SUMMARY Two-dimensional echocardiography underestimates left ventricular volume compared with cineventriculography. To exclude the influence of difference in heart rate, blood pressure, respiration phases and any effect of the contrast material on left ventricular function, simultaneous studies of twodimensional echocardiography and cineventriculography-echoventriculography were performed in 46 patients. Apical two-dimensional echocardiograms in the right anterior oblique (RAO) equivalent view were recorded before and during cineventriculography in the 300 RAO projection. End-diastolic and end-systolic volumes (EDV and ESV) were calculated using a disc method with a semiautomatic computer system. The echo transducer position relative to the left ventricular apex and long axis was analyzed. For EDV determined by two-dimensional echocardiography and cineventriculography, the linear regression equation was radiologic methods.'4 Thus, patient-related problems could explain the systematic underestimation of left ventricular volume as determined by two-dimensional echocardiography. Differences in heart rate, blood pressure and respiration, and possible influences of contrast agents have been reported.4In this study we analyzed left ventricular volumes and ejection fractions from simultaneous recordings of two-dimensional echocardiograms in the apical right anterior oblique (RAO) equivalent view and cineventriculograms in the RAO plane, eliminating any perturbing influences on left ventricular volume.
Methods
PatientsThe study was performed in 46 patients, 39 males and seven females, who were undergoing catheterization for evaluation of clinically suspected coronary artery disease (table 1). The mean age (± SEM) was 51.2 + 6.9 years. Thirty-seven patients had significant coronary artery disease, nine showed features of primary congestive cardiomyopathy, two had arterial hypertension, four mitral regurgitation, one patient had mitral valve prolapse, one obstructive cardiomyopathy, and one aortic insufficiency. Three patients appeared to be normal. Fifteen of the 37 patients with coronary artery disease showed asynergy of the anterior wall and 13 asynergy of the posterior wall.
CatheterizationThe left ventricle was catheterized retrogradely through a percutaneous puncture of the right femoral artery. The patients were fasting and not premedicat-
Summary: Transesophageal echocardiography was performed in 3 14 patients over a period of 24 months using a 3.5 MHz phased-array system fitted to the distal end of a conventional 12 mm endoscope. In 12 patients (2.6%) transesophageal echocardiography could not be performed because of adverse reaction to the gastroscopic procedure. Side effects were a transient A-V block in one patient and asthmatic attack in another. Mitral valve lesions were found in 99 of 314 patients. In 9 of these 99 patients (1 1 %), including 1 patient with mitral valve stenosis and sinus rhythm, 2 with atrial fibrillation, 3 with disc, and 3 with porcine mitral prosthesis, spontaneous echocardiographic contrast was found within the left atrium, described as faint echoes in 2 patients and dense echoes filling the whole left atrium and following turbulent flow in the other 7 patients. Only in 2 patients was left atrium shown to have additional echoes within its cavity in the four-chamber view by transthoracic echocardiography .Signs of cerebral emboli were found in 5 of 9 patients and of peripheral embolism in 3 of 9 patients. Their mechanism seems to involve red cell aggregation, which is greatest at low flow velocity such as in dilated left atria in the case of mitral valve stenosis or prosthesis. The additional effect of platelet aggregation must be discussed because increased platelet aggregation was detected in all patients with spontaneous echocardiographic contrast. Transesophageal echocardiography seems to be of great diagnostic value in patients with mitral valve lesions and cerebral and peripheral embolism, giving new insight into the pathophysiologic mechanism and possibly improving the therapeutic approach in the near future.
SUMMARY The hemodynamic effects of a new,/3 agonist, prenalterol, were studied in 13 patients with severe left ventricular failure (New York Heart Association functional class III or IV). Seven patients had ischemic heart disease and six congestive cardiomyopathy. Left PRENALTEROL, the levo-isomer of S-(-)-l-(4 hydroxyphenoxy)-3-isopropyl-amino-propanol-2 hydrochloride, is a new selective /Th adrenoceptor agonist with little chronotropic effect demonstrable in animal studies.1 When administered orally or intravenously, prenalterol enhanced left ventricular contractility in humans.3 Dose-dependent shortening of electromechanical systole and preejection time have been reported.3'4 In patients who had suffered acute myocardial infarction, prenalterol increased left ventricular contractility without altering diastolic blood pressure and with little change in heart rate or pulse pressure.5.6Left ventricular function improved in patients with severe heart failure.7'-We studied the effects of prenalterol on left ventricular contractility and relaxation, power, wall stress and compliance in patients with marked symptomatic impairment (New York Heart Association [NYHA] functional class III or IV) and either ischemic heart disease (IHD) or congestive cardiomyopathy (COCM).
The purpose of the study was to determine the sensitivity and specificity of two-dimensional echocardiography (2dE) in the detection of impaired left ventricular function, compared with cineventriculography (CVG). Apical two-dimensional echocardiograms were performed in 110 patients undergoing heart catheterization for the evaluation of clinically suspected coronary heart disease (50 patients), valvular heart disease (38 patients) and congestive cardiomyopathy (22 patients). The left ventricle was scanned in the RAO-equivalent view; cineventriculograms were filmed in the 30 degrees RAO projection. Left ventricular volumes at end-diastole (EDV) and end-systole (ESV) were determined using a disc method; stroke volume (SV) and ejection fraction (EF) were calculated. Based on normal values, the sensitivity, specificity, and predictive accuracy were determined for two-dimensional echocardiography. For EDV, the sensitivity was 80%, specificity 88% and (+) predictive accuracy 86%. The left ventricular ejection fraction was 57.8 +/- 17.2% with CVG and 53.8 +/- 15.6% with 2dE in patients with coronary heart disease, 24.9 +/- 10.5% with CVG and 25.2 +/- 11.1% with 2dE in patients with congestive cardiomyopathy, and 61.1 +/- 13.9% with CVG and 54.2 +/- 9.1% with 2dE in patients with valvular heart disease. Sensitivity was 81%, specificity 100%, and (+) predictive accuracy 100%. The study demonstrates that impaired left ventricular function can be detected by 2dE with high sensitivity and specificity. Thus, 2dE seems to be suitable screening method for evaluation of left ventricular function.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.