocardiography and several approaches have been followed. However, the main interest has been centered on reconstruction of left ventricular cavity. So far, dynamic three-dimensional representation of cardiac structures has been rather disappointing. OBJECTIVES: In this study, we describe the clinical application of dynamic three-dimensional echocardiography with a rotational imaging acquisition. METHODS: Three-dimensional echocardiography was performed in 50 patients referred to the Echocardiographic Laboratory at the Thoraxcenter for routine standard two-dimensional echocardiography (multiplane transesophageal = 30 patients; transthoracic = 20 patients) for different reasons. For transthoracic echocardiography, patients with good quality images were selected. We used prototype ultrasound probes connected to commercially available echocardiographic equipments interfaced to the Echo-Scan system. The steering logic of the system controlled the image acquisition in a given plane, at a predetermined moment in the respiratory and heart cycles (respiratory and ECG gating). Ninety rotational (2 degree interval) sector images of the heart were collected. The images were digitized, reformatted and interpolated, yielding a three-dimensional data set. From this data set, any desired cross-section of the heart could be computed, volume rendered and displayed in motion. Different algorithms were applied and mixed to produce a shaded dynamic three-dimensional display of cardiac anatomy. RESULTS: Acquisition of images and three-dimensional reconstructions were possible in all the patients. Both conventional and unusual projections were displayed. Thus, we were able to represent the cardiac structures from cutting planes which could not be visualized from standard transthoracic or transesophageal approaches. In particular, in patients with mitral valve prolapse and mitral stenosis the left atrial "surgical" view on the valve provided additional information on both site and extent of leaflets pathology. The presence and the degree of systolic anterior movement were seen in all the patients with hypertrophic cardiomyopathy and outflow obstruction, and the site of the leaflet involved identified. CONCLUSIONS: Dynamic three-dimensional echocardiography is clinically feasible and has the potential to offer information unavailable with conventional two-dimensional echocardiography. Rotational scanning is the logical extension of multiplane transesophageal probe, and circumvents the limitations due to the small acoustic windows during precordial acquisition.
Algorithms↗
[Stress echocardiography: 4 years of experience at the Thoraxcenter].
In this article, we report the experience on stress echocardiography at the Thoraxcenter of Erasmus University of Rotterdam in the years 1990-1994. Different types of stress have been used in conjunction with ultrasound techniques. The results have been compared with other non-invasive methods (exercise ECG testing, myocardial perfusion scintigraphy with single photon emission computed tomography) and with coronary arteriography. Both the diagnostic and prognostic value of stress echocardiography have been assessed in different clinical situations, as in patients with chest pain and suspected or proven coronary artery disease, patients referred for percutaneous transluminal coronary angioplasty, patients referred for major non cardiac vascular surgery. After this period of validation, stress echocardiography has now a definite role in the clinical decision making for the evaluation of myocardial ischemia. The assessment of viable myocardium, especially in patients with advanced left ventricular dysfunction, is one of the major topic currently under investigation. Practical aspects of the interpretation of the tests, costs and organization of the stress echo laboratory, indications and newest research applications are also discussed.
Angioplasty, Balloon, Coronary↗
Effects of exogenous hyaluronic acid and serum on matrix organization and stability in the mouse cumulus cell-oocyte complex.
Compact cumulus cell-oocyte complexes (COCs) isolated from preovulatory mouse follicles undergo expansion in vitro when high levels of hyaluronic acid (HA) are synthesized and organized into an extracellular matrix. We studied the effects of fetal bovine serum (FBS) and of exogenous HA and HA-oligomers on the expansion process. Maximum retention of HA in the COC matrix, and hence complete COC expansion, occurs when 1% FBS is continuously present during the first 18 h of culture. Irrespective of the culture time, HA synthesized when serum is absent is primarily in the medium, whereas HA synthesized when serum is present is primarily in the cell matrix. These findings support the hypothesis that the serum factor, identified as an inter-alpha-trypsin inhibitor by Chen et al. (Chen, L., Mao, S. J., and Larsen, W. J. (1992) J. Biol. Chem. 267, 12380-12386), is a structural component of the matrix. Addition of exogenous HA or of HA oligomers of decasaccharide size (GlcUA-GlcNAc)5 or larger effectively displaces endogenously synthesized HA from the matrix into the medium, thereby preventing COC expansion. Addition of exogenous chondroitin sulfate affects neither matrix organization nor COC expansion, thus indicating specificity of the binding of some structural component(s) to HA. Fully expanded COCs disassemble when cultured longer than 18 h, a process which occurs also in vivo and which correlates with loss of oocyte fertilizability both in vivo and in vitro. This process involves release of macromolecular HA from the matrix into the medium, with loss of 50% of the HA in the first 8 h of incubation after full expansion. The release is not facilitated when HA oligomers, long enough to prevent matrix formation, are added to the culture medium after the COCs are fully expanded. This suggests that cooperative binding to HA of either the serum factor, an endogenously synthesized factor(s), or both is required to stabilize the fully expanded COC matrix.
Animals↗
Oocytes preserve the ability of mouse cumulus cells in culture to synthesize hyaluronic acid and dermatan sulfate.
A soluble factor(s) produced by fully grown oocytes is essential, together with follicle stimulating hormone (FSH), to stimulate in vitro hyaluronic acid (HA) synthesis by mouse cumulus cells (CCs). The stability of the response to this stimulus by CCs in culture was investigated. The data showed that preculture for 8 hr in basal medium reduced to approximately 30% the ability of CCs to synthesize HA in response to FSH or dibutyryl cyclic AMP (Bt2cAMP) and soluble oocyte factor(s). However, if CCs were precultured for the same period of time as intact cumulus cell-oocyte complexes, or in the presence of fully grown oocytes, or in medium conditioned by fully grown oocytes, their ability to synthesize HA was 75-95% preserved. In vitro stimulation of dermatan sulfate (DS) synthesis by CCs does not require oocyte factors and is induced by FSH or Bt2cAMP treatment alone. However, the preservation of such activity, like that of HA synthesis, depended on the presence of a soluble oocyte factor(s) during preculture. The presence of isolated oocytes or of oocyte-conditioned medium also prevented the spreading of CCs in culture. However, inhibiting CC spreading by culture on agar-coated plates or in serum-free medium did not preserve their HA or DS synthetic activity, thus suggesting that the two oocyte actions on CCs are independent. Growing oocytes were unable both to induce HA synthesis in freshly isolated CCs stimulated with FSH and to preserve the ability to synthesize HA and DS in 8-hr precultured CCs. The results suggest that the stability of the differentiated state of mouse CCs in vitro depends upon continued exposure to a soluble factor(s) produced by fully grown oocytes.
Animals↗
Simultaneous dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography in patients with suspected coronary artery disease.
OBJECTIVES: The purpose of this study was to determine the relative value of dobutamine stress echocardiography and technetium-99m isonitrile single-photon emission computed tomography (mibi SPECT) in the detection of myocardial ischemia. BACKGROUND: Stress-induced new wall motion abnormalities and transient perfusion defects are both used for the diagnosis of myocardial ischemia. METHODS: One hundred five consecutive patients with either proved or suspected coronary artery disease, who were referred for perfusion scintigraphy, were studied by a combination of the two techniques. Both echocardiographic and mibi SPECT images were visually analyzed. Three patients were excluded from the final analysis because of unsatisfactory examinations: two with noninterpretable stress echocardiograms and one with noninterpretable mibi SPECT images. The response to stress was concordantly classified by both techniques in 68% of patients (kappa = 0.51). RESULTS: Dobutamine stress echocardiography revealed the presence of ischemia in 38 and mibi SPECT in 45 patients (overall agreement = 74%, kappa = 0.46). The agreement was higher in patients without previous myocardial infarction (84%, kappa = 0.62). When regional analysis was performed, concordance of stress echocardiography and mibi SPECT occurred in 84% of the 306 regions (kappa = 0.45). Regional agreement was also slightly higher in patients without previous infarction (88%, kappa = 0.50). In 21 patients without previous myocardial infarction who underwent coronary angiography, the overall sensitivity of dobutamine stress echocardiography and mibi SPECT for the diagnosis of coronary artery disease (diameter stenosis > 50%) was 75% and 83%, respectively, with a specificity of 89% (eight of nine patients) for both tests. CONCLUSIONS: Dobutamine stress echocardiography represents a reasonable alternative to dobutamine mibi SPECT for the functional assessment of patients with suspected myocardial ischemia and without previous myocardial infarction.
Adult↗
Enhanced sensitivity for detection of coronary artery disease by addition of atropine to dobutamine stress echocardiography.
Patients undergoing dobutamine stress echocardiography often take beta antagonists which limit heart rate response and sensitivity in the test for detection of coronary artery disease. The aim of this study was to assess the effect of the addition of atropine to dobutamine stress echocardiography on clinical, electrocardiographic and echocardiographic outcomes. Dobutamine stress echocardiography was performed starting at and increasing every 3 minutes with 10 micrograms/kg/min to a maximum of 40 micrograms/kg/min (stage 4), which was continued for 6 minutes. In patients not achieving 85% predicted maximal exercise heart rate and in whom the test was not judged positive on echocardiographic or electrocardiographic criteria, atropine (0.25 mg intravenously, repeated up to a maximum of 1 mg if necessary) was added and dobutamine continued for up to a further 5 minutes, or until an adequate heart rate was achieved or the test was stopped because of chest pain or electrocardiographic changes. Of 80 consecutive patients undergoing dobutamine stress echocardiography within 2 weeks of coronary angiography, 49 required atropine (group A) and 31 required only dobutamine (group B). After dobutamine alone, heart rate (mean +/- SD) was higher in group B than in group A: 129 +/- 20 vs 90 +/- 18 beats/min, p less than 0.0001; but after the addition of atropine, heart rate in group A increased to 120 +/- 20 beats/min. Overall sensitivity for the detection of coronary disease was 70%, 95% confidence interval (CI) 55 to 83%; after the addition of atropine, sensitivity for group A was 65%, 95% CI 45 to 81%; in group B, sensitivity was 81%, 95% CI 54 to 96%.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Dobutamine stress echocardiography before and after coronary angioplasty.
Myocardial function was assessed by stress echocardiography in 28 patients before and after successful elective coronary angioplasty. Dobutamine stress echocardiography was performed using up to 40 micrograms/kg/min, followed by the addition of atropine in 20 patients to achieve 85% of the predicted maximal exercise heart rate. The initial studies were performed 1 day before and the second ones within 3 days (mean 1.3) after angioplasty. Peak heart rates and systolic blood pressures were the same for the 2 studies. The frequency of dobutamine-induced new wall motion abnormalities decreased from 20 (71%) before to 4 (14%) after angioplasty (p less than 0.0001). Before angioplasty, wall motion score index (an indicator of left ventricular wall motion, an increase in which indicates impaired wall motion due to myocardial ischemia) increased from 1.06 at rest to 1.23 at peak stress (p less than 10(-6)), but there was no significant increase in this index in the study after angioplasty. Before angioplasty, 14 patients (50%) developed chest pain during the stress test compared with 6 (21%) after angioplasty (p = 0.05), and before angioplasty, the stress test was stopped before the target heart rate was achieved, because of symptoms, ST-segment change or severe new wall motion abnormality in 14 patients compared with 7 after angioplasty (p = 0.09). Thus, early after angioplasty there is a reduction in myocardial ischemia as assessed by dobutamine stress echocardiography.
Aged↗
Exercise echocardiography and single photon emission computed tomography in patients with left anterior descending coronary artery stenosis.
To compare the diagnostic value of exercise echocardiography and perfusion single photon emission computed tomography (SPECT) in the detection of the presence and the severity of coronary artery disease, we studied 21 patients with isolated stenosis of different degree of the left anterior descending artery. Both echocardiography and SPECT were performed in conjunction with the same symptom-limited bicycle exercise test. Positivity of the test was based on the presence of exercise-induced wall motion abnormalities and transient perfusion defects, respectively. For both tests, an 'ischemic' score was derived, as index of extent and severity of myocardial ischemia. Coronary arteriography was evaluated by caliper. The agreement between exercise echocardiography and SPECT for the presence of coronary artery disease was 90%; the discordance was due to two patients with positive echocardiography and negative SPECT. A good correlation between ischemic wall motion and perfusion score indices was found (r = 0.78, p less than 0.0001. Moreover, the percent diameter stenosis was well correlated with both ischemic indices (r = 0.75, p less than 0.0001; r = 0.67, p less than 0.001, respectively). In patients with a positive test, the mean value of ischemic wall motion score index was higher in patients with a diameter stenosis greater than or equal to 70% than in patients with a diameter stenosis less than 70% (0.59 +/- 0.19 vs 0.29 +/- 0.12, p less than 0.01); a similar trend was found for ischemic perfusion score index (0.51 +/- 0.35 vs 0.27 +/- 0.12, ns).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Relationship between exercise echocardiography and perfusion single-photon emission computed tomography in patients with single-vessel coronary artery disease.
The aim of this study was to assess the relative value of exercise echocardiography and perfusion single-photon emission computed tomography (SPECT) in identifying the presence and severity of coronary artery stenosis. Accordingly, 44 consecutive patients with stenosis in one vessel performed simultaneous postexercise echocardiography and perfusion SPECT (with either thallium-201 [n = 19] or 99m-Tc-methoxyisobutyl isonitrile [n = 25]) in conjunction with symptom-limited bicycle exercise testing. Positive test results were based on the presence of new or worsened exercise-induced wall motion abnormalities and transient perfusion defects, respectively. Moreover, an "ischemic" score index was derived for semiquantitative assessment of both echocardiography (with a 14-segment model of left ventricular wall on a 4-point scale) and SPECT (47-segment model on a 5-point scale). All patients underwent correlative coronary arteriography, assessed by digital caliper. Significant coronary artery disease (diameter stenosis greater than or equal to 50%) was present in 30 patients. There was a good overall concordance between the two tests in terms of result (79%); compared with patients with positive results of both tests, in the seven patients with positive SPECT and negative echocardiography the time of recording echocardiographic images was longer (p = 0.05). When analyzing patients according to the percent diameter stenosis (greater than 70%, 50% to 70%, and less than 50%) for both echocardiography and SPECT, the prevalence of an ischemic response was directly related to the severity of the coronary stenosis (p less than 0.001); moreover, a negative test result was highly predictive of a diameter coronary stenosis less than 70%.(ABSTRACT TRUNCATED AT 250 WORDS)
Contrast Media↗
Localization and synthesis of hyaluronic acid in the cumulus cells and mural granulosa cells of the preovulatory follicle.
Mural and cumulus granulosa cells synthesize hyaluronic acid (HA) and expand in vitro in response to follicle-stimulating hormone and a soluble factor(s) produced by fully grown oocytes. In the present study we examined HA synthesis and extracellular matrix organization by the two cell populations in vivo during the preovulatory period. After injection of human chorionic gonadotropin into pregnant mares' serum gonadotropin-primed animals, a progressive increase in HA synthesis was observed by the cumulus cell-oocyte complex (COC), and by the mural granulosa cells adjacent to the antrum (antral granulosa cells). The outermost layers of mural granulosa cells (peripheral granulosa cells) did not synthesize HA. Net HA synthesis was approximately 4 pg/cell for COCs isolated after full expansion induced either in vivo or in vitro, whereas the total HA content and cell number in the ovulated COC (approximately 11 ng HA and approximately 3000 cells per COC) were about threefold higher than for COCs expanded in vitro (approximately 4 ng HA and approximately 1000 cells per COC). The increased cell content of ovulated COCs appears to be primarily the result of inclusion of proximal mural granulosa cells which synthesize HA in response to the oocyte factor(s) and become incorporated in the expanded COC extracellular matrix mass. Media conditioned by oocytes enclosed in the cumulus cell mass (intact COCs) contained only 10-20% of the HA-stimulatory activity of media conditioned by an equal number of isolated oocytes when tested on mural granulosa cell cultures. Further, HA-stimulatory activity of media conditioned by isolated oocytes was dramatically reduced (approximately 70%) by preincubation for 5 hr with cumulus cells compared to preincubation in the absence of cells. The results suggest that differences in HA synthesis between subregions of membrana granulosa depend on a diffusion gradient of the oocyte factor(s).
Animals↗
Dobutamine stress echocardiography: its role in the diagnosis of coronary artery disease.
We have assessed the usefulness of dobutamine infusion for the diagnosis of coronary artery disease by using two-dimensional echocardiography and 12-lead electrocardiogram. Dobutamine was infused at incremental doses (up to a maximum of 40 micrograms kg-1 min-1) in 52 patients with chest pain; all the patients underwent coronary angiography; significant coronary artery disease was quantitatively defined as greater than or equal to 50% diameter stenosis. Thirty-six patients were on betablockers. The test was considered positive when new regional wall motion abnormalities appeared during dobutamine infusion. No significant side effects occurred in any patient during the test. Transient wall motion abnormalities were detected in 20 of 37 patients with coronary artery disease (sensitivity = 54%); ischaemic ST segment changes were present on ECG in nine patients (sensitivity = 24%). Dobutamine stress echocardiography was negative in 12 of 15 patients with coronary artery diameter stenosis less than 50% (specificity = 80%). Exercise electrocardiography (ECG) was performed in 35 of these 52 patients. Maximum heart rate and systolic blood pressure were significantly higher during exercise than during dobutamine stress test (127 +/- 23 vs 99 +/- 24 beats min-1, P less than 0.0001; 179 +/- 25 vs 152 +/- 30 mmHg, P less than 0.0001). The exercise ECG test was positive in 12 of the 26 patients with significant coronary artery disease (sensitivity = 46%), and dobutamine stress echocardiography in 16 (sensitivity = 62%). Dobutamine stress echocardiography test is a safe and feasible diagnostic test for the noninvasive diagnosis of coronary artery disease and can be performed in patients unable to exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Pharmacological stress echocardiography in the diagnosis of coronary artery disease and myocardial ischaemia: a comparison between dobutamine and dipyridamole.
The objective of this study was to relate regional wall motion abnormalities assessed by dobutamine and dipyridamole stress echocardiography to quantitative measurements of coronary artery stenoses in consecutive patients referred for coronary angiography, and to compare haemodynamic effects of and complications related to the two agents. Patients underwent stress echoes on separate days in random sequence and had coronary angiography within 3 days of stress echocardiography. Echocardiograms were assessed by two investigators unaware of the patients' coronary anatomy. Coronary angiograms were also assessed quantitatively using the computer-assisted Cardiovascular Angiography Analysis System. There were 46 consecutive patients referred for coronary angiography; 28 were using beta-antagonists. Main outcome measures were sensitivity and specificity for dobutamine and dipyridamole stress echocardiography for detection of coronary artery disease (wall motion abnormalities at rest or stress) and myocardial ischaemia (stress induced new wall motion abnormalities). Sensitivity for the detection of myocardial ischaemia was found to be 57% for dobutamine and 64% for dipyridamole. Specificities were 78% and 89% respectively. Sensitivities for detection of coronary artery disease (lesion > or = 50% diameter stenosis) was 79% for dobutamine and 82% for dipyridamole; specificities were 78% and 89% respectively. These differences between the two agents are not significant. There were no severe side effects with either agent. Mean heart rate rose significantly with both tests but was higher with dobutamine; mean systolic blood pressure rose with dobutamine and fell with dipyridamole. It was concluded that dobutamine and dipyridamole stress echocardiography have similar sensitivities and specificities for detection of myocardial ischaemia and coronary artery disease although the haemodynamic effects of the two agents are different. Both are free from serious complications.
Adult↗
Exercise echocardiography versus thallium-201 SPECT for assessing patients before and after PTCA.
This study was designed (1) to assess the relationship between stress exercise echocardiography (echo) and 201-Tl single photon emission computed tomography (SPECT) applied simultaneously in 23 patients who were candidates to percutaneous transluminal coronary angioplasty (PTCA), (2) to assess the relationship between the development of exercise-induced wall motion abnormalities, transient perfusion defects and the severity of quantitatively assessed coronary stenoses and (3) to compare the functional improvement after PTCA by exercise echo and SPECT. Before PTCA there was an agreement of 78% between stress echo (new wall motion abnormalities) and SPECT (transient perfusion defects) results. All patients with a percentage diameter stenosis greater than 70% had a positive echo and SPECT, while they were both negative if the percentage diameter stenosis was less than 50%. In 19 patients re-studied 4 weeks after PTCA, an ischaemic response at stress echo was found in two of the 13 patients who had a positive stress echo test before PTCA, and SPECT was still positive in three of the 10 patients who had a positive SPECT study before PTCA. Echo and SPECT were concordant in 17/19 cases. It is concluded that exercise echo and 201-Tl SPECT are useful non-invasive tools for the functional assessment of patients before and after PTCA, and that they provide highly concordant results.
Aged↗