945-65 Effect of Left Anterior Hemiblock on the Sensitivity of Exercise Stress Tests

We had observed a relatively high frequency of false negative stress electrocardiograms compared with SPECT thallium scintigraphy in patients with LAHB.PurposeTo assess the effect of LAHB on the sensitivity of exercise induced ST depressions for ischemia compared with SPECT thallium scintigraphyMethodsA 5–year retrospective analysis of all treadmill thallium stress tests performed in our exercise laboratory was performed. Patients with LBBB, RBBB, IVCD, LVH or <85% of maximal HR were excluded.Study groupn=25 (16 M, 9 F, ages 35–87)Matched controlsn=18.Results(1) The sensitivity of ST depressions for ischemia in the study group was 30% compared with 71%in the control group, the specificities were 90% and 75% respectively.(2) There was no significant association between presence of ischemia on ECG and on SPECT thallium scans in the study group, while an association was found in the control group (p<0.01).ConclusionsThe sensitivity of exercise stress tests for ischemia is low in the presence left anterior hemiblock

Correlation of Prehypertension with Left Ventricular Mass Assessed by Cardiac Magnetic Resonance Imaging

Introduction. The purpose of this observational cross-sectional study was to assess left ventricular mass (LVM) in prehypertensive individuals in comparison to normotensives and to determine if central blood pressure (BP) correlates better with LVM index (LVMI) than brachial BP. Methods and Result. Brachial and central BP measurements were completed at first visit and at 4 weeks in 65 healthy volunteers who were at least 40 years old and not on medication. Subjects were divided into two groups of normotensives and prehypertensives based on JNC-7 criteria and LVM was obtained using cardiac magnetic resonance imaging. Prehypertensives had significantly higher LVMI compared to normotensives (P<0.01). Brachial and central BP also both positively correlate with LVMI (r=0.460, P<0.01; r=0.318, P=0.012, resp.) in both groups and neither method was superior to the other. After multivariate regression analysis and adjusting for cardiovascular risk factors, prehypertension remained an independent determinant of LVM. Conclusion. Prehypertension is associated with cardiovascular target organ damage, and central BP was not superior to brachial BP or vice versa for association with LVMI

Absolute quantitation of coronary steal induced by intravenous dipyridamole

AbstractOBJECTIVESThe study was done to determine whether coronary steal (defined as an absolute decrease in perfusion from resting blood flow) is induced by intravenous (IV) dipyridamole in patients with severe coronary artery disease (CAD).BACKGROUNDMyocardial ischemia during coronary vasodilation is usually attributed to coronary steal. However, there is limited data on the absolute magnitude of coronary steal in humans.METHODSEighteen patients with multivessel CAD underwent dynamic positron emission tomography (PET) imaging with 13NH3at rest and after infusion of IV dipyridamole. Eight myocardial sectors were analyzed per short axis slice and myocardial blood flow calculated with a two-compartment model in absolute terms.RESULTSCoronary steal occurred in 8 of the 18 patients. In the 8 patients with coronary steal, myocardial blood flow decreased from 90 ± 18 ml/100 g/min at rest to 68 ± 27 ml/100 g/min following dipyridamole in the segments with steal, and increased from 87 ± 19 to 138 ± 16 ml/100 g/min following dipyridamole in the segments without steal. Significant clinical correlates of coronary steal were either ST elevation or the combination of ST depression and angina.CONCLUSIONSCoronary vasodilation with IV dipyridamole is associated with significant reductions in blood flow to collateral-dependent myocardium consistent with coronary steal in about 45% of patients with severe CAD

Model dependence of gated blood pool SPECT ventricular function measurements

Background. Calculation differences between various gated blood pool (GBP) single photon emission computed tomography (SPECT) (GBPS) algorithms may arise as a result of different modeling assumptions. Little information has been available thus far regarding differences for right ventricular (RV) function calculations, for which GBPS may be uniquely well suited. Methods and Results. Measurements of QBS (Cedars-Sinai Medical Center, Los Angeles, Calif) and BP-SPECT (Columbia University, New York, NY) algorithms were evaluated. QBS and BP-SPECT left ventricular (LV) ejection fraction (EF) correlated strongly with conventional planar-GBP LVEF for 422 patients (r = 0.81 vs r = 0.83). QBS correlated significantly more strongly with BP-SPECT for LVEF than for RVEF (r = 0.80 vs r = 0.41). Both algorithms demonstrated significant gender differences for 31 normal subjects. BP-SPECT normal LVEF (67% +/- 9%) was significantly closer to values in the magnetic resonance imaging (MRI) literature (68% +/- 5%) than QBS (58% +/- 9%), but both algorithms underestimated normal RVEF (52% +/- 7% and 50% +/- 9%) compared with the MRI literature (64% +/- 9%). For 21 patients, QBS correlated similarly to MRI as BP-SPECT for LVEF (r = 0.80 vs r = 0.85) but RVEF correlation was significantly weaker (r = 0.47 vs r = 0.81). For 16 dynamic phantom simulations, QBS LVEF correlated similarly to BP-SPECT (r = 0.81 vs r = 0.91) but QBS RVEF correlation was significantly weaker (r = 0.62 vs r = 0.82). Volumes were lower by QBS than BP-SPECT for all data types. Conclusions. Both algorithms produced LV parameters that correlated strongly with all forms of image data, but all QBS RV relationships were significantly different from BP-SPECT RV relationships. Differences between the two algorithms were attributed to differences in their underlying ventricular modeling assumptions

Comparison among tomographic radionuclide ventriculography algorithms for computing left and right ventricular normal limits

Background. Various algorithms have been developed to compute right ventricular (RV) and left ventricular (LV) end-diastolic volumes, end-systolic volumes, and ejection fractions (EF) from tomographic radionuclide ventriculography (TRV). The aims of this investigation were to establish sex-specific normal limits, to determine whether different algorithms produce the same normal values, and to compare TRV normal limits vs for magnetic resonance imaging values in the literature. Methods. Fifty-one healthy volunteers (29 men, 22 women) were studied prospectively. All subjects had normal electrocardiograms and echocardiographic examinations, and underwent both planar radionuclide ventriculography and TRV. Four algorithms were used to process TRV data. Results. Normal limits for most functional parameters differed significantly from one algorithm to another. Volumes were greater in men, but no statistically significant differences were found between men and women for LV EF or RV EF values for any method. Normal LV and RV EF and volumes were largely consistent with the literature for cardiac magnetic resonance imaging. Conclusions. Ventricular measurements differ significantly among TRV algorithms. Therefore, it is important to apply sex-specific normal limits that are specific to a given TRV algorithm in interpreting LV and RV EF and volume measurements for each patient