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PubMed1986

Isoproterenol infusion stress two-dimensional echocardiography in diagnosis of coronary artery disease in elderly patients. Comparison with the other stress testing methods.

Since a dynamic exercise stress test cannot always be performed adequately in elderly patients, an alternative method is needed for evaluation of coronary reserve. We studied two-dimensional echocardiographic (2-DE) and electrocardiographic (ECG) responses to infusion of isoproterenol (ISP) at a rate of 0.02 micrograms/Kg/min in 40 elderly patients with chest pain. The results were compared with exercise ECG (EX-ECG) tests and exercise radionuclide angiocardiography (EX-RNA) in 13 of these patients. No serious complications were encountered in the ISP test. The diagnostic sensitivity for coronary artery disease (CAD) was 71% for ISP-2-DE, 71% for ISP-ECG, 86% for EX-ECG and 71% for EX-RNA. The specificity for CAD was 83% for ISP-2-DE, 33% for ISP-ECG, 50% for EX-ECG and 100% for EX-RNA. In conclusion, the ISP-2-DE test is a safe, easily available and useful method for the assessment of coronary artery disease in elderly patients.

Aged↗

PubMed2006

Importance of right ventricular end-systolic regional wall stress in idiopathic pulmonary arterial hypertension: a new method for estimation of right ventricular wall stress.

RV dysfunction in idiopathic (primary) pulmonary hypertension (IPAH) is often characterized by chamber dilation, ventricular hypertrophy, and impaired systolic function. In this study we characterize right ventricular (RV) chamber size, end-diastolic thickness, myocardial mass, and ejection fraction in patients with right ventricular heart failure from IPAH, n = 16 and compare these characteristics to a control population of cardiac transplant patients (TX, n = 4) and a group of normal subjects (N, n = 5). Subjects underwent both gated cardiac magnetic resonance imaging (MRI) of the right ventricle and right heart catheterization (RHC). Using parameters from both the MRI and RHC, an estimate of RV end-systolic relative wall stress (RWS) was calculated. RV RWS was 34.7 +/- 8.4 and 17.3 +/- 3.8 Kdynes/cm2 in the cardiac transplant and control subjects respectively and was significantly elevated 104.1 Kdynes/cm2 in IPAH patients (IPAH vs N and TX; p = 0.004 and 0.008 ). RV ejection fraction RVEF was lower in IPAH patients 0.36 +/- .10 than in N and TX 0.57 +/- .04 and 0.55 +/- .08 respectively, (p = 0.0006 N and 0.0007 TX). An inverse linear correlation was demonstrated between RWS and RVEF (y = 215- 332x; R = .80, p < or = .0001). Right ventricular RWS is significantly elevated in IPAH and may provide a useful quantitative monitoring tool in patients with IPAH to assess the benefit of different therapeutic interventions and provide prognostic information.

Cardiomegaly↗

PubMed1996

[Prospective study of subjective stress caused by dobutamine stress echocardiography--effect on diagnostic accuracy].

UNLABELLED: We used a standardized questionnaire to assess physical and mental distress caused by dobutamine stress echocardiography (DSE). The examination was performed according to a standardized protocol (5-40 micrograms/kg/min including atropine). 91 patients (pts), 68 men (62 +/- 9 years), 23 women (65 +/- 7 years) were asked to quantify the severity of the following symptoms: palpitations, anxiety, headache, nausea, discomfort of left lateral position, angina pectoris and dyspnea. Numbers on a rating scale from 1-10 defined the degree of distress. Absence of a symptom equalled mark, 1, slight expression marks 2-4. Moderate expression was defined by marks 5-7 and very strong expression by marks 8-10. RESULTS: 86% of pts felt affected by one or more symptoms to a slight to moderate extent (mark 4 +/- 2.17). Palpitations were felt by 85% of the pts (mark 6 +/- 2.83), anxiety by 42% (mark 3 +/- 2.5), headache by 50% (3 +/- 2.54), nausea by 20% (2 +/- 1.72), angina pectoris by 42% (3 +/- 2.5), dyspnea by 30% (2 +/- 2.42) and discomfort of left lateral recumbent position by 43% (mark 3 +/- 2.59). 43 pts underwent coronary angiography. The negative predictive value of DSE to identify pts without a coronary artery stenosis extending a 50% diameter reduction was 85% for the 16 pts who reached their individual submaximal heart rate compared to 60% for those 27 pts who did not reach it. Unspecific symptoms led to test termination in these pts. The positive predictive values were comparable (89 and 94%). CONCLUSION: DSE causes physical and mental distress. If symptoms lead to test termination before age corrected submaximal heart rate is reached, normal wall motion does not exclude significant coronary artery disease.

Angina Pectoris↗

PubMed1960