RESUMEN
To compare the sensitivity of dipyridamole, dobutamine and pacing stress echocardiography for the detection of myocardial ischemia we produced a physiologically significant stenosis in the left circumflex artery of 14 open-chest dogs (range: 50 to 89% reduction in luminal diameter). In each study, dobutamine (5 to 40 microg kg(-1) min(-1) in 3-min stages) and pacing (20 bpm increments, each 2 min, up to 260 bpm) were performed randomly, and then followed by dipyridamole (up to 0.84 mg/kg over 10 min). The positivity of stress echocardiography tests was quantitatively determined by a significant (P<0.05) reduction of or failure to increase absolute and percent systolic wall thickening in the stenotic artery supplied wall, as compared to the opposite wall (areas related to the left anterior descending artery). Systolic and diastolic frozen images were analyzed off-line by two blinded observers in the control and stress conditions. The results showed that 1) the sensitivity of dobutamine, dipyridamole and pacing stress tests was 57, 57 and 36%, respectively; 2) in animals with positive tests, the mean percent change of wall thickening in left ventricular ischemic segments was larger in the pacing (-19 +/- 11%) and dipyridamole (-18 +/- 16%) tests as compared to dobutamine (-9 +/- 6%) (P = 0.05), but a similar mean reduction of wall thickening was observed when this variable was normalized to a control left ventricular segment (area related to the left anterior descending artery) (pacing: -16 +/- 7%; dipyridamole: -25 +/- 16%; dobutamine: -26 +/- 10%; not significant), and 3) a significant correlation was observed between magnitude of coronary stenosis and left ventricular segmental dysfunction induced by ischemia in dogs submitted to positive stress tests. We conclude that the dobutamine and dipyridamole stress tests showed identical sensitivities for the detection of myocardial ischemia in this one-vessel disease animal model with a wide range of left circumflex artery stenosis. The pacing stress test was less sensitive, but the difference was not statistically significant. The magnitude of segmental left ventricular dysfunction induced by ischemia was similar in all stress tests evaluated.
Asunto(s)
Cardiotónicos , Dipiridamol , Dobutamina , Isquemia Miocárdica/diagnóstico por imagen , Vasodilatadores , Animales , Estimulación Cardíaca Artificial , Enfermedad Coronaria/diagnóstico por imagen , Modelos Animales de Enfermedad , Perros , Ecocardiografía/métodos , Femenino , Modelos Lineales , Masculino , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
To compare the sensitivity of dipyridamole, dobutamine and pacing stress echocardiography for the detection of myocardial ischemia we produced a physiologically significant stenosis in the left circumflex artery of 14 open-chest dogs (range: 50 to 89 percent reduction in luminal diameter). In each study, dobutamine (5 to 40 æg kg-1 min-1 in 3-min stages) and pacing (20 bpm increments, each 2 min, up to 260 bpm) were performed randomly, and then followed by dipyridamole (up to 0.84 mg/kg over 10 min). The positivity of stress echocardiography tests was quantitatively determined by a significant (P<0.05) reduction of or failure to increase absolute and percent systolic wall thickening in the stenotic artery supplied wall, as compared to the opposite wall (areas related to the left anterior descending artery). Systolic and diastolic frozen images were analyzed off-line by two blinded observers in the control and stress conditions. The results showed that 1) the sensitivity of dobutamine, dipyridamole and pacing stress tests was 57, 57 and 36 percent, respectively; 2) in animals with positive tests, the mean percent change of wall thickening in left ventricular ischemic segments was larger in the pacing (-19 Ý 11 percent) and dipyridamole (-18 Ý 16 percent) tests as compared to dobutamine (-9 Ý 6 percent) (P = 0.05), but a similar mean reduction of wall thickening was observed when this variable was normalized to a control left ventricular segment (area related to the left anterior descending artery) (pacing: -16 Ý 7 percent; dipyridamole: -25 Ý 16 percent; dobutamine: -26 Ý 10 percent; not significant), and 3) a significant correlation was observed between magnitude of coronary stenosis and left ventricular segmental dysfunction induced by ischemia in dogs submitted to positive stress tests. We conclude that the dobutamine and dipyridamole stress tests showed identical sensitivities for the detection of myocardial ischemia in this one-vessel disease animal model with a wide range of left circumflex artery stenosis. The pacing stress test was less sensitive, but the difference was not statistically significant. The magnitude of segmental left ventricular dysfunction induced by ischemia was similar in all stress tests evaluated
Asunto(s)
Animales , Dipiridamol , Dobutamina , Isquemia Miocárdica , Enfermedad Coronaria , Modelos Animales de Enfermedad , Ecocardiografía/métodos , Modelos Lineales , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
Pathogenesis of chronic Chagas' heart disease may include various disturbances in the coronary circulation, that could be responsible for the myocardial lesions seen in human hearts and in experimental models of the disease. In this paper we critically reviewed the anatomical and functional abnormalities described in chronic chagasic patients, pertaining to the so-called vascular pathogenetic theory of Chagas' disease. The epicardial coronary arteries are usually free of significant obstructive disease in nonselected groups of chagasic patients examined at autopsy or by coronary angiography. However, chagasic patients who were studied after an episode of acute myocardial infarction, show the same patterns of atherosclerotic coronary artery disease seen in the general nonchagasic population. Studies of chagasic patients with angiographically normal coronary arteries, by several scintigraphy methods, revealed myocardial perfusion abnormalities which may be caused by the microcirculatory derangements described in animals experimentally infected with the T. cruzi. Since hypoperfusion has been detected in regions with normal or mildly impaired wall motion, it is likely that the microvascular disturbances precede and may be causative mechanism for the subsequent myocardial damage. We speculate that hibernating ventricular areas may occur in chagasic patients, on the basis of the evidence gathered from these studies. Recent investigations of chronic patients with Chagas' disease and chest pain showed attenuation of the vasomotor responses to physiological and pharmacological stimuli, in the epicardial coronary arteries.
Asunto(s)
Cardiomiopatía Chagásica/fisiopatología , Circulación Coronaria/fisiología , Animales , Cardiomiopatía Chagásica/patología , Enfermedad Crónica , Angiografía Coronaria , Circulación Coronaria/efectos de los fármacos , Humanos , Persona de Mediana Edad , Infarto del Miocardio/patologíaRESUMEN
A 14-month-old infant was found to have a giant aneurysm of the ascending aorta at the time he underwent angiography. At the time of autopsy, a saccular chamber was found to take the place of the aorta. Histologic examination of the aneurysm revealed absence of the medial layer. Thus, medial genesis may be another cause of aneurysm of the ascending aorta.