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William L Winters - One of the best experts on this subject based on the ideXlab platform.
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:Background— There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl201) scintigraphy. Methods and Results— Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl201 tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher...
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:BACKGROUND: There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl(201)) scintigraphy. METHODS AND RESULTS: Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl(201) tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher than dysfunctional myocardium without recovery of function (P or =60% (P 1.5 dB/s for recovery of function was 90% and was similar to Tl(201) scintigraphy (92%) and any contractile reserve (80%); specificity was higher than for Tl(201) and DE (63%, 45%, and 54%, respectively; P<0.05). CONCLUSIONS: MCE with intravenous contrast identifies Myocardial Hibernation in humans. Prediction of viable myocardium with MCE is best using quantification of Myocardial blood flow and provides improved accuracy compared with DE and Tl(201) scintigraphy.
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microvascular structural correlates of Myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction implications for the assessment of Myocardial Hibernation
Circulation, 2002Co-Authors: Sarah Shimoni, William L Winters, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, Michael J ReardonAbstract:Background— Myocardial contrast echocardiography (MCE) has been used to evaluate Myocardial viability. There are no data, however, on the pathological determinants of Myocardial perfusion by MCE in humans and the implications of such determinants. Methods and Results— MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before Myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak Myocardial contrast intensity (MCI) and the rate of increase in MCI (β) were quantitated. Thirty-six transmural Myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 μm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and in...
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end diastolic wall thickness as a predictor of recovery of function in Myocardial Hibernation relation to rest redistribution t1 201 tomography and dobutamine stress echocardiography
Journal of the American College of Cardiology, 2000Co-Authors: Jucylea M Cwajg, Sherif F Nagueh, Mario S Verani, William L Winters, Miguel A Quinones, Eduardo Cwajg, Zuoxiang He, Usman Qureshi, Leopoldo Olmos, William A ZoghbiAbstract:Abstract OBJECTIVES The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of Myocardial viability in patients with suspected Myocardial Hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (Tl-201) scintigraphy. BACKGROUND Because Myocardial necrosis is associated with Myocardial thinning, preserved EDWT may provide a simple index of Myocardial viability that is readily available from the resting echocardiogram. METHODS Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution Tl-201 tomography before revascularization and a repeat resting echocardiogram ≥2 months later. RESULTS Global wall motion score index decreased from 2.38 ± 0.73 to 1.94 ± 0.82 after revascularization (p 0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a Tl-201 maximal uptake of ≥60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum Tl-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%). CONCLUSIONS End-diastolic wall thickness is an important marker of Myocardial viability in patients with suspected Hibernation, and it can predict recovery of function similar to Tl-201 scintigraphy. Importantly, a simple measurement of EDWT ≤0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of Myocardial viability.
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identification of hibernating myocardium comparative accuracy of Myocardial contrast echocardiography rest redistribution thallium 201 tomography and dobutamine echocardiography
Journal of the American College of Cardiology, 1997Co-Authors: Sherif F Nagueh, Periyanan Vaduganathan, Alvin Blaustein, Mario S Verani, William L Winters, William A ZoghbiAbstract:Abstract Objectives. We sought to evaluate the comparative accuracy of Myocardial contrast echocardiography (MCE), quantitative rest-redistribution thallium-201 (Tl-201) tomography and low and high dose (up to 40 μg/kg body weight per min) dobutamine echocardiography (DE) in identifying Myocardial Hibernation. Background. Myocardial contrast echocardiography can assess Myocardial perfusion and may therefore be useful in predicting Myocardial Hibernation. However, its accuracy in comparison to Myocardial perfusion scintigraphy and to that of high dose DE remains to be investigated. Methods. Eighteen patients (aged [±SD] 57 ± 10 years) with stable coronary artery disease and ventricular dysfunction underwent the above three modalities before coronary revascularization. Myocardial contrast echocardiography was achieved with intracoronary Albunex. Rest echocardiographic and Tl-201 studies were repeated ≥6 weeks after revascularization. Results. Of 109 revascularized segments with severe dysfunction, 46 (42%) improved. Left ventricular ejection fraction increased from 38 ± 14% to 45 ± 13% at follow-up (p = 0.003). Rest Tl-201 uptake and the ratio of peak contrast intensity of dysfunctional to normal segments with MCE were higher (p Conclusions. In Myocardial Hibernation, methods evaluating rest perfusion (MCE, Tl-201) or any contractile reserve have a similar high sensitivity but a low specificity for predicting recovery of function. A limited contractile reserve (biphasic response) increases the specificity of DE. Importantly, the three techniques identified all patients who had significant improvement in global ventricular function. (J Am Coll Cardiol 1997;29:985–93) © 1997 by the American College of Cardiology
William A Zoghbi - One of the best experts on this subject based on the ideXlab platform.
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end diastolic wall thickness as a predictor of recovery of function in Myocardial Hibernation relation to rest redistribution t1 201 tomography and dobutamine stress echocardiography
Journal of the American College of Cardiology, 2000Co-Authors: Jucylea M Cwajg, Sherif F Nagueh, Mario S Verani, William L Winters, Miguel A Quinones, Eduardo Cwajg, Zuoxiang He, Usman Qureshi, Leopoldo Olmos, William A ZoghbiAbstract:Abstract OBJECTIVES The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of Myocardial viability in patients with suspected Myocardial Hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (Tl-201) scintigraphy. BACKGROUND Because Myocardial necrosis is associated with Myocardial thinning, preserved EDWT may provide a simple index of Myocardial viability that is readily available from the resting echocardiogram. METHODS Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution Tl-201 tomography before revascularization and a repeat resting echocardiogram ≥2 months later. RESULTS Global wall motion score index decreased from 2.38 ± 0.73 to 1.94 ± 0.82 after revascularization (p 0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a Tl-201 maximal uptake of ≥60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum Tl-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%). CONCLUSIONS End-diastolic wall thickness is an important marker of Myocardial viability in patients with suspected Hibernation, and it can predict recovery of function similar to Tl-201 scintigraphy. Importantly, a simple measurement of EDWT ≤0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of Myocardial viability.
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identification of hibernating myocardium comparative accuracy of Myocardial contrast echocardiography rest redistribution thallium 201 tomography and dobutamine echocardiography
Journal of the American College of Cardiology, 1997Co-Authors: Sherif F Nagueh, Periyanan Vaduganathan, Alvin Blaustein, Mario S Verani, William L Winters, William A ZoghbiAbstract:Abstract Objectives. We sought to evaluate the comparative accuracy of Myocardial contrast echocardiography (MCE), quantitative rest-redistribution thallium-201 (Tl-201) tomography and low and high dose (up to 40 μg/kg body weight per min) dobutamine echocardiography (DE) in identifying Myocardial Hibernation. Background. Myocardial contrast echocardiography can assess Myocardial perfusion and may therefore be useful in predicting Myocardial Hibernation. However, its accuracy in comparison to Myocardial perfusion scintigraphy and to that of high dose DE remains to be investigated. Methods. Eighteen patients (aged [±SD] 57 ± 10 years) with stable coronary artery disease and ventricular dysfunction underwent the above three modalities before coronary revascularization. Myocardial contrast echocardiography was achieved with intracoronary Albunex. Rest echocardiographic and Tl-201 studies were repeated ≥6 weeks after revascularization. Results. Of 109 revascularized segments with severe dysfunction, 46 (42%) improved. Left ventricular ejection fraction increased from 38 ± 14% to 45 ± 13% at follow-up (p = 0.003). Rest Tl-201 uptake and the ratio of peak contrast intensity of dysfunctional to normal segments with MCE were higher (p Conclusions. In Myocardial Hibernation, methods evaluating rest perfusion (MCE, Tl-201) or any contractile reserve have a similar high sensitivity but a low specificity for predicting recovery of function. A limited contractile reserve (biphasic response) increases the specificity of DE. Importantly, the three techniques identified all patients who had significant improvement in global ventricular function. (J Am Coll Cardiol 1997;29:985–93) © 1997 by the American College of Cardiology
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dobutamine echocardiography and quantitative rest redistribution 201tl tomography in Myocardial Hibernation relation of contractile reserve to 201tl uptake and comparative prediction of recovery of function
Circulation, 1997Co-Authors: Usman Qureshi, Sherif F Nagueh, Periyanan Vaduganathan, Alvin Blaustein, Mario S Verani, William L Winters, Imran Afridi, William A ZoghbiAbstract:Background The purposes of this study were to evaluate the comparative accuracy of dobutamine echocardiography and quantitative rest-redistribution 201Tl tomography in the prediction of recovery of function after revascularization and to assess the relation of contractile reserve to thallium uptake. Methods and Results Thirty-four patients with stable coronary disease and regional dysfunction underwent dobutamine echocardiography (2.5 up to 40 μg·kg−1·min−1) and rest-redistribution 201Tl tomography 1 day before revascularization. Resting echocardiography and scintigraphy were repeated at ≥6 weeks. Before revascularization, resting 201Tl uptake was similar in segments demonstrating biphasic or sustained improvement and was higher than in those exhibiting no change or worsening function during dobutamine. After revascularization, 201Tl uptake increased only in segments that showed a biphasic response (from 66±12% to 78±13%; P<.05). Biphasic response had a sensitivity of 74% and specificity of 89% for predic...
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dobutamine echocardiography in Myocardial Hibernation optimal dose and accuracy in predicting recovery of ventricular function after coronary angioplasty
Circulation, 1995Co-Authors: Imran Afridi, Neal S Kleiman, Albert E Raizner, William A ZoghbiAbstract:Background Myocardial Hibernation is a condition of chronic left ventricular dysfunction associated with severe coronary artery disease whereby significant recovery of function occurs after revascularization. Identification of hibernating myocardium has important prognostic and therapeutic implications. The presence of contractile reserve as assessed by dobutamine echocardiography may be promising in the detection of Hibernation. We designed a prospective study to evaluate the accuracy and optimal dose of dobutamine echocardiography for predicting recovery of ventricular function after angioplasty in patients with stable coronary artery disease and ventricular dysfunction. Methods and Results Twenty patients with stable coronary artery disease and segmental ventricular dysfunction scheduled for coronary angioplasty underwent dobutamine echocardiography before revascularization using incremental doses of 2.5, 5, 7.5, 10, 20, 30, and 40 μg/kg per minute every 3 minutes. Digital images of all eight stages we...
Mario S Verani - One of the best experts on this subject based on the ideXlab platform.
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:BACKGROUND: There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl(201)) scintigraphy. METHODS AND RESULTS: Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl(201) tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher than dysfunctional myocardium without recovery of function (P or =60% (P 1.5 dB/s for recovery of function was 90% and was similar to Tl(201) scintigraphy (92%) and any contractile reserve (80%); specificity was higher than for Tl(201) and DE (63%, 45%, and 54%, respectively; P<0.05). CONCLUSIONS: MCE with intravenous contrast identifies Myocardial Hibernation in humans. Prediction of viable myocardium with MCE is best using quantification of Myocardial blood flow and provides improved accuracy compared with DE and Tl(201) scintigraphy.
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:Background— There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl201) scintigraphy. Methods and Results— Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl201 tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher...
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end diastolic wall thickness as a predictor of recovery of function in Myocardial Hibernation relation to rest redistribution t1 201 tomography and dobutamine stress echocardiography
Journal of the American College of Cardiology, 2000Co-Authors: Jucylea M Cwajg, Sherif F Nagueh, Mario S Verani, William L Winters, Miguel A Quinones, Eduardo Cwajg, Zuoxiang He, Usman Qureshi, Leopoldo Olmos, William A ZoghbiAbstract:Abstract OBJECTIVES The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of Myocardial viability in patients with suspected Myocardial Hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (Tl-201) scintigraphy. BACKGROUND Because Myocardial necrosis is associated with Myocardial thinning, preserved EDWT may provide a simple index of Myocardial viability that is readily available from the resting echocardiogram. METHODS Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution Tl-201 tomography before revascularization and a repeat resting echocardiogram ≥2 months later. RESULTS Global wall motion score index decreased from 2.38 ± 0.73 to 1.94 ± 0.82 after revascularization (p 0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a Tl-201 maximal uptake of ≥60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum Tl-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%). CONCLUSIONS End-diastolic wall thickness is an important marker of Myocardial viability in patients with suspected Hibernation, and it can predict recovery of function similar to Tl-201 scintigraphy. Importantly, a simple measurement of EDWT ≤0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of Myocardial viability.
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identification of hibernating myocardium comparative accuracy of Myocardial contrast echocardiography rest redistribution thallium 201 tomography and dobutamine echocardiography
Journal of the American College of Cardiology, 1997Co-Authors: Sherif F Nagueh, Periyanan Vaduganathan, Alvin Blaustein, Mario S Verani, William L Winters, William A ZoghbiAbstract:Abstract Objectives. We sought to evaluate the comparative accuracy of Myocardial contrast echocardiography (MCE), quantitative rest-redistribution thallium-201 (Tl-201) tomography and low and high dose (up to 40 μg/kg body weight per min) dobutamine echocardiography (DE) in identifying Myocardial Hibernation. Background. Myocardial contrast echocardiography can assess Myocardial perfusion and may therefore be useful in predicting Myocardial Hibernation. However, its accuracy in comparison to Myocardial perfusion scintigraphy and to that of high dose DE remains to be investigated. Methods. Eighteen patients (aged [±SD] 57 ± 10 years) with stable coronary artery disease and ventricular dysfunction underwent the above three modalities before coronary revascularization. Myocardial contrast echocardiography was achieved with intracoronary Albunex. Rest echocardiographic and Tl-201 studies were repeated ≥6 weeks after revascularization. Results. Of 109 revascularized segments with severe dysfunction, 46 (42%) improved. Left ventricular ejection fraction increased from 38 ± 14% to 45 ± 13% at follow-up (p = 0.003). Rest Tl-201 uptake and the ratio of peak contrast intensity of dysfunctional to normal segments with MCE were higher (p Conclusions. In Myocardial Hibernation, methods evaluating rest perfusion (MCE, Tl-201) or any contractile reserve have a similar high sensitivity but a low specificity for predicting recovery of function. A limited contractile reserve (biphasic response) increases the specificity of DE. Importantly, the three techniques identified all patients who had significant improvement in global ventricular function. (J Am Coll Cardiol 1997;29:985–93) © 1997 by the American College of Cardiology
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dobutamine echocardiography and quantitative rest redistribution 201tl tomography in Myocardial Hibernation relation of contractile reserve to 201tl uptake and comparative prediction of recovery of function
Circulation, 1997Co-Authors: Usman Qureshi, Sherif F Nagueh, Periyanan Vaduganathan, Alvin Blaustein, Mario S Verani, William L Winters, Imran Afridi, William A ZoghbiAbstract:Background The purposes of this study were to evaluate the comparative accuracy of dobutamine echocardiography and quantitative rest-redistribution 201Tl tomography in the prediction of recovery of function after revascularization and to assess the relation of contractile reserve to thallium uptake. Methods and Results Thirty-four patients with stable coronary disease and regional dysfunction underwent dobutamine echocardiography (2.5 up to 40 μg·kg−1·min−1) and rest-redistribution 201Tl tomography 1 day before revascularization. Resting echocardiography and scintigraphy were repeated at ≥6 weeks. Before revascularization, resting 201Tl uptake was similar in segments demonstrating biphasic or sustained improvement and was higher than in those exhibiting no change or worsening function during dobutamine. After revascularization, 201Tl uptake increased only in segments that showed a biphasic response (from 66±12% to 78±13%; P<.05). Biphasic response had a sensitivity of 74% and specificity of 89% for predic...
Sarah Shimoni - One of the best experts on this subject based on the ideXlab platform.
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:Background— There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl201) scintigraphy. Methods and Results— Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl201 tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher...
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:BACKGROUND: There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl(201)) scintigraphy. METHODS AND RESULTS: Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl(201) tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher than dysfunctional myocardium without recovery of function (P or =60% (P 1.5 dB/s for recovery of function was 90% and was similar to Tl(201) scintigraphy (92%) and any contractile reserve (80%); specificity was higher than for Tl(201) and DE (63%, 45%, and 54%, respectively; P<0.05). CONCLUSIONS: MCE with intravenous contrast identifies Myocardial Hibernation in humans. Prediction of viable myocardium with MCE is best using quantification of Myocardial blood flow and provides improved accuracy compared with DE and Tl(201) scintigraphy.
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microvascular structural correlates of Myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction implications for the assessment of Myocardial Hibernation
Circulation, 2002Co-Authors: Sarah Shimoni, William L Winters, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, Michael J ReardonAbstract:Background— Myocardial contrast echocardiography (MCE) has been used to evaluate Myocardial viability. There are no data, however, on the pathological determinants of Myocardial perfusion by MCE in humans and the implications of such determinants. Methods and Results— MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before Myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak Myocardial contrast intensity (MCI) and the rate of increase in MCI (β) were quantitated. Thirty-six transmural Myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 μm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and in...
Miguel A Quinones - One of the best experts on this subject based on the ideXlab platform.
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:Background— There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl201) scintigraphy. Methods and Results— Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl201 tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher...
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identification of hibernating myocardium with quantitative intravenous Myocardial contrast echocardiography comparison with dobutamine echocardiography and thallium 201 scintigraphy
Circulation, 2003Co-Authors: Sarah Shimoni, Mario S Verani, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, William L WintersAbstract:BACKGROUND: There are currently no data on the accuracy of intravenous Myocardial contrast echocardiography (MCE) in detecting Myocardial Hibernation in man and its comparative accuracy to dobutamine echocardiography (DE) or thallium 201 (Tl(201)) scintigraphy. METHODS AND RESULTS: Twenty patients with coronary artery disease and ventricular dysfunction underwent MCE 1 to 5 days before bypass surgery and repeat echocardiography at 3 to 4 months. Patients also underwent DE (n=18) and rest-redistribution Tl(201) tomography (n=16) before revascularization. MCE was performed using continuous Optison infusion (12 to 16 cc/h) with intermittent pulse inversion harmonics and incremental triggering (1:1 to 1:8). Myocardial contrast intensity (MCI) replenishment curves were constructed to derive quantitative MCE indices of blood velocity and flow. Recovery of function occurred in 38% of dysfunctional segments. MCE parameters of perfusion in hibernating myocardium were similar to segments with normal function and higher than dysfunctional myocardium without recovery of function (P or =60% (P 1.5 dB/s for recovery of function was 90% and was similar to Tl(201) scintigraphy (92%) and any contractile reserve (80%); specificity was higher than for Tl(201) and DE (63%, 45%, and 54%, respectively; P<0.05). CONCLUSIONS: MCE with intravenous contrast identifies Myocardial Hibernation in humans. Prediction of viable myocardium with MCE is best using quantification of Myocardial blood flow and provides improved accuracy compared with DE and Tl(201) scintigraphy.
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microvascular structural correlates of Myocardial contrast echocardiography in patients with coronary artery disease and left ventricular dysfunction implications for the assessment of Myocardial Hibernation
Circulation, 2002Co-Authors: Sarah Shimoni, William L Winters, Miguel A Quinones, Nikolaos G Frangogiannis, Constadina J Aggeli, Kesavan Shan, Rafael Espada, George V Letsou, Gerald M Lawrie, Michael J ReardonAbstract:Background— Myocardial contrast echocardiography (MCE) has been used to evaluate Myocardial viability. There are no data, however, on the pathological determinants of Myocardial perfusion by MCE in humans and the implications of such determinants. Methods and Results— MCE was performed in 20 patients with coronary artery disease and ventricular dysfunction within 24 hours before Myocardial biopsy at surgery using a continuous Optison infusion (12 to 16 cc/h), with intermittent pulse inversion harmonics and incremental triggering. Peak Myocardial contrast intensity (MCI) and the rate of increase in MCI (β) were quantitated. Thirty-six transmural Myocardial biopsies (2 per patient) were obtained by transesophageal echocardiography. Total microvascular (<100 μm) density, capillary density and area, arteriolar and venular density, and percent collagen content were quantitated with immunohistochemistry. Peak MCI correlated with microvascular density (r=0.59, P<0.001) and capillary area (r=0.64, P<0.001) and in...
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end diastolic wall thickness as a predictor of recovery of function in Myocardial Hibernation relation to rest redistribution t1 201 tomography and dobutamine stress echocardiography
Journal of the American College of Cardiology, 2000Co-Authors: Jucylea M Cwajg, Sherif F Nagueh, Mario S Verani, William L Winters, Miguel A Quinones, Eduardo Cwajg, Zuoxiang He, Usman Qureshi, Leopoldo Olmos, William A ZoghbiAbstract:Abstract OBJECTIVES The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of Myocardial viability in patients with suspected Myocardial Hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (Tl-201) scintigraphy. BACKGROUND Because Myocardial necrosis is associated with Myocardial thinning, preserved EDWT may provide a simple index of Myocardial viability that is readily available from the resting echocardiogram. METHODS Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution Tl-201 tomography before revascularization and a repeat resting echocardiogram ≥2 months later. RESULTS Global wall motion score index decreased from 2.38 ± 0.73 to 1.94 ± 0.82 after revascularization (p 0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a Tl-201 maximal uptake of ≥60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum Tl-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%). CONCLUSIONS End-diastolic wall thickness is an important marker of Myocardial viability in patients with suspected Hibernation, and it can predict recovery of function similar to Tl-201 scintigraphy. Importantly, a simple measurement of EDWT ≤0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of Myocardial viability.
