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Nuklearmedizin 1984; 23(05): 221-226
DOI: 10.1055/s-0038-1624248
Originalarbeiten – Original Articles
Schattauer GmbH

Funktionsszintigraphie des Herzens bei Patienten mit Herzklappenerkrankungen[*]

Gated Blood Pool Scintigraphy in Patients with Valvular Heart Disease
H.-P. Breuel
,
J. H. Heusinger
1   Aus dem Institut für klinische und experimentelle Nuklearmedizin der Universität Bonn, Bundesrepublik Deutschland
,
K. Hanisch
1   Aus dem Institut für klinische und experimentelle Nuklearmedizin der Universität Bonn, Bundesrepublik Deutschland
› Author Affiliations
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Publication History

Publication Date:
11 January 2018 (online)

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Zusammenfassung

Bei 58 Patienten mit reinen Stenosen oder Insuffizienzen an nur einer Herzklappe wurden mittels der Funktionsszintigraphie des Herzens sowohl die Auswurffraktion als auch die Volumenänderungsgeschwindigkeiten bestimmt. Es fand sich, daß bei den Patienten mit Herzklappenerkrankungen die Auswurffraktion im Mittel gering erniedrigt war, insgesamt jedoch noch meist im unteren Normbereich lag. Die Volumenänderungsgeschwindigkeiten dagegen zeigten nicht pathologisch veränderte Werte, mit Ausnahme der Patienten mit Aortenklappeninsuffizienz, bei denen die Volumenänderungsgeschwindigkeiten im Mittel signifikant herabgesetzt waren. Bei 6 der 11 Patienten mit Aortenklappeninsuffizienz und normaler Auswurffraktion lagen auch im Einzelfall die Volumenänderungsgeschwindigkeiten im pathologischen Bereich, so daß dieser Parameter eventuell bereits unter Ruhebedingungen die Erkennung von myokardialen Funktionsstörungen bei Patienten mit Herzklappenerkrankungen zuläßt.

Summary

In 58 patients suffering from either stenosis or insufficiency of a single heart valve, gated blood pool scintigraphy was performed to determine the ejection fraction as well as the peak filling and peak ejection rates. It could be demonstrated that in patients with valvular disorders the ejection fraction was only moderately decreased, generally remaining in the lower reference range. The peak filling and ejection rates showed no pathologic changes with the exception of patients with aortic regurgitation where these rates were significantly decreased. Thus, the estimation of left ventricular peak filling and ejection rates may permit diagnosis of myocardial impairment in patients with valvular disease even under resting conditions.

* Herrn Prof. Dr. med. Dr. rer. nat. h.c. C. Winkler zum 65. Geburtstag.


 

  • Literatur

  • 1 Berger H. J., Zaret B. L. Nuclear cardiology. Cardiovascular performance. New Engl. J. Med. 1981; 305: 855-65.
    CrossrefPubMedGoogle Scholar
  • 2 Bonow R. O., Bacharach S. L., Green M. V.. et al. Impaired left ventricular diastolic filling in patients with coronary artery disease. Assessment with radionuclide angiography. Circulation. 1981; 64: 315-23.
    CrossrefPubMedGoogle Scholar
  • 3 Bonow R. O., Kent K. M., Rosing D. R. et al. Improved left ventricular diastolic filling in patients with coronary artery disease after percutaneous transluminal coronary angioplasty. Circulation. 1982; 66: 1159-67.
    CrossrefPubMedGoogle Scholar
  • 4 Borer J. S., Bacharach S. L., Green M. V. et al. Real-time radionuclide cineangiography in the noninvasive evaluation of global and regional left ventricular function at rest and during exercise in patients with coronary-artery disease. New Engl. J. Med. 1977; 296: 839-44.
    CrossrefPubMedGoogle Scholar
  • 5 Borer J. S., Bacharach S. L., Green M. V. et al. Exercise-induced left ventricular dysfunction in symptomatic asymptomatic patients with aortic regurgitation Assessment with radionuclide cineangiography. Am. J. Cardiol. 1978; 42: 351-7.
    CrossrefPubMedGoogle Scholar
  • 6 Borer J. S., Bacharach S. L., Jeffrey M. V. et al. Left ventricular function in aortic stenosis. Response to exercise and effects of operation. Amer. J. Cardiol. 1978; 41: 382.
    Google Scholar
  • 7 Borer J. S., Rosing D. R., Kent K. M. et al. Left ventricular function at rest and during exercise after aortic valve replacement in patients with aortic regurgitation. Amer. J. Cardiol. 1979; 44: 1297-1305.
    CrossrefPubMedGoogle Scholar
  • 8 Boucher C. A., Bingham J. B., Osbakken M. D. et al. Early changes in left ventricular size and function after correction of left ventricular volume overload. Amer. J. Cardiol. 1981; 47: 991-1004.
    CrossrefPubMedGoogle Scholar
  • 9 Brady T. J., Thrall J. H., Lo K. et al. The importance of adequate exercise in the detection of coronary heart disease by radionuclide ventriculography. J. nucl. Med. 1980; 21: 1125-30.
    PubMedGoogle Scholar
  • 10 Breuel H-P, Bahre M. Assessment of left ventricular global function. In Developments in Nuclear Medicine/Nuclear Cardiology. Biersack H. J., Cox P. H. eds.) Martinus Nijhoff Publishers; (in press)
    Google Scholar
  • 11 Breuel H-P, Felix R, Knopp R. et al. Funktionsszintigraphie der Kontraktion des linken Ventrikels. III. Ergebnisse bei Patienten mit koronarer Herzerkrankung. Fortschr. Röntgenstr. 1978; 129: 317-20.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Breuel H-P, Knopp R, Felix R, Neumann G. P., Altland C, Winkler H. Funktionsszintigraphie der Kontraktion des linken Ventrikels. II. Methodische Untersuchungen zur Background-Korrektur. Fortschr. Röntgenstr. 1978; 129 1: 18-23.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Breuel H-P, Simon H, Bähre M. et al. Die Funktionsszintigraphie des Herzens nach Indikatorgleichverteilung zur nichtinvasiven Beurteilung der links-ventrikulären Funktion. Klin. Wschr. 1979; 57: 839-44.
    CrossrefPubMedGoogle Scholar
  • 14 Dehmer G. J., Firth B. G., Hillis L. D. et al. Alterations in left ventricular volumes and ejection fraction at rest and during exercise in patients with aortic regurgitation. Amer. J. Cardiol. 1981; 48: 17-27.
    CrossrefPubMedGoogle Scholar
  • 15 Dehmer G. J., Lewis S. E., Hillis L. D. et al. Exercise-induced alterations in left ventricular volumes the pressure-volume relationship. A sensitive indicator of left ventricular dysfunction in patients with coronary artery disease. Circulation. 1981; 63: 1008-18.
    CrossrefPubMedGoogle Scholar
  • 16 Fischer P, Knopp H.-P, Breuel R. Zur Anwendung der harmonischen Analyse bei der Funktionsszintigraphie des Herzens. Nucl. Med. 1979; 18: 8-12.
    Google Scholar
  • 17 Gottdiener J. S., Borer J. S., Bacharach S. L. et al. Left ventricular function in mitral valve prolapse. Assessment with radionuclide cineangiography. Amer. J. Cardiol. 1981; 47: 7-13.
    CrossrefPubMedGoogle Scholar
  • 18 Hammermeister K. E., Brooks R. C., Warbasse J. R. The rate of change of left ventricular volume in man. I. Validation and peak systolic ejection rate in health and disease. Circulation. 1974; 49: 729-38.
    CrossrefPubMedGoogle Scholar
  • 19 Hammermeister K. E., Warbasse J. R. The rate of change of left ventricular volume in man. II. Diastolic events in health and disease. Circulation. 1982; 49: 739-47.
    Google Scholar
  • 20 Hecht H. S., Josephson M. A., Hopkins J. M. et al Reproducibility of equilibrium radionuclide ventricular ejection fraction and regional wall motion to supine bicycle exercise. Amer. Heart J. 1982; 104: 567-74.
    CrossrefPubMedGoogle Scholar
  • 21 Henze E, Wisenberg G, Schelbert H. R. Effect of exercise on regurgitant fraction and right and left ventricular function in aortic and mitral insufficiency. J. nucl. Med. 1981; 21: 49.
    Google Scholar
  • 22 Henze E, Schelbert H. R., Wisenberg G. et al. Assessment of regurgitant fraction right left ventricular function at rest during exercise. A new technique for determination of right ventricular stroke counts from gated equilibrium blood pool studies. Amer. Heart J. 1982; 104: 953-62.
    CrossrefPubMedGoogle Scholar
  • 23 Hofmann M, Schwarz E, Schuler G. et al. The effect of aortic valve replacement on left ventricular function at rest and during exercise. J. nucl. Med. 1981; 21: 4.
    Google Scholar
  • 24 Iskandrian A. S., Hakki A, Kane S. A. et al. Quantitative radionuclide angiography in assessment of hemodynamic changes during upright exercise. Observations in normal subjects, patients with coronary artery disease and patients with aortic regurgitation. Amer. J. Cardiol. 1981; 48: 239-46.
    CrossrefPubMedGoogle Scholar
  • 25 Johnson L. L., Marshall M, Johnson Y. E. et al. Radionuclide angiographic evaluation of left ventricular function by resting ejection rate during the first third of systole in patients with chronic aortic regurgitation. Amer. Heart J. 1982; 104: 92-100.
    CrossrefPubMedGoogle Scholar
  • 26 Knopp R, Breuel H-P, Schmidt H. et al. Funktionsszintigraphie des Herzens. I. Datentechnische Grundlagen und Methodik. Fortschr. Röntgenstr. 1978; 128: 44-7.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Knopp R, Winkler C. Ein universell anwendbares neues DV-System für die klinische Nuklearmedizin. Med. Techn. 1976; 96: 102.
    Google Scholar
  • 28 Lewis S. M., Riba A. L., Berger H. J. et al. Radionuclide angiographic exercise left ventricular performance in chronic aortic regurgitation. Relationship to resting echographic ventricular dimensions and systolic wall stress index. Amer. Heart J. 1982; 103: 498-504.
    CrossrefPubMedGoogle Scholar
  • 29 Manyari D. E., Purves P, Kostuk W. J. Effect of valve replacement on left ventricular function at rest and during exercise in aortic valvular insufficiency. J. nucl. Med. 1981; 22: 23.
    Google Scholar
  • 30 Okada R. D., Kirshenbaum H. D., Kushner F. G. et al. Observer variance in the qualitative evaluation of left ventricular wall motion and the quantitation of left ventricular ejection fraction using rest and exercise multigated blood pool imaging. Circulation. 1980; 61: 128-36.
    CrossrefPubMedGoogle Scholar
  • 31 Pfisterer M. E., Ricci D. R., Schuler G. et al. Validity of left-ventricular ejection fractions measured at rest and peak exercise by equilibrium radionuclide angiography using short acquisition times. J. nucl. Med. 1979; 20: 484-90.
    PubMedGoogle Scholar
  • 32 Sachs L. Statistische Auswertungsmethoden. 1971 3. Auflage, S. 209ff. Springer, Berlin.
    PubMedGoogle Scholar
  • 33 Schuler G, Olshausen K. v., Schwarz F. et al. Noninvasive assessment of myocardial contractility in asymptomatic patients with severe aortic regurgitation and normal left ventricular ejection fraction at rest. Amer. J. Cardiol. 1982; 50: 45-52.
    CrossrefPubMedGoogle Scholar
  • 34 Slutsky R, Karliner J, Battler A. et al. Reproducibility of ejection fraction and ventricular volume by gated radionuclide angiography after myocardial infarction. Radiology. 1979; 132: 155-9.
    CrossrefPubMedGoogle Scholar
  • 35 Slutsky R, Watkins J, Peterson K. et al. The response of left ventricular size and function to atrial pacing, volume loading and afterload stress in CAD Patients. Circulation. 1980; 62: 111-91. (Abstr.).
    Google Scholar
  • 36 Upton M. T., Rerych S. K., Newman G. E. et al. The reproducibility of radionuclide angiography measurements of left ventricular function in normal subjects at rest and during exercise. Circulation. 1980; 62: 126-32.
    CrossrefPubMedGoogle Scholar