Comparative evaluation of segmental asynergy in remote myocardial infarction by radionuclide angiography,two-dimensional echocardiography,and contrast ventriculography

Radionuclide angiography (RNA), two-dimensional echocardiography (2DE), and contrast ventriculography (CVG) were compared in the evaluation of regional wall motion (RWM) in 58 patients with remote myocardial infarction (MI). All 58 patients were studied by 2DE, 52 by RNA, and 24 by CVG. Severe degrees of segmental asynergy (akinesia/dyskinesia) were noted more often by 2DE (56% of all segments, p < 0.005) and CVG (52%, p < 0.05) than by RNA (39%). The apex was the most frequent site of akinesia/dyskinesia by all techniques (43% by RNA, 36% by 2DE, and 45% by CVG). 2DE and RNA agreed in 64% of regions (p < 0.005), 2DE and CVG agreed in 68% (p < 0.005), and RNA and CVG agreed in 70% (p < 0.005); the highest agreement was for the apical region. Dyskinesia was noted in 77% of patients by RNA, in 71% by 2DE, and in 79% by CVG. RNA and CVG agreed in 89% of patients and in 57% of regions, 2De and CVG agreed in 67% of patients and in 53% of regions, and RNA and 2DE agreed in 71% of patients and in 38% of regions. Combined RNA and 2DE detected dyskinesia in 94% of the 16 patients with dyskinesia by CVG who underwent all three techniques and in 90% of the 52 patients studied by RNA and 2DE. We conclude that (1) RNA, 2DE, and CVG agree significantly in the evaluation of regional wall motion; (2) there is better agreement concerning the presence or absence of dyskinesia in a given patient than the exact region involved; and (3) the combination of RNA and 2DE is more useful than either alone as a screening procedure for the detection of ventricular dyskinesia.     

Optimizing Cinefilm

A system for improving the quality of cinefilm and for maintaining quality control is described. Objective criteria for contrast, resolution, and grain structure were established to measure the effects of varying X-ray dose, f-stop, development temperature, and selection of film and developer. We found that all variables must be adjusted to maximize the viewing quality and that similar density curves can be achieved, independently of the choice of film and developer.     

M mode and cross-sectional echocardiographic features of flail posterior mitral leaflets

Seventeen patients with accepted M mode echocardiographic criteria for flail mitral leaflet were studied. M mode echocardiograms revealed characteristic disordered mitral valve motion: (1) 16 (94 percent) had chaotic diastolic mitral motion; (2) 14 (82 percent) had systolic mitral flutter; (3) 14 (82 percent) had systolic left atrial echoes; and (4) 12 (71 percent) had systolic mitral valve prolapse. In 8 patients (47 percent) all four findings were present, with three findings present in 16 (35 percent) and two findings present in 13 (18 percent); none had fewer than two findings. Cross-sectional echocardiographic studies in 10 patients revealed a systolic whipping motion of the posterior mitral leaflet into the left atrium in all, abnormal systolic mitral coaptation in all and an abnormal mass of systolic left atrial echoes in 4. None of the first three M mode criteria were observed in 230 patients with uncomplicated “mid systolic click-late systolic murmur” syndrome; cross-sectional echocardiography in 30 of 230 patients revealed normal systolic mitral coaptation and no systolic whipping of the tip of the posterior mitral leaflet into the left atrium.     

Clinical inquiries. Does blood pressure screening benefit children?

Screening may not show benefits in childhood but could pay off for adults. Although major professional organizations recommend measuring blood pressure (BP) at every clinic visit for all children older than 3 years (strength of recommendation [SOR]: C, expert opinion), scant evidence links earlier detection and treatment of childhood hypertension with improved patient-oriented outcomes. However, detecting childhood hypertension may help identify adults who would benefit from earlier treatment. Children with elevated BP have a more than 60% chance of being hypertensive as young adults (SOR: B, prospective cohort study). Children with systolic BP above the 95th percentile had a more than 4-fold increase in coronary artery disease as adults compared with children below the 95th percentile (SOR: B, retrospective study). Identifying hypertension in children is associated with a 15-fold greater likelihood of hypertension in their parents (SOR: B, case series).