William P. Hood

Advantage of the cranial-right anterior oblique view in diagnosing mid left anterior descending and distal right coronary artery disease

The value of the cranial-right anterior oblique view in uncovering or improving the arteriographic visualization of lesions in the mid left anterior descending coronary artery, the origin of its diagonal and septal branches and the distal branches of the right coronary artery was analyzed in 300 consecutive patients. The cranial-right anterior oblique view was compared with standard and other angled views. In the mid left anterior descending artery the view provided improved visualization over the other views in 80 percent of cases and uncovered lesions in 7 percent. In the septal arteries, the view improved visualization in more than 90 percent of cases and uncovered lesions in 26 percent. In the diagonal branches, the view improved visualization in nearly 75 percent of cases. In the distal right coronary artery there was improved visualization of the posterior descending and posterolateral branch arteries in more than 80 percent of cases. The cranial-right anterior oblique view was also the most advantageous view from a technical standpoint, yielding satisfactory exposure factors in obese and extremely heavy patients.

Heparin and Infarct Coronary Artery Patency After Streptokinase in Acute Myocardial Infarction

Anticoagulant therapy is frequently used after thrombolytic agents in the treatment of acute myocardial infarction (AMI) although it is unclear that such therapy will prevent subsequent infarct vessel reocclusion. The role of duration of heparin therapy in maintaining infarct artery patency was studied retrospectively in 53 consecutive AMI patients who received streptokinase therapy and underwent coronary angiography acutely and at 14 +/- 1 days. Of the 39 patients with initial infarct vessel patency, patency at follow-up angiography was observed in 100% (22 of 22) of those who received greater than or equal to 4 days of intravenous heparin but in only 59% (10 of 17) of those patients who received less than 4 days of heparin (p less than 0.05). Of the 14 patients not initially recanalized after streptokinase, patent infarct-related arteries at follow-up angiography were found in 3 of 8 (38%) treated with greater than or equal to 4 days of heparin therapy but in none of the 6 patients treated for less than 4 days (difference not significant). No significant difference in hemorrhagic complications was noted between the short- and long-term heparin treatment groups. Thus, greater than or equal to 4 days of intravenous heparin therapy after successful streptokinase therapy in AMI is more effective in maintaining short-term infarct vessel patency than a shorter duration of therapy and it may maintain the short-term patency of the infarct vessel in those patients who later spontaneously recanalize.

Cardiac catheterization and angiographic analysis computer applications.

S IGNIFICANT EFFORT has been invested to use digital computers as a tool for data processing in several areas of clinical cardiology. From the mid 1960s efforts have been made to utilize computer systems for the analysis of data from cardiac catheterization. These efforts have led to the development of several commercial systems. More recently similar efforts have been made at automating the patient monitoring process in the Coronary Care Unit (CCU). This article presents several computer applications for the analysis of cardiac catheterization data. While some effort is made to present an overview of work done in this area by other investigators, the approach taken in this article is to present in some detail the features of cardiac catheterization systems developed at the University of Alabama in Birmingham Medical Center over the past decade. The intent was to focus on the computer processing techniques typical of catheterization laboratory applications.

Advantages of the caudocranial left anterior oblique left ventriculogram in adult heart disease

Biplane axial left cineventriculography represents the most accurate diagnostic technique for evaluating acquired and congenital heart disease. However, data have accumulated to indicate that without angled views of the left ventricle, the diagnosis will be incomplete and inaccurate in a significant number of patients. Left ventriculography is the acknowledged standard for left ventricular performance. However, comparison of the conventional or nonangled left anterior oblique left ventriculogram with the angled views of the left ventricle obtained with either two dimensional ultrasound or radionuclide left ventriculography may in many cases be invalid because dissimilar views are compared. The cranial-left anterior oblique view allows more accurate assessment of the precise degree and extent of asynergy, left ventricular aneurysms and ventricular septal defects. Left ventricular outflow tract abnormalities such as discrete subaortic stenosis and the obstructive form of hypertrophic cardiomyopathy can easily be distinguished. Lesions involving the mitral valve, especially mitral valve prolapse, are readily evaluated. Lastly, comparison with noninvasive tests of left ventricular performance can be more accurately performed.

Morphology of occlusive coronary lesions during acute myocardial infarction: An angiographic and clinical analysis

In an attempt to identify angiographic and clinical predictors of reperfusion, 42 patients who received intracoronary streptokinase during the early phase of myocardial infarction were analyzed. The different morphologies (regular and irregular) of the occlusive lesions did not show a significant relation with the response (reperfusion vs nonreperfusion) to intracoronary streptokinase; neither did the presence of angiographically visualized thrombus in the infarct-related artery favor reperfusion. Among the clinical variables analyzed (previous myocardial infarction, previous angina, diabetes mellitus, hypertension, use of tobacco, and hyperlipidemia), a history of previous angina was significantly related to absence of reperfusion (p = 0.001). Although the presence of thrombus showed a trend toward reperfusion (p = 0.1), overall, our angiographic observations did not contribute to predicting the response to streptokinase. Further studies are needed to identify morphologic criteria favoring reperfusion and select groups of patients most likely to benefit from it.

Noninvasive assessment of left ventricular function in chronic heart disease

Externally recorded STI were compared with invasively determined EF in 10 normal subjects and 86 patients with various forms of chronic heart disease. From phono-, apex-, and electrocardiograms and carotid pulse tracings, recorded without rigidly controlled conditions (postabsorptive state, fixed time of day, exclusion of atrial fibrillation, and discontinuation of cardiac drugs), PEP, electromechanical interval, isovolumic contraction period, and LVET were measured and deltaPEP (deviation from predicted normal) and PEP/LVET were drived. EF was determined with biplane angiocardiographic methods. Patients were divided into groups based on pathophysiology and state of clinical compensation. The ability of STI to discriminate abnormal from normal function, as compared with EF, varied with each noninvasive parameter and with each physiologic group. On a group basis, the discriminatory ability of PEP was better than that of other noninvasive parameters studied, but did not always parallel that of EF. PEP also tended to correlate better with EF than the other noninvasive measurements. On an individual patient basis, however, the ability of even PEP to predict EF was poor. It is concluded that the usefulness of assessing left ventricle function in chronic heart disease by STI is limited.

Systems for Quantitative Analysis of Left Ventricular Wall Motion

Tennant and Wiggers [1] were perhaps the first to demonstrate the phenomenon of segmental left ventricular dysfunction when, in 1935, they ligated a coronary artery in a dog and at once observed paradoxic motion of the underlying myocardium. Subsequently, Harrison [2] recognized disordered patterns of contraction in the kinetocardiograms of patients with ischemic heart disease and applied the term “asynergy,” and, later, “dyssynergy,” [3] to this condition. More recently, Herman et al. [4], in an elegant quantitative ventriculographic study of patients with coronary artery disease, introduced the now familiar terms “hypokinesis,” “akinesis,” and “dyskinesis” for description of left ventricular contraction abnormalities.