skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: The interval ejection fraction: a cineangiographic and radionuclide study

Abstract

To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls and 25 patients with clinically stable angina pectoris and severe CAD without and with resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control. Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.

Authors:
; ; ; ; ;
Publication Date:
Research Org.:
Department of Cardiology, Veterans Administration Medical Center, West Roxbury, Massachusetts
OSTI Identifier:
6783655
Resource Type:
Journal Article
Resource Relation:
Journal Name: Circulation; (United States); Journal Volume: 65:6
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLOOD VESSELS; BIOMEDICAL RADIOGRAPHY; CARDIOVASCULAR DISEASES; DIAGNOSIS; RADIOISOTOPES; DIAGNOSTIC USES; BLOOD CIRCULATION; BLOOD PRESSURE; COMPARATIVE EVALUATIONS; HEART; PATIENTS; BODY; CARDIOVASCULAR SYSTEM; DIAGNOSTIC TECHNIQUES; DISEASES; ISOTOPES; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; USES 550601* -- Medicine-- Unsealed Radionuclides in Diagnostics

Citation Formats

Kemper, A.J., Bianco, J.A., Shulman, R.M., Folland, E.D., Parisi, A.F., and Tow, D.E. The interval ejection fraction: a cineangiographic and radionuclide study. United States: N. p., 1982. Web. doi:10.1161/01.CIR.65.6.1094.
Kemper, A.J., Bianco, J.A., Shulman, R.M., Folland, E.D., Parisi, A.F., & Tow, D.E. The interval ejection fraction: a cineangiographic and radionuclide study. United States. doi:10.1161/01.CIR.65.6.1094.
Kemper, A.J., Bianco, J.A., Shulman, R.M., Folland, E.D., Parisi, A.F., and Tow, D.E. 1982. "The interval ejection fraction: a cineangiographic and radionuclide study". United States. doi:10.1161/01.CIR.65.6.1094.
@article{osti_6783655,
title = {The interval ejection fraction: a cineangiographic and radionuclide study},
author = {Kemper, A.J. and Bianco, J.A. and Shulman, R.M. and Folland, E.D. and Parisi, A.F. and Tow, D.E.},
abstractNote = {To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls and 25 patients with clinically stable angina pectoris and severe CAD without and with resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control. Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.},
doi = {10.1161/01.CIR.65.6.1094},
journal = {Circulation; (United States)},
number = ,
volume = 65:6,
place = {United States},
year = 1982,
month = 6
}
  • To evaluate the clinical usefulness of the first-third ejection fraction (1/3 EF) for detecting patients with coronary artery disease (CAD), resting contrast ventriculography and first-pass radionuclide angiography with a high-count-rate, multicrystal camera system were performed in 47 subjects: 22 normal controls (group 1) and 25 patients with clinically stable angina pectoris and severe CAD (mean 2.3 vessels) without (group 2, n = 12) and with (group 3, n = 13) resting wall motion abnormalities. By contrast angiography, only group 3 had depressed global EF or 1/3 EF compared with control (global EF: group 1, 0.71 = 0.09; group 2, 0.67more » = 0.09 (NS); group 3, 0.49 = 0.05 (p < 0.01 vs groups 1 and 2); 1/3 EF: group 1, 0.29 = 0.06; group 2, 0.28 = 0.05 (NS); group 3, 0.22 = 0.05 (p < 0.01 vs groups 1 and 2)). Whereas 11 of 25 CAD patients had global EF outside the normal range, only two of 25 had depressed 1/3 EF. Both had left ventricular asynergy and a depressed global EF. Studies performed using first-pass radionuclide angiography revealed similar results, i.e., only four of 25 CAD patients, all with left ventricular asynergy and depressed global EF, had depressed 1/3 EF values. A wide range of 1/3 EF values was found in normal subjects by both techniques. Thus, the ejection fraction during the first third of systole at rest is of limited value for detecting patients with CAD.« less
  • Thirty-one consecutive patients undergoing intravenous blurred mask digital subtraction right ventriculography were submitted to first pass radionuclide angiography. Second order mask resubtraction of end-diastolic and end-systolic right ventricular digital image frames was executed using preinjection end-diastolic and end-systolic frames to rid the digital subtraction images of mis-registration artifact. End-diastolic and end-systolic perimeters were drawn manually by two independent observers with a light pen. Ejection fractions calculated from the integrated videodensitometric counts within these perimeters correlated well with those derived from the first pass radionuclide right ventriculogram (r = 0.84) and the interobserver correlation was acceptable (r = 0.91). Interobserver differencesmore » occurred more frequently in patients with atrial fibrillation and in those whose tricuspid valve planes were difficult to discern on the digital subtraction right ventriculograms. These results suggest that videodensitometric analysis of digital subtraction right ventriculograms is an accurate method of determining right ventricular ejection fraction and may find wide clinical applicability.« less
  • Sequential quantitative first pass radionuclide angiocardiograms (RA) were used to measure left ventricular ejection fraction (LVEF) and left ventricular ejection rate (LVER), and to assess regional wall motion (RWM) in the anterior (ANT) and left anterior oblique (LAO) positions. Studies were obtained with a computerized multicrystal scintillation camera suitable for acquiring high count-rate data. Background was determined in a new fashion by selecting frames temporally from the left ventricular region of interest time-activity curve. A ''representative'' cardiac cycle was formed by summing together counts over three to six cardiac cycles. From this background corrected, high count-rate ''representative''cardiac cycle, LVEF, LVER,more » and RWM were determined. In 22 patients with normal sinus rhythm in the absence of significant valvular regurgitation, RA LVEF correlated well with that measured by contrast angiography (r = 0.95). LVER correlated well with LVEF measured at contrast angiography (r = 0.90) and allowed complete separation of those with normal (LVER = 3.4 +- 0.17 sec/sup -1/) and abnormal (LVER = 1.22 +- 0.11 sec/sup -1/) (P < 0.001) left ventricular performance. This separation was independent of background. Isoproterenol infusion in five normal subjects caused LVER to increase by 81 +- 17% while LVEF increased by 10 +- 2.0%. RWM was correctly defined in 21/22 patients and 89% of left ventricular segments with abnormal wall motion.« less
  • The detection of regional asynergy provides strong evidence for a critical reduction of coronary blood flow to that zone. In the present study, the usefulness of combining computer-assisted radionuclide angiography and isometric handgrip exercise testing to detect coronary heart disease (CHD) was evaluated. One hundred twenty-nine patients with chest pain undergoing cardiac catheterization were evaluated using radionuclide angiography. Thirty-four patients were found to have severe contraction abnormalities during the initial radionuclide angiographic study. Of these, 33 had significant CHD. Ninety-five patients had normal or borderline normal left ventricular contraction and therefore underwent a second radionuclide angiogram during handgrip. Radionuclide angiogrammore » data were quantitatively analyzed by computer to determine regional left ventricular contribution to ejection fraction during handgrip stress. Of the 95 patients, 30 had normal coronary arteries of whom 26 (87%) had normal relative regional ejection fraction. Sixty-five patients had CHD; 20 had single and 45 had two or three vessel obstructive disease. Overall, of the 95 patients who underwent isometric handgrip stress, sensitivity was 86% for detection of CHD and specificity was 87% for accurately defining the patients with normal coronary arteries. The results of the present study suggest that the radionuclide angiographic assessment of relative regional ejection fraction during isometric handgrip exercise may provide a useful new diagnostic approach for patients with suspected CHD as well as providing important additional data concerning its location and severity.« less