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  • 1
    Electronic Resource
    Electronic Resource
    The surgical complications of acute myocardial infarction: Color Doppler evaluation (1989)
    Springer
    The international journal of cardiovascular imaging 4 (1989), S. 45-47 
    Details
    ISSN: 1573-0743
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Two-dimensional echocardiography in combination with Doppler and color Doppler flow mapping is now considered the technique of choice for the early diagnosis and assessment of the ‘surgical’ complications of acute myocardial infarction. It has the advantage of being a rapid, safe technique with ease of portability and repeatability, at relatively low cost. Transesophageal echocardiography may provide an alternative ‘window’ for imaging cardiac structure and function, but as yet its value in the diagnosis of the complications of myocardial function is not proven. In the acute phase, color Doppler flow mapping can diagnose the cause of hemodynamic deterioration by distinguishing primary pump failure from the mechanical complications such as ventricular septal rupture or papillary muscle rupture. In the subacute phase, complications including left ventricular true and false aneurysms may be detected and this information allows optimal management decisions to be made. Thus, color Doppler flow mapping has become an indispensable technique in the coronary care unit. It provides a complete picture of cardiac structure and function making it superior to other methods in the clinical situation of an acute myocardial infarction which has such a volatile and unpredictable course.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01795121
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  • 2
    Electronic Resource
    Electronic Resource
    Comparison of dobutamine stress echocardiography and technetium-99m sestamibi single-photon emission tomography for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy (1997)
    Springer
    European journal of nuclear medicine 25 (1997), S. 69-78 
    Details
    ISSN: 1619-7089
    Keywords: Key words: Hypertension ; Sestamibi single-photon emission tomography ; Echocardiography ; Coronary artery disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Stress echocardiography has been considered an accurate method for the diagnosis of coronary artery disease in hypertensive patients and in patients with left ventricular hypertrophy. In contrast, the specificity of myocardial perfusion scintigraphy in these patients has been questioned. The aim of this study was to compare the accuracy of these two imaging modalities in conjunction with dobutamine stress test for the diagnosis of coronary artery disease in hypertensive patients with and without left ventricular hypertrophy. Dobutamine (up to 40 μg kg–1min–1) stress echocardiography in conjunction with sestamibi (MIBI) single-photon emission tomography (SPET) was performed in 84 patients with the diagnosis of systemic hypertension who had been referred for evaluation of myocardial ischaemia. Ischaemia was defined as new or worsened wall motion abnormalities at echocardiography and reversible perfusion defects at SPET. Significant coronary artery disease (≥50% luminal diameter stenosis) was detected in 66 patients (79%). The sensitivity, specificity and accuracy of the ischaemic pattern at echocardiography for the diagnosis of coronary artery disease were 73% (CI 63%–82%), 83% (CI 75%–91%) and 75% (CI 66%–84%), those for MIBI were 67% (CI 57%–77%), 83% (CI 75%–91%) and 70% (CI 60%–80%) respectively (P = NS vs echocardiography). Significant stenosis was detected in 123 (49%) of the 252 analysed coronary arteries. The sensitivity, specificity and accuracy of echocardiography for the regional diagnosis of coronary artery disease were 63% (CI 56%–69%), 90% (CI 86%–94%) and 77% (CI 72%–82%). Those for MIBI were 58% (CI 51%–64%), 91% (CI 87%–94%) and 75% (CI 69%–80) respectively (P = NS vs echocardiography). Left ventricular hypertrophy was detected in 59 patients (70%) by echocardiography and did not influence the overall or regional specificity of echocardiography or MIBI SPET. It is concluded that in hypertensive patients, dobutamine stress echocardiography and MIBI SPET have a comparable accuracy for the overall and regional diagnosis of coronary artery disease. Hypertensive patients with or without left ventricular hypertrophy should not be considered unsuitable candidates for stress myocardial perfusion scintigraphy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002590050196
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  • 3
    Electronic Resource
    Electronic Resource
    Dobutamine stress thallium-201 single-photon emission tomography versus echocardiography for evaluation of the extent and location of coronary artery disease late after myocardial infarction (1999)
    Springer
    European journal of nuclear medicine 26 (1999), S. 467-473 
    Details
    ISSN: 1619-7089
    Keywords: Key words: Dobutamine ; Echocardiography - Thallium-201 single-photon emission tomography ; Myocardial infarction- Ischaemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Dobutamine stress echocardiography and thallium-201 myocardial perfusion scintigraphy are clinically useful methods for the evaluation of coronary artery disease (CAD). However, the relative merits of these imaging modalities in the evaluation of the extent of CAD after myocardial infarction have not been well studied. The aim of this study was to compare the accuracy of dobutamine stress echocardiography and simultaneous 201Tl single-photon emission tomography (SPET) imaging for the diagnosis and localization of CAD late after acute myocardial infarction. Dobutamine (up to 40 µg kg–1 min–1)-atropine (up to 1 mg) stress echocardiography in conjunction with stress-reinjection 201Tl SPET was performed for the evaluation of myocardial ischaemia in 90 patients with previous myocardial infarction who underwent coronary angiography. Significant CAD was predicted on bases of myocardial ischemia (new or worsening wall motion abnormalities on echocardiography and reversible perfusion defects on 201Tl SPET). Significant CAD (≥ 50% luminal diameter stenosis) was detected in 73 (81%) patients. The sensitivity, specificity and accuracy of echocardiography in detecting remote ischaemia for the diagnosis of remote CAD (present in 53 patients) were, respectively, 79% (CI 70%–88%), 85% (CI 77%–93%) and 81% (CI 73%–90%), while the corresponding figures for 201Tl SPET were 75% (CI 66%–85%), 78% (CI 69%–87%) and 76% (CI 67%–86%) respectively (P = NS vs echocardiography). The sensitivity, specificity and accuracy of echocardiography in detecting peri-infarction ischaemia for the diagnosis of infarct-related artery stenosis (present in 70 patients) were, rspectively, 77% (CI 68%–86%), 85% (CI 78%–92%) and 79% (CI 70%–87%) while the corresponding figures for 201Tl SPET were 73% (CI 64%–82%), 85% (CI 78%–92%) and 76% (CI 67%–84%) respectively (P = NS vs echocardiography). The agreement between the two methods for the diagnosis of peri-infarction and remote ischaemia was 70% (kappa = 0.37) and 80% (kappa = 0.59) respectively. It is concluded that dobutamine stress echocardiography and 201Tl SPET have comparable accuracy for the diagnosis of infarct related and remote CAD in patients with previous myocardial infarction. The agreement between the methods is higher for the diagnosis of remote CAD than for that of peri-infarction ischaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002590050412
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  • 4
    Electronic Resource
    Electronic Resource
    Altered myocardial perfusion during dobutamine stress testing in silent versus symptomatic myocardial ischaemia assessed by quantitative MIBI SPET imaging (1996)
    Springer
    European journal of nuclear medicine 23 (1996), S. 1354-1360 
    Details
    ISSN: 1619-7089
    Keywords: Silent ischaemia ; Dobutamine stress test ; Methoxyisobutylisonitrile single-photon emission tomography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of the study was to compare the extent and severity of reversible underperfusion in silent versus painful myocardial ischaemia during the dobutamine stress test. A consecutive series of 85 patients with significant coronary artery disease and reversible perfusion defects on technetium-99m methoxyisobutylisonitrile single-photon emission tomography performed at rest and during high-dose dobutamine stress (up to 40 μg kg−1 min−1) were studied. The left ventricle was divided into six segments. An ischaemic perfusion score was derived quantitatively by subtracting the rest from the stress defect score. Patients with multivessel disease had a higher ischaemic score (610±762 vs 310±411,P〈0.05) and a higher number of reversible perfusion defects (2.1±1.2 vs 1.1±0.8,P〈0.01) than patients with single-vessel disease. Typical angina occurred in 37 patients (44%) during the test. There was no significant difference between patients with and patients without angina with respect to age, gender, peak rate-pressure product, prevalence of previous myocardial infarction, diabetes mellitus, multivessel disease or number of stenotic coronary arteries. Stress, rest and ischaemic scores as well as the number and distribution of reversible defects were not different in patients with and patients without angina. Patients with angina more frequently had a history of typical angina before the test (43% vs 17%,P〈0.01) and ST-segment depression during the test (54% vs 25%,P〈0.01). It is concluded that in patients with coronary artery disease and ischaemia detected by dobutamine scintigraphy, the extent and severity of coronary artery disease and myocardial perfusion abnormalities are similar with or without angina during stress testing.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01367591
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  • 5
    Electronic Resource
    Electronic Resource
    Absence of beneficial effect of intravenous metoprolol given during angioplasty in patients with single-vessel coronary artery disease (1993)
    Springer
    Cardiovascular drugs and therapy 7 (1993), S. 677-682 
    Details
    ISSN: 1573-7241
    Keywords: coronary angioplasty ; coronary artery disease ; electrocardiography ; hypoxanthine ; intravenous metoprolol ; lactate ; pain ; rate-pressure product ; urate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a double-blind, randomized, placebo-controlled trial, the possible antiischemic effect of metoprolol during percutaneous transluminal coronary angioplasty was tested. Electrocardiograms, hemodynamics, and metabolism were studied in 27 patients with a stenosis in the left anterior descending coronary artery. Measurements took place before angioplasty, after each of four 1-minute occlusions and 15 minutes after the last balloon deflation. Patients were randomly given placebo or metoprolol (15 mg as a bolus intravenously, followed by an infusion 0.04 mg/kg/hr). At the end of the procedure, the rate-pressure product had decreased by 15% (NS) and 23% (p=0.001) in the placebo and metoprolol groups, respectively, mainly due to similar decreases in heart rate. Metoprolol tended to lower chest pain and reduce precordial ST-segment elevation due to angioplasty, but the effects were not statistically significant. Lactate, hypoxanthine, and urate release immediately after deflation was similar in both groups. Metoprolol reduced arterial plasma hypoxanthine throughout the procedure by about 30% (p ≦ 0.02 vs. placebo). Thus, intravenous infusion of metoprolol did not significantly attenuate chest pain and ST-segment elevation, and failed to decrease cardiac lactate and oxypurine release. It did, however, reduce arterial hypoxanthine concentrations during angioplasty, possibly indicating that the beta-blocker inhibits extracardiac ATP catabolism.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00877821
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  • 6
    Electronic Resource
    Electronic Resource
    Exercise echocardiography and single photon emission computed tomography in patients with left anterior descending coronary artery stenosis (1992)
    Springer
    The international journal of cardiovascular imaging 8 (1992), S. 27-34 
    Details
    ISSN: 1573-0743
    Keywords: exercise echocardiography ; SPECT ; coronary artery disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract 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〈0.0001. Moreover, the percent diameter stenosis was well correlated with both ischemic indices (r= 0.75, p〈0.0001; r=67, p〈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 ≥ 70% than in patients with a diameter stenosis 〈70% (0.59 ± 0.19 vs 0.29 ± 0.12, p 〈 0.01); a similar trend was found for ischemic perfusion score index (0.51 ± 0.35 vs 0.27± 0.12, ns). The results of this study indicate that in patients with single vessel disease of left anterior descending artery exercise echocardiography and SPECT give the same information on the presence, the extent and the severity of myocardial ischemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01137563
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