Curt Thorstrand

Comparison of Different Echocardiographic Methods With Radionuclide Imaging for Measuring Left Ventricular Ejection Fraction During Acute Myocardial Infarction Treated by Thrombolytic Therapy

The aim of this study was to: (1) compare the usefulness, in clinical practice, of different echocardiographic methods of left ventricular (LV) function determination in patients with a recent thrombolytic-treated acute myocardial infarction (AMI); (2) compare these measurements with the reference method radionuclide imaging; and (3) evaluate the reproducibility of visual estimation of the LV ejection fraction (EF) and the use of the biplane method of discs (Simpsons rule) in clinical practice. Echocardiography and radionuclide imaging were performed within 2 hours of each another, 5 to 8 days after hospital admission. Ninety-six patients (70 men and 26 women) age 64 +/- 9 years (range 45 to 75) were studied. The echocardiographic study was performed by 2 experienced physicians, independently of each another. LV wall motion score index and visual estimation of the EF correlated best with the radionuclide EF (r = 0.72 and r = 0.71), thereafter simply counting the number of affected LV segments (r = 0.67) or atrioventricular plane measurements (r = 0.64). Simpsons rule had low correlation to the radionuclide EF (r = 0.45 to 0.51) and could not be used in approximately half of the patients due to poor identification of endocardial borders. The interobserver coefficient of variation for independent visual echocardiographic estimation of the EF was 10%, for Simpsons rule 18%, and for the radionuclide EF 5%. We conclude that the EF estimated from quantitative echocardiographic volume calculations (Simpsons rule) may differ substantially from radionuclide methods of measuring the EF. However, with experienced sonographers, the LV wall motion score index or visual estimation of the EF had reasonable agreement with the radionuclide EF in most of the patients. Atrioventricular plane measurement is an acceptable alternative.

Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction

Abstract. Echocardiographic recording of the atrioventricular (AV) plane displacement during the cardiac cycle was used to assess left ventricular (LV) global function in patients with congestive heart failure (CHF). The study population consisted of 70 patients with chronic CHF (NYHA functional groups III and IV) following dilated cardiomyopathy (DCM) or myocardial infarction (MI), and 35 age‐matched healthy subjects. The AV plane displacement was recorded from the apical 4‐ and 2‐chamber views at four LV sites located about 90 degrees apart and representing the septal, anterior, lateral and posterior parts of the LV wall. A mean value was calculated from the above sites (AV‐mean). Patients with CHF showed a significant generalized reduction of AV plane displacement compared to healthy subjects (5.6 mm vs. 14.5 mm, P < 0.001). Thirty CHF patients also underwent radionuclide angiography in order to determine the ejection fraction (EF). The correlation between AV‐mean and EF was good (r=0.82, P < 0.001). The selection of an AV‐mean of < 7 mm to define a severely depressed LV function (EF < 30%) gave a sensitivity of 92% and a specificity of 67%. It is concluded that the AV plane displacement can be used to estimate LV systolic function in patients with CHF.

Effects of acute myocardial infarction on the displacement of the atrioventricular plane: an echocardiographic study

Abstract Höglund C, Alam M, Thorstrand C (Section of Cardiology. Department of Medicine I, Karolinska Institute at Södersjukhuset (South Hospital), Stockholm, Sweden). Effects of acute myocardial infarction on the displacement of the atrioventricular plane: an echocardiographic study.

Left ventricular function in patients with atrial fibrillation before and after cardioversion

Abstract A trial fibrillation (AF) is a clinically important arrhythmia with important therapeutic and prognostic implications. The disorganized electrical and mechanical activity causes loss of active atrial contraction. This in turn results in insufficient atrial emptying and impaired ventricular filling. 1 AF may be converted to sinus rhythm by means of direct-current countershock. Hemodynamic studies before and after cardioversion of AF to normal sinus rhythm report conflicting results regarding improvement in hemodynamic function. 2–4 Some studies suggested that normal atrial contraction may not occur immediately after successful cardioversion of AF to sinus rhythm. 1,3 The purpose of this study was to evaluate, using echocardiography and Doppler, the mechanical activity of the left atrium and its effect on left ventricular (LV) function after electrocardioversion of AF to sinus rhythm.

The pH-dependent excretion of mono methylated tricyclic antidepressants; In dog and man

After intravenous administration of desmethylimipramine and nortriptyline to dogs, the excretion of unchanged drug in urine or gastric juice was found to be of little quantitative importance. The renal excretion was pH dependent, indicating nonionic diffusion between blood and urine. The urinary excretion of desmethylimipramine or nortriptyline given in therapeutic doses to depressed patients was also shown to be pH dependent. At a steady‐state plasma level of the antidepressant drugs, less than 5 per cent of the daily dose was excreted unchanged through the kidney. These data are discussed in relation to the treatment of tricyclic drug intoxications.