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ABSTRACT: Because the microbiology and patient population of infective endocarditis (IE) have evolved, the traditional definition of nosocomial IE may require revision. The question of whether this definition should be extended to 6 months after discharge was explored, and a high rate of episodes with nosocomial pathogens (coagulase-negative staphylococci) and a low rate of episodes with community pathogens (streptococci) in the extended nosocomial group were found. Therefore, modification of the traditional definition is proposed, distinguishing between early (as traditionally described) and late nosocomial IE (IE in association with a significant invasive procedure performed during a hospitalization between 8 weeks and 6 months before the onset of symptoms).
Clinical Microbiology and Infection 09/2008; 14(10):970-3. · 4.54 Impact Factor
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ABSTRACT: The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) is increasing. This study compared clinical characteristics and mortality in patients with methicillin-sensitive S. aureus (MSSA) IE versus MRSA IE, based on a prospectively collected series of 72 consecutive patients with definite S. aureus IE according to the modified Duke criteria between June 2000 and December 2006. Sixteen of 72 IE patients (22%) were caused by MRSA. Nosocomial origin, surgical site infection, surgery in the previous 6 months, the presence of a catheter and persistent bacteremia were significantly associated with MRSA. MSSA patients had significantly more unknown origin of bacteremia and experienced a significantly higher rate of major embolism than MRSA patients. MSSA patients underwent more frequently combined surgical and antimicrobial therapy, and MRSA patients were treated more frequently with antimicrobial therapy due to a contraindication to surgery. The 6-month mortality was higher in patients with MRSA than MSSA. In the MSSA group treated with antimicrobial therapy without an indication to surgery, all patients survived, and in the combined surgical and antimicrobial group 29% died. The mortality in MRSA patients was lowest if combined surgical and antimicrobial therapy was performed. Both in MSSA and MRSA patients with antimicrobial therapy due to a contraindication to surgery, the mortality was extremely high. These data suggest that in S. aureus IE patients with a nosocomial origin, the presence of a catheter or recent surgery, initial therapy should include antimicrobial agents active against MRSA. Antimicrobial therapy alone with close monitoring of the therapeutic effect and signs of complicated course is an acceptable approach in selected patients with MSSA IE. Denial of surgery because of local or general factors in patients that meet criteria for surgical intervention in acute IE is prognostically ominous.
European Journal of Clinical Microbiology 07/2008; 27(6):445-50. · 2.86 Impact Factor
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European Journal of Clinical Microbiology 04/2006; 25(3):202-4. · 2.86 Impact Factor
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ABSTRACT: Infective endocarditis is a microbial infection of the endocardial surface and, despite improvements in diagnostic accuracy, medical therapy and surgical techniques, mortality remains high. This review focuses on changes in epidemiology, microbiology and diagnosis, as well as changes in medical and surgical management of infective endocarditis affecting native and prosthetic valves in adults, that have evolved during the past two decades. Significant changes have included an increasing involvement of prosthetic valves and nosocomially-acquired disease, an increased involvement of staphylococci as the causative agents, and a recognition that elderly individuals with degenerative valvular disease are the most vulnerable population. Topics still requiring study include whether and when valve replacement should be performed, and how to predict perivalvular complications or embolisation based on echocardiography findings. Optimisation of antimicrobial treatment schemes (choice of the antibiotic, dose and duration) also requires further investigation.
Clinical Microbiology and Infection 02/2006; 12(1):5-12. · 4.54 Impact Factor
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M Kowalski, M-C Herregods,
L Herbots,
F Weidemann,
L Simmons,
J Strotmann,
C Dommke,
J D'hooge,
P Claus,
B Bijnens,
L Hatle,
G R Sutherland
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ABSTRACT: Ultrasonic strain rate and strain can characterize regional one-dimensional myocardial deformation at rest. In theory, these deformation indices could be used to quantify normal or abnormal regional function during a dobutamine stress echo test.
The aims of our pilot study were threefold: (1) to determine the percentage of segments in which interpretable strain rate/strain data could be obtained during routine dobutamine stress echo, (2) to establish whether either the increase in heart rate or artefacts induced by respiration during dobutamine stress echo would influence analysis by degrading the data and (3) to determine the optimal frame rate vs image sector angle settings for data acquisition. Furthermore, although the detection of ischaemia was not to be addressed specifically in this study, we would describe the findings on the potential clinical role of regional deformation vs velocity imaging in detecting ischaemia-induced changes.
A standard dobutamine stress echo protocol was performed in 20 consecutive patients with a history of chest pain (16 with angiographic coronary artery disease and four with normal coronary angiograms). DMI velocities were acquired at baseline, low dose, peak dose, and recovery. To evaluate radial function (basal segment of the left ventricle posterior wall segment), parasternal LAX, SAX views were used. For long axis function data were acquired (4-CH, 2-CH views) from the septum; lateral, inferior and anterior left ventricle walls. Data was acquired using both 15 degrees (>150 frames per second (fps) and 45 degrees (115fps) sector angles. During post-processing each wall was divided into three segments: basal, mid and apical. Strain rate/strain values were averaged over three consecutive heart cycles.
Data was obtained from 1936 segments, of which only 54 had to be excluded from subsequent analysis (2.8%) because of suboptimal quality. An increase in heart rates (up to 150/min) was not associated with a significant reduction in the number of interpretable segments. There was a significant correlation between maximal systolic strain rate/strain values obtained at narrow and at wide sector angles (e.g. a correlation for the septal segments: r=0.73,P <0.001 for strain rate, and r=0.71; P<0.001 for strain). The correlation for the timing of events obtained from narrow and wide sector angles was weaker. This would indicate that there was the insufficient temporal resolution for the latter acquisition method. Normal and abnormal regional strain rate/strain responses to an incremental dobutamine infusion were defined. In normal segments, maximal systolic strain rate values increased continuously from baseline, reaching the highest values at the peak dose of dobutamine. The segmental strain response was different. For strain, there was an initial slight increase at low dose of dobutamine (5, 10 microg/kg/min), but no further increase with increasing dose. A pattern representing an ischaemic response was identified and described.
The feasibility study would suggest that with appropriate data collection and post-processing methodologies, strain rate/strain imaging can be applied to the quantification of dobutamine stress echo. However, appropriate post-processing algorithms must be introduced to reduce data analysis time in order to make this a practical clinical technique.
European Heart Journal – Cardiovascular Imaging 07/2003; 4(2):81-91. · 2.32 Impact Factor
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ABSTRACT: The differentiation between differing regional ischaemic substrates is crucial for decision-making in patients with coronary artery disease. This study demonstrates that quantification of dobutamine stress echocardiography using ultrasonic strain measurement has the potential to identify three differing regional ischaemic substrates (ischaemic, stunned and scarred) in the same patient. The data were validated by traditional analysis of dobutamine stress echo, coronary angiography and correlative quantitative positron emission tomography information.
European Heart Journal – Cardiovascular Imaging 04/2003; 4(1):23-8. · 2.32 Impact Factor
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ABSTRACT: The study aim was to address independently, in a randomized patient cohort, the impact of Silzone coating on the prevalence and impact of paravalvular leak in patients undergoing mechanical valve replacement.
Randomized implantation of the uncoated St. Jude Medical Masters, and the Silzone-coated prosthesis was performed in 95 patients, excluding those with suspected or diagnosed infective endocarditis. The company did not support the study; this cohort is not contained in the AVERT trial. Following recall of the Silzone-coated valves, all patients in this cohort were invited to undergo control transthoracic echocardiography and plasma LDH determination.
Silzone-coated valves were implanted in 46 patients (57 valves; 34 aortic, 20 mitral, three tricuspid), and uncoated valves in 49 patients (55 valves; 38 aortic, 16 mitral, one tricuspid). One patient with an uncoated mitral valve died from left ventricular dissection. In total, 73 patients returned for specifically planned echocardiography (mean interval 478+/-78 days). Sixteen patients underwent echocardiography on another occasion (mean interval 113+/-202 days). Six hospital survivors did not undergo any postoperative echocardiography. In total, 51 Silzone-coated valves (31 aortic, 18 mitral, two tricuspid), and 53 uncoated valves (37 aortic, 15 mitral, one tricuspid) were evaluated. No patients were reoperated for intrinsic or extrinsic valve dysfunction. No major paravalvular leaks were seen. Five of 51 Silzone-coated valves showed minimal (grade <1+; four aortic, one mitral) paravalvular leak when specifically sought; two showed minimal (grade <1+; one aortic, one mitral), and one slight (grade 1+; one mitral) paravalvular leak in the uncoated group (p = 0.55). The LDH level was 654+/-163 U/I in the Silzone group, and 598+/-124 U/l in the control group (p = 0.10).
No differences were detected in the incidence of paravalvular leak between Silzone-coated and uncoated mechanical St. Jude Medical valves. The incidence of major paravalvular leaks appears to be lower in the present cohort than was reported in the AVERT trial.
The Journal of heart valve disease 11/2001; 10(6):712-5; discussion 715-6. · 0.81 Impact Factor
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ABSTRACT: The aim of this study was to evaluate changes of flow, metabolism and left ventricular function in patients revealing a "reversed mismatch" pattern (reduced glucose uptake relative to perfusion) on positron emission tomography (PET) early after myocardial infarction. In 19 out of 68 patients (28%), prospectively included in the GUSTO-I or STAR studies, a PET reversed mismatch pattern in the infarct-related region was found. All patients received thrombolytic therapy within 3 h after onset of pain and coronary angiography 90 min later. 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG)/nitrogen-13-labelled ammonia (13NH3) PET was performed after 5 days and 3 months. In 12 of the 19 patients, functional recovery was investigated with two-dimensional echocardiography at the same time points. In the infarct-related region, normalized 13NH3 uptake was 76% +/- 11% at 5 days and 85% +/- 10% at 3 months (P < 0.00001). Absolute blood flow in this region was 75 +/- 25 ml/min per 100 g at 5 days and 80 +/- 19 ml/min per 100 g at 3 months. At 5 days, normalized 18F-FDG uptake in the infarct-related region was decreased (51% +/- 12%). At 3 months, 18F-FDG uptake in this region had significantly recovered (75% +/- 11%, P < 0.00001). In the infarct-related region, absolute FDG metabolism was 17 +/- 6 mumol/min per 100 g at 5 days and 26 +/- 9 mumol/min per 100 g at 3 months (P < 0.0001). At 5 days, normalized 18F-FDG uptake was more severely decreased as compared to the normalized 13NH3 uptake (P < 0.00001) in the infarct-related region, resulting in a reversed mismatch pattern (25% +/- 13% of the left ventricle). At 3 months, 18F-FDG metabolism had partially recovered, giving rise to a change into a PET match pattern. Reversed mismatch regions were present in only 7% +/- 7% of the left ventricle at that time. The ratio of 18F-FDG uptake to 13NH3 uptake in the infarct-related region increased from 0.67 +/- 0.8 at 5 days to 0.88 +/- 0.09 at 3 months (P < 0.00001). No functional recovery was observed in the infarct-related region (the 5-day and 3-month wall motion scores were both 2.5 +/- 0.5). In patients with a myocardial infarction showing a PET reversed mismatch pattern 5 days after thrombolytic therapy, recovery of 18F-FDG uptake was found but no functional recovery was observed at 3-month follow-up.
European Journal of Nuclear Medicine 05/2001; 28(4):466-71.
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B Bijnens,
J D'hooge,
M Schrooten,
S Pislaru,
C Pislaru,
B De Man,
J Nuyts,
P Suetens,
F Van de Werf,
G R Sutherland, M C Herregods
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ABSTRACT: Integrated backscatter (IB) from a myocardial region, calculated from radiofrequency echocardiographic data, has been proposed as a useful parameter for investigating changes in myocardial tissue induced by ischemia. In 10 closed-chest dogs, 5 minutes of myocardial ischemia was induced by either a proximal occlusion of the circumflex coronary artery (CX) (5 dogs), resulting in extensive ischemia in the posterior wall, or by occluding the distal CX vessel (5 dogs) to produce a small localized ischemic zone in the posterior wall. High-resolution digital radiofrequency data from the whole left ventricular myocardium, in the imaging plane during one complete heart cycle, were acquired with a whole-image real-time acquisition approach. Regions in the septum and posterior wall (both ischemic tissue and, in the case of distal occlusions, tissue surrounding the ischemic zone) were chosen for analysis, and IB and cyclic variation (CV) of IB were calculated. Post occlusion, an increase in mean IB values was found in the ischemic segment. However, an increase in CV was also observed in the peri-ischemic zone for the distal CX occlusion and in the septum after proximal CX occlusion. These findings show that changes in CV are not restricted to the ischemic zone but may also occur in distal myocardium. This may be explained by changes in the regional contractile state and loading conditions of the "normal" myocardium, which are altered in response to the distal ischemia.
Journal of the American Society of Echocardiography 05/2000; 13(4):306-15. · 3.71 Impact Factor
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J D'hooge,
B Bijnens,
F Jamal,
C Pislaru,
S Pislaru,
J Thoen,
P Suetens,
F Van de Werf,
C Angermann,
F E Rademakers, M C Herregods,
G R Sutherland
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ABSTRACT: Integrated backscatter (IB) and its cyclic variation (CV) derived from radio-frequency (RF) data have been used as parameters to attempt myocardial tissue characterization. Prior imaging systems used to measure IB and its CV typically acquired data at frame rates of 20-30 Hz and at a resolution of 6-8 bits. If changes in IB levels are in part related to specific short-lived events, occurring within the cardiac cycle, this frame rate and resolution could have been too low to resolve adequately what might be a more complex data set.
To investigate this possibility, we acquired real time two-dimensional (2D) myocardial IQ data (the 'in-phase quadrature' sampled RF data) at high frame rate (> 100 Hz), high dynamic resolution (theoretical 19-bit) and a sector angle of 20 degrees. Several consecutive heart cycles of myocardial data were acquired from individual cardiac walls in five closed chest dogs and 10 healthy, young volunteers at normal heart rates. On the reconstructed RF data regions of interest were indicated, and IB and its CV were calculated. The extracted high frame rate curves showed that the CV of IB is not a smooth sinusoidal-like curve, but is made up of multiple reproducible peaks and troughs with local minima and maxima which are temporally related to active or passive mechanical events, i.e. systolic contraction, early ventricular relaxation and ventricular filling due to atrial contraction.
This study shows that increasing the rate of real-time RF data acquisition results in a more complex, reproducible IB curve. The resolved maxima and minima in IB levels are related to specific phases of the myocardial contraction. Furthermore, spectral analysis showed that IB curves acquired at normal heart rates contain information up to 40 Hz. Hence, cardiac imaging data sets used to analyse regional myocardial function obtained at frequencies lower than 80 frames per second can contain aliased information.
European Heart Journal – Cardiovascular Imaging 03/2000; 1(1):32-41. · 2.32 Impact Factor
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ABSTRACT: Cerebral events are recognized, although infrequent, complications of cardiac catheterization. We report on an exceptional case of a posterior cerebral circulation syndrome comprising a confusional state, amnestic disturbances, aphasia, and cortical blindness, accompanied by life-threatening cardiac arrhythmia after left and right internal mammary artery graft angiography, with complete recovery over 5 days. The diagnostic potential of computed tomography, magnetic resonance, and SPECT imaging of the brain in diagnosing this rare but important complication is illustrated. The need for early continuous monitoring of patients with clinically important cerebrovascular events postangiography is emphasized. Cathet. Cardiovasc. Intervent. 48:397-401, 1999.
Catheterization and Cardiovascular Interventions 01/2000; 48(4):397-401. · 2.29 Impact Factor
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ABSTRACT: Integrated backscatter (IB) has been used for ultrasonic tissue characterization. To assess the potential variables in IB measurements, we performed both theoretical simulations and in vitro phantom measurements. First, we simulated data in which the scatterer position randomly was varied. IB values for the resulting images were calculated. Second, RF data from a tissue-mimicking phantom were acquired. Third, an adapted imaging approach, based on phase insensitivity, was evaluated. For both the simulations and phantom measurements, IB showed a standard deviation of +/-20%. These large deviations can be explained by variations in interference of signals and are not related to the state of the tissue. Small deviations in position of the scatterers resulted in important variations in IB. They must be taken into account and may limit the use of IB in cardiological applications. An improvement potentially can be obtained using phase insensitivity in new ultrasound processing schemes.
Ultrasound in Medicine & Biology 02/1999; 25(1):95-103. · 2.29 Impact Factor
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ABSTRACT: Absolute integrated backscatter (IB) levels and other derived
parameters such as cyclic variation (CV) have been used for ultrasonic
tissue characterization. Ideally, such a parameter would provide
information on the scattering structure and would be independent of the
acquisition or the equipment used. It is well known however, that the
measured reflected signal of a scattering structure depends on the
precise position of the individual scatterers. In order to estimate the
sensitivity of IB to this stochastical process, the authors analyzed
backscattered data from structures with fixed scatterer densities but
with a random distribution, Several independent measurements were made
and the variability in IB was calculated. In order to produce the radio
frequency (RF) data the authors firstly used computer simulations.
Secondly, a real-time RF acquisition system was used to acquire RF data
from a tissue mimicking phantom. Finally, an adapted imaging approach
was evaluated using mathematical simulations in order to see if it can
reduce the measured variability of IB
Ultrasonics Symposium, 1997. Proceedings., 1997 IEEE; 11/1997
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ABSTRACT: Positron emission tomographic imaging is known to be a reliable indicator of viable myocardium in chronic heart disease. Its value in acute myocardial infarction has not been studied extensively.
Sixty-two patients receiving thrombolytic therapy were studied. Myocardial tissue flow and metabolism were measured at 5 days and 3 months. Recovery of left ventricular function was investigated with echocardiography or radionuclide ventriculography. In eight patients, normal flow was found in the infarct area at 5 days with no significant changes in flow, metabolism or function over the next 3 months. In 54 patients, impaired regional myocardial blood flow in the infarct zone was observed at 5 days. In 39 patients, there was a matching positron emission tomographic pattern, while in 15 the pattern was mismatched. None of the patients with a TIMI flow grade < 3 revealed recovery of left ventricular function. In seven out of 11 patients with TIMI 3 flow and a mismatching pattern, additional angioplasty was performed with functional improvement in six.
Recovery of ventricular function is exclusively found in patients with a TIMI flow grade 3. Patients with a positron emission tomographic mismatching pattern reveal functional recovery only after subsequent angioplasty.
European Heart Journal 07/1997; 18(6):954-62. · 10.48 Impact Factor
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ABSTRACT: In vivo hemodynamic assessment of bileaflet aortic valve prostheses using standardized echocardiography is still uncommon; hence, adequate comparison of valve types can rarely be made. We compared the postoperative hemodynamics of St. Jude Standard valves (SJS) with those of Sorin Bicarbon valves (BC) implanted in the aortic position, using pulsed, continuous and color Doppler echocardiography.
The examination was performed four months after aortic valve prosthesis implantation in 76 patients (39 SJS valves, 37 BC valves). Valve sizes varied from 19 mm to 25 mm. Maximal and mean instantaneous pressure gradients were measured by Doppler echocardiography. Effective valve orifice area (EOA) was calculated and prosthetic valve regurgitation was assessed by color Doppler flow imaging.
At valve sizes of 21 mm, 23 mm and 25 mm, SJS valves had a significantly lower EOAs than BC valves (p < 0.05). However, for a given nominal size, BC valves are larger, i.e. they have a larger anatomic (AOA) and geometric orifice area (GOA) than SJS valves. Consequently, BC valves were implanted in patients with a larger left ventricular outflow tract (p < 0.05). When EOA is related to the corresponding AOA, BC valves still show a larger EOA than SJS valves (p < 0.05). Prosthetic valve regurgitation is low in both valve types.
(a) Nominal valve size is not always a good basis for comparison of hemodynamic profiles between valve types. (b) Using the relationship between EOA and AOA, the hemodynamic profile of BC valves in the aortic position is shown to be superior to that of SJS valves.
The Journal of heart valve disease 06/1997; 6(3):269-73. · 0.81 Impact Factor
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ABSTRACT: Quantification is becoming increasingly important in echocardiography. Therefore, the authors have developed a software package, called 'Speqle', that provides an interface to different types of echocardiographic data, including radio-frequency (RF) data, video data and synchronized physiological signals, enabling manipulation of these data via an event-driven user interface. Several classical and ultrasonic tissue characterization (UTC) parameters can be calculated. Speqle has proved its usefulness in several experiments. As an illustration, three experiments are described.
Computers in Cardiology, 1996; 10/1996
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ABSTRACT: A new case ofNeisseria elongata ssp.nitroreducens bacteremia and endocarditis in a 74-year-old woman who had undergone aortic valve replacement in 1992 is reported in detail.N. elongata ssp.nitroreducens differs from the other subspecies ofN. elongata in the additional reduction of nitrate without gas formation. Like mostNeisseria spp. exceptNeisseria meningitidis andNeisseria gonorrhoeae, thisN. elongata ssp.nitroreducens is usually classified in the group of non-pathogenicNeisseria spp. This case report indicates that the presence of subspecies of this group is significant when isolated from normally sterile sites and can cause severe disease in susceptible individuals.Wir berichten ber einen neuen Fall von Bakterimie und Endokarditis durchNeisseria elongata ssp.nitroreducens bei einer 74-jhrigen Frau, die 1992 einen Aortenklappenersatz durchgemacht hatte.N. elongata ssp.nitroreducens unterscheidet sich von anderen Subspecies vonN. elongata durch zustzliche Nitratreduktion ohne Gasbildung. Wie die meistenNeisseria spp. — mit Ausnahme vonNeisseria meningitidis undNeisseria gonorrhoeae — wird dieseN. elongata ssp.nitroreducens in der Regel als apathogeneNeisseria sp. eingeordnet. Unser Fallbericht zeigt, da die Anwesenheit einer Subspecies dieser Gruppe dann von klinischer Bedeutung ist, wenn die Isolation aus einer normalerweise sterilen Umgebung erfolgt ist. Bei empfnglichen Personen kann dieser Keim schwere Krankheitssymptome verursachen.
Infection 04/1996; 24(3):258-260. · 2.66 Impact Factor
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ABSTRACT: The value of high resolution integrated backscatter (IB) for use
in myocardial tissue characterization during acute ischemia was
examined. In closed chest dogs, myocardial ischemia was induced in a
small region. Before and after 5, 30 and 60 minutes of occlusion,
echocardiography was performed. High resolution digital radiofrequency
(RF) data of the complete sectorscan, and of 2 consecutive heart cycles,
were acquired using a new acquisition approach. A region of interest was
drawn on each image in both the (normally perfused) septum and the
(ischemic) posterior wall. IB and cyclic variation (CV) of IB was
calculated. Values were expressed using a linear scale. We found a
significant increase in mean IB after 5 min in the ischemic region
compared to the normally perfused region in all experiments. This
increase persisted during the 60 minutes of occlusion. Furthermore, an
increase in CV was observed during ischemia. This is in contradiction to
the findings of other groups. One of the explanations is that we don't
express the values on a logarithmic scale (dB), We can state that
comparing the mean IB from different regions within the myocardium can
discriminate ischemia in a very early stage in a canine model. The value
and the meaning of the change in CV of IB however is not straightforward
and remains an issue for further investigation
Ultrasonics Symposium, 1995. Proceedings., 1995 IEEE; 12/1995
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ABSTRACT: We have developed a method for the digital acquisition of the radiofrequency (RF) data in echocardiography. We are able to acquire the complete signal from at least one (and the same) heart cycle. This approach enables us to study segmentation of the left ventricle based on classification of features of this RF signal. We have extracted and investigated several signal properties. These can be separated into two groups, first some traditional features used for segmentation (integrated backscatter, image moments, ...), secondly, properties that are not commonly used for segmentation purposes: features based on modeling the reflected signal using a "transfer function" approach. Once the parameters of the RF signal are extracted, the actual segmentation can be performed either using "simple" methods as thresholding or more sophisticated approaches like clustering in an n-dimensional feature space.
Computers in Cardiology 1995; 10/1995
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ABSTRACT: The aim of this study was to evaluate the usefulness of dobutamine echocardiography (DE) in distinguishing necrotic from ischemic myocardium in infarct zones. We performed DE in 39 patients, 3 to 5 days after admission for a first, acute myocardial infarction, treated with thrombolysis. DE was considered positive if wall motion in the infarct zone worsened progressively during increasing dose of dobutamine or if wall motion in the infarct zone initially improved at low dose of dobutamine and deteriorated at higher dose. The results of DE were correlated to the evolution of wall motion in the infarct zone after 3 months and to the need for supplementary balloon dilatation. In 15 of the 39 patients, there was evidence of residual ischemia in the infarct zone. Twenty of the 39 patients had a positive dobutamine echocardiogram. Eleven of these 20 patients had evidence of residual ischemia in the infarct zone. They showed generalized changes of wall motion in the total infarct territory during DE. The other 9 patients demonstrated only localized changes of wall motion in isolated segments of the infarct zone during DE. None of these patients had evidence of residual ischemia. In conclusion: DE seems worthwhile in the detection of residual ischemia in the region of infarction. To reduce the number of false positive DE early after myocardial infarction, only extensive changes of wall motion in the total infarct territory should be accepted as indicative of residual ischemia in the infarct zone.
International Journal of Cardiac Imaging 10/1995; 11(3):171-5.
