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At least 973 records · Page 54Linked to original sources
PubMed2002

Quantification of left ventricular diastolic pressure-volume relations during routine cardiac catheterization by two-dimensional digital echo quantification and left ventricular micromanometer.

BACKGROUND: Currently there is no simple clinical method for quantifying the left ventricular (LV) diastolic pressure-volume relation. Echocardiographic-automated endocardial border detection, however, may be combined with LV micromanometer to construct LV pressure-volume loops. We investigated the feasibility of on-line display and sampling of LV pressure-volume loops by such an approach. For this purpose we used a new echocardiographic digital echo quantification (DEQ) method in combination with LV pressures on-line and in real-time. METHODS: Eighteen patients were screened by conventional echocardiography and DEQ. Ten of the patients with high quality images were included in the study. Left ventricular pressures and volumes were recorded simultaneously and were displayed on-line as pressure-volume loops. Changes in LV volume were induced by intravenous saline. Left ventricular chamber compliance was estimated as change in volume divided by change in pressure from minimum diastolic pressure to end-diastolic pressure (average LV chamber compliance). RESULTS: Left ventricular pressure-volume loops were displayed on-line during the examination. When compared with the Simpson's method, DEQ underestimated end-diastolic volume (EDV) by 35% and overestimated end-systolic volume (ESV) by 14%. Beat-to-beat variability for ESV and EDV were 7.4% +/- 0.8% and 7.2% +/- 0.7 %, respectively. Volume loading increased LV end-diastolic pressure (LVEDP) from 14.0 +/- 1.6 to 24.7 +/- 2.0 mm Hg (P <.05) and EDV from 79 +/- 10 to 85 +/- 11 mL (NS), and decreased LV chamber compliance from 4.0 +/- 0.7 to 2.0 +/- 0.3 mL/mm Hg (P <.05). CONCLUSION: The current study demonstrates that LV pressure-volume loops can be displayed and evaluated in real-time during routine cardiac catheterization. This may represent a clinically useful method for identifying patients with reduced chamber compliance. The underestimation of the volumes by DEQ compared with the Simpson's method suggests that further refinements should be performed to improve the endocardial border detection algorithm.

Aged↗
PubMed1999

The effect of race and sex on physicians' recommendations for cardiac catheterization.

BACKGROUND: Epidemiologic studies have reported differences in the use of cardiovascular procedures according to the race and sex of the patient. Whether the differences stem from differences in the recommendations of physicians remains uncertain. METHODS: We developed a computerized survey instrument to assess physicians' recommendations for managing chest pain. Actors portrayed patients with particular characteristics in scripted interviews about their symptoms. A total of 720 physicians at two national meetings of organizations of primary care physicians participated in the survey. Each physician viewed a recorded interview and was given other data about a hypothetical patient. He or she then made recommendations about that patient's care. We used multivariate logistic-regression analysis to assess the effects of the race and sex of the patients on treatment recommendations, while controlling for the physicians' assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test. RESULTS: The physicians' mean (+/-SD) estimates of the probability of coronary artery disease were lower for women (probability, 64.1+/-19.3 percent, vs. 69.2+/-18.2 percent for men; P<0.001), younger patients (63.8+/-19.5 percent for patients who were 55 years old, vs. 69.5+/-17.9 percent for patients who were 70 years old; P<0.001), and patients with nonanginal pain (58.3+/-19.0 percent, vs. 64.4+/-18.3 percent for patients with possible angina and 77.1+/-14.0 percent for those with definite angina; P=0.001). Logistic-regression analysis indicated that women (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) and blacks (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) were less likely to be referred for cardiac catheterization than men and whites, respectively. Analysis of race-sex interactions showed that black women were significantly less likely to be referred for catheterization than white men (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.7; P=0.004). CONCLUSIONS: Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.

Age Factors↗
PubMed1983

Tracking left ventricular performance noninvasively. Response of the peak ear pulse derivative during cardiac catheterization.

The peak derivative of the ear densitograph displacement pulse was monitored on 12 patients undergoing routine coronary angiography and left ventricular angiography. Simultaneous recording of cardiac output, heart rate, systolic time intervals, and ear densitogram were obtained throughout the progression from before angiographic injections to postcoronary angiography to after left ventricular angiography. The peak derivative of the ear densitogram (PD) consistently tracked mean systolic ejection rate, and changes in PD showed good correlation with changes in ejection rate (r=.749, p less than 0.0001). The PD of the ear densitogram appears to be a reliable noninvasive tool for tracking left ventricular function during hemodynamic and other challenges.

Angiocardiography↗
PubMedDate not supplied

Comparative imaging technologies in the cardiac catheterization laboratory.

Evaluation of digital technology in the cardiac cath lab has introduced a desire to extend these technologies into electronic storage capability. Cine film is the current standard for image archiving because it meets the most important requirements of superior resolution, long-term stability, universal viewing and single-patient unit record capabilities. The major limitations of film include serial viewing (versus random access) and its incompatibility with computer techniques, such as quantitative angiography. Manufacturers and vendors have introduced several archiving alternatives that address the limitations of film. These options currently require trade offs and/or compromises in image quality, longevity, cost and numerous other requirements. Investments in alternatives should be made after comprehensive review of the expected productivity gains, anticipated media, equipment and supporting service cost improvements and prospective technological enhancements. This article has introduced a number of the issues that should be considered in comparing archiving media. As technology evolves and standards are developed, this task will become easier. In the meantime, no system to date has been able to achieve the existing advantages of film while overcoming its limitations.

Analog-Digital Conversion↗