Limitations of radionuclide ventriculography in the non-invasive diagnosis of coronary artery disease. A correlation with right heart haemodynamic values during exercise

Prebiotic effects of yeast mannan, which selectively promotes Bacteroides thetaiotaomicron and Bacteroides ovatus in a human colonic microbiota model

Yeast mannan (YM) is an indigestible water-soluble polysaccharide of the yeast cell wall, with a notable prebiotic effect on the intestinal microbiota. We previously reported that YM increased Bacteroides thetaiotaomicron abundance in in vitro rat faeces fermentation, concluding that its effects on human colonic microbiota should be investigated. In this study, we show the effects of YM on human colonic microbiota and its metabolites using an in vitro human faeces fermentation system. Bacterial 16S rRNA gene sequence analysis showed that YM administration did not change the microbial diversity or composition. Quantitative real-time PCR analysis revealed that YM administration significantly increased the relative abundance of Bacteroides ovatus and B. thetaiotaomicron. Moreover, a positive correlation was observed between the relative ratio (with or without YM administration) of B. thetaiotaomicron and B. ovatus (r = 0.92), suggesting that these bacteria utilise YM in a coordinated manner. In addition, YM administration increased the production of acetate, propionate, and total short-chain fatty acids. These results demonstrate the potential of YM as a novel prebiotic that selectively increases B. thetaiotaomicron and B. ovatus and improves the intestinal environment. The findings also provide insights that might be useful for the development of novel functional foods.

First-pass radionuclide cineangiography: a reevaluation of its sensitivity and limitations in the detection of significant coronary artery disease

The sensitivity of first-pass cineangiography in the detection of significant coronary artery disease (CAD) was recently assessed in 33 patients. No normal controls were studied. Overall sensitivity was 86% with a predictive value of 83% and a 36% false-positive rate. Attainment of an adequate exercise end point increased sensitivity to 92%; failure to achieve this end point diminished sensitivity to 71%. Correlation between first-pass and contrast angiography ejection fractions was high (r = 0.88, p less than .005) with a moderate correlation in wall motion analysis (r = 0.58, p less than .005). The development or the intensification of a wall motion abnormality (WMA) was the single most sensitive indicator of CAD (84%). Presence of WMA plus failure of the ejection fraction to increase by 6% over baseline increased testing sensitivity to 89%. The mean WMA score for patients with CAD was 2.0 +/- 1.5 compared with 0.6 +/- 1.3 for those with normal study results (p less than .01). The first-pass method identified 4 subjects who subsequently had normal findings from catheterization. Data confirm testing sensitivity of the first-pass technique and underscore the apparent limitations of this modality in differentiation of patients with normal vasculature.

Radionuclide ventriculography (equilibrium gated blood pool scanning)--its present clinical position and recent developments

Myocardial scanning (MS) and radionuclide ventriculography (RNV) are the foundation of nuclear cardiology. These procedures aim in two completely different directions: RNV tries to image heart motion, that is, mechanical (pump) function, and therefore belongs to the group of first-order functional imaging (FI, imaging mechanical function), whereas MS is based on myocardial metabolism, and therefore can be attributed to third-order functional imaging (metabolism). This statement is relevant for the assessment of the clinical position of RNV: Third-order (metabolism) functional imaging is the domain of nuclear medicine (NM), whereas first-order FI has to face the competition of alternative noninvasive procedures such as ultrasound (US), digital subtraction angiography (DSA), computer tomography (CT), and nuclear magnetic resonance (NMR). The domain of RNV includes stages two (acute infarction) and three (postinfarction period) of coronary arterial disease (CAD). The advantageous combination of quantitative data on global, left ventricular (LV) function and imaging of regional motion ensures the superiority of RNV over US. However, RNV is inferior to MS in physical examinations in the preinfarction stage of CAD, whereas US is clearly inferior to both NM procedures. Recent progress could be attained by gated SPECT (GASPECT). A proposal is presented for simplification of this time-consuming procedure. Technetium-labeled isonitriles offer the chance for the combination of "perfusion-motion" imaging of the myocardium. However, even standard RNV offers new possibilities. The multitude of parameters produced by quantitation has not yet been exploited completely. This can be done by discriminant analysis. The computer finds out an optimal subset from the whole set of parameters for the solution of a significant clinical problem. The software "learns" to find the "label" of a special pathognomonic entity. This computer work is supported by a relational data bank (Oracle) and an optical disk. Two examples for the effectiveness of the computer in problem solving are presented. It is concluded that RNV, even in the very competitive class of first-order functional imaging, enjoys a preferred position. The future indeed seems brighter because labeled isonitriles offer the chance for the combination of perfusion-motion imaging of the myocardium.

Radionuclide ventriculography and hemodynamic evaluation by right heart catheterization with exercise for assessing the functional significance of coronary artery stenoses. A comparative study

A series of 13 patients with significant coronary stenoses but without prior myocardial infarction were simultaneously studied by right heart catheterization and radionuclide ventriculography to determine the extent to which abnormal responses in left ventricular ejection fraction and wall motion to maximum exercise are paralleled by abnormal left ventricular filling pressures. The correlations of the filling pressure as evaluated by the diastolic pulmonary artery pressure with both the exercise ejection fraction and the rest-to-exercise change in ejection fraction were high (r = -0.89, P less than 0.01 and r = -0.76, P less than 0.01, respectively). In addition, the filling-pressure response to stress separated the patients into distinct radionuclide categories. All the 7 patients with grossly abnormal filling pressures (P greater than or equal to 30 mmHg) developed regional wall motion abnormalities with exercise as evaluated by visual interpretation or quantitative phase analysis. These patients also had a decrease in ejection fraction from rest to exercise ranging from -9% to -32% together with an exercise ejection fraction below 50%. Conversely, these abnormalities were never found in patients with filling pressures below this threshold level. The data suggest that radionuclide ventriculography and measurement of left ventricular filling pressure with exercise yield corresponding results when assessing the functional significance of coronary stenoses in normotensive patients without prior myocardial infarction and normal global left ventricular function at rest.

The detection of coronary artery disease: a comparison of exercise thallium imaging and exercise equilibrium radionuclide ventriculography

This study compared the accuracy of rest and exercise gated equilibrium technetium ventriculography with exercise thallium imaging in 50 consecutive male patients undergoing routine coronary angiography for the evaluation of chest pain. No patients were excluded on the basis of prior myocardial infarction, nature of angiographically defined coronary disease or symptoms. Antianginal therapy was continued in all patients. Eight patients had normal coronary arteries, 9 had single vessel, disease, 20 had double vessel disease and 13 had triple vessel disease. Sixteen patients had previously documented myocardial infarction. Using exercise radionuclide ventriculography, 34 patients with coronary disease were detected resulting in a sensitivity of 81%; 6 patients with normal coronary arteries had normal scans, a specificity of 75%, with a predictive accuracy of 80%. In comparison, thallium imaging detected 42 patients with coronary disease resulting in a sensitivity of 100%. Six patients with normal coronary arteries had normal thallium images resulting in a specificity of 75% and a predictive accuracy of 96%. These results suggest that exercise thallium imaging is a more accurate investigation than exercise equilibrium radio-nuclide ventriculography and is the investigation of choice in the noninvasive detection of coronary artery disease.

Left heart function in chronic obstructive lung disease

In patients with varying degrees of chronic obstructive pulmonary disease (COPD), simultaneous measurements of central hemodynamics and left ventricular radionuclide ventriculograms at rest and during exercise were made. In 21 of these patients, satisfactory echocardiograms could be performed. In seven of the patients, arterial blood pressure at rest was increased. Decreased compliance of the left ventricle was thought to be present in patients with COPD and additional arterial hypertension. The left ventricular ejection fraction (LVEF) at rest was in the high normal range in all patients. During exercise, no further increase was observed. This pattern of LVEF response seems to be typical in patients with COPD. Because the highest values were observed in the more severe COPD and right ventricular hypertrophy, it is unlikely that an impairment of left ventricular function is caused by COPD. In five of 27 patients, an abnormal decrease of LVEF and regional hypokinesis occurred during exercise, thus suggesting additional coronary heart disease. The fact that at least 30% of the patients with COPD suffered from arterial hypertension and 20% of the patients exhibited unexpected ischemia detected by regional hypokinesis in RNV during exercise, but not in the ECG, may be of practical relevance. Coronary angiography was not indicated because most of these patients were over 65 and the factor limiting the working capacity was ventilatory impairment and not angina pectoris, in all patients. For this reason, a diagnostic uncertainty remains with regard to additional coronary heart disease in the older patients with advanced chronic obstructive pulmonary disease.