Validation of low-dose dobutamine magnetic resonance imaging for assessment of myocardial viability after infarction by serial imaging.

Cine magnetic resonance imaging with low-dose dobutamine stimulation allows prediction of viability after infarction with an accuracy of 80%. In akinetic segments, however, viability tends to be underestimated.

MR of the heart under pharmacologic stress.

Magnetic resonance imaging is one method for assessing cardiac function and perfusion at rest and under stress conditions. In this article, the potential of stress magnetic resonance imaging for evaluating ischemic heart disease is reviewed, and technical aspects of some developments that may contribute to comprehensive magnetic resonance imaging assessment of heart disease under rest and stress are discussed.

Patent foramen ovale and decompression sickness in sports divers.

Patency of the foramen ovale (PFO) may be a cause of unexplained decompression sickness (DCS) in sports divers. To assess the relationship between PFO and DCS, a case-control study was undertaken in a population of Belgian sports divers. Thirty-seven divers who suffered from neurological DCS were compared with matched control divers who never had DCS.

Contrast enhanced and functional magnetic resonance imaging for the detection of viable myocardium after infarction.

Purpose: Viable myocardium after acute myocardial infarction may be characterized by magnetic resonance imaging (MRI) either by demonstration of recovery of wall motion under dobutamine stress or by perfusion patterns after contrast medium administration. This study examines the relation between the two techniques.

Materials And Methods: Gradient-echo MRI at rest and under low-dose dobutamine stress was performed in 28 patients within the first 2 weeks after acute myocardial infarction.

Distinction between open and occluded infarct-related arteries using contrast-enhanced magnetic resonance imaging.

Ultrafast contrast-enhanced magnetic resonance imaging can be used to distinguish open and closed infarct-related arteries. An open artery is characterized by a faster rise and fall in signal intensity.

Wall thickening at rest and contractile reserve early after myocardial infarction: correlation with myocardial perfusion and metabolism.

Background: Abnormalities in wall thickening and their reaction to stimulation can be studied by magnetic resonance imaging.

Objective: To analyse the relationship between these abnormalities and changes in myocardial perfusion and fatty acid metabolism.

Methods: Fifteen patients with a myocardial infarction underwent low-dose dobutamine magnetic resonance imaging to assess their wall thickening and contractile reserve, and technetium-99m sestamibi (MIBI) and beta-methyl-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission tomography to assess their myocardial perfusion and fatty acid uptake.

Sublingual nitrates during head-up tilt testing for the diagnosis of vasovagal syncope.

Pharmacologic stimulation during head-up tilt test (HUT) is used to increase the diagnostic yield of the test to detect vasovagal syncope. Reported lack of specificity of stimulation with intravenous isoproterenol has made a pharmacologic alternative desirable. Because nitrates are known to cause syncope of a vasovagal origin, we administered sublingual nitrates after classic tilt test in 32 patients with a history of typical vasovagal syncope and 20 healthy volunteers to assess the sensitivity, specificity, and accuracy of this new HUT technique.

Physical fatigability and exercise capacity in chronic fatigue syndrome: association with disability, somatization and psychopathology.

Physical fatigability and avoidance of physically demanding tasks in chronic fatigue syndrome (CFS) were assessed by the achievement or nonachievement of 85% of age-predicted maximal heart rate (target heart rate, THR) during incremental exercise. The association with functional status impairment, somatization, and psychopathology was examined. A statistically significant association was demonstrated between this physical fatigability variable and impairment, and a trend was found for an association with somatization.

Dipyridamole-induced angina pectoris during sestamibi stress test in patients with significant coronary artery disease: clinical, angiographic, and nuclear determinants.

Intravenous dipyridamole induces angina pectoris (AP) in some patients with significant coronary artery disease (CAD). The aim of this prospective study was to identify the angiographic, nuclear, and clinical determinants. The authors examined 50 patients consecutively with significant CAD on coronary angiography.

Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis.

Essential hyperhidrosis (EH) is caused by an unexplained overactivity of the sympathetic fibers which pass through the upper dorsal sympathetic ganglia D2 and D3. Since the D2 and D3 ganglia are also involved in the sympathetic cardiac innervation, cardiocirculatory autonomic function may also be abnormal in EH. In order to study the function of the sympathetic nervous system in EH, and to assess the effects of thoracoscopic sympathiocolysis, cardiocirculatory autonomic function tests were performed in 13 consecutive patients with EH, before (baseline) and 6 weeks after the thoracoscopic intervention.

Prediction of functional outcome after myocardial infarction using BMIPP and sestamibi scintigraphy.

Unlabelled: We determined the predictive value of combined beta-methyl iodophenyl pentadecanoic acid (BMIPP) and sestamibi scintigraphy for the functional outcome after myocardial infarction and compared the value of this approach with dobutamine echocardiography.

Methods: Rest BMIPP, rest sestamibi and low-dose dobutamine echocardiographic studies were obtained in 18 patients 4 to 10 days after infarction (mean 6.7 +/- 2.

Clinical nuclear cardiology: flow tracers and free fatty acid analogs to detect viable myocardium after infarction.

Among the available invasive and noninvasive modalities, nuclear cardiology techniques utilizing single photon emission computerized tomography (SPECT) have achieved a preeminent position for the assessment of myocardial viability. This arises from the rather unique potential of scintigraphic methods to assess myocardial perfusion, cell membrane integrity, and metabolic activity. The purpose of this article is to review the relative merits and limitations of myocardial flow tracers (thallium and sestamibi) and metabolic tracers (fatty acid analogs) to identify residual myocardial viability in patients with coronary artery disease and left ventricular dysfunction.

Exercise myocardial perfusion and wall motion imaging to predict recurrence of angina pectoris after successful angioplasty.

Objectives: This study investigates the predictive value of concurrent exercise radionuclide ventriculography and myocardial perfusion scintigraphy obtained six weeks after successful percutaneous transluminal coronary angioplasty for the recurrence of angina.

Methods: Both studies were obtained simultaneously with a single injection of technetium-99m sestamibi using the first-pass technique and the computerized tomographic technique, respectively. Ninety-five patients were investigated at rest and at maximal exercise 6 weeks after technically successful coronary angioplasty.

Cardiopulmonary exercise testing following bilateral thoracoscopic sympathicolysis in patients with essential hyperhidrosis.

Background: Essential hyperhidrosis is characterised by an overactivity of the sympathetic fibres passing through the upper dorsal sympathetic ganglia D2-D3. Anatomical interruption at the D2-D3 level is a highly effective treatment for essential hyperhidrosis but also causes (partial) cardiac denervation and, after surgical sympathicolysis, important impairment of cardiopulmonary exercise function has been observed. The purpose of this study was to compare the results of cardiopulmonary exercise testing between patients with essential hyperhidrosis and a normal control population, and to examine the effects of thoracoscopic D2-D3 sympathicolysis on cardiopulmonary exercise capacity in patients with essential hyperhidrosis.

Regional diastolic wall motion dynamics in anterior myocardial infarction: analysis and quantification with magnetic resonance imaging.

Background: Regional variability in systolic and diastolic cardiac function occurs in most cardiac disorders. The influence of this regional functional heterogeneity on global function is not well understood and is difficult to study with the common imaging modalities.

Methods: A midventricular short axis slice of the left ventricle was obtained with ECG-triggered magnetic resonance imaging in eight infarct patients and 10 control volunteers.

Low-dosage dobutamine magnetic resonance imaging as an alternative to echocardiography in the detection of viable myocardium after acute infarction.

The objective of this study was the evaluation of the feasibility of magnetic resonance (MR) imaging of the heart with low-dosage dobutamine stimulation for the detection of viability after acute myocardial infarction. Gradient echo MR images were obtained in 37 patients with recent myocardial infarction. Images of wall motion abnormalities and their reaction to low-dosage dobutamine stimulation were analyzed and compared with two-dimensional echocardiograms.

Combined left ventricular wall motion and myocardial perfusion stress imaging in the initial assessment of patients with a recent uncomplicated myocardial infarction.

Unlabelled: The aim of the study was to examine the ability to simultaneously assess left ventricular function and myocardial perfusion by using a single injection of technetium-99m sestamibi at rest and during submaximal exercise to identify high-risk patients with left main, proximal left anterior descending (LAD), or three-vessel coronary artery disease (CAD) after an uncomplicated acute myocardial infarction (AMI). Multiple studies have evaluated the separate value of the exercise ECG, myocardial perfusion scintigraphy, and radionuclide angiocardiography (RNA) for identifying patients with severe CAD. The availability of technetium-99m (Tc99m)-labeled myocardial imaging agents offers the opportunity to evaluate simultaneously ventricular function and myocardial perfusion during a single exercise session.

Abnormal free fatty acid uptake in subacute myocardial infarction after coronary thrombolysis: correlation with wall motion and inotropic reserve.

Unlabelled: Iodine-123-free fatty acid analogs, such as beta-methyliodophenylpentadecanoic acid (BMIPP), allow for myocardial metabolic studies with SPECT. The goal of this investigation was to determine whether BMIPP uptake can be used to differentiate viable myocardium from scar tissue soon after coronary thrombolysis for acute myocardial infarction.

Methods: BMIPP and 99mTc-sestamibi (MIBI) myocardial distribution after injection at rest were analyzed in 22 patients 4 to 10 days after coronary thrombolysis.

Magnetic resonance imaging of the heart in a case of hepatocellular carcinoma extending into the right atrium.

Hepatocellular carcinoma is the most common primary malignant liver tumor occurring in more than 1 million cases a year all over the world. Vascular invasion is known to occur in 30% of patients at initial presentation [1]. An extension of the tumor into the right atrium is well described in the literature [2], with surgical resection as the only procedure available.

Ectopic atrial tachycardia in a young athlete.

We report the case of a young boy on routine sports medical examination, who presented an incessant atrial tachycardia. At the slightest exercise the ventricular rhythm accelerated to 160 beats.min-1.

Regional distribution of 123I-(ortho-iodophenyl)-pentadecanoic acid and 99Tcm-MIBI in relation to wall motion after thrombolysis for acute myocardial infarction.

To characterize the myocardium after thrombolytic therapy for infarction single photon emission computed tomographic (SPECT) studies with 123I-(ortho-iodophenyl)-pentadecanoic acid (oPPA) and 99Tcm-methoxyisobutyl isonitrile (MIBI) were obtained at rest in nine patients within a fortnight after the acute event. A decreased oPPA activity compared to MIBI was observed in 15/45 segments (7/9 patients). The segments with discordant oPPA/MIBI activities showed less severe wall motion abnormalities than the segments with concordant decreased oPPA and MIBI activities (P = 0.

Leiomyosarcoma of the small intestine presenting as fever of unknown origin.

We report a patient with a jejunal leiomyosarcoma who presented with fever of unknown origin. Resection of the tumour resulted in resolution of his symptoms.

Prevalence of ventricular premature beats during stress testing in patients with exercise hypertension and the association with a positive family history of established hypertension.

The prevalence of multiple ventricular premature beats during exercise testing was examined in 50 untreated patients with exaggerated systolic blood pressure response to exercise and 54 control subjects. Statistical analysis of the results showed significantly more frequent episodes of repetitive ventricular premature beats in the exercise hypertension group (this was present both in normotensive and mildly hypertensive individuals at rest). We also demonstrated that among normotensives there was a higher prevalence of exercise hypertension in those with a family history of established hypertension.