Ventriculography In Patients Research Articles

Динаміка рівня ендотеліального моноцитактивуючого пептиду-ІІ у хворих на гострий інфаркт міокарда з супутнім цукровим діабетом 2 типу

The purpose of the study was to investigate the dynamics of endothelial monocyte activating polypeptide-ІІ in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 six months after a coronary event. Materials and methods. 120 patients participated in the study: group 1 – patients with acute myocardial infarction with diabetes mellitus type 2 (n=70), group 2 – patients with acute myocardial infarction (n=50). The control group included 20 practically healthy people. All patients underwent laboratory and instrumental examination on the first day of acute myocardial infarction and 6 months after it. The level of endothelial monocyte activating polypeptide-ІІ was determined using the test system “Human Endothelial Monocyte Activating Polypeptide-ІІ ELISA KIT”. Results and discussion. The average level of endothelial monocyte activating polypeptide-ІІ on the first day of an acute myocardial infarction was: in patients who were part of the 1st group – 4.54 ± 0.331 ng/ml; 2nd – 2.74 ± 0.21 ng/ml; control group – 1.1 ± 0.037 ng/ml (р<0.05). In patients of the 1st group, half a year after acute myocardial infarction, the average level of endothelial monocyte activating polypeptide-ІІ was equal to 3.6 ± 0.11 ng/ml; 2nd – 2.28 ± 0.05 ng/ml (р<0.00001). Re-examination of patients, depending on treatment tactics, showed the following results: in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after cardiac ventriculography, the endothelial monocyte activating polypeptide-ІІ level was equal to 3.5 ± 0.04 ng/ml; in patients with acute myocardial infarction with concomitant diabetes mellitus type 2 after standard anticoagulant therapy it was 3.71 ± 0.03 ng/ml; in patients with isolated acute myocardial infarction after cardiac ventriculography – 2.24 ± 0.01 ng/ml; in patients with isolated acute myocardial infarction after standard anticoagulant therapy – 2.33 ± 0.04 (р<0.01). Conclusion. Endothelial monocyte activating polypeptide-ІІ is a marker of endothelial dysfunction that has prognostic properties in relation to comorbid pathology in the form of acute myocardial infarction with. diabetes mellitus type 2. In patients with an acute myocardial infarction in the presence of diabetes mellitus type 2, a higher level of endothelial monocyte activating polypeptide-ІІ was noted on the 1st day of a coronary event and 6 months after it, compared to patients with an isolated acute myocardial infarction and individuals of the control group (p<0.05). After cardiac ventriculography in patients, the level of endothelial monocyte activating polypeptide-ІІ was significantly lower compared to this indicator after standard anticoagulant therapy

Factors That Impact the Decision to Perform Left Ventriculography in Coronary Artery Disease.

ResumoFundamento A ventriculografia esquerda é um método invasivo para avaliar a função sistólica do ventrículo esquerdo. Depois do advento de métodos não invasivos, o seu uso tem sido questionado por resultar em algum risco para o paciente.Objetivos Avaliar quais fatores associam-se independentemente com a decisão de realizar ventriculografia em pacientes com doença arterial coronariana.Métodos Tratou-se de um estudo analítico, retrospectivo, avaliando prontuários eletrônicos e banco de dados e comparando 21 variáveis de interesse pré-definidas entre pacientes submetidos a cineangiocoronariografia. Foi considerado significante p < 0,05.Resultados Avaliamos 600 pacientes consecutivos, e a ventriculografia esquerda foi realizada na maioria dos pacientes submetidos a uma cineangiocoronariografia (54%). Depois da análise multivariada, os pacientes com síndromes coronarianas crônicas ( odds ratio [OR] 1,72; intervalo de confiança de 95% [IC 95%]: 1,20–2,46; p < 0,01) tiveram maior chance de serem submetidos ao procedimento. Os pacientes com função ventricular conhecida (OR = 0,58; IC 95%: 0,40–0,85; p < 0,01), os revascularizados (OR 0,31; IC 95% 0,14–0,69; p < 0,01), os hipertensos (OR 0,58; IC 95%: 0,36–0,94; p = 0,02) e aqueles com maiores valores de creatinina (OR 0,42; IC 95% 0,26–0,69; p < 0,01) tiveram maior chance de não realizar ventriculografia.Conclusões Nos pacientes submetidos a cineangiocoronariografia, o diagnóstico de síndrome coronariana crônica associou-se de modo independente com uma maior realização da técnica, enquanto ter a função ventricular previamente conhecida, ser hipertenso, ter sido submetido a revascularização cirúrgica prévia e ter valores de creatinina mais elevados associaram-se a uma maior chance de não realizar o método.

Right Ventricular Function Assessment Using Gated Blood-Pool SPECT Ventriculography in Patients with Advanced Heart Failure

Assessment of right ventricular (RV) function and volumes is critical for planning of advanced heart failure (HF) therapies, but it is often difficult and imprecise, particularly in HF patients after left ventricular assist device (LVAD) implantation. The goal of the study was to test performance of quantitative 3-dimensional gated blood-pool single photon emission computed tomography (SPECT) imaging of the right ventricle using novel high-resolution SPECT camera.

The relationship between serum fibrosis markers and restrictive ventricular filling in patients with heart failure with reduced ejection fraction: A technetium-99m radionuclide ventriculography study.

Myocardial fibrosis leads to a restrictive diastolic filling pattern of the left ventricle which is associated with a poor prognosis in patients with heart failure. We investigated the relationship between cardiac fibrosis and restrictive filling pattern of the left ventricle measured by Tc99m left ventriculography in patients with chronic symptomatic heart failure. Serum cardiac extracellular matrix markers including type I and III aminoterminal propeptide of procollagen (PINP and PIIINP), matrix metalloproteinase-2,9 (MMP-2,9), and tissue inhibitor of MMP-1 (TIMP-1) were analyzed. Fifty-one (39 males) patients were enrolled. Their median age was 51.8 years, and median left ventricular ejection fraction was 31.9%. Time to peak filling rate of the left ventricle was significantly correlated with serum levels of the three cardiac extracellular matrix markers (TIMP-1, PIIINP, and MMP-2). The patients with a restrictive diastolic filling pattern of the left ventricle (time to peak filling rate = 154 ms) had significantly higher levels of these extracellular matrix markers. In receiver operating characteristic curve analysis, areas under the curve of PIIINP, TIMP-1, and MMP-2 were 0.758, 0.695, and 0.751 to predict the presence of a restrictive pattern. In C-statistics, all three cardiac extracellular matrix markers significantly increased the area under the curve after adding creatinine. In net reclassification improvement and integrated discrimination improvement models, PIIINP and MMP-2 significantly improved the predictive power of age, creatinine and brain natriuretic peptide. In conclusion, serum extracellular matrix markers are significantly correlated with restrictive diastolic filling pattern of the left ventricle in patients with heart failure.

Estimation of Ejection Fraction with Ventriculography Versus Echocardiography in Patients Referred for Cardiac Surgery

Aim : The aim of this study was to compare the estimation of ejection fraction (EF) by ventricuography (VG) and echocardiography (ECHO) in patients referred for surgery and to validate the results by comparison with other published data. Methods : One hundred patients who underwent VG prior to surgery were subjected to a trans-thoracic ECHO. Radiographers calculated the EF by tracing the outer border of the ventriculogram during systole and diastole. A single cardiologist, who was blinded to the angiogram result, measured EF during trans-thoracic ECHO using the biplane Simpson’s method. Results : EF was significantly higher by VG versus ECHO for the whole group (67.9±13.2 vs 55.7±8.5, p = 0.000). In 81 patients the EF estimated at VG was higher than that calculated at ECHO (71.7±10.2 vs 55.9±7.2, p = 0.000). In 19 patients the EF estimated at VG was lower than that calculated at ECHO, but the difference was not significant (51.8±12.9 by VG vs 55.4±12.8, p= 0.387). In 13 patients, with an EF less than 50% on VG, the correlation with ECHO was very good (42.0±9.0 vs 42.0±8.3, p= 0.995). Two patients with an EF fraction under 30% had similar measurements by VG and ECHO. The EF range as measured by ECHO was consistent with published data. Conclusion : Ventriculography overestimates EF when compared with ECHO. When EF is less than 50% on VG, ECHO findings were similar. The value of ventriculography in patients referred for cardiac surgery is now being brought into question when ECHO, a better and less invasive test that measures EF, is available.

Clinical validation of the planar radionuclide ventriculography in patients with right ventricular dysfunction

ObjectivesGated radionuclide ventriculography (RNV) may be used for the evaluation of the right ventricular function. However, the accuracy of the method should be clinically validated in patients suffering from diseases with specific pathology of the right ventricle (RV) and with possible left ventricular (LV) interaction. MethodsThree groups of 15 patients each, diagnosed with arrhythmogenic right ventricular dysplasia (ARVD), pulmonary artery hypertension (PAH) or atrial septal defect (ASD) were compared to a group of normal subjects. The parameters for both ventricles were evaluated separately (ejection fractions: LVEF and RVEF, and intraventricular synchronism quantified as phase standard deviation: LVPSD and RVPSD) as well as the relation or interdependence of the right to left ventricle (RV/LV volume ratio, LV/RV ejection fraction and stroke volume ratios, and interventricular synchronism).All the variables as a whole were analyzed to identify groups of patients according to their functional behaviour. ResultsSignificant differences were found between the patients and control group for the RV function while the LV function remained mostly within normal limits.When the RV function was considered, the control group and ASD patient group showed differences regarding the ARVD and PAH patients. On evaluating the RV/LV ratios, differences were found between the control group and the ASD group. In the PAH patients, LV function showed differences in relation to the rest of the groups. ConclusionRNV is a reliable clinical tool to evaluate RV function in patients with RV abnormality.

Clinical validation of the planar radionuclide ventriculography in patients with right ventricular dysfunction

Gated radionuclide ventriculography (RNV) may be used for the evaluation of the right ventricular function. However, the accuracy of the method should be clinically validated in patients suffering from diseases with specific pathology of the right ventricle (RV) and with possible left ventricular (LV) interaction. Three groups of 15 patients each, diagnosed with arrhythmogenic right ventricular dysplasia (ARVD), pulmonary artery hypertension (PAH) or atrial septal defect (ASD) were compared to a group of normal subjects. The parameters for both ventricles were evaluated separately (ejection fractions: LVEF and RVEF, and intraventricular synchronism quantified as phase standard deviation: LVPSD and RVPSD) as well as the relation or interdependence of the right to left ventricle (RV/LV volume ratio, LV/RV ejection fraction and stroke volume ratios, and interventricular synchronism). All the variables as a whole were analyzed to identify groups of patients according to their functional behaviour. Significant differences were found between the patients and control group for the RV function while the LV function remained mostly within normal limits. When the RV function was considered, the control group and ASD patient group showed differences regarding the ARVD and PAH patients. On evaluating the RV/LV ratios, differences were found between the control group and the ASD group. In the PAH patients, LV function showed differences in relation to the rest of the groups. RNV is a reliable clinical tool to evaluate RV function in patients with RV abnormality.

AB0713 Myocardial perfusion and equilibrium radioisotope ventriculography in patients with antiphospholipid syndrome as a scrutiny method for the detection of asymptomatic cardiomyopathy

BackgroundThe prevalence of myocardial perfusion alterations in autoimmune diseases has been estimated by previous studies at 40%. There is no consensus on the scrutiny of cardiovascular alterations in patients with...

Comparison of Three-Year Outcomes After Primary Percutaneous Coronary Intervention in Patients With Left Ventricular Ejection Fraction

Left ventricular (LV) dysfunction and multivessel disease (MVD) have been associated with greater mortality after ST-segment elevation myocardial infarction. The aim of this study was to evaluate the impact of LV dysfunction and MVD in patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention (PCI). Patients from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial treated with primary PCI in whom baseline LV function was assessed using left ventriculography were included in this study. Early and late (3-year) outcomes were examined in groups of patients with reduced (<40%) and preserved (≥ 40%) LV ejection fractions (LVEFs), further stratified by the presence of MVD. A total of 2,430 patients were included. Patients with reduced LVEFs were older; were more likely to be women; were more likely to have histories of myocardial infarction, PCI, and heart failure; and were more likely to present in heart failure. Patients with reduced LVEFs had greater 30-day (8.9% vs 0.9%, hazard ratio 9.81, 95% confidence interval 5.23 to 18.42, p <0.0001) and 3-year (17.1% vs 3.7%, hazard ratio 5.03, 95% confidence interval 3.37 to 7.50, p <0.0001) mortality. Among patients with LVEFs <30% (n = 45), 30% to 40% (n = 157), 40% to 50% (n = 373), 50% to 60% (n = 659), and ≥ 60% (n = 1,196), 3-year mortality was 29.4%, 13.5%, 6.4%, 3.8%, and 2.9%, respectively (p for trend <0.0001). MVD was associated with greater mortality in patients with preserved but not reduced LVEFs. By multivariate analysis, LV dysfunction was the strongest predictor of 30-day and 3-year mortality. In conclusion, the presence of LV dysfunction as assessed on baseline left ventriculography in patients who undergo primary PCI in the contemporary era is a powerful predictor of early and late mortality, regardless of the extent of coronary artery disease.

Equilibrium radionuclide ventriculography in the assessment of cardiotoxicity of chemotherapy and chemoradiotherapy in patients with breast cancer

Multidrug chemotherapy increases the efficacy of the treatment, but at the same time rises its cardiotoxicity. The majority of cardiac complications are caused by anthracyclines.Radiation therapy may intensify cardiotoxicity. The aim of this study was to determine early changes of cardiac function using radionuclide ventriculography in patients with breast cancer and to compare the toxicity of AC and AT chemotherapy programs. The study included 71 patients with breast cancer between the ages of 38 and 71 years. All patients after surgery were qualified for chemotherapy, and for 37 (52%) of them subsequent irradiation treatment was planned.Patients received chemotherapy according to the scheme: AC- 47 patients (66%) and AT - 24 patients (34%). Patients were irradiated using a photon beam (4 to 6 MeV) and an electron beam (6-15 MeV). In all patients, before and six months after the treatment, radionuclide ventriculography was performed. In all 71 patients a reductions in left ventricular ejection fraction (EF) and in peak filling rate (PFR) as well as an increase in the end-systolic and end-diastolic volumes (ESvol,EDvol) were observed. AC chemotherapy, where cumulative anthracycline dose was higher, significantly decreased left ventricular ejection fraction and PFR and increased ESvol. AfterAT chemotherapy the EF reduction proved to be smaller. Radiotherapy did not significantly lower the value of EF as compared to the group of patients who underwent chemotherapy. Radionuclide ventriculography is a useful method of evaluating the cardiotoxicity of the treatment. Early indicators of myocardial damage are EF, PFR, ESvol and EDvol.AC chemotherapy, where the average cumulative dose of anthracyclines was higher, caused more cardiotoxic effects than AT chemotherapy.Applying additional radiotherapy did not significantly increase the cardiotoxicity of the treatment.

Equilibrium radionuclide ventriculography in the assessment of cardiotoxicity of chemotherapy and chemoradiotherapy in patients with breast cancer

BACKGROUND: Multidrug chemotherapy increases the efficacyof the treatment, but at the same time rises its cardiotoxicity. Themajority of cardiac complications are caused by anthracyclines.Radiation therapy may intensify cardiotoxicity. The aim of thisstudy was to determine early changes of cardiac function usingradionuclide ventriculography in patients with breast cancer andto compare the toxicity of AC and AT chemotherapy programs. MATERIAL AND METHODS: The study included 71 patientswith breast cancer between the ages of 38 and 71 years. Allpatients after surgery were qualified for chemotherapy, and for37 (52%) of them subsequent irradiation treatment was planned.Patients received chemotherapy according to the scheme: AC— 47 patients (66%) and AT — 24 patients (34%). Patients wereirradiated using a photon beam (4 to 6 MeV) and an electronbeam (6–15 MeV). In all patients, before and six months afterthe treatment, radionuclide ventriculography was performed.RESULTS: In all 71 patients a reductions in left ventricularejection fraction (EF) and in peak filling rate (PFR) as well asan increase in the end-systolic and end-diastolic volumes (ESvol,EDvol) were observed. AC chemotherapy, where cumulativeanthracycline dose was higher, significantly decreased leftventricular ejection fraction and PFR and increased ESvol. AfterAT chemotherapy the EF reduction proved to be smaller. Radiotherapydid not significantly lower the value of EF as comparedto the group of patients who underwent chemotherapy. CONCLUSIONS: Radionuclide ventriculography is a usefulmethod of evaluating the cardiotoxicity of the treatment. Earlyindicators of myocardial damage are EF, PFR, ESvol and EDvol.AC chemotherapy, where the average cumulative dose of anthracyclineswas higher, caused more cardiotoxic effects thanAT chemotherapy.Applying additional radiotherapy did not significantly increasethe cardiotoxicity of the treatment.

Noninvasive assessment of pulmonary arterial pressure by krypton-81m right cardiac ventriculography in patients with chronic obstructive pulmonary disease

Noninvasive assessment of pulmonary arterial pressure by krypton-81m right cardiac ventriculography in patients with chronic obstructive pulmonary disease

Quantitative Assessment of Angiographic Right Ventricular Wall Motion in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C)

Angiography of the right ventricle (RV) is a standard, reference technique to diagnose wall motion abnormalities in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). RV wall motion is usually assessed by qualitative, visual impression, and has lacked a quantitative basis for defining abnormalities. Since the normal RV has a markedly asymmetric movement, angiographic interpretation can differ, even among experienced clinicians. The purpose of this study was to quantify RV wall motion based on contrast ventriculography in patients with ARVD/C and to specify the severity and location of wall motion abnormalities, as compared with normal subjects. We analyzed the angiographic contours of the RV in three views from 19 normal subjects and 23 subjects with ARVD/C. Contour area movement during contraction was calculated circumferentially and further analyzed in nine zones. RV ejection fraction was also computed. Wall motion in ARVD/C was depressed by more than 30% at the tricuspid valve and inferior wall regions (P < 0.001) and significantly reduced at the apex (P = 0.003). However, the RVOT and anterior wall motion were not significantly reduced. RV ejection fraction was depressed from 60 +/- 11% in normal subjects to 41 +/- 12% in ARVD/C patients (P < 0.001). Wall motion abnormalities in ARVD/C can be quantified and compared with normal controls, showing primarily reduced movement in the tricuspid and inferior wall regions. This study delineates objective measurements that can be used to aid in the diagnosis of ARVD/C. In addition, they may be incorporated in future refinements of criteria to diagnose ARVD/C.

Potenciação pós-extra-sistólica na cardiopatia chagásica crônica: estudo com ventriculografia de contraste radiológico

To determine the existence and frequency of the phenomenon of post-extrasystolic potentiation in dyssynergic myocardial areas of patients with chronic Chagas' heart disease studied by use of radiologic contrast ventriculography. This study is a semiquantitative retrospective analysis of radiologic contrast ventriculography in patients with chronic Chagas' disease, who were consecutively studied to assess the mechanisms of ventricular tachycardia. Of the 72 patients initially included, in only 20 patients was possible the ventriculographic analysis for the purposes of this study. The phenomenon of post-extrasystolic potentiation was observed in 11 (55%) of these patients, and a 15.31% improvement was observed in the contractility score from the baseline to the post-extrasystole condition (P=0.0001). That phenomenon occurred even in ventricular segments with an intense deficit in contractility. The phenomenon of post-extrasystolic potentiation is observed in a significant proportion of patients with chronic Chagas' heart disease, in whom the phenomenon could be angiographically analyzed, indicating the existence of potentially recruitable contractile reserve in ventricular regions, showing marked dyssynergy. Additional studies for clarifying the underlying mechanisms are required.

Coronary angiography transiently increases plasma pro-B-type natriuretic peptide.

Increased plasma concentrations of B-type natriuretic peptide (BNP) and its precursor (proBNP) provide important prognostic information in patients presenting with acute coronary syndromes. Although a majority of these patients undergo early invasive assessment, the effects of coronary angiography per se on plasma BNP and proBNP concentrations are not known. We therefore sought to determine whether coronary angiography and ventriculography affect the cardiac secretion of these prognostic markers. Blood samples were collected before and two minutes after coronary angiography and ventriculography in patients with or without coronary artery disease (CAD) and normal left ventricular ejection fraction. In patients with suspected CAD and normal left ventricular ejection fraction, the plasma proBNP concentration transiently increased from 11 pmol/l (range 1-67 pmol/l) to 19 pmol/l (range 5-102 pmol/l, n=29,P<0.0001) two minutes after coronary angiography and ventriculography. The increase was similar in patients with or without CAD, although patients with stable CAD displayed higher plasma BNP and proBNP concentrations at baseline. In contrast, plasma BNP concentrations did not change after coronary angiography and ventriculography. Coronary angiography induces a transient increase in cardiac proBNP secretion. Blood sampling for plasma proBNP measurements in patient stratification and prognosis estimation should consequently be avoided immediately after coronary angiography.

SPET miocárdico de perfusión y ventriculografía isotópica en la miocardiopatía hipertrófica obstructiva y no obstructiva

To evaluate the role of myocardial perfusion SPET and radionuclide ventriculography in patients with hypertrophic cardiomyopathy (HC). Exercise myocardial perfusion SPET with 99mTc-tetrofosmin and radionuclide ventriculography were performed in a consecutive series of 101 patients (54 15 years, 50 women, 55 with dynamic obstruction) diagnosed of HC by echo. Follow-up from the diagnosis was 9,9 6,7 years (1 to 28 years). Thirty six percent of patients had perfusion defects (non reversible in 15 and reversible in 21). In non obstructive HC higher number of patients with non reversible defects (p = 0.01 was obseved and in patients with no reversible defects higher incidence of pathologic Q waves in ECG (p = 0.01), Higher ventricular volumes (p < 0.05), lower ejection fraction (p = 0,0001) and longer time to peak emptying velocity (p < 0.05). There were 4 cardiac deaths, 15 syncopes, 18 pacemakers and 6 myectomy. Ejection fraction was higher in patients with syncope (p = 0,034) and there was no isotopic variable predictive of mortality, pacemaker or myectomy. Neither SPET nor radionuclide ventriculography have a prognostic role in patients with HC, but patients with syncope have higher values of ejection fraction. Patients with non reversible defects have higher rate of pathologic Q waves in ECG, higher ventricular volumes and lower ejection fraction. This is indicative of evolution to dilated form of HC.

Hemodynamic effects of iodixanol and iohexol during ventriculography in patients with compromised left ventricular function

A crossover study was performed to compare the hemodynamic effects of the iso-osmolar contrast agent iodixanol (Visipaque®) 320 mg I/ml to those of the low-osmolar iohexol (Omnipaque®) 350 mg I/ml. The main hypothesis was that iodixanol and iohexol would affect left ventricular end-diastolic pressure (LVEDP) to different degrees. In 48 patients with reduced cardiac function (mean ejection fraction 33.4%), one ventricular injection was performed with each contrast medium. Ventricular, aortic and right atrial pressures and heart rate were measured continuously. Cardiac output (using Fick's principle) and systemic vascular resistance were calculated. LVEDP increased with both agents, but significantly less after iodixanol than after iohexol (P < 0.01), also in subgroups of patients in whom baseline LVEDP was severely increased and in whom 3-vessel disease was present. Immediate changes in variables reflecting vasodilatation were similar with both agents. In conclusion, both contrast agents influenced hemodynamics during ventriculography, but iodixanol had significantly less influence on LVEDP than did iohexol. Cathet. Cardiovasc. Intervent. 50:314–321, 2000. © 2000 Wiley-Liss, Inc.

Arrhythmogenic effect of ventriculography in patients with left ventricular dilation and/or hypertrophy

Arrhythmogenic effect of ventriculography in patients with left ventricular dilation and/or hypertrophy

Arrhythmogenic effect of ventriculography in patients with left ventricular dilation and/or hypertrophy

1. This study examined the effect of an acute injection of contrast medium on generation of arrhythmias in diseased hearts in man.2. Subjects were 100 patients in sinus rhythm undergoing cardiac catheterization in whom good quality echocardiograms could be obtained. The subjects comprised 78 males and 22 females aged 37-83 years.3. Arrhythmia induced by left ventricular angiography ranged from nil to brief bursts of ventricular tachycardia. There was a strongly positive relationship between left ventricular internal dimension in diastole (LVIDd) and induced arrhythmia. Out of 26 patients, 25 developed arrhythmia when LVIDd>=5 cm (96%), but only 24 out of 74 patients developed arrhythmia when LVIDd<5 cm (32%) (P<0.001). In non-dilated hearts where K+<4.0 mmol/l, arrhythmia developed in 100% (10 out of 10) of those with left ventricular hypertrophy (LVH), but in only 40% (8 out of 20) without LVH (P<0. 005). Where K+>=4.0 mmol/l, no arrhythmia occurred in patients with LVH but was present in 52% (31 out of 60) of patients without LVH (P<0.005). There were no relationships with age, end-diastolic pressure, blood pressure, ischaemic heart disease or sex of patient. 4. These data support the view that acute injection of contrast medium in humans induces arrhythmias dependent upon the underlying state of the heart, with potentially complex interplay between left ventricular dimension, hypertrophy and potassium status, supporting similar observations in experimental animals.

A normal electrocardiogram precludes the need for left ventriculography in the assessment of coronary artery disease

ObjectiveTo assess whether a normal electrocardiogram can identify good left ventricular function and obviate the need for routine left ventriculography in patients undergoing cardiac catheterisation for suspected coronary artery disease.DesignA...