Parameters for coronary plaque vulnerability assessed with multidetector computed tomography and intracoronary ultrasound correlation.

In the absence of a fixed relationship between plaque vulnerability and flow-limiting stenosis, alternative morphological expressions exist that could predict the liability of coronary lesions to rapidly progress or rupture, causing acute coronary syndromes. Modern multidetector computed tomography technology is capable of noninvasively detecting lesion location, attenuation, remodeling and calcification pattern, which may be considered as surrogate morphological markers of vulnerability and could contribute to increase the prognostic value of individual coronary plaque burden.

Prognostic significance of akinesis becoming dyskinesis during dobutamine stress echocardiography.

Background: Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown.

Objectives: We sought to assess the long-term outcome of patients with AKBD during DSE.

Long-term prognostic value of ejection fraction changes during dobutamine-atropine stress echocardiography.

Objective: Dobutamine stress echocardiography (DSE), using subjective wall motion scoring, provides incremental prognostic information over clinical data. The aim of the study was to test the additional prognostic value of left ventricular ejection fraction (LVEF) changes during DSE at different stages.

Methods: The study population comprised 106 consecutive patients (mean age 60+/-11 years, 73% men) with suspected or known coronary artery disease referred for DSE.

Impact of hand-carried cardiac ultrasound on diagnosis and management during cardiac consultation rounds.

Aim: To evaluate the impact of hand-carried cardiac ultrasound (HCU) on the diagnosis and management of patients during cardiac consultation rounds.

Methods And Results: One hundred and fifty patients hospitalized in non-cardiac units were included after the consulting cardiologist felt that an echocardiographic examination was indicated as part of his work-up. They were randomly allocated to echocardiography with an HCU device (SonoHeart, SonoSite, Inc.

Pulsed-wave tissue Doppler quantification of systolic and diastolic function of viable and nonviable myocardium in patients with ischemic cardiomyopathy.

Background: Detection of myocardial viability is crucial for clinical treatment of patients with ischemic cardiomyopathy. Currently, quantitative information for the evaluation of systolic and diastolic function of viable tissue is limited. Our aim was to compare quantitatively systolic and diastolic function in viable and nonviable dysfunctional myocardium in patients with ischemic cardiomyopathy.

Opposite patterns of left ventricular remodeling after coronary revascularization in patients with ischemic cardiomyopathy: role of myocardial viability.

Background: In patients with ischemic cardiomyopathy, left ventricular (LV) remodeling is an important prognostic indicator. The precise relation between viable myocardium, revascularization, and ongoing or reversed remodeling is unknown and was evaluated in the present study.

Methods And Results: A total of 100 patients with ischemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability and LV geometry (volumes and shape).

Prognostic stratification of patients with right bundle branch block using dobutamine stress echocardiography.

The presence of a right bundle branch block (RBBB) is associated with increased mortality. We studied the role of dobutamine stress echocardiography for the prognostic stratification of patients with RBBB. The presence of an abnormal dobutamine stress echocardiography was the strongest predictor of cardiac events and provided incremental prognostic information to clinical and stress test data.

Comparison of long-term effect of coronary artery bypass grafting in patients with ischemic cardiomyopathy with viable versus nonviable left ventricular myocardium.

In this study, 63% of patients with a substantial amount of viable myocardium showed an increased left ventricular ejection fraction (LVEF) 12 +/- 3 months after coronary artery bypass grafting. In 93% of these patients, increased LVEF persisted at 4.5 +/- 1 years of follow-up.

Does resting two-dimensional echocardiography identify patients with ischemic cardiomyopathy and low likelihood of functional recovery after coronary revascularization?

Objective: To evaluate the potential of a simple and widely available technique as two-dimensional (2D) echocardiography to identify patients with ischemic cardiomyopathy and low likelihood of functional recovery after coronary revascularization.

Methods: Two-dimensional echocardiography and radionuclide ventriculography (RNV) were performed before coronary revascularization in 94 patients with ischemic cardiomyopathy. Left ventricular ejection fraction (LVEF) was measured by RNV.

QT dispersion correlates to myocardial viability assessed by dobutamine stress echocardiography in patients with severely depressed left ventricular function due to coronary artery disease.

Background: QT dispersion is prolonged in numerous cardiac diseases, representing a general repolarization abnormality.

Aim: To evaluate the influence of viable myocardium on QT dispersion in patients with severely depressed left ventricular (LV) function due to coronary artery disease.

Methods And Results: 103 patients with ischemic cardiomyopathy (LV ejection fraction [EF]: 25+/-6%) were studied.

Comparison of functional recovery of mildly hypokinetic versus severely dysfunctional left ventricular segments after revascularization in patients with ischemic cardiomyopathy.

Dysfunctional left ventricular (LV) segments showing contractile reserve during dobutamine stress echocardiography (DSE) are considered viable myocardium; functional recovery is expected after revascularization. Many segments, however, particularly mildly hypokinetic segments, do not recover. The reason for this failure is unknown.

Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device.

Background: The hand-carried cardiac ultrasound (HCU) device is a recently introduced imaging device, which may be potentially useful in the primary care setting.

Aim: To test the screening potential of a HCU for the detection of left ventricular (LV) dysfunction by evaluating LV ejection fraction (LVEF) and inferior vena cava (IVC) collapse. Standard echocardiographic system (SE) and plasma brain natriuretic peptide (BNP) measurements were used as a reference.

Long-term prognosis after normal dobutamine stress echocardiography.

Patients with normal dobutamine stress echocardiography (DSE) were shown to have a favorable outcome at an intermediate-term follow-up. However, there are scarce data regarding long-term survival after normal DSE. This study sought to assess the long-term outcome after normal DSE.

Relation between QT dispersion and myocardial viability in ischemic cardiomyopathy.

The aim of this study was to evaluate the relation between QT dispersion and myocardial viability as assessed by single-photon emission computed tomography. The study population included 97 consecutive patients with severely impaired left ventricular function secondary to chronic coronary artery disease. Patients with a low QT dispersion had a substantial amount of viable myocardium, whereas patients with a high QT dispersion had predominantly nonviable scar tissue.

Effect of atorvastatin on myocardial contractile reserve assessed by tissue Doppler imaging in moderately hypercholesterolemic patients without heart disease.

An improvement in myocardial longitudinal systolic velocities, assessed by pulsed-wave tissue Doppler imaging during low-dose dobutamine infusion, was observed at 6-month follow-up after 6 months of treatment with atorvastatin. Our findings indicate a favorable effect of atorvastatin on contractile reserve, possibly through an enhancement of flow-dependent coronary dilatation during stress.

Safety of dobutamine stress echocardiography in patients with aortic stenosis.

Background And Aim Of The Study: Aortic valve disease is becoming one of the most important cardiac diseases in western society. Low-dose dobutamine stress echocardiography (DSE) is recommended in patients with low-gradient aortic stenosis (AS) and severe left ventricular (LV) dysfunction. DSE is also used in patients with AS and moderately reduced or normal LV function for diagnostic purposes.

Individual prediction of functional recovery after coronary revascularization in patients with ischemic cardiomyopathy: the scar-to-biphasic model.

Currently, the prediction of improvement of left ventricular (LV) ejection fraction (EF) after revascularization in patients with ischemic cardiomyopathy relies only on viable myocardium extent, whereas both the amount of viable and scar tissue may be important. A model was developed, based on the amount of viable and nonviable myocardium, to predict functional recovery. Viable and scarred myocardium was defined by dobutamine stress echocardiography (DSE) in 108 consecutive patients.

Effect of diabetes mellitus on myocardial 18F-FDG SPECT using acipimox for the assessment of myocardial viability.

Unlabelled: During the noninvasive assessment of myocardial viability with (18)F-FDG metabolic imaging, adequate regulation of metabolic conditions is needed to ensure optimal image quality. The aim of this study was to compare the feasibility and image quality of cardiac (18)F-FDG SPECT imaging using acipimox in patients with diabetes and patients without diabetes.

Methods: Seventy patients with ischemic cardiomyopathy underwent (18)F-FDG SPECT using acipimox for the assessment of myocardial viability, followed by resting 2-dimensional echocardiography to identify dysfunctional myocardial tissue.

Prognostic value of dobutamine stress echocardiography in patients with diabetes.

Objective: The aim of this study was to assess the incremental value of dobutamine stress echocardiography (DSE) for the risk stratification of diabetic patients who are unable to perform an adequate exercise stress test. Exercise capacity is frequently impaired in patients with diabetes. The role of pharmacologic stress echocardiography in the risk stratification of diabetic patients has not been well defined.

Incremental value of exercise technetium-99m tetrofosmin myocardial perfusion single-photon emission computed tomography for the prediction of cardiac events.

Technetium-99m (Tc-99m) tetrofosmin single-photon emission computed tomography (SPECT) is a useful alternative to thallium-201 scintigraphy for the assessment of myocardial perfusion. This study assessed the incremental value of exercise Tc-99m tetrofosmin SPECT for the prediction of cardiac events in patients with known or suspected coronary artery disease. Exercise Tc-99m tetrofosmin SPECT imaging was performed in 655 consecutive patients.

Dobutamine-induced contractile reserve in stunned, hibernating, and scarred myocardium in patients with ischemic cardiomyopathy.

Unlabelled: Because of damage to cardiomyocytes and the contractile apparatus, contractile reserve may be observed less frequently in hibernating than in stunned myocardium. The aim of this study was to assess the presence of contractile reserve in response to dobutamine infusion in a large group of patients with stunned and hibernating myocardium.

Methods: A total of 198 consecutive patients with ischemic cardiomyopathy (left ventricular ejection fraction < or = 40%) underwent resting 2-dimensional echocardiography to assess regional contractile dysfunction.

Assessment of residual myocardial viability in regions with chronic electrocardiographic Q-wave infarction.

Background: Q waves on the electrocardiogram are often considered to be reflective of irreversibly scarred myocardium due to antecedent transmural myocardial infarction. However, there are some indications that residual viable tissue may be present in Q-wave-infarcted regions. It is clinically relevant to know how many Q-wave regions contain viable tissue because these patients may benefit from revascularization in terms of improvement of function and long-term survival.

Prognostic value of dobutamine-atropine stress myocardial perfusion imaging in patients with diabetes.

Objective: Exercise tolerance in patients with diabetes is frequently impaired due to noncardiac disease such as claudication and polyneuropathy. This study assesses the prognostic value of dobutamine stress myocardial perfusion imaging in patients with diabetes.

Research Design And Methods: A total of 207 consecutive diabetic patients who were unable to undergo exercise stress testing underwent dobutamine-atropine stress myocardial perfusion imaging.