WITHDRAWN: Quantitative Analysis of Dobutamine-Atropine Stress Echocardiography

The publisher regrets that this was an accidental duplication of an article that has already been published in Eur. J. Echocardiogr., 4 (2003) 169-177, . The duplicate article has therefore been withdrawn.

Quantitative analysis of dobutamine-atropine stress echocardiography

AIMS

To investigate the usefulness of fractional area change of entire left ventricular areas obtained from apical views for quantitative analysis of dobutamine-atropine stress echocardiography in the presence of mild to moderately reduced left ventricular function and abnormal intra-thoracic heart motion after coronary artery bypass surgery.

METHODS AND RESULTS

Stress echocardiograms from 38 echogenic patients before and 3 months after bypass surgery and from 44 echogenic healthy subjects were analysed. In successfully revascularized patients the fractional area change at peak stress was correlated to the baseline left ventricular ejection fraction (r=0.54, P<0.01), whereas the increase from baseline to peak stress was constant over a wide range of baseline ejection fractions. With respect to identifying the pre-revascularization examination as diseased, the area under the receiver operator characteristics curve based on Delta fractional area change from baseline to peak stress was 0.78 (95% CI 0.55-1.00) indicating moderate accuracy comparable with the results obtained with conventional analysis.

CONCLUSION

Fractional area change of entire left ventricular cavity areas is a useful parameter for quantitative analysis of dobutamine-atropine stress echocardiography. The diagnostic properties of the parameter are not offset by moderate reduction in left ventricular function or by surgery-induced abnormal intra-thoracic heart motion.

Quantitative analysis of dobutamine-atropine stress echocardiography by fractional area change

AIMS

To investigate the usefulness of fractional area change with respect to the diagnosis of coronary artery disease in patients undergoing dobutamine-atropine stress echocardiography.

METHODS AND RESULTS

Sixty-eight echogenic patients with a normal left ventricular function referred for coronary angiography underwent dobutamine-atropine stress echocardiography. Measures of fractional area change by segments and by total left ventricular areas were normalized using data from 27 echogenic healthy subjects. The area under the receiver operator characteristics curve indicated a significant diagnostic contribution of fractional area change for both methods (P<0.05) and sensitivity and specificity for predicting significant coronary stenosis were 80% (95% CI 69-91%) and 76% (95% CI 56-97%) for fractional area change of the total left ventricular area of the two chamber view, comparable to results of conventional wall motion analysis. Segmental fractional area change offered no advantages to that of total left ventricular areas with regard to the diagnosis or localization of coronary artery disease.

CONCLUSION

Fractional area change of the total left ventricular area is an accurate marker of coronary artery disease and may form a basis for quantitative dobutamine-atropine stress echocardiography analysis provided that reproducible endocardial tracings can be obtained.

Relationship between regional 18F-fluorodeoxyglucose and 13N ammonia uptake in normal myocardium assessed by positron emission tomography: patterns of mismatch and effects of aging

Increased regional myocardial 18F fluorodeoxyglucose (18FDG) uptake in relation to 13N ammonia (13NH3) uptake--i.e. glucose metabolism-blood flow 'mismatch'--appears to be a strong indicator of myocardial viability in patients with ischemic heart disease (IHD) and regionally reduced contractile function. Reference values of regional 18FDG and 13NH3 uptake have not been determined in healthy subjects with the target age for the development of IHD. We therefore studied healthy middle-aged and old men using positron emission tomography (PET). Twenty-three healthy men aged 51 to 83 years of age were studied. 18FDG and 13NH3 uptake was quantified in 16 myocardial segments with PET and circumferential profile analysis. The relative 18FDG/13NH3 uptake was considerably heterogeneous with 18FDG uptake consistently higher than 13NH3 uptake in the left lateral ventricular wall. This regional 'mismatch' pattern was observed in all subjects, but was most prominent in middle-aged men. The observed age-dependency was the result of a progressive increased in 13NH3 uptake with advancing age in the left ventricular lateral wall. Age-matched reference values of myocardial 18FDG and 13NH3 uptake appears to be important for the discrimination between physiological and pathological glucose metabolism-blood flow mismatch assessed by PET and circumferential profile analysis.

Atrioventricular plane motion during dobutamine-atropine stress echocardiography: the biphasic response in healthy subjects revisited

This study was undertaken to establish normal values for the systolic atrioventricular plane motion (AVPM) from base to apex during dobutamine-atropine stress echocardiography (DASE) and to compare them with those of patients with coronary artery disease. The AVPM was measured at baseline, low dose and peak dobutamine-atropine infusion in 20 patients referred for coronary angiography and in 20 control subjects. Atrioventricular plane motion was measured at the posterior, anterior, septal, and lateral positions of the mitral annulus in the apical 2- and 4-chamber views by an observer blinded to clinical and angiographic data. In healthy subjects undergoing DASE, AVPM initially increased but subsequently decreased to below baseline values at peak stress. Atrioventricular plane motion at any stage and the changes therein during DASE were within the normal reference interval in the majority of patients. In conclusion, AVPM decreased during DASE in healthy subjects and was not a sensitive marker of coronary artery disease.

[Hypertrophic cardiomyopathy]

Hypertrophic cardiomyopathy is a heterogeneous, progressive disease with a variable age of debut. Hypertrophic cardiomyopathy is characterized by myocardial hypertrophy with a bizarre fibre disarray. Angina pectoris, dyspnoea and syncope are the most frequent symptoms. Hypertrophic cardiomyopathy is an important cause of sudden death, especially in children and young adults. The aetiology is genetic in more than 60% of the cases, with an autosomal dominant mode of inheritance. More than 50 different mutations involving six genes have so far been associated with the development of hypertrophic cardiomyopathy. These mutations are located to genes coding for several of the proteins in the cardiac sarcomere. The protein changes seem to compromise contractility as well as sarcomere assembly, thereby secondarily causing compensatory hypertrophy. The management of hypertrophic cardiomyopathy has been markedly improved within the last few years. This emphasizes the importance of determining prognostic markers in each patient. A specific genetic diagnosis may prove to be of major importance.

Effect of ramipril on mitral regurgitation secondary to mitral valve prolapse

Ramipril 10 mg/day reduced regurgitation in chronic mitral regurgitation secondary to mitral valve prolapse in patients with sinus rhythm.

Influence of meal composition on postprandial peripheral plasma concentrations of vasoactive peptides in man

In a randomized cross-over study healthy non-obese male human subjects received standardized isocaloric, isovolumetric meals consisting of either carbohydrate, protein or fat and a non-caloric control meal consisting of an equal volume of water. Peripheral venous plasma concentrations of calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal peptide (VIP), and peptide YY (PYY) were measured pre- and postprandially. Plasma CGRP concentrations were lowered following the protein meal and following the fat meal, but remained unaltered after carbohydrate or water ingestion. Plasma VIP concentrations increased slightly following the carbohydrate meal and following water loading. The PYY concentrations increased after the protein and the carbohydrate meal and a slight rise was observed following fat ingestion. Water loading did not affect the plasma level of PYY. We conclude that the postprandial peripheral plasma concentrations of CGRP, VIP and PYY are dependent on the caloric meal composition. The VIP, but not the CGRP and PYY concentrations seem to be influenced by gastric distension. The physiological significance of the postprandial alterations in peripheral concentrations of these peptides is at present uncertain.

Myocardial infarction 1979-1988 in Denmark: secular trends in age-related incidence, in-hospital mortality and complications

All admissions to a coronary care unit (CCU) in Copenhagen County were prospectively registered over a 10-year period, from 1979 to 1988, i.e. after the introduction of CCUs but before the era of intervention with thrombolytic or prophylactic medical treatment. The catchment area remained nearly constant throughout the study period; all patients with MI were admitted to the CCU regardless of age and concomitant diseases, and treatment and discharge policy of the department was unchanged. A total of 4176 MI admissions were registered. During the study period, the age-specific incidence of MI decreased in males above 50 years of age, but was virtually unchanged in females, increasing the proportion of women in the MI population from 26 to 33%. In-hospital and 30-day mortality was unchanged. The occurrence of atrial fibrillation during the admission increased significantly (from 11 to 18%), while the incidence of ventricular fibrillation, heart failure and pulmonary oedema was unchanged.