Download Left Ventricular Performance Assessed by

Left Ventricular Performance Assessed by
Radionuclide Angiocardiography and
Echocardiography in Patients with Previous
Myocardial Infarction
By HARTMUT HENNING, M. D., HEINZ SCHELBERT, M.D.,
MICHAEL H. CRAWFORD, M.D., JOEL S. KARLINER, M.D.,
WILLIAM ASHBURN, M.D., AND ROBERT A. O'ROURKE, M.D.
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SUMMARY
In 61 patients (77 studies) who had a transmural myocardial infarction, we compared the left ventricular
ejection fraction by echocardiography with the ejection fraction determined by a computerized radioisotope
technique that makes no assumptions regarding left ventricular geometry. In 31 studies of 26 patients with
normal left ventricular wall motion by videotracking and normal left heart size, ejection fraction averaged
0.57 ± 0.09 (SD) by ultrasound and 0.62 ± 0.10 by the isotope method. Measurements of ejection fraction
by both techniques correlated well (r = 0.86) and there was complete separation between patients with normal and reduced ejection fraction. In 46 studies of 35 patients in whom left ventricular wall motion abnormalities were recorded by videotracking, ejection fraction by the isotope method averaged 0.46 ± 0.08,
while average echo ejection fraction was 0.62 ± 0.12. The correlation between the ultrasound and isotope
methods in these 46 studies was poor (r 0.33) and in 28 studies measurement of the ejection fraction by
the two techniques was discordant. In 26 of the 27 studies where there was a reduced ejection fraction by the
isotope method and a normal ejection fraction by echo, the dyssynergy involved the anterolateral left ventricular wall. These data indicate that echocardiographic measurements frequently overestimate left ventricular performance in patients with previous myocardial infarction associated with anterolateral wall motion disorders.
=
THE LEFT VENTRICULAR EJECTION FRAC-
TION and velocity of internal diameter shortening are useful measurements of left ventricular performance.' - Echocardiography is a noninvasive method for measuring left ventricular dimensions, volume,
ejection fraction, and the mean rate of internal
diameter shortening. Furthermore, these measurements of left ventricular performance correlate
well with those derived from biplane cineangiography in normal subjects and patients with left
ventricular disease.4-6 Usually, the quantitative assessment of left ventricular performance by ultrasound is performed by measuring a single chord in
the transverse plane of the left ventricular chamber.
Measurements of left ventricular volume are based on
a theoretical elliptical model and the assessment of
From the Division of Cardiology, Department of Medicine, and
Division of Nuclear Medicine, Department of Radiology, University of California Medical Center, San Diego, La Jolla, California
92037.
Supported in part by NHLI Myocardial Infarction Research Contract N01-HV-81332. Dr. O'Rourke is a Teaching Scholar of the
American Heart Association.
Address for reprints: Robert A. O'Rourke, M.D., University
Hospital, 225 W. Dickinson Street, San Diego, California 92103.
Received April 28, 1975; revision accepted for publication July 7,
1975.
Circulation, Volume 52, December 1975
ejection phase indices is based on the assumption that
the recorded segmental function is representative of
the entire left ventricle. However, regional left ventricular wall motion abnormalities occur in most
patients with acute transmural myocardial infarction
and persist in the majority of postinfarction patients.7
Furthermore, the reduction in left ventricular ejection
fraction after myocardial infarction correlates with the
extent and severity of segmental wall motion abnormalities.8 The presence of abnormal wall motion with
or without left ventricular dilatation distorts left ventricular geometry and may lead to an erroneous estimation of left ventricular volumes when data are
derived from the recording of a single standardized
echo beam. Therefore, we examined the influence of
left ventricular wall motion abnormalities and left
ventricular enlargement on the echocardiographic
measurement of the left ventricular ejection fraction
in patients with myocardial infarction. We compared
the echo results with the radioisotope ejection fraction
utilizing a computerized isotope technique that makes
no assumptions with regard to left ventricular
geometry.
Subjects and Methods
Sixty-one patients, 51 men and 10 women, with well
documented transmural myocardial infarction were studied
1069
HENNING
1070
on one or more occasions (77 total studies). The diagnosis of
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myocardial infaretion was based on at least two of the
following criteria: 1) a history of typical prolonged chest
pain, 2) electrocardiographic changes indicative of acute
myocardial injury with the subsequent evolution of a typical
transmural infarction pattern and 3) characteristic
elevations ofserum enzymes (CPK, GOT and/or LDH).
Their average age was 59.2 years (range 38 to 82). In 14
patients studies were performed one to 15 days (average 4.5
days) after acute myocardial infarction and in 47 patients
one to 53 months (average 20.2 months) after infaretion.
Serial studies were obtained on two or more occasions three
days to 11 months after infarction in 13 patients whose left
heart size and/or left ventricular wall motion changed after
myocardial infaretion.
Wall motion videotracking was performed as previously
described9' 1 employing a commercially available device
(Biotronex Heart Motion Videotracker). Utilizing a 23 cm
image intensifier, the fluoroscopic cardiac silhouette was displayed on a Plumbicon television system and either
recorded on videotape for later analysis or tracked directly
during the fluoroscopic study. The analog videotracking
signal was recorded on a Honeywell Visicorder
photographic system for subsequent analysis. Recordings
were made of five sites between the high and apical portion
of the left ventricular silhouette in the 100 right anterior
oblique, frontal, the 150 left anterior oblique, and lateral
projections. Abnormal wall motion was defined according to
a modification of the terminology of Herman and Gorlin.1
Dyskinesis was defined as holosystolic paradoxical movement of the left ventricular wall;asynchrony as early or late
systolic outward bulging; akinesis as localized absence of
a.
:tW
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wall motion; and hypokinesis as a diminution by greater
than 50% of the extent of motion as compared to normal
segments.
The external left heart dimension was used as an index of
left ventricular size. It was measured as the widest distance
from anterior midline markers to the left heart border on a
calibrated supine frontal chest X-ray exposed precisely at
end-diastole by means of an electrocardiographic gating
device after a measured inspiration of 1000 ml above functional residual capacity. It has previously been shown that
the external left heart dimension correlates well with
of left ventricular size.12
cineangiographic measurements
The ultrasound method for determining left ventricular
dimensions has been described previously in detail.1314 A
(Picker Echoview 11)
commercially available ultrasonoscope
was employed utilizing a 2.25 MHz, 1.25 cm transducer
focused at 7.5 cm, or a 1.6 MHz, 1.9 cm transducer focused
at 10 cm, both with a repetition rate of 1000 impulses per
second. The output of the ultrasonoscope was displayed and
recorded on a Honeywell Visicorder Oscillograph Model
1856. The standard technique of examining the structures
traversed by a single beam through the body of the left ventricle was followed. Ultrasound reflections were obtained
septal endocardium,
anteriorly from the interventricular
and posteriorly from the left ventricular posterior wall endocardial surface (fig. 1). To assure accurate definition of the
left ventricular endocardium and consistent localization of
the ultrasound beam, echoes from the anterior mitral valve
leaflet and chordal structures were included in the echocareach case, end-diastolic and enddiographic tracing.wereIn calculated
volumes
by the cube method of
systolic
Pombo and associates5 and by the regression formula of Fortuin and coworkers,4 using the average of three beats. Ejection fraction was calculated as the ratio of stroke volume to
end-diastolic volume. An electrocardiographic leadII, and
an indirect carotid arterial pulse tracing were recorded
echocardiogram on the mulsimultaneously withThethe mean
rate of internal diameter
tichannel recorder.
(Vcf) was calculated using previously described
shortening
methods.
A recently described radioisotope method for measuring
left ventricular ejection fraction was employed.l"-8 By this
method, ejection fraction is derived from instantaneous
count rates corresponding to the changes in left ventricular
volume at end-systole and end-diastole, and no assumptions
are made with respect to left ventricular geometry (fig. 2).
to 14 mCi sodium pertechnetate, dissolved in one
'9mTe(10
ml of 0.9% NaCI) was injected into an antecubital or external jugular vein. Precordial activity was recorded during the
first circulation through the heart with a gamma scintillation
camera (Searle Pho-Gamma HP) equipped with a medium
hole collimator in a 300 right anterior
energy 4000 parallel
on magnetic tape
oblique position and stored in realA time
com(Searle Data Storage/Accessory). small dedicated
Milwaukee,
II, General toElectric Company,
puter (Med was
utilized generate time-activity curves
Wisconsin)
from the left ventricular blood pool. Ejection fraction was
the cyclic fluctuations of the left ventricular
computed fromcurve
by dividing the difference between
time-activity
count rates at end-diastole and at end-systole by the count
rate at end-diastole. In each study, the counts collected in
the background region of interest were multiplied by the
ratio of the number of matrix points in the left ventricular
points in the
region of interest toof the number of matrix
five, and subfour
or
usually
interest,
background
region
tracted from the left ventricular time-activity curve.
Circulation, Volume 52. December 1975
15
EPI
Figure 1
Echocardiogram showing the left ventricular endocardial surface of
the interventricular septum (IVS) and the left ventricular posterior
wall endocardium (END). Inclusion of the posterior chordae (PC)
and anterior mitral valve leaflet insure accurate definition of the left
ventricular endocardium and consistent localization of the ultrasound beam. The simultaneous electrocardiogram (ECG),
carotid arterial pulse tracing (CPT) and time-distance markers are
incorporated in the display. The left ventricular internal enddiastolic dimension (LVIDd) between endocardial surfaces was
commeasured along the vertical line through the peak of the
plex. The left ventricular internal end-systolic dinension (LVIDs) is
defined as the smallest distance separating the endocardial surfaces
of the septum and posterior wall. EPI = epicardium; LVET = left
QRS
ventricular ejection
time.
ET AL.
1071
LV PERFORMANCE BY ANGIO, ECHO AFTER MI
11u
U U+
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but
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7u+
bUt
50+
U-
z
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ary
50
2 SEC
+
+
+
+
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100
150
200
250
300
35C
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bUU
45
400
TIME
Figure 2
Computer prin tout of a typical radionuclide high frequency left ventricular time-activity curve corrected for background
interference (see text). The vertical axis (count rate) represents the number of counts collected per 40 msec and the
horizontal axis represents time. On the computer printout the numbers refer to each subsequently collected curve point,
i.e., 50 points on the curve correspond to two seconds. The peaks on the curve correspond to end-diastole and the valleys
to end-systole. The ejection fraction is calculated from the count rates at end-diastole and at end-systole (see text).
Downloaded from http://circ.ahajournals.org/ by guest on June 11, 2017
Moreover, in view of the relatively low count rates, the
statistical reliability of this technique was improved by
employing a standard sine-wave analysis, thus including all
curve points into the calculation of the left ventricular ejection fraction.
Other investigators have shown previously that the ejection fraction determined by similar radioisotope techniques
correlates well with the ejection fraction measured by single
plane cineangiocardiography.'7 18 More recently, we
reported an excellent correlation between the ejection fraction by the radioisotope technique used in this study and the
ejection fraction measured by biplane left ventricular
cineangiography in 20 patients, 14 of whom had coronary
artery disease and nine of whom had major wall motion abnormalities.
Ultrasound examinations and isotope studies were performed within one hour on the same day in each patient. All
patients were in sinus rhythm and none had angina pectoris
during the procedure. No medications were taken between
the two procedures.
Data were analyzed using standard statistical methods
with the aid of a Sigma III computer.
However, the correlation between the two methods
was slightly reduced when the echo ejection fraction
was calculated using the regression equation of Fortuin and coworkers (r 0.76). The two methods for
determining ejection fraction were concordant, i.e.,
six patients had an abnormal ejection fraction
(< 0.52) and the remaining 25 patients had a normal
ejection fraction by both methods.
In the 46 studies in 35 patients with abnormal left
=
-a
Circulation, Volume 52, December 1975
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90
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80
-
70
-
60
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*-.
0
3a
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0
p:h
0
Results
Seventy-seven studies were performed in 61
patients. The average left ventricular ejection fraction
was 0.51 ± 0.10 (SD) by the radioisotope method and
was significantly higher by ultrasound (0.63 ± 0.11,
P < 0.001). For the entire patient group, there was a
poor correlation between the isotope and echo
measurements of ejection fraction (r = 0.43).
In the 31 studies in 26 patients with normal left
ventricular wall motion by videotracking and normal
left heart size, the ejection fraction by the radioisotope
method averaged 0.57 ± 0.09 as compared to an
echocardiographic ejection fraction (cube method) of
0.62 ± 0.10 (fig. 3). For this group of patients, there
was a good correlation between the isotope and echo
measurements of ejection fraction (r = 0.86).
100
*
50-
0 0
0
1r_
Cl
40
LU.
N=31
r z.86
30LL
20
-
10
-
un 0
10
20
30
40
50
60
70
80
90
100
EJECTION FRACTION (isotope)%
Figure 3
Ejection fraction derived from echocardiography (ordinate)
is
plotted against ejection fraction determined by isotope angiography
(abscissa) in patients with normal left ventricular wall motion by
videotracking. The crossed lines depict the lower limit of normalfor
ejection fraction (52%).
HENNING ET AL.
1072
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ventricular wall motion by videotracking, the ejection
fraction by the isotope method averaged 0.46 ± 0.08,
while ejection fraction by ultrasound averaged
0.62 ± 0.12 (P < 0.001) (fig. 4). In 28 of the 46 studies
measurements of the ejection fraction by the two
methods were discordant. Thus, in 27 studies the ejection fraction was normal (> 0.52) by the echocardiographic technique and reduced by the radioisotope
method, while in one patient the ejection fraction was
reduced by echo and normal by the isotope method.
For these postinfarction patients with abnormal wall
motion, 16 of whom (35%) also had cardiomegaly (left
heart dimension > 52 mm/M2 BSA), there was a poor
correlation between the isotope and echo measurements of the ejection fraction (r = 0.33). Substituting
the volume formula of Fortuin and associates for the
echo measurement of ejection fraction did not improve the correlation between the two methods
(r = 0.34). In the 16 patients with cardiomegaly, there
was also a poor correlation between the measurements
of the ejection fraction by the two methods (r = 0.39),
regardless of which echo formula was used for
calculating left ventricular volumes.
Thirty-eight of 46 (83%) wall motion videotracking
studies in the 35 patients with left ventricular
dyssynergy demonstrated involvement of the
anterolateral left ventricular surface and an associated
apical abnormality was present in 30 (79%) of these
studies. An isolated abnormality of the lateral left ven100
o
90-
ASNORMAL WALL MOTION
CARDIOMEGALYrAWV
80o
oA
-
00
70
A
0
A
0
0*A
A
X
.
-ii
z
o
60
*0
0
A
*°
8
50-
oc
IL-
40
-
30
-
20
-
10
-
N-46
r -. 33
LUJ
()
a
0
20
30
40
50
60
70
80
90
100
EJECTION FRACTION (isotope)%
Figure 4
Ejection fraction by ultrasound is plotted against ejection fraction
by isotope angiography in patients with abnormal left ventricular
wall motion by videotracking, with or without cardiomegaly. The
crossed lines depict the lower limit of normal for ejection fraction
(52%).
tricular wall occurred in only three patients and of the
anterior left ventricular wall in only two patients.
Four of the five patients with posterior wall motion
disorders also had involvement of the lateral or apical
surface of the left ventricle. Twenty-seven of the 46
studies (59%) where wall motion abnormalities were
present demonstrated a reduced ejection fraction by
the isotope method and a normal ejection fraction by
the echo method (fig. 3). In 23 of these 27 studies the
wall motion abnormality involved the anterolateral
left ventricular surface, in two the lateral, in one the
anterior, and in another the apical surface. Only two
of the patients with anterolateral dyssynergy had an
associated posterior wall motion abnormality.
The mean rate of internal diameter shortening
(mean Vcf) averaged 1.02 ± 0.04 circ/sec for the 30
studies in patients with normal wall motion and
0.98 ± 0.04 circ/sec for the 46 studies in patients with
abnormal wall motion. Thirteen of the 46 studies
(28%) in patients with wall motion disorders
demonstrated a normal mean Vcf by ultrasound
(> 1.05 circ/sec) but a reduced ejection fraction by
the isotope technique. In all 13 patients the wall motion abnormality involved the anterolateral or lateral
surface, extending only in two to the posterior wall.
Figure 5 illustrates serial left ventricular echocardiograms in a patient with an anterolateral myocardial
infarction who had dyskinesis of the low anterior,
apical and lateral left ventricular surfaces. During the
first study, the patient was in cardiogenic shock, and
the cardiac index was 1.4 L/min/m2 by the thermodilution technique when the ejection fraction by
the isotope method was 0.36. However, the
simultaneous echocardiographic measurement of the
ejection fraction was normal (0.72) and the tracing
showed an exaggerated septal excursion of 1.1 cm and
a normal systolic posterior wall movement of 1.1 cm.
There was no systolic murmur and right heart
catheterization did not indicate either mitral
regurgitation or a ventricular septal defect. During
the second study two months later the patient was no
longer in congestive heart failure and the dyssynergy
of the anterolateral left ventricular wall had improved. The isotope ejection fraction had increased to
0.58, but the echo method again overestimated the
ejection fraction (0.80). The ultrasound recording
again showed an exaggerated septal motion of 1.2 cm
suggesting a localized reduction in myocardial performance at a site not traversed by the single echo beam.
Discussion
Assumptions Underlying Ultrasound Methods
In the standard echocardiographic technique for
determining left ventricular volumes and ejection
fraction, the left ventricular end-diastolic and endCirculation, Volume 52,
December
1975
1073
LV PERFORMANCE BY ANGIO, ECHO AFTER MI
systolic distances between opposing endocardial surfaces of the interventricular septum and left ventricular posterior wall immediately inferior to the
mitral valve echo are measured. The usefulness of
these indices of ventricular performance has been
demonstrated in selected groups of patients.5 6, 19 The
cube method for determining left ventricular volumes
is based on the following assumptions: first, that the
motion of the two opposed loci traversed by a single
standardized echo beam is representative of the moA
ECG
tion and function of the entire left ventricular
chamber; second, that the chord measured by the ultrasound beam is a true minor axis; and third, that the
longitudinal axis of the cavity is twice the minor axis.
In the chamber with disordered wall motion the first
two assumptions may not be valid since the location
and degree of segmental wall motion abnormalities
vary and the area traversed by the single chord may
not represent the performance of the remainder of the
left ventricle. The third assumption applies where left
ventricular volume is normal. However, when left
ventricular dilatation results in a more spherical
chamber, the ratio of the long to the short axis will
decrease and lead to progressive overestimation of
volume. For determination of left ventricular volumes
in patients with cardiomegaly, regression equations
correcting for this discrepancy are available." 21
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Influence of Abnormal Wall Motion on
Ultrasound Measurements
B
Figure
5
Serial echocardiograrsm in a patient with myocardial infarction
associated with dyskinesis of the anterolateral left ventricular wall.
A) Following acute myocardial infarction during cardiogenic shock
when the ejection fraction by the radioisotope method was reduced
to 0.36 and the cardiac index was 1.4 L/min/mm the ejection fraction by echo was 0. 72. Note the normal systolic posterior wall rrmvement and the exaggerated septal excursion of 1.1 cm. B) Two
months later when the ejection fraction by isotope angiography had
increased to 0.58, the ultrasound method continued to overestimate
the ejection fraction (0.80). Normal excursion of the posterior left
ventricular wall and exaggerated septal notion (1.2 am) are again
present. ECG electrocardiogram, IVS - interventricular septum; CPT = carotid arterial pulse tracing, PC = posterior chordae,
=
END
=
left ventricular endocardium.
Circulation, Volume 52, December 1975
Utilizing wall motion videotracking, we have shown
previously that major wall motion abnormalities can
be demonstrated in 86% of patients with acute
myocardial infarction.7 Dyssynergy after myocardial
infarction is most commonly located at the anterior,
lateral, anterolateral or apical surfaces of the left ventricle. External videotracking often does not detect
wall motion disorders limited to the septal or
diaphragmatic portion of the left ventricular surface.
However, wall motion disorders involving the
posteroinferior left ventricular surface can be detected
in the majority of patients since such abnormalities extend to the left ventricular apex in 88% of patients
with inferior myocardial infarction.8 The standard ultrasonic beam passes through the superior portion of
the interventricular septum and the basal portion of
the posterior left ventricular wall. Since reduced
systolic inward movement or dyskinesis of one of the
ventricular surfaces often results in compensatory increased excursion of the opposing surface, the echo
measurement may overestimate the ejection fraction,
particularly when either septal or posterior wall motion is unchanged or enhanced.
Utilizing M-mode scanning of the left ventricle
between the aortic root and the posterior papillary
muscle, Feigenbaum and associates have demonstrated that the echocardiogram can be used to detect left
ventricular asynergy in patients with coronary artery
disease.20 However, in the current investigation where
a standard single beam echo was employed, only 15 of
the 46 studies (33%) in patients with abnormal left
ventricular wall motion determined by videotracking
exhibited abnormal wall motion by ultrasound. In
these 15 studies the ejection fraction by echo did not
correlate better with the isotope ejection fraction
1074
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(r = 0.39) as compared to the total group of studies in
patients with wall motion disorders. This correlation
was similar when patients with exaggerated motion of
either wall were excluded, although the echocardiographic overestimation of ejection fraction was
considerably less (11%) as compared to the average
overestimate of 35% in the total group of patients with
wall motion abnormalities.
Thus, it appears that even when areas of asynergy
are included in the standard echocardiographic recording, over-all left ventricular performance may not be
assessed accurately. This is so because of the variable
extent, severity and location of segmental wall motion
abnormalities in postinfarction patients. Furthermore,
the interventricular septum or the posterior left ventricular wall are rarely the solitary site of a wall motion
abnormality after myocardial infarction. In the present investigation, only one of the 31 studies in
patients with normal left ventricular wall motion
demonstrated a hypokinetic septum on the standard
echo recording. In the group with abnormal wall motion, all 11 patients with abnormal septal motion by
echo had abnormal motion of the anterolateral or
lateral left ventricular wall detected by videotracking. This may be why the ultrasound technique rarely
underestimates the ejection fraction.
In an earlier study,19 we examined ultrasound and
cineangiographic measurements of left ventricular
performance in patients with wall motion abnormalities of varying etiology and found a better correlation between these measurements than in the present
study of patients with wall motion disorders resulting
exclusively from myocardial infarction. The majority
of the patients previously studied with coronary artery
disease or primary myocardial disease had either
localized areas of akinesis or hypokinesis or diffuse hypokinesis involving the entire left ventricle. The latter abnormality is included in the standard echo recording because of its uniform nature, and thus is
representative of over-all left ventricular function. A
small localized hypokinetic area, on the other hand,
may not lead to major functional changes in the entire
left ventricle and the ejection fraction by the two
methods may be more closely correlated than in
patients who have more severe and extensive wall motion abnormalities. Thus, in the seven patients with
either diffuse hypokinesis or localized hypokinesis,
there was a strong correlation between the isotope and
echo measurements of ejection fraction (r = 0.79).
Measurement of the ejection fraction from the
radionuclide left ventricular time-activity curve is not
without potential errors. It appears to slightly
overestimate very low ejection fractions or underestimate high ejection fractions when compared to
cineventriculography.'7 18 In addition, inaccurate
HENNING ET AL.
assignment of the regions of interest to the left ventricular blood pool and the noncardiac background
structures and improper correction for background interference may lead to an over or underestimation of
the ejection fraction (see Methods). However, in our
previous study utilizing this radioisotope technique,
there was an excellent correlation (r = 0.94) between
the ejection fraction determined by radionuclide
angiocardiography and the ejection fraction by
biplane left ventricular cineangiography.'6 Furthermore, there was no difference in the correlation
between the two techniques in the nine patients with
abnormal wall motion by cineangiography as compared to the 11 patients with normal wall motion. In
addition, the isotope technique appeared to accurately estimate ejection fraction in the three
patients in the previous study who had cineangiographic evidence of mitral regurgitation.
Our results are consistent with the data reported by
Teichholz and associates (21) who noted errors in the
calculation of left ventricular ejection fraction by standard time-motion echocardiography compared with
biplane cineangiography in 14 patients with left ventricular asynergy.
The data obtained in the present study indicate that
standard echocardiographic measurements of the
ejection fraction, when compared to radionuclide
angiography, tend to overestimate left ventricular
performance in patients with myocardial infarction
associated with anterolateral wall motion abnormalities.
References
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failure. Am J Cardiol 22: 24, 1968
2. DODGE HT, HAY RE, SANDLER H: An angiocardiographic
method for directly determining left ventricular stroke
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3. KARLINJER JS, GAULT JH, ECKBERG D, MULLINS CB, Ross J JR:
Mean velocity of fiber shortening. Circulation 44: 323, 1971
4. FORTLIN NJ, Hooo WJ JB, SHERMAN ME, CRAIGE E:
Determination of left ventricular volumes by ultrasound.
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5. POMBO JG, TROY BL, RUSSELL RO: Left ventricular volumes
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480, 1971
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Circulation, Volume 52, December 1975
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LV PERFORMANCE BY ANGIO, ECHO AFTER MI
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15. COOPER RH, O ROURKE RA, KARLINER JS, PETERSON KL,
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NP, ROSE FJ, ASHBURN WL: Nontraumatic determination of
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17. VAN DYKE D, ANGER HO, SULLIVAN RW, VETTER WR, YANO Y,
PARKER HG: Cardiac evaluation from radioisotope
dynamics. J Nucl Med 13: 585, 1972
18. STEELE P, KIRCH D, MATTHEWS M, DAVIES H: Measurement of
left heart ejection fraction and end-diastolic volume by a
computerized, scintigraphic technique using a wedged
pulmonary artery catheter. Am J Cardiol 34: 179, 1974
19. LUDBROOK P, KARLINER JS, PETERSON KL, LEOPOLD G,
O ROURKE RA: Comparison of ultrasound and
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Correction
Chaitman et al.: Circulation 52: 420, 1975. On page 424,
the legend to figure 4 belongs with figure 5 and the legend
to figure 5 belongs with figure 4.
Jaffe: Circulation 52: 714, 1975. On page 719 the relevant
portion of figure 6 was left out. The correct figure will be
printed with part 2 of this report to be published in the
January 1976 issue of Circulation.
Circulation, Volume 52, December 1975
Left ventricular performance assessed by radionuclide angiocardiography and
echocardiography in patients with previous myocardial infarction.
H Henning, H Schelbert, M H Crawford, J S Karliner, W Ashburn and R A O'Rourke
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Circulation. 1975;52:1069-1075
doi: 10.1161/01.CIR.52.6.1069
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