Left ventricular volumes in moderate alcohol users: a study from the workplace.

We measured resting and exercise left ventricular volumes by a count-based, nongeometric radionuclide method in 23 healthy volunteers grouped according to reported average daily alcohol consumption: 0-20 g (Gp A), 21-50 g (Gp B) and greater than 50 g (Gp C). No patient had measurable alcohol in his blood at the time of study. Mean resting LV Ejection Fraction (EF) was 65 +/- 2% in Group A, 64 +/- 2% in Group B, and 65 +/- 3% in Group C. Exercise EF was 76 +/- 1,75 +/- 3 and 74 +/- 4%, respectively. Resting Endsystolic Volume Indices in the three groups were 19.2 +/- 3, 18.9 +/- 2 and 21.8 +/- 3 ml/m2; exercise values were 15.9 +/- 2, 12.8 +/- 2 and 13.3 +/- 2 ml/m2, respectively. This cohort was selected for absence of markers of alcohol-related illness, and all subjects were employed. We found no evidence for impaired left ventricular systolic function with moderate alcohol usage using a sensitive radionuclide technique.

Peak filling rate normalized to mitral stroke volume: a new Doppler echocardiographic filling index validated by radionuclide angiographic techniques.

The noninvasive measurement of left ventricular filling has relied predominantly on radionuclide-derived peak filling rate normalized to end-diastolic volume. Doppler echocardiography also has the ability to measure peak filling rate, but wide application of this technique has been limited by technical errors involved in quantitative echocardiographic determination of mitral anulus cross-sectional area and ventricular volumes. For Doppler echocardiography, normalization of peak filling rate to mitral stroke volume rather than end-diastolic volume permits the derivation of a diastolic filling index that is relatively free of errors caused by geometric assumptions, diameter measurements and sample volume positioning. This normalization process can be achieved by simply dividing early peak filling velocity by the time velocity integral of mitral inflow. To validate this new Doppler echocardiographic filling index, Doppler echocardiographic and radionuclide-derived peak filling rate, both normalized to mitral stroke volume, were compared in 30 patients; there was an excellent correlation (r = 0.91, SEE = 0.88). This variable was not influenced by the position of the sample volume in relation to the mitral apparatus in contrast to early filling velocity, which increased 37%, and early/late filling (E/A) ratio, which increased 43% as the sample volume was moved from the anulus to the tips of the mitral leaflets. In a cohort of 22 normal patients, the mean peak filling rate normalized to mitral stroke volume (SV) was 5.25 +/- 1.47 SV/s. The mean peak filling rate for a subgroup of eight normal patients aged 57 to 89 years (mean 71 +/- 9) was 3.9 +/- 1 SV/s.(ABSTRACT TRUNCATED AT 250 WORDS)

Dynamics of early and late left ventricular filling determined by Doppler two-dimensional echocardiography during percutaneous transluminal coronary angioplasty.

To study the influence of ischemia on both early and late left ventricular filling, Doppler 2-dimensional echocardiography was used to measure filling parameters during percutaneous transluminal coronary angioplasty (PTCA) in 26 patients. Doppler recordings were taken immediately before balloon inflation and continuously during balloon inflation and deflation until 60 seconds into the recovery period. During PTCA of the left anterior descending artery (16 patients) there was a 35% decrease in early peak filling rate from 269 +/- 88 to 169 +/- 55 ml/s (p less than 0.0005) by 60 seconds of balloon inflation. In patients undergoing PTCA of the left circumflex (4 patients) or dominant right coronary artery (6 patients), the early peak filling rate decreased 15% from 325 +/- 126 to 284 +/- 137 ml/s (p less than 0.005). The decrease in early peak filling rate became evident at approximately 15 seconds after balloon inflation and fully recovered 20 seconds after balloon deflation. Rather than an expected increase in atrial stroke volume and a decrease in early to late filling ratio during coronary occlusion, there was a 28% decrease in atrial stroke volume during left anterior descending coronary artery PTCA and a 6% decrease during right coronary and circumflex PTCA. Because of the simultaneous decrease in both early and late ventricular filling, peak early to late filling ratio was only slightly altered during PTCA. There was an 83% increase in mean pulmonary artery wedge pressure during balloon inflation from 12 +/- 5 to 20 +/- 4 mm Hg. In 11 of these patients global systolic function was measured on subsequent inflations during PTCA using 2-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Doppler echocardiographic determination of aortic valve area using the continuity equation.

The noninvasive measurement of aortic valve area by use of the continuity equation has been proposed as an accurate method for determining the severity of aortic stenosis. In 32 patients (mean age 64 +/- 14 years) with proven aortic stenosis and without significant regurgitation, aortic valve areas derived by the Gorlin equation from cardiac catheterisation data were compared with valve areas calculated from the continuity equation using Doppler echocardiography. There was a close correlation between Doppler and catheter derived aortic valve areas (r = 0.87, SEE = 0.17 cm2). The interobserver error for aortic valve area measurement in 20 patients was 9.0 +/- 6.8%. The specificity of this method for critical aortic stenosis (aortic valve area less than 0.75 cm2) was 73% and the sensitivity 88%. We conclude that in an adult, predominantly elderly population with calcific aortic stenosis, this Doppler echocardiographic method is reproducible and can be used accurately to derive aortic valve area.