ABSTRACTS

ECHOCARDIOGRAPHIC EXAMINATION OF THE ANTERIOR LEFT VENTRICULAR WALL IN PATIENTS WITH CORONARY ARTERY

DISEASE.

Betty C. Corya, MD; Harvey Feigenbaum, MD, FACC; Susan

Rasmussen, RN; Mary Jo Black, BA; Krannert Institute of Cardiology, Indiana University School of Medicine,

Indianapolis, Indiana.

Previous studies have demonstrated segmental changes in

the echocardiographic motion of the interventricular

septum (IVS) and posterior left ventricular wall in

coronary artery disease (CAD). Having the transducer

laterally 2-3 inches from where the mitral valve, right

(RV) and left ventricles (LV) are recorded, the IVS is crossed and the anterior RV wall becomes the anterior

left ventricular wall (ALV). The ALV was recorded in

50 of 54 consecutive patients having coronary arterio-

graphy. Twelve patients were normal and 42 had CAIN (1 50% obstruction). Abnormal ALV motion (flat or

anterior motion during systole) was noted in 21 patients.

Twenty of these patients had CAD, with 18 patients

having left anterior descending artery (LAD) lesions.

One patient had an isolated rigl,t coronary artery (RCA)

obstruction, and one had a RCA and lert circumflex

lesion. In 14% of the patients with CAD (6 of 42), the

ALV was the only area of the LV echogram which demon-

strated abnormal motion. This echocardiographic

technique offers the examination of another area of the

LV which is frequently affected by CAL, and should be

particularly useful in patients with LAD lesions.

SUSTAINED LOSS OF MYOCARDIAI. NOREPHINEPHRIh" AFTER RELIEF

OF CONGESTIVE HEART FAILURE

Richard L. Coulson,Ph.D.; Shahriar Yazdanfar,MD; Alfred

h. bve,krn; .aes F. Spann,MD,FACC; Temple University,

Philadelpia, Pa.

It is not I:nown if the depletion of cardiac norepinepll-

rine (NE) stores which accompanies pressure overload ily-

pertrophy and congestive heart [ailure (CHF) is reversed

lollowing relief of CIIF. Right (RV) and 1cfL (LV) ventri-

cular NE stores were evaluated in 3 groups of cats:4 con-

trols, (C); 5 with CHF due to 13 days of pulmonary con- striciion, (F); and 5 studied 32 days after relief of a

II day period of CHF due to pulmonary consiriction, (R).

Control CHF Recovery

Ilenri rate, beatslmin 234i13 196;t16 234;t13

Cardiac output/ml/min/Kg 6O.Y;t.23 47.911.0 72.8f2.2 Sysiolic pressure mmllg 199;tlO 154f7 13o;t9

Diastolic pressure mmHg 15027 11527 13917

RV systolic pressure mmHg 36.1~2.5 77.1s 3223.3

ItV end diastolic pressure 3.2522.5 14.9k1.4 2.58&57

I<\) wieght increased tram C=O.52&4g/Kg to F=1.14f.08

ipa.01) and following relief did not recover (R=

0.78i.08). LV weight remained relatively constant (C=

2.06L.l5g/Kg,F=2.4&08,R=2.56til,p 0.1). NE was reduced

rrom the control value of 1.42;t29ug/g (RV) and 1.35d.33

(LV) to 0.08k.02 '(RV) and 0.72L.08 (LV) in F, and remaind

low in R,0.272.09 (RV) and 0.63f.12 (LV) despite relief

~11 CHF. Thus the cardiac adrenergic defectof congestive

lIeart failure is not relieved by abolition of the prc-

ssure overload and resultant hemodynamic abnormalities.

Further,it is suggested that, the persistence of NE de-

pletion does not result from hypertrophic structural

changes since reduced catecholamine levels continued iv

the left ventricle which did not hypertrophy.

COMPARATIVE EFFECTIVENESS OF EXERCISE TESTING AND

HOLTER MONITORING FOR DETECTING ARRHYTHMIAS IN

PATIENTS WITH PREVIOUS MYOCARDIAL INFARCTION

Michael Crawford, MD; Robert O’Rourke, MD, FACC; Nallan

Ramokrishno, MD; Hartmut Henning, MD; John Ross, Jr., MD,

FACC, University of California, San Diego, California

To detect arrhythmias requiring therapy, we studied 50 patients

(pts) three to 44 months following myocordial infarction by both

submaximal treadmill exercise testing (TE) and 10 hours of contin-

uous ECG monitoring (HM) during normal activity. Fourteen pts

(28%) had an enlarged left heart dimension on ECG-triggered x-

ray ( ~52mm/M*). In 23 pts (46%) significant arrhythmias were

detected (ventricular tachycardia, atria1 tachyarrhythmias, ’ 2

PVG/min on TE or 1 1 PVC/500 cycles on HM). Fourteen pts

(28%) had frequent ectopic beats during or within 15 minutes after

TE and 18 pts (36%) had significant arrhythmias during HM. In

nine pts 118%) HM detected significant arrhythmias when TE did

not, while in five instances (10%) frequent WCs were present with

TE but not during HM. In fi\fe of nine pts in whom both tests were

positive, HM detected seriow arrhythmias such as ventricular

tochycardia when TE showed only isolated PVG. Eight pts (16%)

had one or more PVG on resting ECG and all had significant ar-

rhythmias detected by TE and,/or HM; five pts were in NYHA Class

I I I and al I had significant arrhythmias. The presence of arrhyth-

mias did not correlate with patient age, history of palpitation,

left heart dimension, duration of follow-up, site of infarction by

ECG, or development of angina or ST depression during TE. We

conclude that both TE and HM are required for complete orrhyth-

mia detection in post myocardial infarction pts and that HM often

discloses different and more serious arrhythmias than TE.

132 January 1974 The American Journal of CARDIOLOGY Volume 33