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Biomedical subjects

E H Botvinick

Publications and source records attributed to E H Botvinick.

At least 109 records · Page 6Linked to original sources
PubMed1980

The complementary roles of M-mode echocardiography and scintigraphy in the evaluation of adults with suspected left-to-right shunts. Additional observations on the role of two-dimensional echocardiography.

We sought to determine the relative clinical abilities and roles of echocardiography and scintigraphy in left-to-right shunt diagnosis. M-mode echocardiographic and scintigraphic studies were analyzed in 37 adults presenting diagnostic difficulties with suspected left-to-right shunts. The historic, physical, radiographic and electrocardiographic data were frequently ambiguous. An enlarged right ventricle on M-mode echocardiography was a sensitive (100%) but not specific (55%) indicator of atrial septal defect (ASD). M-mode lacked sensitivity for ventricular septal defect (VSD) and patent ductus arteriosus (PDA). In a few studies, two-dimensional echocardiography provided additional specific and clinically important anatomic information. Scintigraphic analysis demonstrated complete diagnostic accuracy and excellent localizing and quantitative abilities in all patients studied. Because it is extremely sensitive to ASD, free of any exposure to radioactivity, entirely noninvasive and may be simply and visually analyzed, echocardiography is the study of choice in the preliminary evaluation of patients presenting diagnostic difficulty with suspected ASD. Scintigraphy is the study of choice in the preliminary evaluation of patients presenting diagnostic difficulty with suspected VSD and PDA and is the logical response to the finding of echocardiographic right ventricular enlargement when the diagnosis remains in doubt.

Cardiac Catheterization↗
PubMed1979

Left ventricular volume from paired biplane two-dimensional echocardiography.

To evaluate the applicability of two-dimensional echocardiography to left ventricular volume determination, 30 consecutive patients undergoing biplane left ventricular cineangiography were studied with a wide-angle (84 degrees), phased-array, two-dimensional echocardiographic system. Two echographic projections were used to obtain paired, biplane, tomographic images of the left ventricle. We used the short-axis view (from the precordial window) as an anolog of the left anterior oblique angiogram, and the long-axis, two-chamber view (from the apex impulse window) as a right anterior oblique angiographic equivalent. A modified Simpson's rule formula was used to calculate systolic and diastolic left ventricular volumes from the biplane echogram and the biplane angiogram. These methods correlated well for ejection fraction (r = 0.87) and systolic volume (r = 0.90), but only modestly for diastolic volume (r = 0.80). These correlations are noteworthy because 65% of the patients had significant segmental wall motion abnormalities. The volumes determined from the minor-axis dimensions of M-mode echograms in 23 of the same patients correlated poorly with angiography.

Adult↗
PubMed1978

Thallium-20 1 myocardial perfusion scintigraphy for the clinical clarification of normal, abnormal and equivocal electrocardiographic stress tests.

Sixty-five patients were studied with stress electrocardiography and thallium-20 1 relative myocardial perfusion scintigraphy. Results were correlated with selective coronary angiography. Scintigraphy was more sensitive (85 versus 67 percent), more specific (89 versus 63 percent) and significantly more accurate (87 versus 65 percent) than stress electrocardiography for the diagnosis of significant coronary arterial lesions in patients with isoelectric S-T segments at rest. Stress scintigraphy helped clarify the equivocal stress test due to left bundle branch block, left ventricular hypertrophy, drugs, hyperventilation and other conditions and was more accurate than the stress electrocardiogram (89 versus 53 percent) even in the presence of a depressed S-t segment at rest. Thallium-20 1 scintigraphy is a safe and simple noninvasive method for identifying abnormal myocardial perfusion, stress-induced ischemia and, indirectly, significant coronary arterial lesions.

Adult↗
PubMed1978

Thallium-201 myocardial perfusion scintigraphy to evaluate patients after coronary bypass surgery.

To determine the utility of thallium-201 stress scintigraphy in assessing the results of coronary bypass surgery, chest pain, stress electrocardiograms and scintigrams were evaluated in 27 patients postoperatively. These findings were compared with coronary angiographic data in which a significant postoperative lesion was defined as 75 percent or more stenosis in a graft, its distal vessel or in an ungrafted native vessel. As an indicator of postoperative coronary lesions, chest pain lacked sensitivity (60 percent) and was nonspecific (20 percent). The stress electrocardiogram had poor sensitivity (60 percent) and good specificity (86 percent) but was not helpful in six patients who had equivocal or suboptimal tests. The scintigram had good sensitivity (77 percent) and was highly specific for the diagnosis of coronary stenosis. It was significantly more specific than chest pain (P less than 0.01), gave excellent localizing information and added to the accuracy of both conclusive and inconclusive stress tests. In nine patients with preoperative stress scintigrams, comparison of pre- and postoperative studies reflected the éffects of bypass surgery on coronary perfusion. Scintigraphy is a useful technique for the noninvasive evaluation of the patient after coronary bypass surgery, and postoperative scintigraphy alone is of great value in documenting surgical results.

Adult↗
PubMed1978

Gallium-67 uptake in silent myocardial infarction: a case report.

Scintigrams obtained 24 and 48 hours after the injection of 67Ga in a patient undergoing evaluation for fever of unknown origin revealed positive myocardial uptake. The subsequent clinical course, electrocardiograms, radionuclear studies, and postmortem examination confirmed a silent myocardial infarction in the region of 67Ga localization. No other clinical reports were found of an acute myocardial infarction diagnosed by scintigraphy with 67Ga.

Electrocardiography↗
PubMed1978

Myocardial perfusion scintigraphy in patients with mitral valve prolapse: Its advantage over stress electrocardiography in diagnosing associated coronary artery disease and its implications for the etiology of chest pain.

Patients with mitral valve prolapse (MVP) frequently experience chest pain which may, expecially in older subjects and males, be difficult to differentiate from angina pectoris. Electrocardiographic (ECG) changes, ventricular arrhythmias, metabolic abnormalities and rare reports of myocardial infarction and sudden death further suggest the presence of an ischemic process in these patients. The recognition of accompanying coronary artery disease (CAD) and exclusion of other causes of ischemia, therefore, may be important in determining the prognosis and appropriate therapy for such patients.

Adult↗
PubMed1978

The clinical estimation of acute myocardial infarct size with 99mTechnetium pyrophosphate scintigraphy.

We evaluated scintigraphic techniques in estimating infarct size. In 26 patients with acute transmural myocardial infarction, 99mTechnetium pyrophosphate (TcPYP) infarct scintigraphy, gated cardiac blood pool scintigraphy and 201-Thallium (201-Tl) perfusion scintigraphy were performed. Invasive hemodynamic measurements were obtained and serial venous blood specimens taken for measurement of total and MB creatine phosphokinase (CPK). In farct size was estimated from the area of abnormal TcPYP uptake, the extent of reduced 201-Tl uptake, the percentage of abnormally contracting segments, and serial enzyme measurements. Left ventricular ejection fraction (LVEF) and stroke work index (LVSWI) were calculated. TcPYP infarct area was associated with the extent of reduced 201-Tl uptake (r = 0.66), the percentage of abnormally contracting segments (r = 0.64), and with both LVSWI (r = 0.73) and LVEF (r = 0.58). TcPYP infarct area did not correlate with cumulative total or MB-CPK release or the integrated total CPK-time curve, nor did the enzyme estimates of infarct size correlate with LVSWI or LVEF. Variable perfusion of infarcts of different sizes may explain the lack of correlation between TcPYP infarct area and enzyme estimates of infarct size. A combination of anatomic and functional indices derived from scintigraphic and hemodynamic measurements may provide the best assessment of infarct size.

Acute Disease↗
PubMed1978

The noninvasive diagnosis of right ventricular infarction.

We evaluated scintigraphy and echocardiography for the diagnosis of right ventricular (RV) infarction. Of 26 patients with acute transmural myocardial infarction (MI), six with inferior MI had abnormal radionuclide uptake localized to the RV free wall on infarct scintigraphy or segmental akinesis of the RV free wall on gated radioangiography or both. These six patients with RV involvement (group I) were compared with the remaining nine with inferior MI (group II) and 11 with anterior MI (group III). RV/LV area ratios determined radioangiographically were significantly greater in group I than group II in diastole and systole. Echocardiographic RV enddiastolic dimension and RV/LV end-diastolic dimension ratio were significantly greater and RV stroke work index was significantly lower in group I than in group II. Predominant RV involvement in inferior MI may occur commonly. Anatomic and functional evidence of this diagnosis can be obtained noninvasively.

Echocardiography↗
PubMed1978

Beneficial effects of hydralazine in severe mitral regurgitation.

The severity of mitral regurgitation is, in part, determined by aortic impedance to left ventricular outflow. Sodium nitroprusside acutely decreases regurgitant flow, but the importance of its dual vasodilating effects, the lowering of peripheral vascular resistance and increasing of venous capacitance, is unclear. We studied the hemodynamic response to intravenous hydralazine, which selectively acts on the arteriolar resistance bed, in 10 patients with severe mitral regurgitation. Hydralazine produced a 50% increase in forward stroke volume (22 +/- 2 to 33 +/- 3 ml/m2, P less than 0.001) and a 33% reduction in regurgitant stroke volume (40 +/- 6 to 27 +/- 6 ml/m2, P less than 0.001), with a resultant fall in pulmonary capillary wedge v wave and mean pressures. Unlike nitroprusside, it did not alter left ventricular end-diastolic volume or pressure. Oral hydralazine maintained this hemodynamic improvement for at least 48 hours and, in three patients, provided more sustained clinical improvement. We conclude that hydralazine, by virtue of its selective lowering of aortic impedance, reduces the amount of mitral regurgitation and thus may be a useful mode of interim or chronic therapy in selected patients.

Adult↗
PubMed1978

Relationship of regional myocardial perfusion to segmental wall motion: a physiologic basis for understanding the presence and reversibility of asynergy.

Experimental work has shown that even small reductions in myocardial perfusion impair contractile performance. We, therefore, studied the relationship between regional perfusion, assessed by thallium-201 scintigraphy and segmental wall motion, quantitated on biplane contrast ventriculograms, in patients with coronary artery disease. We evaluated 270 segments in 54 patients, including 27 without evidence of myocardial infarction. Most normally perfused regions (125 of 140) contracted normally, whereas those with scintigraphic defects at rest were usually asynergic (42 of 46). Surprisingly, 57% (48 of 84) of regions with exercise-induced perfusion defects were also asynergic, including 48% (25 of 52) of those in patients without myocardial infarction. In 22 patients who had intervention ventriculograms, improvement of perfusion abnormalities at rest correlated closely with reversibility of asynergy. Although there was an association between the location and severity of coronary artery stenosis and segmental wall motion, myocardial perfusion during exercise was a significantly better predictor of asynergy. These findings suggest that resting asynergy may occur even in patients without previous infarction, predominantly in regions with jeopardized perfusion. Asynergy in regions with exercise-induced perfusion abnormalities may, therefore, be an indicator of resting ischemia and may be reversible by coronary artery revascularization.

Adult↗
PubMed1978

The specificity of pyrophosphate myocardial scintigrams in patients with prior myocardial infarction: concise communication.

Fifty-five patients with old (9 days to 10 yr) transmural infarcts but with no evidence of recent infarction, were imaged with Tc-99m pyrophosphate. Discrete uptake was rare in the setting of an old infarct. Diffuse uptake was neither sensitive to, nor specific for, acute infarction. Prior infarction will rarely cause diagnostic error if the discrete pattern is required for a positive diagnosis.

Acute Disease↗
PubMed1977

Myocardial stress perfusion scintigraphy with rubidium-81 versus stress electrocardiography.

Fifty-six patients who subsequently underwent selective coronary angiography were studied noninvasively with relative myocardial perfusion scintigraphy with rubidium-81 and graded stress electrocardiography in an attempt to evaluate the ability of these tests to identify the presence of significant ischemia and, indirectly, coronary stenosis. Both the sensitivity (0.91) and specificity (0.91) of perfusion scintigraphy were impressive and better than the sensitivity (0.79) and specificity (0.64) of stress electrocardiography, the specificity of scintigraphy significantly so (P less than 0.05). Additionally, perfusion scintigraphy yielded excellent localizing information and was reliable even in the presence of drug effect, conduction abnormalities and nonspecific electrocardiographic abnormalities. Rare cases of triple vessel disease, prior myocardial infarction or single vessel disease with widespread collateral vessels were causes of scintigraphic misdiagnosis. Although ribidium-81 perfusion scintigraphy with the scintillation camera requires special collimation and significant quality control, it provides well resolved images and may prove particularly useful in facilitating quick successive multiple scintigraphic cardiac studies.

Angina Pectoris↗
PubMed1977

The specificity of the diffuse pattern of cardiac uptake in myocardial infarction imaging with technetium-99m stannous pyrophosphate.

To analyze the specificity of the diffuse pattern of cardiac uptake with technetium-99m stannous pyrophosphate (TcPYP), we evaluated the bone scans of 1,383 noncardiac patients and the myocardial scintigrams of 120 cardiac patients. Seventy (14.4%) of 483 bone scans performed on a scintillation camera revealed diffuse TcPYP cardiac uptake. Among the total 603 camera bone scans and myocardial scintigrams, the incidence of diffuse cardiac uptake was 16% among patients with clinical coronary disease but 13% among those patients without clinical symptoms. Discrete myocardial uptake was seen in 25 of 26 patients with transmural infarction. Femoral vasculature was more frequently visualized (84% vs 3%, P less than 0.001) and left mastectomy occurred more often (30% vs 1%, P less than 0.001) among patients with diffuse cardiac uptake than among patients with negative images, indicating possible blood pool imaging. The diffuse pattern of cardiac uptake appeared nonspecific and may be due to unintentional cardiac blood pool imaging.

Bone and Bones↗