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Alterations in left ventricular diastolic function in chronic ischemic heart failure. Assessment by radionuclide
P Bareiss1, A Facello, A Constantinesco
1Service de Cardiologie, Centre Hospitalier Régional et Universitaire, Hôpital de Hautepierre, Strasbourg, France.
Insights
Radionuclide angiography revealed significant differences in left ventricular ejection fraction and filling rates in patients with ischemic heart disease and heart failure. Diastolic dysfunction, indicated by reduced peak filling rate, persisted even after accounting for ejection fraction.
Area of Science:
- Cardiology
- Nuclear Medicine
- Biomedical Imaging
Background:
- Chronic ischemic heart disease (CIHD) and myocardial infarction (MI) can impair left ventricular (LV) function.
- Assessing systolic and diastolic function is crucial for managing heart failure (HF).
Purpose of the Study:
- To evaluate left ventricular systolic and diastolic function in patients with CIHD and varying degrees of heart failure using radionuclide angiography.
- To identify specific functional impairments in patients with CIHD and heart failure.
Main Methods:
- Sixty patients were divided into three groups: controls (G1), CIHD without HF (G2), and CIHD with NYHA class II-III HF (G3).
- Radionuclide angiography at rest was used to assess ejection fraction, peak emptying rate, peak filling rate, and times to peak rates.
- Functional images (MIN/MAX images) and time histograms were generated to analyze the dispersion of peak emptying/filling times.
Main Results:
- Significant differences (p ≤ 0.01) in ejection fraction, peak emptying rate, and peak filling rate were observed among all groups.
- Peak filling rate was significantly reduced in the heart failure group (G3) compared to controls (G1), even after adjusting for ejection fraction and heart rate.
- A linear correlation (r = 0.68, p ≤ 0.0001) was found between peak filling rate and ejection fraction in patients with ischemic heart disease (G2 + G3).
Conclusions:
- Radionuclide angiography effectively differentiates LV systolic and diastolic function in patients with CIHD and heart failure.
- Diastolic dysfunction, evidenced by reduced peak filling rate, is a significant finding in heart failure patients with ischemic heart disease.
- LV diastolic function is closely related to systolic function in this patient population.
Abstract:
Using radionuclide angiography at rest, we studied several parameters of left ventricular systolic and diastolic function in 60 patients divided into three groups, a control group (G1) of 15 patients and two groups of patients with chronic ischemic heart disease and previous anterior wall myocardial infarction but without aneurysm or dyskinetic wall motion, a second group (G2) of 23 patients with no history of heart failure, and a third group (G3) of 22 patients in New York Heart Association (NYHA) class II or III of heart failure. Ejection fraction, peak emptying, and peak filling rates, in addition to times to reach peak rates, were evaluated after constructing a global time-activity curve and its first time derivative. In addition, we computed the first time-derivative curves for each image pixel and obtained functional images (MIN/MAX images) representing the distribution of times to peak emptying or filling rates Using a left ventricular region of interest, time histograms were generated, and indexes of dispersion of times to peak rates, defined as the full width at half maximum of the histograms, were obtained. Significant (p less than or equal to 0.01) differences were observed among all groups for ejection fraction, peak emptying rate, and peak filling rate. The decrease of the peak filling rate still remained significant from group G1 to group G3 even after adjustment for differences in ejection fraction and heart rate. Peak filling rate was linearly correlated with ejection fraction in the population with ischemic heart disease (G2 + G3) (r = 0.68, p less than or equal to 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)