Impact of body mass index on markers of left ventricular thickness and mass calculation: results of a pilot analysis

Specific correlations between body mass index (BMI) and left ventricular (LV) thickness have been conflicting. Accordingly, we investigated if a particular correlation exists between BMI and echocardiographic markers of ventricular function. METHODS: A total of 122 patients, referred for routine transthoracic echocardiography, were included in this prospective pilot study using a 3:1 randomization approach. Patient demographics were obtained using a questionnaire. RESULTS: Group I consisted of 80 obese (BMI was >30 kg/m2), Group II of 16 overweight (BMI between 26 and 29 kg/m2), and Group III of 26 normal BMI (BMI < 25 kg/m2) individuals. No difference was found in left ventricular wall thickness, LV end-systolic cavity dimension, fractional shortening (FS), or pulmonary artery systolic pressure (PASP) among the groups. However, mean LV end-diastolic cavity dimension was greater in Group I (5.0 +/- 0.9 cm) than Group II (4.6 +/- 0.8 cm) or Group III (4.4 +/- 0.9 cm; P < 0.006). LV mass indexed to height(2.7) was also significantly larger in Group I (61 +/- 21) when compared to Group III (48 +/- 19; P < 0.001). Finally, left atrial diameter (4.3 +/- 0.7 cm) was also larger (3.8 +/- 0.6 and 3.6 +/- 0.7, respectively; P < 0.00001). DISCUSSION: We found no correlation between BMI and LV wall thickness, FS, or PASP despite the high prevalence of diabetes and hypertension in obese individuals. However, obese individuals had an increased LV end-diastolic cavity dimension, LV mass/height(2.7), and left atrial diameter. These findings could represent early markers in the sequence of cardiac events occurring with obesity. A larger prospective study is needed to further define the sequence of cardiac abnormalities occurring with increasing BMI.     

Determination of left ventricular systolic wall thickness by digital subtraction angiography

The accuracy of digital subtraction angiography (DSA) for determination of left ventricular (LV) systolic wall thickness and muscle mass was evaluated in 20 patients (mean age 50 +/- 11 years). Conventional LV angiograms were digitized and subtracted using a combined subtraction mode ('mask mode' and 'time interval difference' subtraction). Wall thickness and muscle mass were determined at end-diastole, after the first- and second-third of systole and at end-systole. M-mode echocardiography (Echo), which was obtained from beam selection of the two-dimensional echocardiogram and conventional angiography (LVA), served as reference techniques. Angiographic LV wall thickness and muscle mass were determined according to the technique of Rackley in both, right (RAO) and left (LAO) anterior oblique projections, whereas echocardiographic wall thickness was measured just below the mitral valve orthogonal to the posterior wall (= LAO equivalent). Percent wall thickening was calculated in all patients. LV end-diastolic wall thickness and muscle mass correlated well between DSA and LVA (LV end-diastolic wall thickness in LAO projection r = 0.72, biplane LV end-diastolic muscle mass r = 0.83), LV end-systolic wall thickness (1.44 vs 1.33 cm, P less than 0.05) and percent wall thickening (52 vs 42%, P less than 0.05) compared favourably between echocardiography and DSA but was significantly larger when echocardiographically measured than with DSA (LAO projection). DSA and echocardiography showed a good correlation in regard to LV end-diastolic and end-systolic wall thickness (correlation coefficient r = 0.89, standard error of estimate SEE = 0.15 cm or 13% of the mean value).(ABSTRACT TRUNCATED AT 250 WORDS)     

Determination of left ventricular wall thickness and muscle mass by intravenous digital subtractionangiocardiography: validation of the method

Left ventricular (LV) wall thickness and muscle mass are importantmeasures of LV hypertrophy. In 24 patients LV end-diastolicwall thickness and muscle mass were determined (two observers)by digital subtraction angiocardiography (DSA) and conventionalLV angiocardiography (LVA). Wall thickness was determined overthe anterolateral wall of the left ventricle according to thetechnique of Rackley (method 1) or by planimetry (method 2).Seventeen patients were studied at rest and seven during dynamicexercise. Wall thickness correlated well between LVA and DSA;the best correlations were obtained by a combined subtractionmode using either method 1 or 2 (method 1, r0–80; method2,r0. 75). The standard error of estimate of the mean (SEE) wasslightly lower for method 2 ( 10%) than for method 1 ( 13%).DSA significantly overestimated wall thickness by 5–7%with method 1 and underestimated by 12–14% with method2. Muscle mass correlated well between LVA and DSA; the SEEwas 15% for method 1 and 12% for method 2. Overestimation ofmuscle mass by DSA was 7–11% with method 1 and underestimationwas 13–15% with method 2.It is concluded that LV wallthickness can be determined accurately by DSA with an SEE rangingbetween 10 and 13%. Determination of LV muscle mass is slightlyless accurate and the SEE is slightly larger ranging between13 to 17%. With method 1, wall thickness and muscle mass wereover estimated and with method 2 underestimated.     

Regional myocardial performance of non-ischaemic zones remote from anterior wall left ventricular aneurysm: Effects of aneurysmectomy

The aim of this work was to investigate the effects of resectinga post-infarction left ventricular anterior aneurysm on thekinetics of the non-ischaemic inferior wall, remote from thehealed lesion. Thirteen patients, with an anterior post-infarctionaneurysm and a normal right coronary artery who underwent aneurysmectomywith endoventricular circular patch plasty reconstruction, hada complete haemodynamic study before and shortly after surgery.The shape of the left ventricle was quantitatively analysedby calculating the regional curvature at 90 points of the angiographicoutlines (30° right anterior oblique projection). Segmentalwall motion was studied by means of the centreline method andby constructing pressure-length loops from the endocar dialmovement of 18 chords intersecting the left ventricular inferiorcontour and by simultaneously tracing the high-fidelity leftventricular pressure. Analysis of pressure-length regional loopsshowed a complex pattern of abnormal, contract ion and relaxationin the non-ischaemic inferior regions at baseline; after surgerysuch abnormalities decreased significantly and tended to revertto normal in many cases. Left ventricular shape in the inferiorregion was abnormal in 10/13 patients in that there was negativecurvature at the interface between the aneurysm and the inferiorwall that was corrected to positive after surgery. Regionalinferior wall motion and global ejection fraction significantlyimproved after surgery in these 10 patients. The three patientswhose global ejection fraction did not improve showed no inferiornegative curvature pre-operatively, nor did they show an increasein inferior wall motion. The results indicate that regionalfunction and shape in inferior, non-ischaemic regions, remotefrom an anterior aneurysm, are abnormal but potentially correctibleif the abnormal mechanical burden imposed on the wall is relieved.     

Dynamic changes in left ventricular regional wall thickness during premature ventricular contraction in conscious dogs

The contractile pattern of the regional left ventricular wall during premature ventricular contraction was analyzed in conscious dogs instrumented with an ultrasonic dimension gauge across the anterior and posterior left ventricular walls. Aortic flow was measured with an electromagnetic flow probe. A single premature ventricular contraction was induced by stimulating either the anterior or posterior wall with varied coupling intervals from 380 to 650 msec. Stroke volume of premature ventricular contraction was significantly smaller than that of premature atrial contraction with identical coupling intervals. In premature contractions, stroke volume was linearly related to coupling intervals. Though there was no isovolumic wall thickening in premature atrial contraction, the wall started to thicken during isovolumic ventricular systole in premature ventricular contraction. There was a clear inverse correlation between the ratio of the isovolumic wall thickening to the total wall thickening and coupling intervals.

In premature ventricular contractions with identical coupling intervals, the deformation of thickening characteristics was more pronounced in regions with closer proximity to the ectopic focus. Thus it is concluded that the pump function is depressed in premature ventricular contraction, in part due to the increased ratio of wall thickening during isovolumic systole before the opening of the aortic valve. Isovolumic wall thickening increases along with the shorter coupling intervals and closer proximity to the ectopic focus. These alterations in left ventricular mechanical function due to ectopic contraction might induce serious sequelae, depending upon the ectopic focus in the presence of already depressed regional function.     

Quantitation of left ventricular wall motion in normal subjects: Comparison of various methods

Computer-assisted analysis of percent change in the square root of area in each of 12 consecutive 30-degree, pie-shaped ventricular segments was obtained in 48 normal subjects who underwent cardiac catheterization and left ventriculography. The information obtained permitted establishment of objective confidence limits for normal left ventricular regional wall motion. As an index of dynamic changes in segmental wall motion, the percent change in the square root of area method compared favorably with existing radius, area, hemichord, and chord methods. It also possessed a variety of theoretical advantages over these techniques: 1) large numbers of points were analyzed, 2) wall motion disorders in all areas except base were evaluated, 3) taking the square root of area's percent change provided both area information with least splay and an average measure of radius.     

Increased relative wall thickness is a marker of subclinical cardiac target-organ damage in African diabetic patients

Objective

To assess the prevalence and covariates of abnormal left ventricular (LV) geometry in diabetic outpatients attending Muhimbili National Hospital in Dar es Salaam, Tanzania.

Methods

Echocardiography was performed in 61 type 1 and 123 type 2 diabetes patients. LV hypertrophy was taken as LV mass/height^2.7 > 49.2 g/m^2.7 in men and > 46.7 g/m^2.7 in women. Relative wall thickness (RWT) was calculated as the ratio of LV posterior wall thickness to end-diastolic radius and considered increased if ≥ 0.43. LV geometry was defined from LV mass index and RWT in combination.

Results

The most common abnormal LV geometries were concentric remodelling in type 1 (30%) and concentric hypertrophy in type 2 (36.7%) diabetes patients. Overall, increased RWT was present in 58% of the patients. In multivariate analyses, higher RWT was independently associated with hypertension, longer isovolumic relaxation time, lower stress-corrected midwall shortening and circumferential end-systolic stress, both in type 1 (multiple R² = 0.73) and type 2 diabetes patients (multiple R² = 0.66), both p < 0.001. These associations were independent of gender, LV hypertrophy or renal dysfunction.

Conclusion

Increased RWT is common among diabetic sub-Saharan Africans and is associated with hypertension and LV dysfunction.     

A semiautomated technique for the rapid evaluation of left ventricular regional wall motion

A semiautomated system for the rapid evaluation of left ventricular regional wall motion is described. The system includes direct projection of the cineangiogram film on an X-Y digitizer which is interfaced with a PDP-9 computer. The ventricular model used to evaluate regional wall motion and the methods of data analysis are described. Validation of the accuracy of the technique and specific clinical applications are presented. It is concluded that this technique provides a rapid means of evaluating left ventricular regional wall motion and that the accuracy of the technique is acceptable for clinical application.     

急性心肌梗死患者室壁运动及心功能损害与发病-超声检查时间的关系

目的 探索急性心肌梗死患者室壁运动及心功能损害与发病-超声检查时间的关系.方法 收集初发急性心肌梗死患者219例,均已排除陈旧性心肌梗死、早期心肌再梗死、严重的瓣膜性心脏病、先天性心脏病、心肌病等影响室壁运动及心功能的疾病.所有患者均在予冠状动脉介入干预前行经胸超声心动图检查,采用二维超声等方法测量或（和）计算左心室舒张末期内径（left ventricular diameters in diastasis,LVDd）、收缩末期内径（left ventricular diameters in systole,LVDs）、左心室射血分数（left ventricular ejection fraction,LVEF）、室壁运动计分指数（wall motion index,WMI）及运动正常节段（fragments with normal wall motion,FM）百分比等参数,并精确记录发病-超声检查时间.结果 WMI、LVDd、LVDs、LVEF、FM百分比与发病-超声检查时间的相关关系均有统计学意义（P＜0.05）,相关系数分别为0.167,0.235,0.258,-0.196,-0.144.在WMI的多重线性回归分析结果显示,变量FM百分比、LVEF、左回旋支和（或）右冠状动脉进入方程（R2=0.878,justed R2=0.876）,偏回归系数分别为-1.103,-0.030,-0.001.结论 对于未予冠状动脉介入干预的急性心肌梗死患者,其室壁运动及心功能均随发病-超声检查时间的增加而减弱.     

Prognostic value of left ventricular volume response during dobutamine stress echocardiography

AIMS: An abnormal left ventricular volume response during dobutamineechocardiography identified patients with severe coronary arterydisease. The aim of the study was to assess the prognostic valueof left ventricular volume changes during dobutamine stressechocardiography in 136 patients. MEHTODS AND RESULTS: Endpoints were defined as spontaneous cardiac events at follow-up.Left ventricular end-diastolic and end-systolic volume changes(abnormal response: >10% and >20> decrease, respectively)were compared with other clinical and stress test variables.During 18±7 months of follow-up, 31 cardiac events occurred:12 hard events (cardiac death [n=6 myocardial infarction [n=6])and 19 soft events (unstable angina [n=16] congestive heartfailure [n=3] End-diastolic volume response (P=0·006),diabetes (P=0·008), inducible wall motion abnormalities(P=0·024), end-systolic volume response (P=0·039)and inducible angina (P=0·038) were related to a greaterlikelihood of cardiac events. The Cox regression analysis revealedend-diastolic volume response (odds ratio: 3·0; CI 1·44–6·32)and diabetes (odds ratio: 2·7; CI 1·28–5·69)to be independent predictors of spontaneous cardiac events.Diabetes (odds ratio: 4·0; CI 1·26–12·80)and >40% baseline ejection fraction (odds ratio: 2·21;CI 1·14–4·29) were independent predictorsof hard events. CONCLUSIONS: An abnormal end-diastolic volume response during dobutaminestress echocardiography identifies patients with an unfavourableoutcome; they should be considered for more accurate prognosticstratification.     

Diverging effects of postextrasystolic potentiation on left ventricular segmental wall motion in coronary heart disease

The effects of postextrasystolic potentiation (PESP) on regional left ventricular (LV) wall motion were evaluated in 40 coronary artery disease (CAD) patients. Of the 40 CAD patients, 20 had a prior myocardial infarction and 20 had a history of angina pectoris. PESP was obtained by applying programmed atrial stimulation during LV angiography, in a way that basal cycle length, premature beat, and postextrasystolic pause were almost identical in all patients. Segmental wall motion was evaluated by calculating regional ejection fraction (EF) of 5 different areas with a computerized method before and after the premature beat. The results were compared to those obtained in a group of 8 normal subjects. LV areas were classified as normokinetic, mildly hypokinetic, severely hypokinetic, and hyperkinetic, on the basis of their regional EF in respect to normals, and classified as "responder" (R) and "nonresponder" on the basis of the magnitude of the increase of regional EF with PESP. Of a total of 200 areas 129 were normokinetic (68% R), 45 were mildly hypokinetic (78% R), 17 severely hypokinetic (76% R), and 9 were hyperkinetic (78% R). Infarcted patients had a higher percentage of hypokinetic areas in basal conditions (p less than 0.001), however, the percentage of hypokinetic areas that responded to PESP was not significantly different from noninfarcted patients. In CAD patients, as a whole, a significant direct correlation was found between basal regional EF and regional EF after PESP (r = 0.88, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Systolic wall stress may affect the intramural coronary blood flow velocity in myocardial hypertrophy, independently on the left ventricular mass

AIM: We sought to evaluate the relationship between left ventricular systolic wall stress (LV-SWS) and coronary artery blood flow velocity in patients with LV hypertrophy (LVH). METHODS AND RESULTS: The study population comprised 38 patients, aged 66.7 +/- 12.7, who were divided into two groups based on the LV-SWS median value. Group A included 19 patients at "low-stress" (92.0 +/- 18.0 mmHg/cm2) and group B other 19 patients at "high-stress" (134.2 +/- 32.3 mmHg/cm2) (P < 0.002). Coronary blood flow velocities were measured both in the left anterior descending (LAD) and in the intramural (IM) arteries. There were no significant between-group differences in the main clinical and echocardiographic parameters. Diastolic velocity in the LAD was also comparable, while it was higher in the IM arterioles of patients from group B than from group A (peak velocity 110.9 +/- 35.2 cm/s vs 92.0 +/- 29.4 cm/s, P < 0.02; mean velocity 78.6 +/- 28.8 vs. 56.0 +/- 20.2 cm/s, P < 0.01, respectively). Overall, moderate, but significative, linear correlation was found between IM peak and mean diastolic velocity and LV-SWS (r = 0.41, P = 0.01, and r = 0.44, P = 0.007, respectively), whereas there was no correlation with wall thickening and LV mass. CONCLUSIONS: Main findings from the present study likely suggest that in patients with mild-to-moderate LVH, high blood flow velocity in the IM arterioles, but not in the LAD, may be related to an increase in LV-SWS, rather independent on the absolute LV mass.     

Quantitation of global and regional left ventricular function by cine magnetic resonance imaging during dobutamine stress in normal human subjects

Magnetic resonance imaging (MRI) provides high-resolution imagesof the heart. However, physical exercise during MRI is difficultdue to space restriction and motion artefacts. To evaluate thefeasibility of MRI during stress conditions, dobutamine wasused as an alternative to exercise. Haemodynamics, ventricularvolumes and wall thickening were measured at rest and duringpeak dobutamine infusion (15 µg . kg^–1 . min^–1)in 23 normal human subjects. To calculate left ventricular volumes,eight short-axis views were obtained encompassing the left ventriclefrom base to apex. At six levels, percent systolic wall thickening(% WTh) was measured in 18 segments (20° intervals). Heartrate, systolic and diastolic blood pressures, stroke index,cardiac output and left ventricular ejection fraction increasedsignificantly during dobutamine infusion (all P values <0.001).In addition, % WTh increased significantly (P < 0.001 duringdobutamine compared to the control state at all levels exceptin the apical and low-left ventricular levels. Both in controlconditions and during dobutamine, segmental wall motion analysisshowed the highest % WTh at the posterolateral area and thelowest % WTh at the septal region (P <0.05). MRI clearly identifies wall motion dynamics and provides calculationsof segmental wall thickening and haemodynamic parameters. Dobutamineis a useful stress agent by virtue of its safety, operator controland its effects which resemble physical exercise.     

A study of the 16-Segment Regional Wall Motion Scoring Index and biplane Simpson's rule for the calculation of left ventricular ejection fraction: a comparison with cardiac magnetic resonance imaging

Aims: Accurate calculation of left ventricular ejection fraction (LVEF) is important for diagnostic, prognostic and therapeutic reasons. Cardiac magnetic resonance (CMR) is the reference standard for LVEF calculation, followed by real time three‐dimensional echocardiography (RT3DE). Limited availability of CMR and RT3DE leaves Simpson's rule as the two‐dimensional echocardiography (2DE) standard by which LVEF is calculated. We investigated the accuracy of the 16‐Segment Regional Wall Motion Score Index (RWMSI) as an alternative method for calculating LVEF by 2DE and compared this to Simpson's rule and CMR. Methods and Results: The 2D echocardiograms of 110 patients were studied (LVEF range: 7–74%); 57 of these underwent CMR. A RWMS was applied, based on the consensus opinion of two experienced cardiologists, to each of 16 American Heart Association myocardial segments (RWMSI: hyperkinesis = 3; normal regional contraction = 2; mild hypokinesis = 1.25; severe hypokinesis = 0.75; akinesis = 0; dyskinesis =–1). LVEF was calculated by: LVEF(%) =Σ(16segRWMS)/16×30. LVEF was calculated by Simpson's rule and CMR using standard methods. Results were correlated against CMR. Intertechnique agreement was examined. A P value of<0.05 was considered significant. RWMSI‐LVEF correlated strongly with Biplane Simpson's rule (P< 0.001, r = 0.915). RWMSI‐LVEF had a strong correlation to CMR (P < 0.001, r = 0.916); Simpson's rule‐LVEF had a moderate correlation to CMR (P< 0.001, r = 0.647). In patients with LV dysfunction (EF < 55%), on linear regression analysis, RWMSI‐LVEF had a better correlation with CMR than Simpson's rule. Further more Simpson's rule overestimated LVEF compared to CMR (mean difference: –6.12 ± 16.44, P = 0.002) whereas RWMSI did not (mean difference: 2.58 ± 14.80, P = NS). Conclusion: RWMSI‐LVEF correlates strongly with CMR with good intertechnique agreement. In centers where CMR and RT3DE are not readily available, the use by experienced individuals, of the RWMSI for calculating LVEF may be a more simple, accurate, and reliable alternative to Simpson's rule. (Echocardiography 2011;28:597‐604)     

Left ventricular function and wall thickness in long-term insulin-dependent diabetes mellitus: an echocardiographic study

Left ventricular function and wall thickness were evaluated in 111 type I diabetic subjects (mean age 25.5 +/- 9 years, mean duration of diabetes 13.4 +/- 6.2 years), using 2-D-derived M-mode echocardiography. Patients were carefully selected for the absence of major coronary risk factors or manifest cardiac disorders, and compared with 91 age- and sex-matched control subjects. Fractional shortening and the maximal velocity of cirumferential fibre shortening did not differ significantly between the two groups. Furthermore, no differences were found in the diastolic functional parameter of velocity of circumferential fibre extension. Posterior wall thickness was significantly increased in the diabetic patients compared to the controls (9.5 +/- 1.8 mm vs. 8.4 +/- 1.3 mm. P less than 0.01). As the thickness of the interventricular septum was also moderately increased (9.2 +/- 2.2 mm vs. 8.9 +/- 1.7 mm, NS), these findings provide evidence for an early structural change of the myocardium in young diabetic patients without clinically relevant functional consequences.     

Variability in frame by frame analysis of left ventricular wall motion from contrast angiograms

Background. Measurement of the timing of left ventricular (LV) wall motion, of asynchrony, and of diastolic function from contrast angiograms requires delineation of the endocardial border frame by frame through the cardiac cycle. This study was performed to determine the magnitude of intraobserver and interobserver variability in manual border tracing, and to measure the impact of this variability on the derived functional parameters. Methods. The contrast ventriculograms of 25 patients with coronary artery disease (CAD) or with normal coronary arteries were analyzed frame by frame, by two observers or twice by the same observer. Motion was measured using the centerline method at each twelfth of systole and of diastole. Variability was calculated as the absolute difference between repeated measurements of: wall motion, asynchrony, and the time at which each region of the LV reached 10%, 50%, and 100% of peak contraction, and 50% of filling. Results. Intraobserver and interobserver variability in wall motion were similar, and varied with time in the cycle, and with location on the LV contour. Variability was highest at end systole, when it averaged 8% of the normal mean for wall motion. Variability in timing was highest at peak contraction; however, the variability in measuring asynchrony averaged only 18 msec. Conclusion. Analysis of the magnitude and synchrony of regional LV wall motion through the cardiac cycle from contrast ventriculograms can be performed with reproducibility comparable to that at end systole.     

A simplified method for the calculation of left ventricular volume by equilibrium radionuclide angiography

We have recently reported on the relationship between left ventricular (LV) volume (V) determined by contrast ventriculography (CV) and corresponding volume units calculated from LV region-of-interest counts obtained from ECG gated equilibrium radionuclide angiographic (EQ) time-activity curves. We corrected the absolute number of counts at end-diastole (ED) and end-systole (ES) for the number of processed cardiac cycles, acquisition time, and counts in plasma at the time of the data acquisition. To evaluate a simpler method, which merely involves correcting for counts in whole blood rather than plasma, we studied 15 patients prospectively prior to CV. Each patient underwent EQ using 15–20 mCi of ^99mTc-human serum albumin. Ten ml of blood were withdrawn at the midpoint of each study. Four ml were suspended above the scintillation camera detector to determine the “blood” radioactivity concentration. For comparison, the remaining 6 ml were centrifuged to yield 0.1 ml of plasma and counted separately in a well counter. ED and ES counts were obtained by using a standard commercial semi-automatic computer program with a varying LV region-of-interest edge tracking algorithm. Radionuclide derived volume units by both methods were correlated with CV volume, yielding the following results: when counting plasma, for EDV, r = 0.94, and for ESV, r = 0.95; using the simpler blood counting method, for EDV, r = 0.93, and for ESV, r = 0.94. We conclude that LV volume can be calculated using count-derived radionuclide volume units.     

The multicentric character of normal left ventricular wall motion. Implications for the evaluation of regional wall motion abnormalities by contrast angiography

Current radiologic approaches to evaluation of regional ventricular wall motion generally employ rectilinear hemichords (“hemiaxes”) or radial hemichords (“chords”) defined by the presumptions that wall segments move either perpendicularly toward the ventricular long axis, or toward some common center, respectively. In order to test these presumptions, the end-systolic and end-diastolic frames of 17 normal right anterior oblique (left) ventriculograms were analyzed, using a digitizer and a computer. The motion vectors of 47 points on each ventriculographic perimeter were defined by centers (located along the ventricular long axis). Twenty average centers were found which could be represented by three centers, for six regions of the normal angio-graphic silhouette. Computer models of abnormal regional wall motion, using three centers, disclosed appreciable discrepancies among the chord, hemiaxis and rectilinear area methods, particularly for the apical and basal wall regions. The model data suggest that the wall region, iself, dictates the center which should be used for measuring an abnormality of regional wall motion.     

Optimal use of left ventriculography at the time of cardiac catheterization: A consensus statement from the society for cardiovascular angiography and interventions

The rationale to perform left ventriculography at the time of cardiac catheterization has been little studied. The technique and frequency of use of left ventriculography vary by geographic regions, institutions, and individuals. Despite the recent publication of guidelines and appropriate use criteria for coronary angiography, revascularization, and noninvasive imaging, to date there have been no specific guidelines on the performance of left ventriculography. When left ventriculography is performed, proper technique must be used to generate high quality data which can direct patient management. The decision to perform left ventriculography in place of, or in addition to, other forms of ventricular assessment should be made taking into account the clinical context and the type of information each study provides. This paper attempts to show the role of left ventriculography at the time of coronary angiography or left heart catheterization. The recommendations in this document are not formal guidelines but are based on the consensus of this writing group. These recommendations should be tested through clinical research studies. Until such studies are performed, the writing group believes that adoption of these recommendations will lead to a more standardized application of ventriculography and improve the quality of care provided to cardiac patients. © 2014 Wiley Periodicals, Inc.     

Effects of carvedilol on left ventricular function, mass, and scintigraphic findings in isolated left ventricular non-compaction

A four month old infant with isolated left ventricular non-compaction was treated with carvedilol. Haemodynamic studies and various types of imaging—including echocardiography, radiographic angiography, magnetic resonance imaging, and single photon emission computed tomography with ²⁰¹Tl, ¹²³I-β-methyliodophenylpentadecanoic acid (BMIPP), and ¹²³I-metaiodobenzylguanidine (MIBG)—were performed before and 14 months after treatment. Left ventricular ejection fraction increased from 30% to 57%, and left ventricular end diastolic volume, end systolic volume, and end diastolic pressure showed striking reductions during treatment. Left ventricular mass decreased to about two thirds of the baseline value after treatment. Per cent wall thickening increased after carvedilol in the segments corresponding to non-compacted myocardium. A mismatch between ²⁰¹Tl and BMIPP uptake in the area of non-compaction observed before carvedilol disappeared after treatment. Impaired sympathetic neuronal function shown by MIBG recovered after treatment. Thus carvedilol had beneficial effects on left ventricular function, hypertrophy, and both metabolic and adrenergic abnormalities in isolated left ventricular non-compaction.


Keywords: isolated left ventricular non-compaction; carvedilol; cardiac sympathetic nerve; ventricular remodelling