Comparison of left ventricular ejection fraction values obtained using invasive contrast left ventriculography, two-dimensional echocardiography, and gated single-photon emission computed tomography.

OBJECTIVES: Left ventricular ejection fraction can be measured by a variety of invasive and non-invasive cardiac techniques. This study assesses the relation of three diagnostic modalities to each other in the measurement of left ventricular ejection fraction: invasive contrast left ventriculography, two-dimensional echocardiography, and quantitative gated single-photon emission computed tomography. METHODS: Retrospective chart review was conducted on 58 patients hospitalized with chest pain, who underwent left ventricular ejection fraction evaluation using each of the aforementioned modalities within a 3-month period not interrupted by myocardial infarction or revascularization. RESULTS: The mean left ventricular ejection fraction values were as follows: invasive contrast left ventriculography (0.44±0.15), two-dimensional echocardiography (0.46±0.13), and gated single-photon emission computed tomography (0.37±0.10). Correlations coefficients and associated p values were as follows: invasive contrast left ventriculography versus two-dimensional echocardiography (r=0.69, p<0.001), invasive contrast left ventriculography versus gated single-photon emission computed tomography (r=0.80, p<0.0001), and gated single-photon emission computed tomography versus two-dimensional echocardiography (r=0.69, p<0.001). CONCLUSION: Our results indicate that strong positive correlations exist among the three techniques studied.

Myocardial perfusion imaging analysis in patients with regurgitant valvular heart disease.

BACKGROUND/AIM: We noticed that there was decreased correlation of the findings from myocardial perfusion imaging (MPI) and cardiac catheterization (CATH) in patients with mitral regurgitation (MR) and aortic regurgitation (AR) compared to patients without valve disease. METHODS: Through a systematic review of MPI records at the Harry S. Truman Memorial Veterans' Hospital between 1998 and 2008, we identified 58 patients with at least moderate MR or AR by echocardiogram who underwent cardiac catheterization within 6 months of the MPI study. A control group was formulated with 60 patients who did not have significant MR or AR on echocardiogram and who had both MPI and CATH. Correlation between MPI and CATH was graded as complete, partial, or absent. RESULTS: Correlation between MPI and CATH was lower in the valve disease patients (study group) when compared to controls. Correlation was complete in 76% of study patients and 90% of controls, partial in 15% of study patients and 5% of controls, and absent in 9% of study patients and 5% of controls. Differences between the groups were significant (P < .05). CONCLUSIONS: Patients with regurgitant valvular heart disease may have myocardial perfusion abnormalities that are not associated with angiographic critical coronary stenosis.

Pertinence of myocardial perfusion imaging in octogenarians.

AIM: Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the elderly population. Atypical presentation, reduced activity levels, and comorbidity often confound the diagnosis. We studied the use of stress myocardial perfusion imaging (MPI) in octogenarians. METHODS: We retrospectively reviewed the medical records of all patients with both MPI and coronary angiogram within 6 months from 1998 to 2008. Sixty veterans under the age of 60 years who underwent both cardiac procedures served as controls. RESULTS: We evaluated 53 patients, predominantly men, with mean age of 85 +/- 2.5 yrs. Chest pain (68%) was the most common reason for requesting the stress test. Risk factors included diabetes 44%, hypertension 93%, smoking 48%, hyperlipidemia 93%, and peripheral vascular disease 40%. All patients had an abnormal myocardial perfusion scan. Reversible defects were present in 91% with the following distribution: mild 26%, moderate 39%, severe 15% and multiple defects 11%. Fixed defects were present in 44% of the patients. Analysis of both studies in the 53 patients revealed complete (43), partial (7) and no correlation (3) between the MPI defects and culprit lesions identified on the coronary angiogram. Positive predictive value and accuracy of the myocardial perfusion scan in detection of the disease was 98%. Follow up ranged from 1 to 10 years during which 19 patients died, and 7 deaths were cardiac. CONCLUSION: Myocardial perfusion imaging in octogenarians is as accurate in diagnosing CAD as it is in younger people.

Outcomes in patients with abnormal myocardial perfusion imaging and normal coronary angiogram.

A subset of subjects undergoing myocardial perfusion imaging has perfusion abnormalities that are subsequently labeled false positive based on coronary angiography. We evaluated the long-term prevalence of cardiovascular events in these patients. We retrospectively identified 48 patients who had reversible perfusion abnormalities with myocardial perfusion imaging and normal coronary angiography. Patients with known coronary artery disease, left ventricular dysfunction, valvular disease, and cardiomyopathy were excluded. Patient follow-up, conducted for at least 3 (mean interval, 7.4) years from the index myocardial perfusion imaging, was accomplished by a review of medical records and telephone interviews. Study endpoints were cardiovascular events defined as sudden cardiac death, myocardial infarction, percutaneous coronary revascularization, coronary artery bypass grafting, and cerebrovascular or peripheral revascularization. Thirty-one percent (15 of 48) of the patients had cardiovascular events. Six of the 48 patients had coronary events. These patients had abnormal myocardial perfusion imaging and normal coronary angiogram. The time between myocardial perfusion imaging and coronary event was 0.5 to 8.67 years. There was a strong correlation between the regions of original perfusion abnormality and the ultimate coronary ischemia or revascularization. Abnormal findings on myocardial perfusion imaging may predict a higher prevalence of coronary and peripheral vascular events than suggested by a normal coronary angiogram.

Acute effect of furosemide on glomerular filtration rate in diastolic dysfunction.

We sought to evaluate the acute effect of furosemide on glomerular filtration rate (GFR) in subjects with diastolic dysfunction. An equal number of subjects with documented diastolic dysfunction (DD) and healthy volunteers (controls) were enrolled and underwent a baseline GFR measurement via plasma clearance of technetium-99m-diethylenetriaminepentaacetic acid. Within three to seven days of the baseline, study subjects were scheduled for a second GFR study, which was performed immediately after administration of furosemide (20 mg orally and 20 mg intravenously). There were eight healthy volunteers (8 males with a mean age 42 +/- 7.8 years; 6 white, 2 Asian) and eight subjects with diastolic dysfunction (7 males, 1 female, with a mean age 64.5 +/- 9.3 years; 7 whites, 1 African-American). There was a significant post-furosemide decline in GFR in the healthy volunteers, baseline vs. post-furosemide 131.6 +/- 19.8 vs. 117 +/- 18.2 mL/min, respectively (p = 0.03), and the patients with DD, baseline vs. post-furosemide 117.5 +/- 22.3 vs. 92 +/- 21.7 mL/min, respectively (p = 0.0002). A strong trend was detected, though not statistically significant, of greater GFR decline in subjects with DD compared to the healthy volunteers, 25.5 +/- 9.9 vs. 14.6 +/- 15.6 mL/min, respectively (p = 0.12). To conclude, acute administration of furosemide might potentially cause a greater decline in GFR in subjects with diastolic dysfunction.