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Acid mist and ozone effects on the leaf chemistry of two western conifer species.

Seedlings of Jeffrey pine (Pinus jeffreyi) and giant sequoia (Sequoiadendron gigantea) were more susceptible to leaf chemical changes following exposure to acid mist (pH 3.4-2.0) or acid mist/ozone combinations, than to ozone alone (0.1-0.2 microl/litre), when plants were exposed to alternating doses of these pollutants for 6-9 weeks. Under acid mist treatment, leaves exhibited higher levels of nitrogen and sulfur, two elements applied in acid mist. In addition, levels of foliar sodium, and, in the case of giant sequia, potassium, as well, increased under acid mist treatment. Iron and manganese were also mobilized, resulting in significant increases in these elements in pine, and decreases in manganese in giant sequoia foliage. The acid treatment also reduced chlorophyll b concentrations in pine, and, to a less significant extent, in giant sequoia. Calcium, magnesium, barium and strontium were differentially accumulated in giant sequoia compared to Jeffrey pine. Under acid mist treatment, all of these elements (except strontium) declined in concentration in giant sequoia, with calcium showing the most significant trend. The more extensive changes in leaf chemistry induced by acid mist are consistent with earlier observations of significant changes in spectral reflectance of these seedlings after 3 weeks of fumigation. Limited foliage samples collected from these two species in 1985 and 1986 in Sequoia/Kings Canyon National Parks in the southern Sierra Nevada do not in themselves indicate any clearcut or severe effects of ozone alone on leaf chemistry of these species, but a mild influence of nitrate-laden acid deposition, possibly in combination with ozone, is consistent with the rise in nitrogen and lignin levels in Jeffrey pine on sites observed to have moderate visible injury symptoms. No firm conclusions about effects of pollutants on leaf chemistry in these field sites is possible without further study.

Journal Article↗

Effects of ozone and sulfur dioxide on phyllosphere fungi from three tree species.

Short-term effects of ozone (O(3)) on phyllosphere fungi were studied by examining fungal populations from leaves of giant sequoia (Sequoiadendron giganteum (Lindl.) Buchholz) and California black oak (Quercus kelloggii Newb.). Chronic effects of both O(3) and sulfur dioxide (SO(2)) were studied by isolating fungi from leaves of mature Valencia orange (Citrus sinensis L.) trees. In this chronic-exposure experiment, mature orange trees were fumigated in open-top chambers at the University of California, Riverside, for 4 years with filtered air, ambient air plus filtered air (1:1), ambient air, or filtered air plus SO(2) at 9.3 parts per hundred million. Populations of Alternaria alternata (Fr.) Keissler and Cladosporium cladosporioides (Fres.) de Vries, two of the four most common fungi isolated from orange leaves, were significantly reduced by chronic exposure to ambient air. In the short-term experiments, seedlings of giant sequoia or California black oak were fumigated in open-top chambers in Sequoia National Park for 9 to 11 weeks with filtered air, ambient air, or ambient air plus O(3). These short-term fumigations did not significantly affect the numbers of phyllosphere fungi. Exposure of Valencia orange trees to SO(2) at 9.3 parts per hundred million for 4 years reduced the number of phyllosphere fungi isolated by 75% compared with the number from the filtered-air treatment and reduced the Simpson diversity index value from 3.3 to 2.5. A significant chamber effect was evident since leaves of giant sequoia and California black oak located outside of chambers had more phyllosphere fungi than did seedlings within chambers. Results suggest that chronic exposure to ambient ozone or SO(2) in polluted areas can affect phyllosphere fungal communities, while short-term exposures may not significantly disturb phyllosphere fungi.

Journal Article↗

Altitude-related illness in two California national parks.

High-altitude illness encompasses a spectrum of disorders related to the hypoxia experienced by individuals at elevation. Altitude-related illness has been well described in the United States, but there are no studies published in the medical literature looking at the occurrence of high-altitude illness within the US National Parks system. The purpose of this study is to describe the incidence, treatment, and outcomes of visitors to Sequoia and Kings Canyon National Parks who presented to emergency medical services (EMS) personnel with signs and symptoms consistent with high-altitude illness. We conducted a retrospective review of all EMS patient care records (PCRs) from Sequoia and Kings Canyon National Parks during the study period of June 1992 to August 1995. There were 23 cases of altitude-related illness identified by EMS personnel in the parks during the 38-month study period, including five cases of high-altitude pulmonary edema and 19 cases of acute mountain sickness. One patient died, nine patients were transported to local hospitals, nine patients were assisted in their descent and then released from medical care, and four patients were treated and then allowed to continue their travels. There was an average of 5.9 cases per year of high-altitude illness and an incidence of one case per 27 EMS contacts. We conclude that altitude-related illness does occur in Sequoia and Kings Canyon National Parks and, although high-altitude illness accounts for only 4% of EMS contacts, caring for these patients uses a significant amount of national park resources. We suggest continued training of emergency medical technicians and park medics in the recognition and treatment of these disorders. We also support education of hikers to reduce or prevent the morbidity associated with altitude-related illness.

Adolescent↗

Continuing education at reasonable cost: a case study.

Since January 1, 1995, the American Registry of Radiologic Technologists (ARRT) has mandated that radiologic technologists earn 24 units of continuing education every 24 months. Enforcement will begin in 1997, but the credits must be earned in the two-year period preceding the technologist's birth-month in 1997. Those who have earned 24 credits between their birth-months in 1993 and 1995 will be recognized for voluntary compliance. This article describes how a local affiliate of the California Society of Radiologic Technologists and a hospital in-service program provide continuing education for technologists in a semi-rural area. In 1986 two technologists from Kaweah Delta Hospital organized the Sequoia District Study Group (now called Sequoia District Affiliate). In 1992 that group recognized the need to meet upcoming continuing education requirements and made plans to provide 12 continuing education units per year. The Kaweah Health Care District offers financial support of the group's program and pays an annual fee to the ASRT to receive designated providership of continuing education. Individuals who pay a small annual membership fee to the Sequoia District Affiliate attend meetings for free and receive a discount on registration for an annual seminar. Staff involvement in soliciting speakers generates greater interest and better attendance. Cooperation between staff and management can facilitate the implementation of a low-cost education program that meets ARRT requirements.

California↗

Evaluation of cerebral perfusion deficit in stroke patients using new transcranial contrast imaging CPS technology--preliminary results.

BACKGROUND AND PURPOSE: Contrast-enhanced transcranial duplex sonography can be used to examine cerebral perfusion. This technique, however, is still faced with methodological problems. The aim of the present study is to evaluate cerebral perfusion deficit after administration of the contrast agent SonoVue in acute stroke patients using new contrast imaging software. METHODS: Ten subjects (6 male stroke patients and 4 healthy volunteers), were examined using transcranial duplex sonography (Acuson Sequoia 512 Ultrasound System) after a bolus injection of the contrast agent SonoVue. The transcranial examination was performed using transient response harmonic grey scale imaging with refill kinetics. The Sequoia ultrasonographic system was equipped with a new contrast harmonic imaging software "Cadence contrast pulse sequencing technology" (CPS). Triggered images with the mechanical index (MI) at 1.1 as well as continuous registration with MI at 0.28 were used for the evaluation of time intensity curves in several regions of interest. The sonographically imaged hypoperfused areas were compared with findings from MR imaging. RESULTS: In all healthy volunteers, the contrast-enhanced signal could be recognized well in the ipsi- and also in the contralateral hemisphere up to the skull crown. In stroke patients, the perfusion deficit in the area of the MCA could be detected ipsilaterally in all subjects using triggered registration. Additionally, the area of MCA infarction could also be visualized in two patients using contralateral insonation. The low MI continuous imaging was successful in three patients. For all patients, the ischaemic region corresponded well in shape and size with the findings from MR imaging. CONCLUSIONS: CPS enhances the possibility of perfusion-imaging in cerebral microcirculation and of perfusion-deficit-imaging in patients with cerebral ischaemia. Further studies with a larger number of patients should be carried out to improve this method.

Cerebrovascular Circulation↗

[Phylogenetic relationships among the genera of Taxodiaceae and Cupressaceae from 28S rDNA sequences].

DNA sequences from 28S rDNA were used to assess relationships between and within traditional Taxodiaceae and Cupressaceae s.s. The MP tree and NJ tree generally are similar to one another. The results show that Taxodiaceae and Cupressaceae s.s. form a monophyletic conifer lineage excluding Sciadopitys. In the Taxodiaceae-Cupressaceae s.s. monophyletic group, the Taxodiaceae is paraphyletic. Taxodium, Glyptostrobus and Cryptomeria forming a clade(Taxodioideae), in which Glyptostrobus and Taxodium are closely related and sister to Cryptomeria; Sequoia, Sequoiadendron and Metasequoia are closely related to each other, forming another clade (Sequoioideae), in which Sequoia and Sequoiadendron are closely related and sister to Metasequoia; the seven genera of Cupressaceae s.s. are found to be closely related to form a monophyletic lineage (Cupressoideae). These results are basically similar to analyses from chloroplast gene data. But the relationships among Taiwania, Sequoioideae, Taxodioideae, and Cupressoideae remain unclear because of the slow evolution rate of 28S rDNA, which might best be answered by sequencing more rapidly evolving nuclear genes.

English Abstract↗

Chronomics of tree rings for chronoastrobiology and beyond.

Gliding spectral windows illustrate the changes as a function of time in the relative prominence of signals in a given frequency range, viewed in 3D or as surface charts. As an example, the method is applied to a 2,189-year series of averages of ring measurements on 11 sequoia trees published by Douglass. Analyses of the original data and after filtering reveal, among others, components with periods of about 10.5 and 21 years similar to the Schwabe and Hale solar activity cycles. An alignment of gliding spectra with a global spectrum serves to define, by minima, the ranges of variability around the anticipated Schwabe and Hale cycles. This procedure may have more general applicability when dealing with ranges of only transiently synchronized, wobbly, and perhaps sometimes free-running periodicities. Solar activity is known to affect climate and changes in climate are reflected to some extent in tree growth. The spectral structure in tree rings could serve not only to check any relations of climate with sunspots, auroras and more modern measures of solar activity, but also to check any purely mathematical extrapolations from the much shorter available actual data on solar activity. With such extrapolated series and the data analyzed herein, the task remains to align physical and physiological variables to further study the influence of natural environmental factors near and far on biota, including international battles, which cover an even longer span of 2,556 years.

Chronobiology Phenomena↗

Sequoiamonascins a-d: novel anticancer metabolites isolated from a redwood endophyte.

Aspergillus parasiticus, a fungal isolate from the bark of a redwood tree (Sequoia sempervirens), has been shown to produce the antitumor metabolites sequoiatones A and B and more recently the sequoiatones C-F. We have also isolated another series of compounds with a new carbon skeleton, the sequoiamonascins. The structures of sequoiamonascins A-D were deduced by interpretation of their spectral data and that of some reaction products. The sequoiamonascins were isolated by brine shrimp lethality-guided fractionation and were submitted to the NCI for anticancer evaluation.

Animals↗

The limits to tree height.

Trees grow tall where resources are abundant, stresses are minor, and competition for light places a premium on height growth. The height to which trees can grow and the biophysical determinants of maximum height are poorly understood. Some models predict heights of up to 120 m in the absence of mechanical damage, but there are historical accounts of taller trees. Current hypotheses of height limitation focus on increasing water transport constraints in taller trees and the resulting reductions in leaf photosynthesis. We studied redwoods (Sequoia sempervirens), including the tallest known tree on Earth (112.7 m), in wet temperate forests of northern California. Our regression analyses of height gradients in leaf functional characteristics estimate a maximum tree height of 122-130 m barring mechanical damage, similar to the tallest recorded trees of the past. As trees grow taller, increasing leaf water stress due to gravity and path length resistance may ultimately limit leaf expansion and photosynthesis for further height growth, even with ample soil moisture.

Biological Transport↗

Noninvasive phenotypic analysis of cardiovascular structure and function in fetal mice using ultrasound.

METHODS: We established methods for noninvasive mouse fetal heart imaging using an Acuson/Siemens Sequoia ultrasound scanner equipped with a single-pulse CHIRP Coded Excitation program, and a highfrequency linear array transducer. Mouse fetuses spanning gestation day 12.5 to 18.5 (E12.5-E18.5) were studied. RESULTS: Controlled anesthetic and constant body temperature were found to be essential for hemodynamic stability of the mother and fetuses. Fetal heart rates increased from 160 to 220 beats/min as development progressed. These heart rates were lower than those of newborn mice, so that frame rates above 100 Hz adequately resolved structural details in 2D without misregistration. Analysis of 2D images showed a doubling in crown-torump length (8-19 mm), and rapid growth of the heart from 1 to 3 mm in diameter as fetuses developed from E12.5 to E18.5. A cumulative increase in scanning modalities was achieved with increasing developmental age, with the optimal stage for scanning being E16.5. At E16.5 right and left could be distinguished, and it was possible to obtain diagnostic 2D color flow Doppler in the four-chamber, apical long axis 3/5-chamber and short axis views. In addition, M-mode images of high quality were obtainable from E15.5 to E18.5, whereas spectral Doppler signals could be obtained readily from E12.5 onwards. CONCLUSIONS: These studies show that ultrasound imaging can be used for structural and functional analysis of the developing mammalian heart, even at early stages of development. Such noninvasive cardiovascular ultrasonic evaluation should be ideally suited for high throughput screening of mutagenized mice.

Algorithms↗

A two-dimensional electrophoresis procedure for single meristems of different forest species.

High resolution two-dimensional electrophoresis, with isoelectric focusing in the first dimension and electrophoresis in sodium dodecyl sulfate in thin acrylamide gels in the second dimension, has been applied to separate the proteins of single meristems (200-300 microns) from Sequoiadendron giganteum, Sequoia sempervirens, Pseudotsuga menziesii, Picea abies, Pinus pinaster, Eucalyptus gunnii and Populus nigra. The technique may prove an efficient tool for studying inter- and intraclonal differences in meristem cultures of forest species, especially when referring to cloning from meristems of selected trees in relation to the rejuvenation process.

Electrophoresis, Gel, Two-Dimensional↗

Role of parametric imaging in contrast-enhanced sonography of hepatic focal nodular hyperplasia.

PURPOSE: To assess the value of parametric imaging during contrast-enhanced sonographic examination in the diagnosis of focal nodular hyperplasia (FNH) of the liver. MATERIALS AND METHODS: Thirty-one patients with solitary FNH underwent contrast-enhanced sonographic examination between January 2003 and June 2004 using SonoVue and a Sequoia scanner equipped with Cadence Contrast Pulse Sequencing software. Contrast enhancement from a time sequence of perfusion frames was estimated using QontraXt software, which provides quantification of perfusion parameters. From the time-intensity curves, we obtained the following parameters: peak enhancement value, Tr (time recovery corresponding to time needed to reach 63% of the peak value), beta parameter corresponding to the exponential factor, and slope corresponding to the slope of the tangent to the arterial phase of enhancement. RESULTS: Among the 4 parameters studied, the slope of the arterial phase of enhancement was the most sensitive to image the centrifugal arterial flow originating from the central portion of the lesion, whereas peak enhancement value and Tr were the most sensitive to image full enhancement of the lesion. A blinded review revealed equivalent sensitivity in the diagnosis of FNH between the interpretation of the original videoclips and that of the parametric images. CONCLUSIONS: The results of this study show that parametric imaging can be used in place of original videoclips for clinical reporting of FNH; furthermore, it could help less-experienced sonologists diagnose FNH.

Adult↗

Ultrastructure of the annual cycle of female sperm storage in spermathecae of the torrent salamander, Rhyacotriton variegatus (Amphibia: Rhyacotritonidae).

This study is the first report on the ultrastructure of the sperm storage glands (spermathecae) in the salamander Rhyacotriton variegatus. The population studied is associated with cold-water, rocky streams of the redwood (Sequoia) zone in northern California. Males possess sperm in their vasa deferentia and undergo spermiation throughout the year, but mating is seasonal. Most females with large, vitellogenic follicles (2.0-3.9 mm mean dia.) collected from February-June contain sperm in their spermathecae, although some females with large follicles lack sperm. Other mature-size females collected during this period have small ovarian follicles (0.9-1.2 mm mean dia.) and lack stored sperm. All females collected from September-November have small follicles (0.6-1.6 mm mean dia.) and lack sperm, except in one instance in which a female collected in November had a small amount of degraded sperm, apparently retained from the previous breeding season. The spermathecae consist of simple tubulo-alveolar glands in which the neck tubules produce a mucoid secretory product, and the distal bulbs, where sperm are stored, contain secretory vacuoles of uniform density that stain positively for glycosaminoglycans. In specimens containing sperm, some bulbs have abundant sperm and others lack sperm, but the ultrastructure is similar in both conditions. The acini contain columnar epithelial cells with wide intercellular canaliculi, and a merocrine process releases the secretion. Spermiophagy occurs. In specimens from spring and summer with small ovarian follicles, the neck tubules are similar to those of breeding females, but the distal bulbs are reduced to cords of cells lacking a discernible lumen. Secretory activity in the distal bulbs is initiated in the fall. Spermathecae of R. variegatus are most similar to those of a stream-dwelling plethodontid, Eurycea cirrigera.

Animals↗

Thallium-201 gated single-photon emission tomography for the assessment of left ventricular ejection fraction and regional wall motion abnormalities in comparison with two-dimensional echocardiography.

Simultaneous assessment of myocardial perfusion and function by gated single-photon emission tomography (GS) after a single tracer injection provides incremental information and is feasible with technetium-99m sestamibi. The present study validated the use of GS with thallium-201 for the assessment of left ventricular ejection fraction (LVEF) and regional wall motion by comparison with two-dimensional (2D) echocardiography (echo), which has not been done before. After injection of 111 MBq 201Tl at peak bicycle exercise (n = 55) or pharmacological stress (n = 17), GS was acquired 15 (post stress) and 120 min post injection (rest) on a double-head camera. An automatic algorithm (QGS) was used for processing. Echo (Acuson Sequoia C256) was performed immediately after rest GS. LVEFs assessed by GS and echo were correlated. The overall and segmental sensitivity and specificity of GS for the detection of regional wall motion abnormalities (WMAs) were calculated, echo serving as the gold standard. Perfusion abnormalities were scored. The success rate of the automatic algorithm was 100%, and visually assessed image quality was good to excellent in 88% of cases. Post-stress and rest LVEF as assessed by GS were highly correlated (r = 0.91). Good correlations were obtained between post-stress LVEF (GS) and rest LVEF (echo) and between rest LVEF (GS) and rest LVEF (echo) (r = 0.76 and 0.86 respectively). In patients with a reduced LVEF of less than 50% (n = 23), these correlations were even better (r = 0.84 and 0.89 respectively). Regional wall motion abnormalities (WMAs) were identified by GS with high sensitivity and specificity (88%-100% and 82%-98% respectively) and were directly related to the extent and severity of stress as well as of resting perfusion defects. It is concluded that GS with 201Tl is a feasible and reliable tool for the evaluation of patients with compromised left ventricular function in the context of coronary artery disease, and thus improves diagnosis and prognostic stratification. Regional WMAs were identified with high diagnostic accuracy and the method may prove helpful for the detection of myocardial viability.

Female↗

The influence of circadian blood pressure changes on aortic distensibility and left ventricular diastolic function in hypertensive individuals.

BACKGROUND: Failure to decrease blood pressure (BP) normally during nighttime, which is called non-dipper, in hypertensive individuals is associated with higher cardiovascular morbidity and mortality. In addition, non-dipper BP leads to structural changes in the left ventricle; however, the influences of non-dipper BP on aortic elastic properties and left ventricular diastolic function have not been studied yet. METHODS: In this study, we evaluated aortic elastic properties and left ventricular diastolic function of 22 subjects with non-dipper hypertension, and 15 subjects with dipper hypertension using transthoracic second harmonic standard and tissue Doppler echocardiography (Acuson Sequoia C256). None of the subjects had any systemic disease or coronary risk factor except hypertension. RESULTS: Age, gender, body mass index, lipids, and standard echocardiographic findings including left ventricular mass index were similar between the groups. Office BP recordings were similar between non-dipper and dipper groups (147.9+/-6.1/93.9+/-4.3 vs. 144.0+/-8.0/93.0+/-3.7). Daytime and 24-h ambulatory BP measurements were similar within the groups, but nighttime BPs were significantly greater in non-dipper group than those were in dipper group. Left ventricular diastolic parameters obtained by both standard and tissue Doppler did not differ between the non-dipper and dipper groups. However, aortic distensibility was found to be slightly lower (4.1+/-2.4 vs. 4.9+/-1.9, p=0.08), and aortic stiffness index (6.3+/-0.5 vs. 6.1+/-0.4, p=0.08) and elastic modulus (6.2+/-2.5 vs. 4.8+/-2.3, p=0.08; groups non-dipper and dipper respectively) higher in non-dipper group than in dipper group. However, these differences were not statistically significant. CONCLUSION: Left ventricular remodeling and diastolic function were similar in patients with non-dipper and dipper hypertension. However, aortic elastic properties were slightly impaired in non-dipper hypertensives than those were in dipper ones, but these differences did not reach statistically significance.

Aorta, Thoracic↗

Doppler Tissue Imaging positive preejection velocity wave is a sign of non-transmural necrosis: comparison with delayed-enhancement cardiac magnetic resonance.

AIMS: Our purpose was to test the hypothesis that Tissue Doppler Imaging (TDI)-derived positive preejection velocity (PPV) is associated with transmural extent of necrosis in delayed-enhancement cardio-magnetic resonance (DE-CMR) in patients with reperfused myocardial infarction (MI). METHODS AND RESULTS: Longitudinal myocardial velocities were recorded by TDI in 24 patients with MI reperfused with primary angioplasty, using an Acuson-Sequoia equipment. The same day a CMR study was performed, including cine images in short axis and long axis views and DE images in the same views using a 3D-T1-Turbo-field-echo sequence, 15 min after administration of gadodiamide. Transmural extent of hyperenhancement in each segment was compared to presence or absence of PPV wave. A total of 384 segments were evaluated. Normo-hypokinetic segments (100%) showed a PPV wave, whereas it was only present in 53% of akinetic-dyskinetic segments (p=0.0005). One hundred percent of the segments with absent-mild DE showed a PPV wave; this percentage was lower in segments with intermediate and transmural DE (63 and 10%, p=0.001). The presence of PPV wave in an akinetic segment ruled out transmural necrosis with 97% sensitivity and 90% specificity. CONCLUSIONS: The absence of PPV is strongly associated to transmural necrosis in MI and therefore to absence of viability.

Aged↗

Effects of local estrogen therapy on recurrent urinary tract infections in young females under oral contraceptives.

BACKGROUND: Previous studies have demonstrated the efficacy of local application of estrogen in treating postmenopausal women with recurrent urinary tract infections (RUTI) and urinary incontinence. Younger women under oral contraceptives (OC) can suffer from similar symptoms. The aim of this pilot study was to evaluate the effectiveness of local estrogens on RUTI and the impact of local hormonal supplementation on bladder neck vascularization. METHODS: 30 women (mean age 22.7 years) with a longstanding history of RUTI were included. Pre-treatment investigation included complete clinical history, urinalysis, urine culture and cystoscopy. All subjects completed a questionnaire about onset and duration of disease and quality of life before and after treatment. Local (vaginal) estrogen therapy consisted of 1mg estriol (E3) 7 times a week for two weeks and twice a week for two additional weeks. Sonographic examination of bladder vascularization was performed before and after treatment using transperineal color Doppler ultrasound (6 MHz, Acuson Sequoia 512, Mountain View, CA, USA) with a filled bladder. After angle correction, peak systolic blood flow velocity (PSBFV) and end diastolic blood flow velocity (EDBFV) were measured in 2 bladder arteries; and the Resistive Index (RI) was calculated. Flow velocity in each vessel was measured at least four times and the mean value determined. RESULTS: All patients completed the therapy course without severe side effects. Patients had a mean history of RUTI over 2.3 years; the mean period under OC was 3.2 years. In the follow-up period of 11 months after treatment, 24/30 patients reported no symptoms of cystitis and used no additional medication. Normal bladder epithelium in control cystoscopy after E3 therapy was seen in all patients with trigonal metaplasia and vulnerable, highly vascularized urothelium at the initial investigation. RI decreased from 0.945 to 0.705 after treatment (p<0.001), concomitantly the mean EDBFV increased highly significantly from 0.82 cm/sec to 4.45 cm/sec after estrogen treatment (p<0.001). INTERPRETATION: In a majority of young patients under OC and a longstanding history of RUTI, a considerable infection-free period was achieved after local application of estrogen. Decreased RI and increased EDBFV indicate vasodilatation and less peripheral vascular resistance. Responsiveness to local E3 may correspond to improved cystoscopic findings as a consequence of increased bladder perfusion.

Administration, Intravaginal↗

Real-time myocardial contrast dobutamine stress echocardiography in coronary stenosis.

BACKGROUND: Simultaneous wall motion and myocardial perfusion analysis could offer advantages over either method alone. Diagnostic utility of combining these parameters during dobutamine stress echocardiography is evaluated in this study. METHODS: Myocardial contrast dobutamine stress echocardiography was performed on thirty-eight patients with single or double vessel coronary artery stenosis of >50%. Two-dimensional standard wall motion images were acquired at baseline, low, intermediate and peak stages of dobutamine stress echocardiography. Contrast enhanced wall motion and perfusion were assessed with Cadence Contrast Imaging (Sequoia C256, Acuson) and Optison infusion (GE Healthcare) at baseline and peak stages of the same protocol. Perfusion was analysed by identification of contrast defects and by measuring contrast replenishment time after destructive ultrasound pulses. RESULTS: The group consisted of 28 males and 10 females, mean age 60.9+/-9.7 years. Fifty-four out of one hundred and fourteen coronary arteries were affected by stenoses >50%. Standard wall motion analysis was assessable in 37 cases, one of which was inconclusive, while contrast wall motion and perfusion were assessable in 32 cases. Accuracy for coronary stenosis was 84% for standard wall motion (108 coronary territories), 82% for contrast wall motion (96 territories), 69% for peak stress contrast defects (83 territories), 91% for combined peak stress contrast defects and increased contrast replenishment time (85 territories), and 90% for all contrast modalities combined (96 territories). CONCLUSION: Combined wall motion and real-time perfusion assessment during dobutamine stress is feasible and at least equivalent to conventional stress echocardiography for detection of significant coronary stenosis.

Aged↗