Usefulness of ambulatory radionuclide monitoring of left ventricular function early after acute myocardial infarction for predicting residual myocardial ischemia

Breisblatt, Warren M.; Weiland, Frederick L.; McLain, John R.; Tomlinson, Gregory C.; Burns, Mary Jane; Spaccavento, Leo J.

doi:10.1016/0002-9149(88)90538-3

Cited by 58 publications

(16 citation statements)

References 23 publications

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“…Studies with a cardiac phan tom over a wide range of ejection fractions from 25 to 75% correlated with a value of 0.9-0.96 [12], Even dur ing periods of gated bicycle exercise, Tamaki et al [13] found that changes in ejection fraction detected by equi librium gated blood pool scans or vest were comparable (r value = 0.86). Yang et al [14] demonstrated a high correlation coefficient for exercise ejection fraction de terminations with the vest and gamma camera (r = 0.85), and also found that the changes in ejection fraction for 138 matched stages of exercise in 36 patients was 0.73.…”

Section: 74mentioning

confidence: 94%

“…Breisblatt et al [ 12] cardiac phantom range 25-75%, variability <2% 0.90 3.20 equilibrium RNA exercise Yang et al [ 14] 0.85 3.98 lated highly (>0.95) [11]. Studies with a cardiac phan tom over a wide range of ejection fractions from 25 to 75% correlated with a value of 0.9-0.96 [12], Even dur ing periods of gated bicycle exercise, Tamaki et al [13] found that changes in ejection fraction detected by equi librium gated blood pool scans or vest were comparable (r value = 0.86).…”

Section: 74mentioning

confidence: 99%

“…The few published studies already raise the issue whether silent ischemia can occur without electrocardiographic changes and question the physiological relationship between symptoms, the ECG and changes in left ventricular function [12,25], Recent ambulatory studies with Holter monitoring are provid-ing greater prognostic data than the treadmill in patients with angina and post-myocardial infarction [27,28]. The vest may further help to optimize decision making and stratify risk in some patient subsets, but more studies are needed.…”

Section: Future Applications Of Probe Technologymentioning

confidence: 99%

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Nonimaging Radionuclide Detectors to Continuously Monitor Left Ventricular Function in Cardiac Disease

Breisblatt¹,

Schulman²

1989

Am J Noninvas Cardiol

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Nonimaging radionuclide detectors have the ability to continuously monitor left ventricular performance. Either in an ambulatory or intensive-care unit setting these detectors can provide serial measurements of left ventricular ejection fraction, relative ventricular volumes and parameters describing systolic and diastolic left ventricular function. They have been shown to correlate well with ejection fractions determined by a gamma camera, and they are sensitive enough to detect rapidly changing physiological events. Two commercially available systems are presently available which provide different approaches for the continuous monitoring of ventricular function. While these devices are not meant to replace the gamma camera, because of their ability to rapidly assess changing physiological states they allow unique pathophysiological questions to be addressed. This review will address the current technology and future directions where these nonimaging systems will be useful in the evaluation of cardiac disease.

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Section: 74mentioning

confidence: 94%

Section: 74mentioning

confidence: 99%

Section: Future Applications Of Probe Technologymentioning

confidence: 99%

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Nonimaging Radionuclide Detectors to Continuously Monitor Left Ventricular Function in Cardiac Disease

Breisblatt¹,

Schulman²

1989

Am J Noninvas Cardiol

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“…The patients were placed in front of the gamma camera at the end of the study to check the detector position. Reviewing the study for technical adequacy and the processing of data have been previously described in detail [9,12]. A vest response felt to be indicative of myocardial ischemia was a decrease in ejection fraction >5 ejection fraction units that persisted for >60 s. This definition has been suggested from our previous work and that of others using the vest.…”

Section: Introductionmentioning

confidence: 99%

“…A vest response felt to be indicative of myocardial ischemia was a decrease in ejection fraction >5 ejection fraction units that persisted for >60 s. This definition has been suggested from our previous work and that of others using the vest. [9,13]. A stable baseline ejection fraction was obtained prior to each provoked maneuver.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory Radionuclide Monitoring of Left Ventricular Ejection Fraction with the Nuclear Vest: A Useful Predictor of Prognosis in Patients after Myocardial Infarction

Breisblatt¹,

Wolfe²,

Follansbee³

et al. 1991

Am J Noninvas Cardiol

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Ambulatory radionuclide monitoring of the left ventricular function with the nuclear vest was performed at the time of treadmill testing in 52 patients after an uncomplicated myocardial infarction to identify patients at high risk for clinical events during the 1st year. The patients were evaluated with the nuclear vest during their postinfarction treadmill exercise, activities aimed at provoking myocardial ischemia, and during routine ambulation. Of the 52 patients, 18 had ischemic responses on treadmill testing, but the vest demonstrated 72 ischemic ejection fraction responses in 29 patients. Fifty-one of these episodes were found with exercise (n = 27), mental stress (n = 17), or other provocative maneuvers, while 21 episodes in 14 patients were unprovoked occurring during routine ambulatory activities. During the 15-month follow-up period, 16 patients experienced an adverse cardiac event (31 %), including 6 with recurrent infarction or unstable angina, 1 cardiac death, and 9 referred for angioplasty or bypass surgery because of new or increasing symptoms. Of the 16 adverse events, ambulatory vest studies predicted 15, for a 94% sensitivity, a 62% specificity, and a positive predictive value of 52%, and were more sensitive than treadmill testing which only identified 10 patients. Four particular findings on ambulatory ventricular functioning monitoring helped predict patient outcome. The magnitude of the ejection fraction response to provocative maneuvers identified high-risk patients, as 14 of 17 who demonstrated a decrease in ejection fraction of > 10 ejection fraction units during exercise, mental stress, or other maneuvers had events. Unprovoked ischemic episodes occured in 14 patients; 12 had cardiac complications (75% sensitivity, 95% specificity, 86% predictive value). Mental stress induced ischemia was also a powerful predictor of outcome, as 13 of 17 patients with this finding had cardiac events (81 % sensitivity, 89% specificity, 76% predictive value). Finally, 9 of 11 patients who developed a fall in ejection fraction within 6 min of treadmill exercise had cardiac events. Ambulatory monitoring with the nuclear vest was useful in predicting the prognosis in the postinfarction patients and provided a complete assessment of the factors which may initiate myocardial ischemia in individual patients.

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Outpatient Dobutamine Therapy: The Rhyme and the Riddle

Sacher

Landau

et al. 1992

The Journal of Clinical Pharma

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Advances in critical care medicine have increased survival for victims of myocardial infarction and other acute cardiac events so that increasingly patients are receiving long-term, labor-intensive, and costly medical care. Innovations in drug delivery systems and skyrocketing health care costs have fostered the growth of home health care which has blossomed into a $2.8 billion industry. There is evidence that outpatient dobutamine therapy produces definite physical and possibly psychological improvements of variable degree and duration. Hemodynamic improvements are generally associated with improvement in functional class, and the financial savings are recognizably substantial. However, three major problems confront therapies with beta-adrenergic agonists: tendency for tolerance, ventricular arrhythmias, and increased myocardial oxygen consumption. There is a dire need for establishment of exclusionary patient criteria and for risk stratification, as well as for development of a portable radionuclide nonimaging monitor. Given the current fund of knowledge, outpatient dobutamine therapy should be undertaken cautiously after meticulous patient selection reflecting an awareness of the tremendous complexities and inherent risks. The therapeutic implications are dependent on the nature of the underlying cardiomyopathy and the fact that beta-adrenergic receptor desensitization is unlikely to be overcome by progressive dosage increases. Therapy is initiated with the understanding that treatment will remain blindly empirical and conjectural in the absence of a continuous physiologic monitor and an expanded comprehension of the molecular pathophysiology of the failing ventricle.

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Usefulness of ambulatory radionuclide monitoring of left ventricular function early after acute myocardial infarction for predicting residual myocardial ischemia

Cited by 58 publications

References 23 publications

Nonimaging Radionuclide Detectors to Continuously Monitor Left Ventricular Function in Cardiac Disease

Nonimaging Radionuclide Detectors to Continuously Monitor Left Ventricular Function in Cardiac Disease

Ambulatory Radionuclide Monitoring of Left Ventricular Ejection Fraction with the Nuclear Vest: A Useful Predictor of Prognosis in Patients after Myocardial Infarction

Outpatient Dobutamine Therapy: The Rhyme and the Riddle

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