ADVANCES IN NONINVASIVE CARDIOLOGY DEVELOPMENTS IN CARDIOVASCULAR MEDICINE Lancee CT, ed: Echocardiology. 1979. ISBN 90-247-2209-8. Baan J, Amtzenius AC, Yellin EL, eds: Cardiac dynamics. 1980. ISBN 90-247-2212-8. Thalen HJT, Meere CC, eds: Fundamentals of cardiac pacing. 1970. ISBN 90-247-2245-4. Kulbertus HE, Wellens HJJ, eds: Sudden death. 1980. ISBN 90-247-2290-X. Dreifus LS, Brest AN, eds: Clinical applications of cardiovascular drugs. 1980. ISBN 90-247-2295-0. Spencer MP, Reid JM, eds: Cerebrovascular evaluation with Doppler ultrasound. 1981. ISBN 90-247-90-247-2348-1. Zipes DP, Bailey JC, Elharrar V, eds: The slow inward current and cardiac arrhythmias. 1980. ISBN 90-247-2380-9. Kesteloot H, Joossens JV, eds: Epidemiology of arteral blood pressure. 1980. ISBN 90-247-2386-8. Wackers FJT, ed: Thallium - 201 and technetium-99m-pyrophosphate myocardial imaging in the coronary care unit. 198.\ ISBN 90-247-2396-5. Maseri A, Marchesi C, Chierchia S, Trivella MG, eds: Coronary care units. 1981. ISBN 90-247-2456-2. Morganroth J, Moore EN, Dreifus LS, Michelson EL, eds: The evaluation of new anti- arrhythmic drugs. 1981. ISBN 90-247-2474-0. Alboni P: Intraventricular conduction disturbances. 1981. ISBN 90-247-2483-X. Rijsterborgh H, ed: Echocardiology. 1981. ISBN 90-247-2491-0. Wagner GS, ed: Myocardial infarction: Measurement and intervention. 1982. ISBN 90-247-2513-5. Meltzer RS, Roelandt J, eds: Contrast echocardiography. 1982. ISBN 90-247-2531-3. Amery A, Fagard R, Lijnen R, Staessen J, eds: Hypertensive cardiovascular disease; patho physiology and treatment. 1982. ISBN 90-247-2534-8. Bouman LN, Jongsma HJ, eds: Cardiac rate and rhythm. 1982. ISBN 90-247-2626-3. Morganroth J, Moore EM, eds: The evaluation of beta blocker and calcium antagonist drugs. 1982. ISBN 90-247-2642-5. Rosenbaum MB, ed: Frontiers of cardiac electrophysiology. 1982. ISBN 90-247-2663-8. Roelandt J, Hugenholtz PG, eds: Long-term ambulatory electrocardiography. 1982. ISBN 90-247-2664-8. Adgey AAJ, ed: Acute phase of ischemic heart disease and myocardial infarction. 1982. ISBN 90-247-2675-1. Hanrath P, Bleifeld W, Souquet, eds: Cardiovascular diagnosis by ultrasound. Transeso phageal, computerized, contrast, Doppler echocardiography. 1982. ISBN 90-247-2692-1. Roelandt, J., ed: The practice of M-mode and two-dimensional echocardiography. 1983. ISBN 90-247-2745-6. ADVANCES IN NONINV ASIVE CARDIOLOGY Ultrasound, computed tomography, radioisotopes, digital angiography edited by JORGEN MEYER, MD PETER SCHWEIZER, MD RAIMUND ERBEL, MD Department of internal Medicine i Rheinisch-Westjalische Technische Hochschule Aachen Federal Republic oj Germany 1983 MARTINUS NIJHOFF PUBLISHERS a member of the KLUWER ACADEMIC PUBLISHERS GROUP BOSTON / THE HAGUE / DORDRECHT / LANCASTER Distributors for the United States and Canada: Kluwer Boston, Inc., 190 Old Derby Street, Hingham, MA 02043, USA for all other countries: Kluwer Academic Publishers Group, Distribution Center, P.O.Box 322,3300 AH Dordrecht, The Netherlands Library of Congress Cataloging in Publication Data Main eabr,y udder title: Advances in noninvasive cardiology'. (Developments in cardiovascular medicine) Includes index. 1. Diasnosis, Noninvasive--Addresses, esslQ'B, lec tures. 2. Heart--Diseases--Diasnosis--Addresses, esslQ's, lectures. I. MeyE'r, Jiirgen, MD. II. Schweizer, Peter, MD. III. Erbel, Raimund. TV. Series. rDNIM: 1. Heart diseases--Diagnosis. 2. Heart function tests Methods. Wl DE997VMEJ Rc683.5.N65A38 1983 616.1'20754 83-6267 ISBN-13 :978-94-009-6722-9 e-ISBN-13 :978-94-009-6720-5 DOl: 10.1007/978-94-009-6720-5 Copyright © 1983 by Martinus Nijhoff Publishers, Boston. Softcover reprint of the hardcover 1st edition 1983 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers, Martinus Nijhoff Publishers, 190 Old Derby Street, Hingham, MA 02043, USA. CONTENTS Preface . . . . . IX List of Contributors. XI I. ADVANCES IN METHODOLOGY 1. Computer structures for digital imaging W. AMELING ......... . 2. Digital optical recording - the key to mass picture storage D. MEYER-EBRECHT . . . . . . . . . . . 13 3. Advances and perspectives in ultrasound technology R. HAUKE .............. . 21 4. Automatic evaluation of left ventricular contour from two-dimensional echocardiography E. VAN OCKEN, P. SCHENKELS, V.A. CLAES and D.L. BRUTSAERT. . . 27 5. Clinical implications of transesophageal echocardiography. Present status and future aspects P. HANRATH, M. SCHLUTER, W. THIER, B.A. LANGENSTEIN and W. BLEIFELD. . . . . . . . . . . . . . . . . . . . 31 6. Noninvasive evaluation and quantification of regional myocardial blood flow H.R. SCHELBERT, M. SCHWAIGER, SUNG-CHENG HUANG, A. SHAH and M.E. PHELPS. . . . . . . . . . . . . . . . . . . . 39 II. QUANTIFICATION OF GLOBAL VENTRICULAR FUNCTION 7. Present status of digital angiocardiography P.H. HEINTZEN, R. BRENNECKE and J.H. BURSCH. 51 8. Quantification of left ventricular function by two-dimensional echo cardiography R. ERBEL, P. SCHWEIZER, J. MEYER, W. KREBS and S. EFFERT. 67 9. Imaging of the left ventricle by contrast echocardiography J. ROELANDT and P.W. SERRUYS . . . . . . . . . . 81 10. Quantification ofleft ventricular function by Doppler ultrasound K. RICHARDS and S. CANNON . . . . . . . . . . . . 91 VI 11. Scintigraphic methods for quantifying global left ventricular function H. SCHICHA. . . . . . . . . . . . . . . . . .. 97 12. Quantification of left ventricular function by computed tomography R. RIENMULLER, A BAUMER, C.M. KIRSCH and B.E. STRAUER .. 109 III. REGIONAL WALL MOTION IN MYOCARDIAL ISCHEMIA 13. Early changes in transmural ischemia: an overview on detection capa bilities offered by echocardiographic and nuclear techniques in man A. DISTANTE, O. PARODI, D. ROVAI, P. MARZULLO, E. PICANO, E. MOSCARELLI, W. BENCIVELLI and A. L'ABBATE . . . . . . . . 123 14. Regional wall motion during stress testing: a comparison between atrial pacing and isometric hand grip R.W. BROWER, H.J. TEN KATEN, AH.A. BOM and P.W. SERRUYS 133 15. Digital imaging of the left ventricle by peripheral contrast injection. Detection of impaired global and regional left ventricular function P. SPILLER, T. FISCHBACH, J. JEHLE, A LAUBER, B. POLITZ and F.K. SCHMIEL . . . . . . . . . . . . . . . . . . . . . 143 16. Combined cardiac cineangiography and peripheral digital subtraction angiography K. BACHMANN, H.D. BETHGE and P. MARHOFF 151 IV. DETECTION AND QUANTIFICATION OF ACUTE MYOCARDIAL INFARCTION 17. Technical aspects of precordial ECG-mapping ~. HINSEN, J. SILNY, G. RAU, R. VON ESSEN, W. MERX and S. EFFERT. 157 18. Abilities and limitations of precordial mapping in acute myocardial infarction R. VON ESSEN, W. MERX, S. EFFERT, R. HINSEN, J. SILNY and G. RAU. 167 19. Detection and quantification of acute myocardial infarction by two dimensional echocardiography P. SCHWEIZER, R. ERBEL, W. MERX, J. MEYER, W. KREBS and S. EFFERT 173 20. Detection and quantification of acute myocardial infarction by myo cardial scintigraphy P. PROBST, O. PACHINGER, H. SOCHOR and E. OGRIS. . . . . . . 181 21. Transmission computed tomography in acute myocardial infarction R. HERFKENS, B. BRUNDAGE, P. KRAMER, J. GOLDSTEIN and M. LIPTON 193 V. TISSUE ANALYSIS 22. Tissue quantification by ultrasound. Technical aspects R.C. CHIVERS . . . . . . . . . . . . . . . . . . . 205 VII 23. Approaches to myocardial tissue characterization using ultrasound echo amplitude information D.J. SKORTON, S.M. COLLINS and H.E. MELTON. . . . . . . . 211 24. Digital analysis of echo-signals for tissue characterization P. JENSCH, J. MEYER, P. SCHWEIZER, R. ERBEL, W. KUBALSKI, W. KREBS, W. AMELING and S. EFFERT. . . . . . . . . . . . . . . 223 25. Digital two-dimensional echocardiography: line-mode data acquisition, image processing and approaches to quantitation A.J. BUDA, E.J. DELP, J.M. JENKINS, D.N. SMITH, c.R. MEYER, F.L. BOOKSTEIN and B. PITT . . . . . . . . . . . . 237 26. Analysis of myocardial structure by computed tomography K. LACKNER, O. KOSTER and P. THURN. . . . . . . 249 27. Analysis of coronary bypass graft patency by computed tomography W.G. DANIEL, W. DOHRING, P.R. LICHTLEN and H.-ST. STENDER 259 Subject index . . . . . . . . . . . . . . . . . .. 267 PREFACE Many noninvasive examination methods of the heart have not held out against the invasive methods, which modern cardiac therapy, surgically or with catheterization, requires. They have disappeared completely or are only used by isolated groups of researchers. However, there is an obvious tendency to apply the invasive procedures as the last diagnostic possibility. In the attempt to select clinically relevant methods, the expert authors of this book demonstrate that echocardiography, expanded with contrast and Doppler, has been developed into one of the most important noninvasive methods. The results with tissue characterization show that the possibilities of this method have not yet been fully explored. Nuclear procedures are widely used, although they should only be applied in direct connection with clinical cardiology. The new lead methods of the ecg, such as ecg-mapping, show that standard electrocardiography of electrical functions is not yet fully exploited. The rapidly developing method of computer tomography is also being applied to cardiology. Since nuclear magnetic resonance requires extensive equipment con struction, its future is as yet unsure. Of course, a book like this does not intend to treat the subject of noninvasive cardiology in extensive detail. Established methods like standard electrocardio graphy, phonocardiography and sphygmography are not discussed. The aim of this book is rather to demonstrate the trend of present developments in the field. LIST OF CONTRIBUTORS Ameling, W., Rogowski-Institut fUr Elektronik, Rheinisch-Westfalische Technische Hochschule, Goethestrasse 27/29, D-5100 Aachen, FRG. Bachmann, K., Medizinische Poliklinik, Universitat Eriangen-NUrnberg, Ostliche Stadtmauerstrasse 29, D-8520 Erlangen, FRG. Baumer, A., Radiologische Universitatsklinik, Klinikum Grosshadern, Marchionistrasse 15, D-8000 MUnchen 70, FRG. Bethge, H.D., Medizinische Poliklinik, Universitat Erlangen-NUrnberg, Ostliche Stadtmauerstrasse 29, D-8520 Erlangen, FRG. Bleifeld, W., Universitatskrankenhaus Eppendorf, Medizinische Klinik, Kardiologische Abteilung, Martinistrasse 52, D-2ooo Hamburg 20, FRG. Born, A.H.A., Interuniversity Cardiology Institute and Thorax Centre, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Bookstein, F.L., Division of Radiologic Physics, Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA. Brennecke, R., Abteilung fUr Kinderkardiologie und Biomedizinische Technik, Klinikum der Christian Albrechts-Universitat, Schwanenweg 20, D-2300 Kiel I, FRG. Brower, R.B., Interuniversity Cardiology Institute and Thorax Centre, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Brundage, 8., Department of Radiology and Medicine and Cardiovascular Research Institute, Uni versity of California, Medical Center, San Francisco, CA 94143, USA. Brutsaert, P., Department of Physiology, University of Antwerp (RUCA), Groenenborgerlaan 171, B-2020 Antwerp, Belgium. Buda, AJ., Division of Cardiology, University Hospital, 1405 East Ann Street, Ann Arbor, MI 48109, USA. BUrsch, J .H., Abteilung fUr Kinderkardiologie und Biomedizinische Technik, Klinikum der Christian Albrechts-Universitat, Schwanenweg 20, D-2300 Kiell, FRG. Cannon, S., Cardiology, Veterans Hospital University of Texas Health Science Center, San Antonio, TX 78284, USA. Chivers, R.C., Physics Department, University of Surrey, Guildford, Surrey GU2 5XH, United Kingdom. Claes, V.A., Department of Physiology, University of Antwerp (RUCA), Groenenborgerlaan 171, B- 2020 Antwerp, Belgium. Collins, S.M., Department of Electrical and Computer Engineering, University of Iowa, Iowa City, 10 52242, USA. Daniel, W.G., Medizinische Hochschule Hannover, Abteilung fUr Kardiologie, Konstanty-Gutschow Strasse 8, D-3ooo Hannover 61, FRG. Delp, E.1., Department of Electrical and Computer Engineering, University of Michigan, Ann Arbor, MI 48109, USA. Distante, A., Istituto di Fisiologia Clinica, CNR e Universita di Pisa, Via Savi 8, 1-56100 Pisa, Italy. XII Dohring, W., Medizinische Hochschule Hannover, Abteilung fUr Kardiologie, Konstanty-Gutschow Strasse 8, D-3000 Hannover 61, FRG. Effert, S., Abteilung Innere Medizin I, Medizinische Fakultiit, Rheinisch-Westfalische Technische Hochschule, Goethestrasse 27-29, D-5100 Aachen, FRG. Erbel, R., Abteilung Innere Medizin I, Rheinisch-Westfalische Technische Hochschule, Goethestrasse 27-29, D-5100 Aachen, BRD. Present address: II. Medizinische Klinik und Poliklinik, Johannes Gutenberg Universitiit, Langenbeckstrasse I, D-6500 Mainz, FRG. Essen von, R., Abteilung Innere Medizin I, Rheinisch-Westfalische Technische Hochschule, Goethe strasse 27-29, D-5100 Aachen, FRG. Fischbach, T., Medizinische Einrichtungen der Universitiit Diisseldorf, I. Medizinische Klinik B, Moorenstrasse 5, D-4000 Diisseldorf 5, FRG. Goldstein, J., Departments of Radiology and Medicine and the Cardiovascular Research Institute, University of California, Medical Center, San Francisco, CA 94143, USA. Hanrath, P., Universitiitskrankenhaus Eppendorf, Medizinische Klinik, Kardiologische Abteilung, Martinistrasse 52, D-2000 Hamburg 20, FRG. Hauke, R., Toshiba Medical Systems, Grafenberger Allee 115-117, D-4000 Diisseldorf I, FRG. Heintzen, P.H., Abteilung Kinderkardiologie und Biomedizinische Technik, Klinikum der Christian Albrechts-Universitiit, Schwanenweg 20, D-2300 Kiel I, FRG. Herfkens, R., Department of Radiology and Medicine and the Cardiovascular Research Institute, University of California, Medical Center, San Francisco, CA 94143, USA. Hinsen, R., Helmholtz Institute for Biomedical Engineering, Rheinisch-Westfalische Technische Hoch schule, Goethestrasse 27-29, D-5100 Aachen, FRG. Huang, S.c., University of California, Laboratory of Nuclear Medicine, UCLA School of Medicine, Los Angeles, CA 90024, USA. Jehle, J., Medizinische Einrichtungen der Universitiit Diisseldorf, I. Medizinische Klinik B, Mooren strasse 5, D-4000 Diisseldorf I, FRG. Jenkins, J.M., Department of Electrical and Computer Engineering, University of Michigan, Ann Arbor, MI 48109, USA. Jensch, P., Rogowski-Institut fUr Elektronik, Rheinisch-Westfalische Technische Hochschule, Goethe strasse 27-29, FRG. Katen ten, HJ., Interuniversity Cardiology Institute and Thorax Centre, Erasmus University Rotter dam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Kirsch, C.M., Radiologische Universitiitsklinik, Klinikum Grosshadern, Marchionistrasse 15, D-8000 Miinchen 70, FRG. Koster, 0., Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, D-5300 Bonn Venusberg, FRG. Kramer, P., Departments of Radiology and Medicine and the Cardiovascular Institute, University of California, Medical Center, San Francisco, CA 94143, USA. Krebs, W., Abteilung Innere Medizin I, Rheinisch-Westfalische T echnische Hochschule, Goethestrasse 27-29, D-5100 Aachen, FRG. Kubalski, W., Rogowski-Institut fUr Elektronik, Rheinisch-Westfalische Technische Hochschule, Goethestrasse 27-29, D-5100 Aachen, FRG. Lackner, K., Department of Radiology, University of Bonn, Sigmund-Freud-Strasse, D-5300 Bonn Venusberg, FRG. Langenstein, B.A., Universitiitskrankenhaus Eppendorf, Medizinische Klinik, Kardiologische Abtei lung, Martinistrasse 52, D-2000 Hamburg 20, FRG. Lauber, A., Medizinische Einrichtungen der Universitiit Diisseldorf, I. Medizinische Klinik B, Mooren strasse 5, D-4000 Diisseldorf I, FRG. Lichtlen, P.R., Medizinische Hochschule Hannover, Abteilung fur Kardiologie, Konstanty-Gutschow Strasse 8, D-3000 Hannover 61, FRG. Lipton, MJ., Departments of Radiology and Medicine and Cardiovascular Research Institute, Uni-