Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate the ability of transluminal coronary angioplasty (TCA) to relieve myocardial ischemia, 44 patients with single vessel disease underwent exercise gated radionuclide ventriculography (GRNV) before and 2.8 +/- 1.3 days following angiographically successful TCA. Pre-TCA GRNV was abnormal in 11 of 14 patients with right coronary artery (RCA) stenosis and 24 of 30 with left anterior descending (LAD) stenosis. Following TCA there was an increase in exercise duration from 500 +/- 288 sec to 625 +/- 273 sec (P less than 0.001), and in maximum double product from (209 +/- 69) x 10(2) to (263 +/- 70) x 10(2) (P less than 0.001). The number of patients with stress-induced ST-T abnormalities decreased from 13 to 4 (P less than 0.05), and the number with chest pain during exercise decreased from 18 to one (P less than 0.001). Whereas resting ejection fraction was unchanged (0.58 +/- 0.10 vs 0.59 +/- 0.11) following TCA, the ejection fraction at peak exercise increased from 0.61 +/- 0.13 to 0.66 +/- 0.12 (P less than 0.001). Of 24 patients with resting abnormalities, regional wall motion improved in 13. In 22 of 31 patients with stress-induced asynergy, the wall motion response to exercise improved (P less than 0.001). Of 19 patients restudied angiographically and with exercise GRNV at 6-12 months, restenosis of greater than or equal to 50% had occurred in six, four of whom had abnormal studies. In six of whom the degree of stenosis of the dilated artery had remained less than or equal to 20% the exercise GRNV study remained normal. It is concluded that GRNV is helpful in documenting the improvement in resting left ventricular function and functional reserve in patients with angiographically successful TCA. In the limited number of patients with late follow-up studies, data suggest that GRNV may be a valuable test to detect restenosis.
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PMID:Exercise radionuclide ventriculography in evaluating successful transluminal coronary angioplasty. 622 2

Fifty-five ischemic attacks at rest with ST segment elevation were recorded by two-dimensional echocardiography (2DE) in 20 patients with Prinzmetal angina. Eighteen ischemic attacks were recorded starting from intravenous injection of ergonovine maleate while 37 spontaneous ischemic attacks were recorded from onset of either anginal pain or ECG changes or from the basal state. In each ischemic attack at least one of the following transient alterations was observed by 2DE during ST elevation: (1) Regional hypokinesia, akinesia, or dyskinesia; (2) "step sign," that is, a sharp demarcation between an akinetic or dyskinetic area and an adjacent normal or hypercontracting region; and (3) geometric changes in left ventricular shape, that is, globular appearance in diastole and hourglass silhouette in systole. Regional myocardial asynergy was detected earlier than onset of pain (which was not present in 21 [38%] ischemic episodes) or ST segment elevation on ECG, as documented in 40 ischemic episodes (16 induced and 24 spontaneous) in which echocardiographic monitoring was performed from basal state and carried on up to the appearance of ischemia. All described mechanical changes were fully reversible after pain subsided and ST segment was back to isoelectric, either spontaneously or with nitrates; furthermore, a contractile "rebound phenomenon" of the previously ischemic wall was observed in some episodes. In conclusion, these results outline a role for 2DE in detecting cardiac mechanical impairment due to transient myocardial ischemia with ST segment elevation in humans.
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PMID:Transient changes in left ventricular mechanics during attacks of Prinzmetal angina: a two-dimensional echocardiographic study. 623 83

Twenty patients with ischemic heart disease were studied with biplane contrast left ventriculography and gated bloob pool scans. An ejection fraction (EF) image was calculated from each gated blood pool scan. The EF image and contrast ventriculograms were divided into three regions and seven segments respectively. The sites of asynergy observed in each study were compared. Segments two, three and six of the contrast ventriculogram corresponded to the anteroseptal and inferoapical regions of the EF image, but it was difficult to differentiate between these segments on the EF image. Segments three and four corresponded to the inferoapical region and segments five and seven corresponded to the posterolateral region. Diffuse asynergy with a low EF (less than 30%) causes a large defect on the EF image. The mean regional EF obtained from the EF image correlated well with the EF calculated from the left ventricular volume curve (n = 50, r = 0.94).
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PMID:Assessment of cardiac wall motion with the ejection fraction image: a comparison with contrast left ventriculography. 627 39

Exercise ECG testing is the most popular method clinically detecting temporary myocardial ischemia, but both false-positive and false-negative results are reported. Detection of regional myocardial dysfunction during exercise using radionuclide angiocardiography or echocardiography has recently been developed to detect temporary myocardial ischemia in patients with coronary artery disease. In patients having chest pain and ECG changes during exercise, most of whom have coronary stenosis arteriographically, exercise radionuclide angiocardiography revealed an increased number of abnormal regional motion walls, an aggravation of asynergy by point scoring system, and a decrease of left ventricular ejection fraction (EF). In most of patients without coronary stenosis, on the other hand, no asynergy with increase of EF was observed. For detecting temporary myocardial ischemia, abnormal exercise radionuclide angiocardiography seemed rather sensitive than exercise 201-T1 myocardial imaging abnormality. During exercise, the regional wall motion abnormality was detected earlier by echocardiography than by electrical abnormality. In the cases, in which ST segment elevated during exercise, EF measured by radionuclide angiocardiography decreased remarkably, suggesting severe myocardial ischemia. In many of those, however, T waves were negative at rest and became positive during exercise, and EF increased, suggesting the other mechanism than myocardial ischemia. The success rate of exercise radionuclide angiocardiography was high. This method was useful not only in localizing abnormal wall motion but in obtaining reliable EF, though it is such an expensive device that it can be set only in the limited institutions. A major difficulty with standard M-mode echocardiography is in its "ice-pick" view, which may be compensated by 2-dimensional technique. Echocardiography can be used to detect the time course of the influence of myocardial ischemia. For evaluating temporary myocardial ischemia, examinations of regional wall motion abnormality is useful, because of high specificity, high sensitivity, localizing and grading the ischemia, and new interpretation of the findings of other examinations such as exercise ECG.
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PMID:[Accurate diagnosis of temporary myocardial ischemia by noninvasive regional wall motion analysis]. 652 Apr 36

We correlated the incidence and degree of exercise induced ventricular arrhythmias (EIVA) with the angiographic severity of coronary artery disease (CAD) in 162 patients with a history of stable effort angina, all showing a positive exercise stress test for myocardial ischemia and a greater than or equal to 70% stenosis of a major coronary artery. Patients were grouped according to the following criteria: presence of electrocardiographic evidence of old transmural myocardial infarction (MI), number of significant coronary stenoses and number of left ventricular (LV) areas showing abnormal segmental wall motion (ASWM). The incidence of EIVA in patients with multivessel CAD was higher than in patients with single vessel CAD, but this difference was not statistically significant. The number of LV areas with ASWM was better correlated with the frequency of EIVA, which was 20.0% in patients with normal LV wall motion, 31.2% in patients with 1 area of ASWM, 54.0% in patients with 2 areas of ASWM (p less than 0.005 vs normal LV wall motion), 74.1% in patients with 3 or more areas of ASWM (p less than 0.001 vs normal LV wall motion and 1 area of ASWM), and 81.8% in patients with LV aneurysm (p less than 0.001 vs normal LV wall motion and 1 area of ASWM, p less than 0.005 vs 2 areas of ASWM). Patients with old MI showed a significantly higher incidence of EIVA than those without MI (p less than 0.001), but this difference was due to the more severe LV asynergy in the MI group. In conclusion, our results show that, in a selected population of patients with CAD, the incidence of EIVA correlates better with the extent of LV segmental wall motion abnormalities than with the number of diseased coronary arteries or the presence of an old transmural MI.
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PMID:Exercise induced ventricular arrhythmias. Angiographic correlation with the severity of coronary artery disease. 664 44

The nitroglycerin test was conducted in 21 patients with ischemic heart disease. The changes in the hemodynamic parameters of left-ventricular function, namely the end-diastolic pressure, the end-systolic and end-diastolic volumes, the ejection fraction, and the segmental contractility of the left-ventricular wall were studied. It was found that nitroglycerin discloses the zones of reparable asynergy and thus allows the area of true cicatricial changes of the myocardium to be clearly demarcated. All hemodynamic indices changed under the effect of nitroglycerin; the dynamics of the end-systolic volume and the ejection fraction made it possible to appraise the functional condition of the myocardium. The results obtained showed the importance of the nitroglycerin test in prognosing the results of myocardial revascularization and determining the volume of surgical intervention in aneurysms of the left ventricle.
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PMID:[Nitroglycerin test in evaluating left ventricular contractile function in ischemic heart disease]. 677 58

Effects of nitroglycerin (NTG) on segmental wall motion and pump function of the left ventricle (LV) were studied in 19 patients with ischemic heart disease (IHD) and 10 normal controls by two-dimensional echocardiography (2DE) and coronary arteriography (CAG). Short-axis cross-sectional images of the LV at the mitral valve, papillary muscles and the apex were recorded and subdivided into quadrants at each level. The center of gravity of the end-diastolic LV cavity and the axis intersecting this point and the right side of the posterior end of the interventricular septum were used as the reference point and line. The areas of whole sections and of each quadrant at end-diastole (Ad) and end-systole (As) were measured by the computer. Regional contractility and pump function of the LV were evaluated by (Ad-As)/Ad and (Ad-As) of quadrants and sections. The results were as follows: Blood pressure (BP), Ad and (Ad-As) of sections significantly decreased after NTG administration. (Ad-As)/Ad of the sections with normal wall motion showed no significant change after NTG. (Ad-As)/Ad of the quadrants with hypokinetic segmental wall motion showed a tendency to increase after NTG in contrast with the normal quadrants which showed no significant change. CAG findings and hemodynamic parameters in patients who showed a significant increase in (Ad-As)/Ad of all sections after NTG (Gr. I) were compared with those in patients who showed a decrease in (Ad-As)/Ad of all sections (Gr. II). There was no significant correlation between CAG findings in Gr. I and Gr. II. The only difference between these two groups before NTG was that mean Ad of sections in Gr. I was significantly greater than that of Gr. II. After NTG, Gr. I showed a significant decrease of BP, but Gr. II did not show any significant change. (Ad-As) of sections in Gr. I increased or showed no change after NTG, but those in Gr. II decreased. In conclusion, NTG can reverse wall motion asynergy, especially in hypokinetic segments, and produce favorable changes in pump function in patients with increased Ad before NTG. The mechanism of NTG to improve wall motion and pump function is considered to be afterload and preload reduction.
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PMID:[Evaluation of regional wall motion of the left ventricle before and after nitroglycerin administration in patients with ischemic heart disease: comparison between two-dimensional echocardiograms and coronary angiograms]. 682 Nov 5

The effects and reliability of a simple method of contrast two-dimensional echocardiographic delineation of myocardium after intracoronary injections were evaluated in closed-chest dogs. Multiple injections of an agitated saline-Renografin (meglumine diatrizoate) mixture (3:2 ratio, 2-ml bolus) into the left main coronary artery as well as at different sites of the left anterior descending and circumflex coronary arteries were studied in several short-axis and long-axis cross sections of the left ventricle. These contrast injections opacified specific regions of left ventricular myocardium depending on the site of injection. Contrast injection into the left main coronary artery provided a clear, echo-free outline (negative contrast) of underperfused myocardium distal to the coronary occlusion. Reproducibility studies of the extent of involved zones measured in echocardiographic cross sections indicated high intra- and interobserver correlation coefficients (r = 0.97 and 0.97). The effects of the intracoronary injection of contrast material appeared minor and brief. ECG ST-T changes lasted 49.4 +/- 36.7 seconds, aortic systolic pressure was reduced by 7.6 +/- 4.4% for 18.9 +/- 4.8 seconds, and the peak rate of left ventricular pressure rise decreased by 14.3 +/- 2.6%, but returned to control levels within 19.4 +/- 6.1 seconds. The zone of left ventricular asynergy after coronary occlusions was also delineated by cross-sectional echocardiography and corresponded to the contrast-outlined underperfused zone (negative contrast). This new intracoronary echocardiographic technique has only minor hemodynamic consequences and provides reliable quantitation of underperfused and dysfunctioning zones after experimental coronary occlusions. Further investigation and validation of this method may provide useful characterization of the extent and severity of myocardial ischemia and infarction.
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PMID:Myocardial contrast echocardiography: a reproducible technique of myocardial opacification for identifying regional perfusion deficits. 682 1

Two dimensional echocardiography, because of its wide field of view, has been shown to be superior to the M mode approach for ultrasonic evaluation of the left ventricle. The use of this technique for determination of ventricular volume estimates and detection of asynergy has been promising but is limited by compromised image quality found in many patients with ischemic heart disease. Because it supplies cross-sectional information about the ventricular chamber and wall thickness simultaneously, this new technique lends itself to the anatomic localization of changes in regional performance that accompany ischemic heart disease. It allows simultaneous study of regional dynamic changes in chamber circumference, wall thickness and motion characteristics that give practical information on coronary artery disease and acute myocardial infarction.
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PMID:Evaluation of the left ventricle with two dimensional echocardiography. 700 58

Myocardial contractility was studied in 44 patients with ischaemic heart disease (28 with asynergy) without congestive circulatory insufficiency depending on the degree of coronary atherosclerosis and regional disorder in the movement of the wall of the left ventricle by ventriculography and tensiometry (dp/dt max, Veraguth index, VCE40; t-dp/dt max). No dependence was detected between the growth of the total lesions of cardiac arteries and the increase of the end diastolic and end systolic volumes and the fall of the ejection fraction in patients with normokinesia of the left ventricle. However, a strong inverse relationship has been established between the number of the affected segments of the heart and the ejection fraction (r = -0.90). It was shown that indices of contractility reflecting the pre-ejection phase (dp/dt max, Veraguth index VCE40; t-dp/ max) are less sensitive in determining the cardiac insufficiency than Vcf and must be interpreted simultaneously with the results of the regional contractility according to the ventriculography data.
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PMID:[Myocardial contractile capacity in ischemic heart disease depending on the degree of coronary arteriosclerosis and the presence of parietal asynergy of the left ventricle]. 710 48


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