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Sixteen patients affected by congestive cardiomyopathy were studied by means of right and left cardiac catheterization and cineangiocardiography. Cardiac output and mean pulmonary circulation time were determined by the radiocardiographic method. Left ventriculograms were obtained in all the patients in the 45 degrees RAO projection; the left ventricular end diastolic and end systolic volumes were calculated both by the area-length and by the slice method. Among the several hemodynamic data (stroke index, mean pulmonary circulation time, left ventricular end diastolic pressure, left ventricular volumes and ejection fraction) the most early impaired and therefore usefull for an early diagnosis, were: the left ventricular end-systolic volume, the left ventricular end-diastolic volume and the left ventricular ejection fraction.
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PMID:[Clinical, hemodynamic and cineangiocardiolographic findings in congestive cardiomyopathy]. 47 19

The influence of an instantaneous increase in afterload on the hemodynamics and regional myocardial function was studied in five anesthetized dogs before and after occlusion of the left anterior descending coronary artery. By inflation of an intaaortic balloon during single ejections, an instantaneous increase in afterload was obtained. From biplane cineventriculograms, the following parameters were calculated: left ventricular volumes (EDV, ESV), stroke volume (SV), ejection fraction (EF). Mean circumferential fiber shortening (V CF) was calculated in three ventricular diameters in the RAO projection. Simultaneously PLV, PLVED, PAo, and LV dp/dt were obtained. In the control ventriculograms, an increased afterload (delta PLV 16.4 +/- 8 mm Hg) caused only a minor decrease of SV (2.6 +/- 2.5 ml), EF (4.2 +/- 2.4%), and V CF (0.20 circ . s -1). After coronary occlusion (delta PLV 14.5 +/- 6.7 mm Hg),the reduction of SV (5.9 +/- 2.7 ml) and EF (8.2 +/- 2.6%) was more pronounced. This was caused mainly by a significant reduction of V CF in the center of ischemia (delta V CF -93%). For the evaluation of regional myocardial function by ventriculography, the marked influence of afterload in ischemic areas must be taken into consideration. This is of special interest in comparative ventriculograms, such as those before and after coronary bypass surgery.
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PMID:[The influence of afterload on the normal and ischemic myocardium in the dog]. 71 34

Regional systolic left ventricular performance after myocardial infarct was assessed from 216 radionuclide angiograms performed in 170 patients. Recording of first transit of an intravenously injected bolus of technetium-99m pertechnetate was made by a multicrystal scintillation camera at a framing rate of 20 per second. The RAO view was used and a simultaneous ECG was employed. Statistics adequate for resolving regional events were obtained by a compact bolus input and phasic summation into one representative cycle of data obtained during left ventricular passage. Emphasis was given to imaging of regional systolic left ventricular function: perimeter images of end-systole and end-diastole, regional stroke volume images and ejection fraction images were processed. New trend images were presented that reflect total systolic contraction and improve image quality: regional rate of decrease and increase images, wall motion trend images and regional mean transit time images. In 96% of the cases, correspondence was found between the electrocardiographic location of the infarct and the region of major wall motion and ejection disorder. Akinesia and/or dyskinesia were seen in 77% of the cases; a ventricular aneurysm was found in 11%. Additional areas of wall motion anomalies were shown by 70%. Image analysis, nuclear image signs and their diagnostic meaning, as well as the indications for this nontraumatic examination in coronary heart disease are discussed. Relevant information for medical or surgical therapy can be obtained from early and follow-up studies in patients with unstable, progressive angina, ischemic electrocardiographic signs and those who have had myocardial infarctions.
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PMID:Radionuclide angiography of the heart in coronary heart disease: where do we stand? 74 2

Left ventricular (LV) intramyocardial markers (MM) were used to study the effects of intravenous verapamil on LV pump function and diastolic filling dynamics. Verapamil (0.1 mg/kg bolus followed by 0.005 mg/kg/min) was administered to 10 patients with severe coronary artery disease 4 years after coronary bypass grafting and implantation of 7 tantalum markers into the LV. MM were filmed at 100 frames/sec (biplane 30 degrees RAO/60 degrees LAO). The digitized biplane MM coordinates were transformed into 3-dimensional coordinates and maximal projection area was defined. LV volumes were calculated frame-by-frame and ejection fraction and peak filling rate derived. Pressure-volume relations were calculated in early-, mid-, and end-diastole. Verapamil caused a slight rise in end-diastolic pressure (12 to 14 mmHg, p less than 0.001) and end-diastolic volume (142 to 152 ml; p less than 0.005) and a fall in max dP/dt (1732 to 1570 mmHg/s; p less than 0.01) reflecting the drug's negative inotropic action. Verapamil reduced LV systolic pressure (136 to 126 mmHg; p less than 0.01), diastolic aortic pressure (74 to 68 mmHg; p less than 0.001) and peripheral resistance (1496 to 1348 dynes.s.cm-5; p less than 0.025); cardiac index was increased (2.7 to 2.9 l/min/m2; p less than 0.05), as were ejection fraction (47 to 49%; p less than 0.02) and stroke volume (67 to 75 ml; p less than 0.001). Great cardiac vein flow increased as well (88 to 102 ml/min; p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of intravenous verapamil on left ventricular systolic function and diastolic filling dynamics in patients with coronary artery disease: analysis of intramyocardial markers. 326 99

It is demonstrated that right ventricular volumes can be measured accurately by biplane cineangiography using the Simpson's rule or various area-length methods. In order to validate the single plane approach a biplane (30 degrees RAO-60 degrees LAO) right ventricle (RV) cineangiography was performed in 10 adults investigated for chest pain without coronary artery disease or any other heart disease. RV volumes (EDV: end-diastolic; ESV: end-systolic; SV: stroke volume) and EF (ejection fraction) were measured by biplane and single plane analysis with the same area-length method using the pyramide with triangular base as geometric model (Ferlinz). The results are: RVEDV (ml/m2) biplane (B) 81 +/- 10, monoplane (M) 82 +/- 11; RVESV (ml/m2) B 33 +/- 6, M 35 +/- 8; RVSV (ml/m2) B 48 +/- 8, M 47 +/- 10; RVEF (%) B 59 +/- 6, M 57 +/- 8. Equations of linear regression show the following correlations: RVEDV R = 0.82 p less than 0.01; RVESV R = 0.77 p less than 0.01; RVSV R = 0.92 p less than 0.001; RVEF R = 0.85 p less than 0.01. Authors conclude to a good enough correlation between monoplane and biplane analysis especially for RVSV and RVEF. They underline the great variability of individual values.
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PMID:[Measurement of right ventricular volume by cineangiography. Validation of monoplane analysis compared with biplane]. 361 5

To evaluate the frequency of right ventricular dysfunction following recovery from myocardial infarction (MI) and the relationship of segmental right ventricular (RV) wall motion abnormalities to left ventricular (LV) function or location of coronary arterial stenosis, biplane right and left ventricular cineangiograms were obtained in 100 consecutive patients (4 +/- 3 months post MI). Thirty (group A) had anterior MI and significant stenosis or obstruction of left anterior descending artery (LAD). The remaining 70 patients had inferior MI. They were divided into three groups according to the site of the main coronary stenosis or obstruction and corresponding LV akinesia: right coronary artery (RCA) proximal to the acute marginal artery (RMA), (group B: 32 patients), RCA distal to the RMA (group C: 18 patients), left circumflex artery (LCF), (group D: 18 patients). RV and LV end-diastolic volume index (EDV), end-systolic volume index (ESV), stroke volume (SV) and ejection fraction (EF) have been determined. RV segmental wall motion was assessed in RAO and LAO projection by determining the percentage of systolic shortening (+ delta R) along 11 hemiaxes. Mean axial shortening (delta R) of the RV inferior and free walls were considered. When compared with that in 10 normal subjects, RV end-diastolic volume (RVEDV), RV end-systolic volume (RVESV) were increased and RV ejection fraction (RVEF) was lower in patients with anterior or inferior MI. Inferior delta R exhibited comparable sequential changes in the three groups of inferior MI and similar LVEF alteration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Right ventricular function in healed myocardial infarction in man. A cineangiographic assessment. 400 47

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.
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PMID:Sensitivity and specificity of two-dimensional echocardiography in detection of impaired left ventricular function. 674 90

The parameter derived from right anterior oblique angiocardiography (end diastolic and end systolic volumes, stroke volume, ejection fraction, wall thickness and myocardial mass) are used to decide the most appropriate management of cardiac disease. It is important to assess their reliability especially as other clinical data may be underestimated and the objective results may play a prominent role in the decision. Therefore, good quality cinefilms of 31 patients were reinterpreted by three observers (A, B and C); the contours were traced on a Vanguard console with an electromagnetic pet and the data treated automatically by the SNIASS SYSCOMORAN program (Simpson's method, assimilating the left ventricle to an ellipsoid divided into n identical cylinders). The interobserver variability (A and B; A and C; B and C) was good in the assessment of end diastolic volume (R = 0,96; 0,98; 0,99), end systolic volume (R = 0,96; 0,96; 0,98). On the other hand, it was poor in the measurement of wall thickness (R = 0,63; 0,73; 0,69) and myocardial mass (R = 0,85; 0,83; 0,89). In addition, the ejection fraction and end systolic volume were perfectly reproducible from one observer to another whether or not the left ventricle was dilated. End diastolic volumes seemed to be more reproducible in dilated cavities (EDV greater than 104 ml/m2). These results confirm that monoplane RAO cineangiography remains a good method of assessing left ventricular performance.
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PMID:[Analysis of interobserver variations in the estimation of myocardial volume, thickness and mass in right anterior oblique monoplanar angiocardiography]. 681 Jul 84

A difference was obtained between cineventriculography and 2-D echocardiography in the determination of left ventricular volume and ejection fraction. Normal values obtained by the former could not be used for the latter. The authors, therefore, determined their own normal values. Apical 2-D echocardiography was used for the normal group (35 males, mean age 30.2 years; 20 females, mean age 26.2 years). In addition to mean values and standard deviations, one-sided tolerance limits (T) were calculated, separating the normal range from abnormal within 95% confidence limits for 90% of the total group. End-diastolic and end-systolic volume index in males was 66.8 +/- 8.8 ml/m2 compared with 26.9 +/- 5.2 ml/m2 on biplane evaluation. Tolerance limits were calculated at 82.0 and 35.9 ml/m2, respectively. Stroke volume index was 39.9 +/- 7.0 ml/m2, T = 27.8 ml/m2, ejection fraction 59.2 +/- 6.0%, T = 48.8%. End-diastolic and -systolic volume index for females had a mean of 60.7 +/- 12.5 ml/m2, T = 85.0 ml/m2, and 25.7 +/- 7.4 ml/m2, T = 40.1 ml/m2, respectively. Stroke volume index was 56.5 +/- 10.6 ml/m2, T = 35.9 ml/m2, the ejection fraction 58.1 +/- 6.5%, T = 45.5%. Between monoplane and biplane measurements of apical 2-D echocardiograms there was no significant difference. Normal values for volume and ejection fraction of the left ventricle, determined from apical four-chamber and RAO-equivalent cuts make it possible to categorize the function of the heart and to provide the basis for further studies of the sensitivity and specificity of the method.
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PMID:[Apical two-dimensional echocardiography: normal values for single- and bi-plane determination of left ventricular volume and ejection fraction]. 714 May 70

A method for analysing left ventricular cineangiograms is described, which not only provides information on the overall ventricular performance, but also evaluates the regional contraction of the left ventricle and the related haemodynamic patterns. This simplified Chapman's method (slice method) makes it possible to calculate the end-diastolic, end-systolic volumes, the stroke volume and the ejection fraction of the zones into which the left ventricle is divided by a longitudinal and by three transverse axes, according to Herman's technique. The hemiventriculograms of 21 normal subjects in the AP projection were evaluated using this method and a 10 of them were also studied in RAO projection. A uniform left ventricular contraction pattern was found for three hemiventricles outlined by the anterolateral, lateral, and postero-medial walls (ejection fraction 71.7 +/- 5.1%, 71.6 +/- 5.9%, 70.4 +/- 5.1%, respectively), the regional and zonal ejection fraction (EFR, EFZ) being similar in both projections. The ejection fraction of the hemiventricle outlined by the septal wall was, however, lower (65.6 +/- 6.0%). The standard zonal function curves of the left ventricle in normal subjects was then calculated on the basis of the results obtained, in order to assess, by comparison, zonal function abnormalities in cardiac patients.
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PMID:Quantitative evaluation of the regional left ventricular function in normal subjects by means of cineangiocardiography. 736 91


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